APPLICATION FOR MARINE CONSTRUCTION PERMIT

Transcription

1 APPLICATION FOR MARINE CONSTRUCTION PERMIT For instructions regarding the completion and submission of this application, see Instructions to Applicants Note: Applicants are encouraged to consult with the Channel Development Department concerning the types and levels of detail required or SECTION A APPLICANT 1. Company Name: Mailing Address: Company Contact Name/Title:_/ Emergency Contact (Person or Call Center) Name/Title: / Corporate Officer signing the Permit Name/Title:_/ 2. Authorized Agent (if applicable) Name/Title: / Company Name: 3. Legal interest in property (be specific: owner, leaseholder, etc.) 4. Property Owner Information (if different than 1) Name/Address: Authorized Agent (if applicable): Name/Title: / 5. Has a previous application been submitted to the Port Authority relating to the same site? Yes No If Yes, give previous file (permit) number(s) Office Use Only Application Received: PHA File No.: Rev. 3/10/16

2 SECTION B - PROJECT DESCRIPTION 1. Project Description (Use supplemental sheet at the end of this application if needed): 2. Project Location (physical address or GPS coordinates): 3. Present use of property: 4. List of adjacent property owners and contacts (name/phone number): 5. U.S. Army Corps of Engineers Permit Number: 6. Facility/Terminal Name (if applicable): 7. Estimated construction cost of project: 8. Does the project involve public funds? Yes No 9. Does the project involve dredging? Yes No If yes, provide quantity yd 3 Do you propose using a Port Authority owned dredged material placement area? Yes If yes, a Dredged Material Placement Agreement will be required. 10. Does the project involve fill on submerged land? Yes No If yes, provide quantity of fill in square feet or acres 11. Will the development maintain, enhance, or conflict with public access in the Port? Yes No If yes, describe 12. Does the project require relocation, modification, or addition of aids to navigation? Yes No If yes, U.S. Coast Guard coordination may be required. 13. Will the facility be serviced by Piloted vessels? Yes No If yes, coordination with the Houston Pilots may be required. This coordination may require a passing ship and mooring analysis and/or simulation of the proposed structure. No 2

3 14. Will ships or barges accessing the marine structure interfere with the adjacent property s current or future use? Yes No If yes, coordination with the neighboring property owner(s) may be required. 15. Is this project an initial phase of a larger planned development that will occur within the next 10 years? Yes No a. If No, attach the following, where appropriate: 1. A detailed site plan of all proposed work, including structures to be removed or demolished, dredging and submerged land to be filled (8.5 x 11 to 11 x 17 acceptable). 2. Drawings for all necessary utility line extensions to the waterside structure. 3. Drawings showing the location of pipelines and utilities within 150 feet of the shoreline. b. If Yes, attach complete project description and plans for the entire project. SECTION C - HAZARDOUS MATERIALS AND WASTES 1. List any hazardous material or hazardous waste permits from federal, state, or local regulatory agencies that will be required. Agency 3 Permit Type and Number 2. Are underground tanks present on the property or proposed to be installed within 150 feet of the shoreline? Yes No If yes, indicate volumes and uses. SECTION D - RISK MANAGEMENT INFORMATION 1. Do you have on-site emergency spill response? Yes No 2. Do you have fire protection for your structure? Yes No SECTION E - LAND-USE AND REGULATORY SETTING Provide answers to the following questions using attached sheets or supporting documents, as appropriate. If a question is not applicable, write N/A in the spaces provided on this form. 1. What is the current level of ship or barge traffic, and what changes are projected? 2. Will the project change the capacity of the shoreside handling facilities? Yes No If yes, describe the current and proposed capacities. 3. Will the project result in an increase in truck or rail traffic? Yes No If yes, describe current and proposed traffic conditions.

4 4. What sizes of vessels will use the proposed project and how often? (LOA, beam, draft) 5. Proposed setback of facility from toe of channel 6. Will new storm water outfalls be installed in the project area? Yes No If yes, show them in your proposed drawings. 7. Will the project result in the displacement or abandonment of any existing petroleum related operation? Yes No 8. With what pipeline or other transportation networks will the development be integrated? 9. Will the project include additional lighting near shore? Yes No If yes, do you propose to minimize light leakage? Yes No 10. Does the facility have or propose to have appropriate gangway for vessel access? (embarkation, debarkation) Yes No SECTION F SECURITY 1. If required, does your facility have a Coast Guard approved security assessment and plan? Yes No Pending Not required 2. Is your company and your facility in compliance with all applicable security laws and regulations? Yes No SECTION G - CERTIFICATION I attest that to the best of my knowledge and belief the information supplied in and accompanying this application is true and accurate and that any false or misleading information or nondisclosure of material facts shall be cause for denial of this application and for revocation of any permit issued in reliance on the information contained herein. Signature of Applicant(s) or Authorized Agent Date Name & Title of Applicant or Authorized Agent (printed or typed) *Note: Applicants whose projects require a Federal, City or County permit are advised to apply for that permit concurrent with this application. A PHA permit is issued by the Port Commission. 4

5 APPLICATION FOR MARINE CONSTRUCTION PERMIT Port Authority File (Permit) No.: SUPPLEMENTAL SHEET 5

6 SECTION A - APPLICANT 1. Name, address, and contact information for company or individual applying for permit a. Company Name: The company name should be written exactly as listed with the Office of the Secretary of State or other licensing entity (Documentation may be required) b. Emergency Contact: Person or call center (preferred) for Port Authority to call in case of emergency c. Corporate Officer: A person who has authority to bind the company, and the entity type generally determines who has such authority. The proper person to sign is: (a) the president, vice-president or other senior officer of a corporation, witnessed by the corporate secretary or assistant secretary; (b) the partner of a general partnership, properly witnessed; (c) the owner of a sole proprietorship, properly witnessed; and (c) the general partner of a limited partnership, properly witnessed. If someone other than the person listed is signing, or a witness does not additionally sign, proper papers authorizing that action (such as a corporate resolution or an attorney-in-fact designation) must be included when you return the signed permit) 2. Complete this section if you are authorized by the applicant to apply on their behalf (i.e.: consultant, engineer), otherwise put N/A or not applicable 3. Indicate if the Applicant is the legal owner of the upland property or has another possessory interest 4. If you have a lease or other interest in the property, provide the upland property owner s information and information of the owner s authorized agent, otherwise put N/A 5. Answer Yes or No. If yes and you need the file number(s), contact the Port Authority Channel Development Department at or chandev@poha.com SECTION B - PROJECT DESCRIPTION APPLICATION FOR MARINE CONSTRUCTION PERMIT Instructions to Applicant 1. Fully describe the project including all structures to be placed in the water as well as any structures that will be placed on the proposed construction (i.e., pipe racks, loading arms, etc.). Plan and profile drawings with dimensions should have all structures listed. Include the intended use of the structure 2. Address of adjacent uplands and/or state plane or GPS coordinates of structure 3. Indicate the current use of the upland property and/or existing structure 4. List property owner on each side of your property 5. Provide U.S. Army Corps of Engineers Permit Number. If pending, put pending, otherwise put N/A 6. Provide the name of the facility/terminal where the structure(s) will be located 7. Provide the cost to build the structure (include dredging costs) 8. Answer Yes or No 9. Answer Yes or No. If yes, provide dredge quantity in cubic yards and indicate if you propose to use a Port Authority owned dredged material placement area for your dredged material 10. Indicate if soil will be placed on land that is under water. If yes, provide quantity (ft 2 ) of soil to be used 11. Answer Yes or No. If yes, describe impact to public access 12. Indicate if the project will interfere with existing/require additional ATONs (range markers, buoys, etc) 13. Answer Yes or No 14. Answer Yes or No 15. Answer Yes or No. Provide appropriate documentation SECTION C - HAZARDOUS MATERIALS AND WASTES 1. If applicable, list permits required for hazardous material you will be handling otherwise put N/A 2. Answer Yes or No. Provide appropriate information

7 SECTION D - RISK MANAGEMENT INFORMATION 1. Answer Yes or No 2. Answer Yes or No SECTION E - LAND-USE AND REGULATORY SETTING 1. Provide appropriate information 2. Indicate if cargo across the dock will increase or decrease. Provide appropriate information 3. Answer Yes or No. Provide appropriate information 4. Provide appropriate information 5. Provide the distance from the toe of the federal channel to the uttermost edge of the structure (Excluding the dredge template) 6. Answer Yes or No. Provide appropriate information 7. Indicate if tanks or pipelines will be abandoned or removed 8. If applicable, indicate pipeline systems to be tied into, otherwise put N/A 9. Answer Yes or No. The Houston Pilots are concerned about light pollution affecting visibility at night. 10. Indicate if an appropriate gangway is planned to be integrated into the proposed design of the structure. The Houston Pilots are concerned about safe departure from ships. SECTION F SECURITY 1. Answer Yes, No, Pending, or Not Required 2. Answer Yes or No SECTION G - CERTIFICATION 1. Sign and date the application before submitting 2. Submit the application package as indicated below. The application package includes the completed and signed application, required additional documentation, and copy of payment. SUBMITTING APPLICATION AND PAYMENT Return application package to: Channel Development Department Port of Houston Authority Attn: Licenses/Permits 111 East Loop North Houston, Texas or chandev@poha.com Fees (May be issued as one payment): $675 Application Fee $2,500 As-Built Deposit All fees associated with this application should be sent to: Check Payment- Lockbox Address: Over-night Address: Port of Houston Authority Port of Houston Authority P.O. Box Attn: Lockbox# Grapevine, Texas West Royal Lane, Irving, Texas Wire Transfer and ACH Transfers: Company The Port of Houston Authority Tax ID# Bank Name/Telephone# Branch Banking and Bank Address P.O. Box 95279, Grapevine, TX Checking Acct. No Bank Transit & Routing Number ABA# Swift Code (For international wires) BRBT US33 Wire transfers and ACH transfers payment details must be ed to paymentremitonly@poha.com