ports of dampier and ashburton moorings change of vessel details

Mooring number:

new vessel details are TO BE COMPLETED BY THE MOORING OWNER

The mooring owner/user is responsible for:

  1. Ensuring the mooring has been inspected for the current cyclone season
  2. Submitting the completed Vessel Change on a Mooring advice form to Dampier Port Authority prior to the vessel change
  3. Supplying the Dampier/Ashburton Harbour Masters with the new vessel details and as-built design specifications of the mooring
  4. The mooring may require recertification by a Mooring Designer/Naval Architect if there has been a significant change in vessel

[Contact details of approved Mooring Inspectors and Designers are set out in the Mooring Designers and Inspectors brochure, available on the PPA website along with the Moorings Handbookand the Mooring Licence Terms & Conditions, and other important information you are required to know as a mooring owner/user.]

SECTION 1: Mooring Owner Details

Company Name: / ABN:
Contact Person:
Address:
Postal Address:
Phone: / Mobile:
Email Address:

SECTION 2: Mooring Details (use decimal minutes)

Mooring Number:
Type of Mooring: / Non Cyclone / Cyclone
Mooring Use: / Recreational / Commercial
Is this a rental mooring: / Yes / No
Mooring Location: / GPS Datum / Latitude: / Longitude:

SECTION 3: New Vessel Details

Name of Vessel:
Depth of Water: / Type of bottom
(e.g. mud/sand):
IMO Registration Number: / Nearest Buoy
Gross Tonnage: / Length Overall:
Draft: / Hull Type:

SECTION 4: Vessel Hawser Details

Length of Hawser (metres): / Total Swing Room:
Condition of Hawser:
Hawser Specifications:
NB: Hawsers must be as per the Naval Architects recommendation. Hawsers must not be left floating free from moorings to prevent damage to other craft.

SECTION 5: Owner Declaration

I
(print name)
declare; the contents of this form are:
(a)true and correct, and
(b)understand my responsibilities and obligations as owner of this mooring as set out in the Moorings Handbookand theMooring Licence Terms & Conditions.
Signature: / Date:
Completed forms should be scanned and emailed to:
Alternatively you may post the form to: Pilbara Ports Authority, Port of Dampier, ATTENTION: Moorings Officer,
Locked Bag 5006, KARRATHA WA 6714

PPA Office use only

Is recertification of the mooring required by a Naval Architect/Engineer for this vessel?
Yes / Mooring Owner to forward mooring specifications and vessel design to Mooring Designer / Naval Architect for review of suitability.
Comments:
No
Vessel: / has been approved for Mooring:
Signature:
Name (print):
Date:
ED2013-015579 / SHEQ-SYS-F-338 / Issued Date: 11/8/2014 / Rev No: 2 / Page: 1 of 3