Form TC71-201 "Industrial Haul Permit: Application' " - Kentucky

What Is Form TC71-201?

This is a legal form that was released by the Kentucky Transportation Cabinet - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2011;
  • The latest edition provided by the Kentucky Transportation Cabinet;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form TC71-201 by clicking the link below or browse more documents and templates provided by the Kentucky Transportation Cabinet.

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Download Form TC71-201 "Industrial Haul Permit: Application' " - Kentucky

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Kentucky Transportation Cabinet
TC 71-201
Division of Maintenance
09/2011
Page 1 of 2
INDUSTRIAL HAUL PERMIT:
APPLICATION
IHP CONTROL NO.
DATE
MATERIAL TO BE HAULED
NO. OF TRUCKS
FEE
Attachment 1: Truck Information
Attachment 2: Transportation Plan
Attachment 3: Bridge Weight Limits
SECTION 1: APPLICANT INFORMATION
SECTION 2: DISTRICT INFORMATION
COMPANY NAME
DISTRICT OFFICE
ADDRESS
ADDRESS
CITY, STATE, ZIP
CITY, STATE, ZIP
PHONE
PHONE
FAX
FAX
SECTION 3: PERMIT AGREEMENT
This permit is to be granted under and subject to all and every condition, restriction and regulation prescribed by
the Kentucky Revised Statutes (KRS) and their supplements and amendments which form part thereof, and under
and subject to the general and special conditions, restrictions and regulations of the Kentucky Transportation
Cabinet.
Pursuant to KRS 189.271,
requests permission to conduct
an industrial hauling operation over the state maintained roads and bridges listed on attachments 2 & 3. (County
and city roads, streets, and bridges are not the responsibility of the Transportation Cabinet.)
In consideration of a permit being approved by the Department of Vehicle Regulation to haul overweight/over-
dimensional divisible loads over the aforementioned roads and bridges,
agrees to and understands the following:
1. The industrial haul permit (IHP) shall be issued for a period of time not to exceed three (3) years.
The original IHP, or an authenticated copy and its attachments must be in the possession of the vehicle
2.
operator at all times.
The IHP does not authorize gross weights or dimensions in excess of the limits set forth in KRS 189.222. (See
3.
603 KAR 5:066 for legal "AAA" weight limits.)
4. The IHP does not change the trucking weight classification of any road.
5.
agrees to maintain the aforementioned roads and bridges
at an acceptable level of maintenance. Maintenance responsibility will be prorated, and based on the number
of active IHP's issue d for the road segment in in question.
6. In the performance of these maintenance operations,
shall
exercise the same degree of traffic control set forth in the U.S. Department of Transportation Manual for
Uniform Traffic Control Devices.
7.
is responsible for all damage to the roads and bridges
(attachments 2 & 3) cause by a permitted vehicle (attachment 1).
8. The District's Chief Engineer has determined that
shall
post bond I the amount of six thousand $6,000.00 dollars (per truck, maximum).
9. Failure to fulfill the obligations and responsibilities of the IHP will result in all permits being voided, and
the forfeiture of all or a portion of
bond.
Kentucky Transportation Cabinet
TC 71-201
Division of Maintenance
09/2011
Page 1 of 2
INDUSTRIAL HAUL PERMIT:
APPLICATION
IHP CONTROL NO.
DATE
MATERIAL TO BE HAULED
NO. OF TRUCKS
FEE
Attachment 1: Truck Information
Attachment 2: Transportation Plan
Attachment 3: Bridge Weight Limits
SECTION 1: APPLICANT INFORMATION
SECTION 2: DISTRICT INFORMATION
COMPANY NAME
DISTRICT OFFICE
ADDRESS
ADDRESS
CITY, STATE, ZIP
CITY, STATE, ZIP
PHONE
PHONE
FAX
FAX
SECTION 3: PERMIT AGREEMENT
This permit is to be granted under and subject to all and every condition, restriction and regulation prescribed by
the Kentucky Revised Statutes (KRS) and their supplements and amendments which form part thereof, and under
and subject to the general and special conditions, restrictions and regulations of the Kentucky Transportation
Cabinet.
Pursuant to KRS 189.271,
requests permission to conduct
an industrial hauling operation over the state maintained roads and bridges listed on attachments 2 & 3. (County
and city roads, streets, and bridges are not the responsibility of the Transportation Cabinet.)
In consideration of a permit being approved by the Department of Vehicle Regulation to haul overweight/over-
dimensional divisible loads over the aforementioned roads and bridges,
agrees to and understands the following:
1. The industrial haul permit (IHP) shall be issued for a period of time not to exceed three (3) years.
The original IHP, or an authenticated copy and its attachments must be in the possession of the vehicle
2.
operator at all times.
The IHP does not authorize gross weights or dimensions in excess of the limits set forth in KRS 189.222. (See
3.
603 KAR 5:066 for legal "AAA" weight limits.)
4. The IHP does not change the trucking weight classification of any road.
5.
agrees to maintain the aforementioned roads and bridges
at an acceptable level of maintenance. Maintenance responsibility will be prorated, and based on the number
of active IHP's issue d for the road segment in in question.
6. In the performance of these maintenance operations,
shall
exercise the same degree of traffic control set forth in the U.S. Department of Transportation Manual for
Uniform Traffic Control Devices.
7.
is responsible for all damage to the roads and bridges
(attachments 2 & 3) cause by a permitted vehicle (attachment 1).
8. The District's Chief Engineer has determined that
shall
post bond I the amount of six thousand $6,000.00 dollars (per truck, maximum).
9. Failure to fulfill the obligations and responsibilities of the IHP will result in all permits being voided, and
the forfeiture of all or a portion of
bond.
Kentucky Transportation Cabinet
TC 71-201
Division of Maintenance
09/2011
Page 2 of 2
INDUSTRIAL HAUL PERMIT:
APPLICATION
10. Sole determination concerning the fulfillment of
obligations and
responsibilities regards to this industrial haul permit shall be with the District's Chief Engineer.
I, the undersigned, hereby certify that I have read the rules and regulations, and by my signature to this application
do hereby accept and agree to all conditions set out therein in consideration of the use of said highways and
bridges under a special hauling permit granted by the Kentucky Transportation Cabinet.
COMPANY REPRESENTATIVE (Print Name)
CHIEF DISTRICT ENGINEER (Print Name)
SIGNATURE
DATE
SIGNATURE
DATE
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