CG-4143 Application for Class 1 Private Aids to Navigation on Ar



DEPARTMENT OF HOMELAND SECURITY 
U.S. Coast Guard

OMB 1625-0011
Exp. Date: 02/29/2012

APPLICATION FOR CLASS I PRIVATE AIDS TO NAVIGATION ON ARTIFICIAL ISLANDS AND FIXED STRUCTURES
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1. NAME AND ADDRESS (including zip code) OF CORPORATION
OR PERSON MAKING APPLICATION

2. ACTION REQUESTED FOR PRIVATE AIDS TO NAVIGATION
DISCONTINUE

A.

ESTABLISH AND MAINTAIN

E.

B.

CHANGE OWNERSHIP

F. DATE OF ACTION

C.

CHANGE EQUIPMENT

D.

MOVE

3. POSITION
A. GENERAL LOCALITY AND GRID AREA

B. LATITUDE

C. LONGITUDE

D. BLOCK NUMBER

F. LEASE NUMBER

G. WELL NUMBER

E. SIGN

4. LIGHT
A. CHARACTERISTICS

COLOR

B. NUMBER INSTALLED

WHITE

C. ILLUMINANT (Check)
ELECTRICITY

RED
FLASH

SECONDS

ECLIPSE

D. HEIGHT ABOVE MEAN HIGH
WATER

GAS

OIL

OTHER (Specify)

SECONDS

E. VOLTS

G. INSIDE DIAMETER

F. AMPERES
LENS

H. CANDLEPOWER (If known)

GLOBE

5. FOG SIGNAL (Characteristic will be one two-second blast every twenty seconds)
A. CLASS

B. MANUFACTURED BY

C. MODEL NUMBER

A (2-Mile)
B (1/2-Mile)

6. STRUCTURE
A. COLOR

B. HEIGHT ABOVE MEAN HIGH WATER

C. DEPTH OF WATER BELOW MEAN LOW WATER

7. AUTHORIZED BY CORPS OF ENGINEERS, U.S. ARMY, PERMIT NO.
8. PERSON IN DIRECT CHARGE OF AID
A. NAME

C. ADDRESS

B. TELEPHONE NUMBER

9. The applicant agrees to save the Coast Guard harmless with respect to any claims that may result arising from the alleged
negligence of the operation of the approved aids.
Attached to this application are:
A.

LOCATION PLAT

D.

CERTIFICATE REQUIRED BY 33 CFR 67.10-1 (4)

B.

PRINT OF STRUCTURE

DATE

C.

AIDS TO NAVIGATION EQUIPMENT LIST

SIGNATURE

TITLE

FOR COAST GUARD USE
10. FROM:

Commander

Coast Guard District

A. THE ACTION DESCRIBED ABOVE IS

B. NOTICE TO MARINERS

APPROVED
APPROVED SUBJECT TO THE COMMENTS IN BLOCK 11 ON
REVERSE
C. CHARTS AFFECTED

E. DATE

WILL BE ISSUED
WILL NOT BE ISSUED
D. NAME OF AID(S)

F. SIGNATURE (By direction in accordance with 33 CFR 67)

PREVIOUS EDITION IS USABLE

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Page 2 of CG-4143 (Rev. 1-12)

INSTRUCTIONS
1.

The applicant will complete items 1 through 9.

2.

Submit in triplicate to the Coast Guard District Commander.
Attach a location plat, print of the structure showing
positions of the aids, a complete Aids to Navigation
Equipment List, and when establishing or changing a fog
signal, the certificate required by 33 CFR 67.10-1(4).

3.

You may obtain from the Coast Guard District Commander
copies of Title 33-Navigation and Navigable Waters,
Chapter 1-Coast Guard, Department of Homeland
Security, Subchapter C-Aids to Navigation, Part 67-Private
Aids to Navigation, Outer Continental Shelf and Waters
Under the Jurisdiction of the United States.

11. REMARKS

Privacy Act Statement
Authority: Under 43 USC 1333, the Coast Guard has the authority to promulgate and enforce regulations concerning lights and other warning devices
relating to the promotion of safety of life and property on the artificial islands, installations, and other devices on the outer continental shelf involved in the
exploration, development, removal, or transportation of resources there from. 33 CFR 66.01-15 describes the three classes of private aids to navigation. 33
CFR 67.05 and 33 CFR 67.10 prescribe the types of aids to navigation that must be installed on artificial islands and fixed structures.
Purpose: To obtain approval to establish a private aid to navigation on an artificial island or fixed structure, the applicant must submit CG Form 4143
(Application for Class 1 Private Aids to Navigation on Artificial Islands and Fixed Structures). Information about the private aid to navigation (type, color,
geographic position), as well as the applicant’s contact information is stored in the Coast Guard’s Integrated Aids to Navigation System (I-ATONIS). IATONIS is the Coast Guard’s comprehensive database for managing information about aids to navigation. I-ATONIS has user access controls in place to
govern who may view or access information.
Routine Uses: Collecting the applicant’s contact information is important because it allows the Coast Guard to contact the applicant should there be a
discrepancy or mishap involving the permitted private aid to navigation. Certain discrepancies create hazards to navigation and must be immediately
corrected or repaired. The contact information is available to Coast Guard aids to navigation personnel and contact is only initiated if the private aid to
navigation becomes discrepant or in need of repair.
Disclosure: Provision of the applicant’s contact information is mandatory, as it will allow the Coast Guard to contact the owner should there be a discrepancy
or mishap with the permitted aid to navigation. Failure to provide the required contact information will lead to disapproval of the private aid to navigation
application.
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 1 hr. You may submit any comments concerning the accuracy of this burden estimate or
any suggestions for reducing the burden to: Commandant (G-OPN) U.S. Coast Guard, Washington, DC 20593-0001 or office of Management and Budget,
Paperwork Reduction Project (1625-0011) Washington, DC 20503.

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