HIGHWAY RESTRICTION NOTICE - SIZE AND/OR WEIGHT

Instructions:

Non-ODOT Staff (contractors, etc.): Complete the fields below and submit at least 35 days prior to when the restriction begins per contract specifications 00220.03(a) Work Zone Notifications.

ODOT Staff: Complete the fields below and submit at least 14-28 days prior to when the restriction begins. Refer to the How Much Notice is Required section on the Oregon Travel Restrictions and Guidelines website for more information.

After submitting the form an email confirmation will be sent to you with a copy of the form attached for your records. When the project is complete and the restriction is no longer needed, update this form and select Lift or Cancel to clear this restriction. If you have questions, or the restriction needs to be extended or updated, contact the Restriction Notice Team.

Help: User Guide

Step 1: Complete the request form Step 2: Review Step 3: Confirmation

Status: New Restriction

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* = required Fields

Section 1 - (Location/Project/Event Name) Help: User Guide

Route Number:	Select One I-105 I-205 I-405 I-5 I-82 I-84 OR 10 OR 103 OR 104 OR 104S OR 11 OR 120 OR 126 OR 126B OR 127 OR 130 OR 131 OR 132 OR 138 OR 140 OR 141 OR 153 OR 154 OR 164 OR 173 OR 18 OR 180 OR 182 OR 18B OR 19 OR 194 OR 200 OR 201 OR 202 OR 203 OR 204 OR 205 OR 206 OR 207 OR 210 OR 211 OR 212 OR 213 OR 214 OR 216 OR 217 OR 218 OR 219 OR 22 OR 221 OR 222 OR 223 OR 224 OR 225 OR 226 OR 227 OR 228 OR 229 OR 230 OR 233 OR 234 OR 237 OR 238 OR 240 OR 241 OR 242 OR 244 OR 245 OR 250 OR 251 OR 255 OR 260 OR 27 OR 273 OR 281 OR 282 OR 293 OR 3 OR 31 OR 331 OR 332 OR 334 OR 335 OR 339 OR 34 OR 35 OR 350 OR 351 OR 36 OR 361 OR 37 OR 370 OR 372 OR 38 OR 380 OR 39 OR 402 OR 410 OR 413 OR 414 OR 42 OR 422 OR 422S OR 429 OR 42S OR 43 OR 451 OR 452 OR 453 OR 454 OR 46 OR 47 OR 501 OR 51 OR 52 OR 528 OR 53 OR 540 OR 542 OR 551 OR 569 OR 58 OR 6 OR 62 OR 66 OR 7 OR 70 OR 74 OR 78 OR 8 OR 82 OR 86 OR 86S OR 99 OR 99E OR 99EB OR 99W US 101 US 101B US 197 US 199 US 20 US 20B US 26 US 30 US 30B US 30BY US 395 US 730 US 95 US 95S US 97 US 97B *	Restriction Notice Number: NEW
Beginning Mile Point:	*	Ending Mile Point:	*
Direction:	Northbound Southbound Eastbound Westbound *
Highway Local Name:
City/Town Nearby:	*
Project Name:		Project Key:
Contract Number:		Name of Event/Parade:
Bridge Structure Name:
Bridge Structure Milepost:		Bridge Structure Number:

Section 2 - (Restriction Hours/Days and Explanation of Work) Help: User Guide

Date Work Begins:	*	Estimated Completion Date:	*
The duration (start/end date entered) shall not exceed the anticipated actual restriction period.
Is restriction 24 X 7?	No Yes *
Specify restriction hours and days (e.g. - Sunday through Thursday 10PM to 5AM)	*
Provide a detailed explanation of the work:	*

Section 3 - (Full Highway Closures) Help: User Guide

Is this restriction notice submittal for Full Highway Closure?	Yes   No *
Is there a detour route?	Yes   No *
Authorized Truck Detour Route	*
Detour Approved By	* (Name of City/County Official)
Is the detour approved for annual oversize loads?	Yes   No *

