Free Multiple Trip Statewide Permit Application - Wisconsin

MULTIPLE TRIP STATEWIDE PERMIT APPLICATION
To Transport Oversize Mobile Homes & Modular Building Sections
MV2609 8/2002 s.348.27(7) Wis. Stats.

Log No.-For Dept./Commercial Permit Service Use ONLY

Complete a Separate Application for Each Power Unit
Make Check Payable To: Registration Fee Trust Section A - Customer Please print clearly or type.

New Transfer Renewal
Doing Business As (D/B/A)

Mail to:

Wisconsin Department of Transportation Permit Unit Clear Form P. O. Box 7980 Madison, WI 53707-7980 Telephone: 608-266-7320

1. Permit Customer Number (PC #) - If Known

PC2. Legal Name - Vehicle Owner or Lessee Federal Employer Identification Number U.S. DOT Number Social Security Number (Optional) Mailing Address WI Account Number

City

State

Zip Code

Area Code - Business Telephone Number

County

Contact Name for DOT to Call if Questions

Contact Area Code - Telephone Number

Number of Operating Months Desired

Authority to Obtain Permit - Check One

Transporter
Permit Effective Date - Desired Start Date

Manufacturer

Licensed Mobile Home Dealer

When Application Received at Wisconsin Department of Transportation List Other Future Date (not to exceed 60 days in future) _______________________________ Section B - Vehicle
Vehicle Identification Number Year

Type - Check ONE Truck Truck-Tractor Other - Describe:

Make

Unit Number

Section C - Size Maximum Allowable Dimensions Length Roofline Width Towed Vehicle: 80 feet 16 feet Overall Length: 100 feet Overhang Limitations:

Towed Vehicle below Roof - Widest point to widest point 15 feet

Overall Height 15 feet

Right-side Overhang: No maximum Left-side Overhang: May not exceed right-side overhang

Overall permit Size(s) for Vehicle and Mobile Home/Modular Building Section requested for this permit Overall Length Roofline Width Towed Vehicle below Roof - Widest Overall Height point to widest point Section D - Insurance: If any dimension requested in Section C exceeds limitations of Group A, then Group B insurance will be required. The customer has the insurance coverage indicated in full force and effect. Check Group A or Group B. Group B Permitted: Dimensions exceeding Group A Group A Permitted dimensions cannot exceed 12 ft. wide, 131/2 ft. high, 100 ft. long, 125% of statutory GVW Level Required: Combined Single Limit $750,000 Level Required: Combined Single Limit $1,000,000 ACCEPTANCE OF CONDITIONS: I, the customer or authorized agent, certify that the statements contained in the application are true and correct. I understand that a multiple trip permit to transport oversize mobile homes and modular building sections is granted subject to the conditions stated in Chapter Trans. 261 WI Admin. Code and if granted a permit, I will comply with all terms and conditions.

X
Permit / Renewal Numbers

(Customer or Authorized Agent)

(Date)

FOR DEPARTMENT USE ONLY

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