Limited access renewal application

Section 4a – Address / Owner Changes – Use this section to correct or change the owner and address information on the front of this
form. You do not need to complete this section if your address and vessel information on the front of this form is correct. Information
provided in this section will replace the owner and address information on the front of the form.
Vessel Name:

Owner Name:

Mailing Address:

City:

Telephone:

Alternate Telephone:

Home Port (City, State):

Principal Port (City, State):

State:

Zip:

Section 4b – Permit additions. Permits selected below will be added to existing permits provided the vessel qualifies for the categories
selected. Refer to instructions for categories information and allowable gears.
Gear Codes
120 – Purse Seine 210 – Beach Seine
220 – Boat Seines
330 – Other Trawl
410 – Dredge
700 – Gill/Entangling Nets 800 – Pots & Traps
913 – Tub Trawl
1010 – Harpoons
920 – Longlines / Setlines
1400 – Diving Gear

310 – Bottom Trawl
911 – Hand Lines
1200 – Other Gears

320 – Midwater Trawl
912 – Rod & Reel

►Circle the number or letter of the fishery category for which you are applying and write in the numeric gear code(s) from the list above.

Fisheries
Atlantic Sea Scallop
Northeast Multispecies
Monkfish
Surf Clam/Ocean Quahog
Maine Mahogany Quahog
Summer Flounder
Scup
Black Sea Bass
Squid, Mackerel, Butterfish
Incidental HMS Squid Trawl
Spiny Dogfish
Atlantic Bluefish
Atlantic Herring
Tilefish
Atlantic Deep-Sea Red Crab
Skate
American Lobster – Non Trap
American Lobster - Trap
* Charter/Party permit categories

Open Access
Categories - circle
HB

I*

E
1

6

2*
2*
2*
2*

3

1
1

2*

D
1
A
1

J

K

Limited Access Categories
Qualified Vessels Only
A B C 2 3 4 5 6 7 8 9
A C D E F HA
A B C D F G H

Gear Code(s) – must be written in

410 – Dredge only

4

E
2*

7
1
1
1
1
1

410 – Dredge only

5

A

B

B

C

1

2*

T1 T2 T3

C

A1 A2 A3 A4 A5 A6 AOC

800 – Pots and Traps only

Application processing will be delayed if you select a category that your vessel is not eligible for.

Section 5 – Application Checklist & Signature

 Please include the applicable forms below with your signed and dated application
_____ All vessels: copy of current (not expired) US Coast Guard (CG) Documentation or State Registration.
_____ All vessels: Vessel Ownership Form listing names of current owners/officers/shareholders of the vessel or business
_____ Charter/Party permit holders: CG Documentation must state “coastwise” or include a copy of a valid Captain’s license.
_____ Gillnet Form: NE Multispecies DAS gillnet vessels must complete Section 1 and 3 of the Gillnet Form

I, the undersigned, am the owner or legally authorized agent of the owner of the vessel named in Section 1. I affirm, subject to
the penalties provided in 18 USC 1001, that all the information that I have given in obtaining this permit is true and correct.
Print Name: ______________________________ Signature: _____________________________ Date: ____________
_____ No longer own vessel
Your application will be returned if it does not contain the proper documents listed above and it is not signed and dated
Revised 7/20/11 OMB Control No. 0648-0202 Expires: 4/30/13

OMB Control No. 0648-0601 Expires: 11/30/2014