Section 4 - (Highway Width Restrictions/Lane Closures) Help: User Guide

Is this restriction notice submittal for closing travel lanes?	Yes   No *

Which travel lanes? (e.g. A,B lanes, NB/SB)	*
What is the width for the open travel lane(s) between barriers (including any paved shoulder)?	ft in *
What are the day time widths, days and hours? (e.g. 19 feet, Monday through Thursday, 9 AM to 4 PM)	*
What are the night time widths, days and hours? (e.g. 16 feet, Monday through Thursday, 4 PM to 9 AM)	*
Barrier Type	Hard Barrier    Soft Barrier    N/A *
Are you closing any lanes under overpasses?	Yes   No *
Please describe (e.g. - Which structure? All structures?)	*
Is this workzone straight or on a curve?	Select One Straight Curve Both N/A *
Can wider loads be accommodated without any advanced notice by moving barrier, equipment, etc. out of the way with delay less than 20 minutes?	Yes   No *
Can wider loads be accommodated with advanced notice?	Yes   No *
Please describe	*

If this work will also require lane closures (not a full road closure but width restrictions will be needed), a separate notice will need to be submitted.

Section 5 - (Ramp Closures/Ramp Width Restrictions) Help: User Guide

Is this restriction notice for closing any ramps?	Yes   No *
The duration of the restriction(start/end date entered) shall not exceed the anticipated actual closure period.
Which ramps will be closed?	*
What are the allowable ramp closure days/hours? (eg. Sunday through Thursday 7PM to 7AM)	*
Is there a detour route?	Yes   No *
Authorized Truck Detour Route	*
Is the detour approved for annual oversize loads?	Yes   No *

Are you temporarily reducing the width of any ramps?	Yes   No *
Which ramps are affected?	*
What are the restricted days/hours?	*
What is the width for the open travel lane(s) between barriers (including any paved shoulder)?	*
What are the daytime width days and hours? (e.g. 19 feet, Monday through Thursday, 9 AM to 4 PM)	*
What are the nighttime width days and hours? (e.g. 16 feet, Monday through Thursday, 4 PM to 9 AM)	*
Is this workzone straight or on a curve?	Select One Straight Curve Both N/A *

If this work will also require ramp closures, a separate notice will need to be submitted. The duration of the restriction shall not exceed the anticipated actual closure period.

Section 6 - (Height and Weight Restrictions) Help: User Guide

Are you temporarily installing a feature over the roadway that will create a height restriction? (e.g. temporary traffic signal, false work, etc.)	Yes   No *
Please describe	*
What is the vertical clearance from the roadway to the bottom of the structure/falsework in feet and inches?	ft *   in *
What are the restricted days/hours? (e.g. 24/7, Monday through Thursday 9 AM to 4 PM)	*
Are weight restrictions needed?	Yes   No *

Please select the weights that are allowed:
	Legal Weight (80,000 lbs, Permit Weight Table 1)
	Extended Weights (105,500 lbs, Permit Weight Table 1 or 2)
	Annual Heavy Haul Weights (98,000lbs, Permit Weight Table 3 & 4)
	Above Legal/Extended/Annual Heavy Haul Weights

Indicate the maximum weight allowed:

Section 7 - (Contact Information) Help: User Guide

Submitter's Name:	*
Submitter's Phone:	*
Submitter's Cell Phone:
Submitter's Email:	* (All official correspondence concerning this document will be sent to this email address.)
Alternate Name:
Alternate Phone:
Alternate Email:
Agency (ODOT) Resident Engineer:	* Email: * Phone: *
Alternate (ODOT) Resident Engineer Designee:	* Email: * Phone: *
Other Non-ODOT Project Contact:	Email:
Region Mobility Coordinator:	Select One Region 1 - Debbie Martisak Region 2 - Michele Becker Region 3 - Sarah Thompson Region 4 - Teresa GIBSON Region 5 - Dan Fine *

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* = required Fields

FORM 734-2357 (2-21)