Office of Freight & Commercial Vehicle Operations
395 John Ireland Blvd.
Mail Stop 420, Rm. 153
St. Paul, MN 55155
Fax: 651-215-9677
Single Trip Permit Building Move Application
Page 1 of 2
Permittee Information Section
Provide credit card information below if you
do not have a MnDOT Permit Account #.
MnDOT Permit Account #:
Credit Card Number:
Exp. Date:
__ Visa
__ Mastercard
__ Discover
CVV2:
__ Amex
(Mth/yr)
Permittee Name:
(Last 3 # on back of card)
US DOT Number:
MN Bldg. Mover License #:
Address, City, State, Zip:
Phone Number:
Requestor's Name:
Delivery Method: (Check One)
Fax Number?
E-Mail Address?
Building Information Section
Type of Building:
House
Garage
Width at Trailer Frame:
Farm Building
Commercial Building
Number of Stories: _____
Length of Trailer Frame:
Building Weight
Building Length:
Building Height:
Overall Length:
Overall Height:
(Including Frames) :
Building Width at Walls:
Building Width at Eaves:
Overall Widest Point:
Loading Method Examples (See Below) Check One
2PT
3PT-T
3PT-D
4PT
Represents
Weight Point
Building
Loading Method 3 Point( 3 PT-T) Building Front on Truck Unit
Loading Method : 2 Point (2PT)
Tow Bar
Tow Bar
Building
Building
Loading Method : 4 Point (4PT)
Loading Method : 3 - Point (3PT-D) Building Front on Dolly
Vehicle Information
Truck
Truck Tractor
Unit One Truck Type:
Other
EW = Empty Weight, M = 1,000 Pounds
Unit Two Type:
Dolly
Trailer
Semi-Trailer
Type if Other:
Truck Make:
Make:
Number of Dollies:
License Plate #:
State :
License Plate #
Empty Weight :
No. of Axles:
Empty Weight
Truck Length :
Truck Width :
State:
Of Each Dolly
Total Empty Weight
Of All Dollies:
Desired Route:
Start at:
______________________________
Route #
Ending at: _____________________________
Direction for # of miles - Distance from Location Listed at right
Via:
for
to
Via:
for
to
Via:
for
to
Via:
for
to
Via:
for
to
Via:
for
to
Via:
for
to
Location (Ending point of route segment)
* Check One - Complete Route above: ___ Route is on attached page: ___ Route continued on attached page: ___
Single Trip Permit Building Move
Office of Freight & Commercial Vehicle Operations
395 John Ireland Blvd.
Mail Stop 420, Rm. 153
St. Paul, MN 55155
Application
Fax: 651-215-9677
Page 2 of 2
Building Movement Date(s) and Desired Time(s)
Building Move Begins On:
Through:
Preferred Hours of Movement - Starting At:
Ending At:
Overhead View of Vehicle Axles & Building Dolly Configuration:
Axle Spacing
10' 9"
4'
23'
4' 6"
8'
5'
6' 10"
Axle Width
SAMPLE VIEW
8' 6"
Inside Axle
Space
10' 4"
Axle Width
6' 10"
24' Total
8,600 LBS Axle Weight
Axle Weight Each
Number of Tires on Towing Unit:
Number of Dollies:
Axle Line
Width
13,700 LBS
16,300 Axle Weight Each
Tire Size-Steer Axle:
Number of Tires:
Represents Axle & Tire Grouping
Drive Group:
Tire Size:
Using the illustration above and on the preceding page as examples, complete an illustration of the vehicle's axles, dolly(s),
their spacing, axle weight, axle width and inside spacing.
A physical "approved route survey," meeting MnDOT standards was done on the route listed on page 1 of 2:
Company Phone Number:
Contact Person Name:
Owner or Lessee of Towing Equipment:
Contact Person Mobile/cellphone Number:
/
/
Company Address (Street, City, State, Zip)
I (we) certify that the above information is correct. If granted this permit, I (we) hereby agree to comply with all regulations, limitations, & conditions, including current
MnDOT General Conditions, that apply to this movement and further state that I (we) have read the applicable laws and the information contained on the permit.
Applicant's Signature:
Date: