Oversize/Overweight Permit Application - Single Trip Permit OnlyMinistry of Transportation Oversize/Overweight Permit Application
Single Trip Permit Only See Guidelines for Completing the Oversize/Overweight Permit Application.
1. Declaration I / we understand that under the provision of subsection 110(5) of the Highway Traffic Act, the owner, operator or mover of a heavy vehicle, load, object or structure in respect of which a permit is granted under this section who has obtained a permit is nevertheless responsible for all damages that may be caused to the highway, by reason of the driving, operating or moving of any such heavy vehicle load, object or structure. The applicant certifies that the information contained in this application is true and acknowledges and accepts the responsibilities imposed by law on the applicant in relation to the operation of a commercial motor vehicle under the authority of the permit(s) issued pursuant to this application.
Signature of Authorized Applicant / Agent Position / Title Date
Ministry Use Only
Y M D Staff Initials
2a. Applicant Information C.V.O.R. No. or N.S.C. No. PRIO Account Number Jurisdiction power unit is registered in:
Number of permits required?
Do you require permit issued in bilingual format? Yes Company Name (per Articles of Incorporation) or Last Name, First Name
HEAD OFFICE ADDRESS - Street No. & Name or Lot, Con., Twp. City, Town, Village Province / State Postal Code / Zip Code
Company Tel. No. Company Fax No. Company Contact Name Company Email Address
2b. Permit Agency Information Company Name
Street No. & Name or Lot, Con., Twp. City, Town, Village Province / State Postal Code / Zip Code
Agent Email Address Agent Tel. No. Agent Fax No. Agent Contact Name
3. Purpose of Application
4. Proposed Movement Information
North American origin of goods to be moved - Street Address
City and Province / State
Postal or zip code
North American destination of goods to be moved - Street Address
City and Province / State
Postal or zip code
Start Date Y M D Y M D
End Date Weekend Travel Requested? (subject to eligibility)
5. Route Details: Indicate below entire proposed route, including all provincial highways and municipal roads1 (include jurisdiction).
Total distance on King's Highways: < 100 km 100 km to < 500 km => 500 km 1 Separate Permitting Required
6. Travelling on toll highways? Yes No
Transponder No.
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7. LOAD DESCRIPTION Describe what is being moved
This is a request to: carry tow or operate (self propelled vehicle) a:
If Load is a Self Propelled Vehicle, provide the Make Model Serial Number
Vehicle (Power Unit) Length
kilograms
kgs
Rear Overhang (if exceeds 4.65m) Measured from the centre of the rearmost axle:
metres.
Yes No
Provide ministry issued Configuration Number or complete chart below (heavy bordered area only required if weight exceeds HTA)
Axle # Equipment Type
Tire Width (mm)
Tire Rating (kgs)
13 N/A
Provide a separate diagram for vehicles in excess of 13 axles. Total Weight Requested
8. Registered Gross Vehicle Weight Ontario Carriers:
Registered Gross Vehicle Weight (RGVW)? kgs. Out-of-Province Carriers:
Is Ontario registered on your IRP apportioned Cab Card? Yes No
If yes, what is the Registered Gross Vehicle Weight (RGVW) for Ontario? kgs. If not, what is the RGVW in the Registered Jurisdiction of the Power Unit? kgs.
9. Payment and delivery options Method of Payment : Cheque Credit Card Prepaid Account
Method of Permit Delivery : Picked up E-mailed Faxed
Comments - Ministry use only
Personal information in this form is collected under the authority of Section 205 of the Highway Traffic Act and is used to evaluate eligibility to obtain an overdimensional permit(s). Direct enquiries to: Weight & Load Engineer, MTO, Carrier Sanctions & Investigation Office, Oversize/Overweight Permit Section, 301 St. Paul St., 3rd floor, St. Catharines, On L2R 7R4 (416) 246-7166 / 1(800) 387-7736. http://www.mto.gov.on.ca
SR-LV-034E (2016/05) © Queen’s Printer for Ontario, 2016 Medium Sensitivity when completed Disponible en français
Credit Card Authorization Form
Name / Company / Dealer
Street No. and Name, P.O. Box, R.R. or Lot, Con. and Twp. Apt. / Suite No.
City, Town or Village
Fee Paid
Alternate Phone No.Daytime Phone No.Email
Provide one (1) of the following Ontario identification numbers below. If you do not have any of the information requested below check R the "Not Available / None of the above" box.
Driver's Licence (DL) Number:
National Safety Code (NSC) Number:
Commercial Vehicle Operator's Registration (CVOR) Number:
Motor Vehicle Inspection Station (MVIS) Number:
Vehicle Identification Number (VIN):
Not Available / None of the above
Under provincial legislation, a false statement from the applicant may result in a penalty. The personal information provided by you on this form is collected to assist with payment verification for the Ministry of Transportation’s driver, vehicle and carrier products and services, for which the Ministry is responsible under the Highway Traffic Act. If you have any questions about the information collected on this form, please contact the Operations Manager, ServiceOntario Driver & Vehicle Contact Centre at 416 235-2999 or 1 800 387-3445 or visit ServiceOntario.ca.
