Cg-3752a Application For Inspection Of U.s. Vessel (new Construct

U.S. DEPARTMENT OF
HOMELAND SECURITY
U.S. COAST GUARD
CG-3752A Rev. (01-07)

APPLICATION FOR INSPECTION OF U.S. VESSEL
(NEW CONSTRUCTION)

FORM APPROVED
OMB NO: 1625-0002

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
valid OMB control number. The Coast Guard estimates that the average burden for this report is 15 mins. You may submit any
comments concerning the accuracy of this burden estimate or any suggestion reducing the burden to: Commandant (CG-3PCV),
U.S. Coast Guard, Washington DC 20593-0001 or Office of Management and Budget, Paperwork Reduction Project (1625-0002),
Washington, DC 20503.

TO: Officer in Charge, Marine Inspection
The undersigned applies for inspection of the new vessel:
______________________________________

___________________________________

(Name-if known)

(Hull Number)

Multi Service Requested? (Check one)

Yes

No

_________________________________
(Service: Passenger/Cargo/OSV/etc.)

Route: __________________________ Intended Hailing Port: ____________________________
Inspected under the provisions of 46 CFR Subchapter(s) (D/I/K/L/T, etc.): ____________________
At (Shipbuilder): _________________________________________________________________
Point of Contact at Builder’s Yard: ___________________________________________________
Address/Phone: _________________________________________________________________
Contract Date: ___________________________

Keel Laid Date: _______________________

Est. Date Construction Begins: _________________ Est. Delivery Date: ____________________
Length: _________________
Estimated Tonnage:

Breadth: ______________ Depth: __________________

Regulatory

Gross: ______________

Net: ___________________

International

Gross: _______________

Net: ___________________

Hull Material: __________________________
No. of Engines: _____________

Propulsion Type: _________________________

HP of Each: ____________

Propulsion Automation for Machinery Space (Check one)
Vessel to be Classed (Check one)

Yes

No

Yes

No. of Shafts: ____________
No

By (Class Society) __________________

If Yes, is inspection under the provisions of NVIC 10-82 requested? (Check one)

Yes

No

Yes

No

(A complete list of NVIC’s can be viewed at www.uscg.mil/hq/g-m/nvic/)

International Certificates (SOLAS, MARPOL, etc.) requested (Check one )
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-3752A (Rev. 01-07)

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Proposed Manning: _______________________________________________________________
Requested Number of: Passengers __________

_________________________________________________________.

Industrial/ Scientific _______ Offshore Workers ________ Persons in Addition to Crew _______
Vessel Owner: __________________________________________________________________
Address: _______________________________________________________________________
Point of Contact & Phone: __________________________________________________________

SHIPYARD OR DESIGN AGENT SUBMITTING DRAWINGS FOR APPROVAL
Name: _________________________________________________________________________
Address: _______________________________________________________________________
Point of Contact & Phone: _________________________________________________________
New Hull Design Type (Check one)

Yes

No

If Sistered, Parent Hull is _____________________________ built at ______________________
(Name/Official #)

TYPES OF CARGO TO BE CARRIED
Oil Cargos? (Check one)

Yes

No

If yes, describe here or attach separate sheet that lists

each intended cargo, grade, and quantity. Please include all NLS Cargos and quantities as well.

Chemical Cargos? (Circle one)
Yes
No
If yes, describe here or attach separate sheet
that lists each intended cargo and quantity. ____________________________________________
_______________________________________________________________________________
Deck Cargo? (Circle one)

Yes

No

If yes, amount _________________ (in Long Tons)

Person Submitting Application: _____________________________________________________
Title: _____________________________________________________
Signature: _____________________________________________________
Date: _____________________________________________________
At this stage of your new construction project we realize you may not possess the information to complete every section
on this form. However, a fully completed form will allow us to better facilitate the inspection of your new vessel.
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-3752A (Rev. 01-07)

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