Hot Work Permit
Port of Palm Beach District
Attention: Dock Master
fax: 561.841.0623
email: dockmaster@portofpalmbeach.com

This HOT WORK Permit is required for any operation involving open flames or producing heat and or sparks.  This includes, but is not limited to: Brazing, Cutting, Grinding, Soldering, Electric Welding, Oxyacytelene Welding & Burning.
Please Fill Out ALL Information, Otherwise Your Form Will NOT Be Accepted!
Please provide the following contact information: Required Precautions Checklist
Hot Work Being Done By:
Location:
Date:

-- mm/dd/yy
   
Vessel Name:
Berth and/or Bay Number(s):
   
Company Name:
Telephone Number:
Name/Title of Contact:

Email:

 
   
I verify the above location has been examined, the precautions checked on the Required Precautions Checklist have been taken to prevent fire and permission is authorized for work.
Authorization Code:
  Name of Marine Chemist and copy of certificate (please have available if asked for).  
Care shall be taken as to the wind direction so that sparks do not ignite combustibles in the area of the hot work.
Transferring of fuel is prohibited while hot work is being performed.
Fire watch being manned (no other duties) with at least one UL approved fire extinguisher containing agent appropriate to existing conditions.
Hot Work is not to be conducted within 30 feet of any combustible material.
Hazardous Material on board: What/Where
Qualified operator shall be in charge.
All safety, local laws and ordinances shall be observed.
 

HOT WORK PERFORMED WITHOUT A
PERMIT WILL BE SUBJECT TO A $ 500 FINE
PORT TARIFF RULE-GL, ITEM 477 AND
REPORT FILED WITH THE U.S.C.G.

Official Use Only

Permit Number Issued:
Issued By:
   

THIS PERMIT IS VALID UNTIL:
Start Date: -- mm/dd/yy
Completion Date: -- mm/dd/yy
 

 

for questions/concerns, please call: 561.383.4195

 

REMEMBER: ALL FIELDS MUST BE FILLED OUT FOR US TO ACCEPT