City of Groton, CT
 
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Instructions

Please submit this form using any of the contact methods provided below.

Instructions
Provider Name
City of Groton CT
Provider Mailing Address
CT State Harbormaster Groton: Capt Jeff Dziedzic
295 Meridian Street
Groton, CT 06340
Provider Phone
860-460-1802
Provider FAX
Provider Email
harbormaster@cityofgroton-ct.gov

Application

Reference Number
BRCPKUGX
Application Status
Unknown
Application Phase
Application Type
Shennecossett Yacht Club

Applicant

Mobile Phone
First Name
Middle Name
Last Name
Contact Information
Mailing Street
Mailing City
Mailing State
Mailing Zip
Use Same Address Below
Primary Phone
Email Address

Vessel Owner

Mobile Phone
First Name
Middle Name
Last Name
Contact Information
Mailing Street
Mailing City
Mailing State
Mailing Zip
Use Same Address Below
Local Street Name
Local City
Local State
Local Zip Code
Home Phone
Email Address
Emergency Contact
Emergency Contact Name
Emergency Contact Other Phone

Vessel

Reg or Doc #
I UNDERSTAND THAT MY VESSEL MUST BE PROPERLY REGISTERED IN CONNECTICUT OR BE DOCUMENTED WITH A CONNECTICUT CERTIFICATE OF DECAL IN ORDER TO OBTAIN A MOORING SPACE.
Size
Length
  feet     inches
Beam
  feet     inches
Draft
  feet     inches
Displacement
Characteristics
Vessel Make
Engine
Engine Type
Please circle one of the following:

None

Power

Sail

Other (Please Specify)
Dinghy
Dinghy Present
Dinghy Location Or Access Point
Please circle one of the following:

Bayberry State Boat Launch

PIM

SYC

Other (Please Specify)
Insurance
Liability Insurance Carrier
Copy of Binder Attachment Required
Insurer Policy Number

Berth

Mooring Number
Anchor Type
Location
Yacht Club or Marina
Application Latitude/Longitude
Degrees
Minutes
Seconds
Latitude
Longitude
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Inspection Latitude/Longitude
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Inspection
Service Provider
Inspection Status
Not applicable
Inspection Date
Primary Tackle
Anchor Weight
Shackle Type
Shackle Size
Bottom Chain Diameter
Bottom Chain Length
  feet     inches
Top Chain Diameter
Top Chain Length
  feet     inches
Pennant Diameter
Pennant Length
  feet     inches
Other
Installation Date
Is The Mooring Weight Displayed On The Buoy?
Is The Buoy Showing A Blue Band, Appropriate Size?
Does The Mooring Meet Minimum Standards?

Attachments

Acceptance

Terms and Conditions
- MOORINGS SHOULD HAVE ADEQUATE GROUND TACKLE, PENDANT(S), CHAFING GEAR AND SCOPE FOR THE AREA AND CONDITIONS EXPECTED. A VESSEL RIDING ITS MOORING MUST NOT INFRINGE ON OTHER MOORINGS. MOORINGS, BUT ACTION ON WIND OR CURRENT, SHALL NOT ENCROACH UPON NAVIGATION CHANNELS MAINTAINED BY THE CORPS OF ENGINEERS, OR INTERFERE WITH ESTABLISHED FAIRWAYS, WHARVES, DOCKS OR FLOATS.
- MOORING BUOYS SHALL BE WHITE WITH A CLEARLY VISIBLE HORIZONTAL BLUE BAND AROUND THE CIRCUMFERENCE OF THE BUOY CENTERED MIDWAY BETWEEN THE TOP OF THE BUOY AND THE WATERLINE.
- THE WEIGHT OF THE ANCHOR AND NAME OF THE PERMITEE SHOULD BE INDICATED ON THE BUOY.
- MOORED VESSELS SHALL COMPLY WITH INLAND NAVIGATION RULE 30 (LIGHTS FOR ANCHORED VESSELS).
- MOORING AND ANCHORING IS PROHIBITED OVER SUBMARINE CABLE
- MOORING PERMITS ARE VALID FOR A PERIOD OF ONE YEAR AND NOT TRANSFERABLE TO ANOTHER PARTY.

I have read and understand the Online Mooring User Terms and Conditions
Signature
Date
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