Credit Card Information
Print Name of Cardholder (as it appears on the credit card) Name of Credit Card Company
Visa Mastercard
Print Name of Signing Authority (if different than name of Cardholder)
Signature of Cardholder and/or Signing Authority
X Date
Oversize/Overweight Permit Application - Single Trip Permit Only
1. Declaration
7. Load Description
Credit Card Authorization Form
SR-L-105ST-E (2017/01)
SR-LV-034E (2016/05) © Queen’s Printer for Ontario, 2016 Medium Sensitivity when completed
Disponible en français
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Government of Ontario
Ministry of Transportation
See Guidelines for Completing the Oversize/Overweight Permit Application.
1. Declaration
1.         Declaration
 
The applicant certifies that the information contained in this application is true and acknowledges and accepts the
responsibilities imposed by law on the applicant in relation to the operation of a commercial motor vehicle under
the authority of the permit(s) issued pursuant to this application.
Ministry Use Only
PRIO Account Number
2b. Permit Agency Information
Start Date
5. Route Details: Indicate below entire proposed route, including all provincial highways and municipal roads1 (include jurisdiction).
Total distance on King's Highways:
1 Separate Permitting Required
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SR-L-105ST 05-11

metres
metres
metres
kilograms
metres
metres
metres
kgs
Measured from the centre of the rearmost axle:
metres.
metres
metres
metres
Is load destined for disassembly or scrap?
or complete chart below (heavy bordered area only required if weight exceeds HTA)
Axle #
Equipment
Type
Mfg. Rated Axle
1
2
3
4
5
6
7
8
9
10
11
12
13
N/A
Provide a separate diagram for vehicles in excess of 13 axles.
Total Weight Requested
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Ontario Carriers:
kgs.
kgs.
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Method of Payment :
Method of Permit Delivery :
Personal information in this form is collected under the authority of Section 205 of the Highway Traffic Act and is used to evaluate eligibility to obtain an
overdimensional permit(s). Direct enquiries to: Weight & Load Engineer, MTO, Carrier Sanctions & Investigation Office, Oversize/Overweight Permit Section,
301 St. Paul St., 3rd floor, St. Catharines, On L2R 7R4 (416) 246-7166 / 1(800) 387-7736.
http://www.mto.gov.on.ca
Government of Ontario
ServiceOntario
Provide one (1) of the following Ontario identification numbers below.
If you do not have any of the information requested below check R the "Not Available / None of the above" box.
Provide one (1) of the following Ontario identification numbers below. If you do not have any of the information requested below check the "Not Available / None of the above" box.
Under provincial legislation, a false statement from the applicant may result in a penalty.
The personal information provided by you on this form is collected to assist with payment verification for the Ministry of Transportation’s
driver, vehicle and carrier products and services, for which the Ministry is responsible under the Highway Traffic Act. If you have any
questions about the information collected on this form, please contact the Operations Manager, ServiceOntario Driver & Vehicle Contact
Centre at 416 235-2999 or 1 800 387-3445 or visit ServiceOntario.ca.
Credit Card Information
X
Date
Y
M
D
Expiration Date
MTO
Oversize/Overweight Permit Application - Single Trip Permit Only
Select this link to go to Oversize/Overweight Permit Application - Single Trip Permit Only website. This link will open in a new browser window.:
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Clear Form:
Section 1. Declaration. Position or Title.:
Ministry Use Only. Date. :
Section 2a. Applicant Information. Number of permits required :
Ministry Use Only. Staff Initials.:
Applicant's Information. National Safety Code (NSC) Number.:
Section 2a. Applicant Information. PRIO Account Number:
Section 2a. Applicant Information. Jurisdiction power unit is registered in:
Section 2a. Applicant Information. Do you require permit issued in bilingual format? yes: 0
Applicant's Information. Name or Company or Dealer.:
Section 4. Proposed Movement Information. North American destination of goods to be moved. Street Address:
Applicant's Information. City, Town or Village.:
Applicant's Information. Province or State.:
Applicant's Information. Postal or Zip Code.:
Section 2b. Permit Agency Information. Agent Telephone number.:
Section 2b. Permit Agency Information. Agent Fax number.:
Section 2b. Permit Agency Information. Agent Contact name.:
Section 2b. Permit Agency Information. Agent Email Address.:
Section 3. Purpose of Application. New.:
Section 3. Purpose of Application. Amendment.:
Section 3. Purpose of Application. Previous Permit Number (attach copy if applicable):
Section 4. Proposed Movement Information. North American destination of goods to be moved. Border exit crossing (if applicable) :
Section 4. Proposed Movement Information. End Date. Enter date in format: year: 4 digits, month: 2 digits, day: 2 digits. Or select date from drop down calender.:
