Town of Shelburne Excess Weight Permit Application - SINGLE

Vermont Agency of Transportation
Department of Motor Vehicles

Single Vehicle ($5.00 fee)

Approval is hereby given for the granting of a permit under the provisions of VSA Title 23, Sec. 1400a, and any amendments thereto, covering the operation of motor vehicles over local highways and bridges with gross loads as follows:

* Owner:

* Street/P.O. Box

* City/Town

* State

* Zip Code

* Contact Person - Last Name

* Contact Person - First Name

Email Address

Fax Number

* Phone Number

INFORMATION ABOUT YOUR VEHICLE

* Type of Vehicle

If Other, List Here

* Number of Axles

* Year

* Model

* Registration Number

* VIN Number

* Product Carried

If Other, List Here

* Max Weight Requested

Town will fill in Maximum Weight Approved

* Date

For Department Use Only
Processor's Initials

*Approved for the following highways only: THIS PERMIT AUTHORIZES TRAVEL UP TO STATE REGISTERED WEIGHT ONLY ON WEBSTER RD TO SPEAR ST, SOUTH ON SPEAR ST TO BISHOP RD, EAST ON BISHOP RD TO SLC AND RETURN.

The following restrictions apply: NO TRAVEL ON POND RD OR SPEAR ST BETWEEN IRISH HILL RD AND THOMAS RD (formerly Spear St Extension.)

This approval shall be effective for no more than a one year period ending on March 31, 2009. This approval covers only the vehicle listed above.

The holder of a permit shall be liable for any damage to highways or bridges per VSA Title 23, Sec. 1400a(c) and is required to furnish the municipality a valid Certificate of Insurance in the following amounts: a minimum of $100,000/$300,000 Personal Injury Coverage and $100,000 Property Damage Coverage.

Approved: Paul Goodrich, Shelburne Highway Superintendent

NOTE: A copy of this permit must be carried in each permitted vehicle at all times. Shelburne Limestone will notify each and every customer of the requirement to obtain a weight permit from the Town of Shelburne.

Effective July 1, 1994, a Vermont State Permit is not required to operate on local highways and bridges.

Click Submit button below to submit your application.

Instead you can print this application and fax to (802) 985-9550 or mail to:
Town of Shelburne, ATTN: Judy Lance, P.O. Box 88, Shelburne, VT 05482.
Questions? Call Judy at (802) 264-5031.

* Indicates Response Required