Form CG-4201 Welding and Hotwork

U.S. DEPARTMENT OF
HOMELAND SECURITY
U.S. COAST GUARD
CG-4201 (Rev. 10-06)
FROM: Owner/Operator

Welding and Hot-Work
(Electric Welding, Oxyacetylene Welding, Burning, Cutting and Other Hot-Work)
Check Applicable Box:
Permit
TO: CAPTAIN OF THE PORT

U.S. COAST GUARD
Phone:
Fax:

Phone:
Fax:

Notification
DESCRIPTION OF WORK

Form Approved
OMB No. 1625-0016
Exp. Date: 04/30/2013

LOCATION
FROM

DURATION
TO

I agree to comply with and to require my employees to comply with the below listed requirements. I understand that failure to comply with these
requirements may subject me and any other responsible person to the penalties prescribed in the Ports and Waterways Safety Act (33 USC 1226-1227) and
will result in the cancellation of any permit issued.
DATE

TITLE

SIGNATURE

FROM:
CAPTAIN OF THE PORT

TO:
Attn: Owner/Operator
Facility
Address

PERMIT NUMBER:

U.S. COAST GUARD

FROM

VALID (DATE/TIME)
TO

This permit authorizes the above described welding, burning, or other hot-work to be performed subject to the requirements listed hereafter.
DATE

ISSUED BY

EQUIPMENT

PERSONNEL

REQUIREMENTS (In addition to applicable regulations in 33 Code of Federal Regulations (CFR) Parts 126, 127, and 154)
A qualified operator shall be in charge.
All persons using any cutting, welding, or other hot-work equipment shall be fully qualified in its use and associated safety procedures.

All equipment shall be in good condition.
Oxygen and acetylene cylinders shall be placed in an upright position and properly secured. Hose shall be free of leaks.
In confirmed spaces, mechanical ventilating equipment shall be supplied to exhaust fumes to the outer atmosphere.
Each electric welding machine shall be properly grounded to prevent arcing.
Welding machines driven by liquid fuel shall be equipped with drip pans and shall be fueled off the pier.

SCENE

All flooring in the area of operation shall be swept clean. Wooden planking shall be wet down.
All combustible material shall be removed 35 feet horizontally from the work area or protected with flame proofed covers or shielded with metal
or fire resistant guards or curtains.
The pier superintendent or authorized representative and the welding foreman shall make a joint inspection of the area and adjoining areas
before any hot-work is started.

FIRE PROTECTION

The pier superintendent or authorized representative and the welding foreman shall notify the welder of all fire hazards in the area.
A competent fire watch shall be maintained and, if the hot-work is on the boundary of a compartment (i.e. ,bulkhead, wall or deck) an additional
fire watch shall be stationed in the adjoining compartment and have immediately available at least one UL approved fire extinguisher containing
an agent appropriate to existing conditions. The minimum rating of the fire extinguisher shall not be less than 4A or 4B as defined by National
Fire Code 10. A fire hose shall be available, already led out, and with pressure at the nozzle.
Fire watchers shall have no duties except to watch for the presence of fire and to prevent the development of hazardous conditions. The fire
watch shall be maintained for at least one half hour after completion of the hot-work.
Flammable vapors, liquids or solids must first be completely removed from any container, pipe or transfer line subject to hot-work. Tanks used
for storage of volatile substances must be tested and certified gas free prior to starting hot-work.

GENERAL

Proper safety precautions in relation to purging, inerting, or venting shall be followed for hot-work on containers.
All safe practices in NFPA 51B and all local laws and ordinances shall be observed.
In case of fire or other hazard, all cutting, welding or other hot-work activity and equipment shall be completely secured.
This permit does not exempt you from applicable notification requirements.

ADDITIONAL DIRECTIONS OR ORDERS

I acknowledge receipt of this welding and hot-work permit. (Please return signed copy to the COTP.)
DATE

TITLE

NAME and SIGNATURE

Reset

A. Scope: The following is intended as explanatory language for federal requirements contained in 33
Code of Federal Regulations (CFR) Parts 126, 127 and 154 regarding permit and notifications for
conducting welding and hot-work at waterfront facilities or aboard vessels moored thereto. It does not
account for local laws and ordinances nor does it account for differing procedures or additional
requirements implemented by your local Coast Guard Captain of the Port (COTP).
B. Permit Application: The operator of a Liquefied Natural/Hazardous gas facility, subject to 33 CFR
Part 127, shall ensure that no welding, torch cutting, or other hot-work takes place on the facility or on a
vessel moored thereto unless a permit has been granted by the COTP and the conditions on the permit
are met.
C. Prohibited Hot-Work: Facilities subject to 33 CFR Part 126 and/or 33 CFR Part 154, are prohibited
from conducting welding or hot-work during gas freeing operations or within-1.
2.
3.
4.
D.

30.5 meters (100 feet) of bulk cargo operations involving flammable/combustible materials,
30.5 meters (100 feet) of fueling operations,
30.5 meters (100 feet) of explosives, or
15.25 meters (50 feet) of other hazardous materials.

Notifications:
1. Facilities Subject to 33 CFR Part 126: The operator of a facility subject to 33 CFR Part 126
must notify the COTP before conducting hot-work on a vessel moored thereto, when
containerized dangerous cargo is located within the distances noted in paragraph C above. This
form may be used for such notification. Additionally, this form may be used to notify (if required
by the local COTP) of welding or hot-work at a facility subject to 33 CFR Part 126. Any such
welding or hot-work must be done in compliance with 33 CFR 126.30.
2. Facilities Subject to 33 CFR Part 154: This form may also be used to notify (if required by the
local COTP) of welding or hot-work at a facility subject to 33 CFR Part 154. Any such welding or
hot-work must be done in compliance with 33 CFR 154.735(l).

E. Additional Requirements: The COTP retains the authority to request prior notification for all hotwork conducted at any facility or vessel within the COTP zone if the COTP deems it necessary. There
may be additional requirements regarding hot-work for vessels at anchor. Additionally, there are specific
requirements for different types of vessels such as tank vessels (46 CFR 35.01-1) and passenger vessels
(46 CFR 71.60(c)(1)). Please consult with your local COTP for hot-work aboard such vessels.

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 30 minutes. You may submit any comments concerning the accuracy of this burden
estimate or any suggestions for reducing the burden to: Commandant (G-3PCP-2), U.S. Coast Guard, 2100 2nd St, SW, Washington, D.C. 20593-0001 or
Office of Management and Budget, Paperwork Reduction Project (1625-0016), Washington, DC 20593.
PREVIOUS EDITION IS OBSOLETE

APPLICANT COPY