Section 4. Proposed Movement Information. Weekend Travel Requested? (subject to eligibility): 0
Section 5. Route Details: Indicate below entire proposed route, including all provincial highways and municipal roads (Separate Permitting Required) (include jurisdiction).:
Section 5. Route Details. Total distance on King's Highways: less than 100 kilometres.:
Section 5. Route Details. Total distance on King's Highways: 100 kilometres to 500 kilometres.:
Section 5. Route Details. Total distance on King's Highways: greater than 500 kilometres.:
Section 8. Registered Gross Vehicle Weight. Is Ontario registered on your IRP apportioned Cab Card? Yes.:
Section 8. Registered Gross Vehicle Weight. Is Ontario registered on your IRP apportioned Cab Card? No.:
Section 6. Travelling on toll highway? Transponder Number:
Section 6. Travelling on toll highway? Tractor Plate Number:
Section 6. Travelling on toll highway? Trailer Plate Number :
Section 7. LOAD DESCRIPTION. Describe what is being moved. This is a request to: carry.:
Section 7. LOAD DESCRIPTION. Describe what is being moved. This is a request to: tow.:
Section 7. LOAD DESCRIPTION. Describe what is being moved. This is a request to: or operate.:
Section 7. LOAD DESCRIPTION. Describe what is being moved. This is a request to carry tow, or operate or self propelled vehicle a::
Section 7. LOAD DESCRIPTION. Describe what is being moved. If Load is a Self Propelled Vehicle, provide the Make:
Section 7. LOAD DESCRIPTION. Describe what is being moved. Model:
Section 7. LOAD DESCRIPTION. Describe what is being moved. Serial Number:
Section 7. LOAD DESCRIPTION. Describe what is being moved. Height at Highest Point in metres.:
Section 7. LOAD DESCRIPTION. Describe what is being moved. Width at Widest point in metres.:
Section 7. LOAD DESCRIPTION. Describe what is being moved. Load Weight in kilograms:
Section 7. LOAD DESCRIPTION. Describe what is being moved. Bill of Lading Number::
Section 7. LOAD DESCRIPTION. Describe what is being moved. Rear Overhang (if exceeds 4.65m) Measured from the centre of the rearmost axle in metres.:
Section 7. LOAD DESCRIPTION. Describe what is being moved. Gross Weight: Within HTA Weight.:
Section 7. LOAD DESCRIPTION. Describe what is being moved. Gross Weight: Exceeds HTA Weight.:
Section 7. LOAD DESCRIPTION. Describe what is being moved. Provide ministry issued Configuration Number or complete chart below (heavy bordered area only required if weight exceeds HTA).:
Total Weight Requested:
Axle number 13. Mfg. Rated Axle Capacity in kilogram.:
Axle number 13. Tire Width in millimetre.:
Axle number 13. Tire Rating in kilograms.:
Axle number 13. Requested weight per axle in kilogram.:
Axle number 12. Inter-axle Spacing in metre.:
Section 8. Registered Gross Vehicle Weight. Out-of-Province Carriers. If yes, what is the Registered Gross Vehicle Weight (RGVW) for Ontario in kilograms?:
Section 8. Registered Gross Vehicle Weight. Out-of-Province Carriers. If not, what is the RGVW in the Registered Jurisdiction of the Power Unit in kilograms?:
Section 9. Payment and delivery options. Method of Payment: Cheque:
Section 9. Payment and delivery options. Method of Payment: Credit Card:
Section 9. Payment and delivery options. Method of Payment: Prepaid Account.:
Section 9. Payment and delivery options. Method of Permit Delivery: Picked up:
Section 9. Payment and delivery options. Method of Permit Delivery: Emailed.:
Section 9. Payment and delivery options. Method of Permit Delivery: Faxed.:
Comments. Ministry use only. Line 1 of 4.:
Select this link to go to ServiceOntario website. This link will open in a new browser window.:
Applicant's Information. Street Number and Name, Post Office Box, Rural Route or Lot, Concession and Township.:
Applicant's Information. Apartment or suite number.:
Office Use Only. Operator Number:
Office Use Only. Office Number:
Office Use Only. Business Date:
Office Use Only. Fee Paid: 0
Applicant's Information. Country.:
Applicant's Information. Email.:
Applicant's Information. Provide one of the following Ontario identification numbers below. If you do not have any of the information requested below check the "Not Available or None of the above" box. Driver's Licence (DL) Number.:
Applicant's Information. Licence Plate Number.:
Applicant's Information. Registrant Identification Number (RIN).:
Applicant's Information. Dealer Number.:
Applicant's Information. Motor Vehicle Inspection Station (MVIS) Number.:
Applicant's Information. Vehicle Identification Number (VIN).:
Applicant's Information. Not Available or None of the above: 0
Credit Card Information. Print Name of Cardholder (as it appears on the credit card).:
Credit Card Information. Name of Credit Card Company: Visa.:
Credit Card Information. Name of Credit Card Company: Mastercard.:
Credit Card Information. Print Name of Signing Authority (if different than name of Cardholder).:
Credit Card Information. Signature of Cardholder and/or Signing Authority.:
Credit Card Information. Date. Enter date in format: year: 4 digits, month: 2 digits, day: 2 digits. Or select date from drop down calender.:
Credit Card Information. Credit Card Number: