Form 1433 "Request for Close Clearance Inspection" - Michigan

What Is Form 1433?

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

Form Details:

  • Released on June 1, 2020;
  • The latest edition provided by the Michigan Department of Transportation;
  • 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 fillable version of Form 1433 by clicking the link below or browse more documents and templates provided by the Michigan Department of Transportation.

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Download Form 1433 "Request for Close Clearance Inspection" - Michigan

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Michigan Department
Clear Form
of Transportation
REQUEST FOR CLOSE CLEARANCE INSPECTION
1433( 0 6 /20 )
INSTRUCTIONS: Requestor to complete the first three sections.
DATE
1) LOCATION OF CLOSE CLEARANCE CONCERN
ORGANIZATION NAME
STREET ADDRESS
CITY/ TOWNSHIP
STATE
ZIP CODE
COUNTY
RAILROAD
2. INSPECTION INFORMATION
BRIEF DESCRIPTION OF CLOSE CLEARANCE ISSUE
3. CONTA CT INFORMATION
NAME /TITLE
ORGANIZATION
STREET ADDRESS
CITY
STATE
ZIP CODE
I
PHONE NO.
FAX NO.
E-MAIL ADDRESS
OTHER
I
ADDITIONAL CONTACTS
WAS AN "APPLICATION FOR AUTHORITY FOR VARIANCE FROM STANDARD CLEARANCE (MOOT 140 1 ) FORM COMPLETED?
NO
YES
4. MDOT DETERMINATION
HOLD INSPECTION
INSPECTION DATE
YES
NO
INSPECTOR
CC#
COMMENTS
E-mail completed form to
MDOT-RailSafety@Michigan.gov ;
or mail to MOOT Rail Safety Section, 425 W. Ottawa, Lansing, Michigan 48 9 0 9 .
Michigan Department
Clear Form
of Transportation
REQUEST FOR CLOSE CLEARANCE INSPECTION
1433( 0 6 /20 )
INSTRUCTIONS: Requestor to complete the first three sections.
DATE
1) LOCATION OF CLOSE CLEARANCE CONCERN
ORGANIZATION NAME
STREET ADDRESS
CITY/ TOWNSHIP
STATE
ZIP CODE
COUNTY
RAILROAD
2. INSPECTION INFORMATION
BRIEF DESCRIPTION OF CLOSE CLEARANCE ISSUE
3. CONTA CT INFORMATION
NAME /TITLE
ORGANIZATION
STREET ADDRESS
CITY
STATE
ZIP CODE
I
PHONE NO.
FAX NO.
E-MAIL ADDRESS
OTHER
I
ADDITIONAL CONTACTS
WAS AN "APPLICATION FOR AUTHORITY FOR VARIANCE FROM STANDARD CLEARANCE (MOOT 140 1 ) FORM COMPLETED?
NO
YES
4. MDOT DETERMINATION
HOLD INSPECTION
INSPECTION DATE
YES
NO
INSPECTOR
CC#
COMMENTS
E-mail completed form to
MDOT-RailSafety@Michigan.gov ;
or mail to MOOT Rail Safety Section, 425 W. Ottawa, Lansing, Michigan 48 9 0 9 .