Loading...
HomeMy Public PortalAboutRenewal Mooring Permit ApplicationTOWN OF BREWSTER, MASSACHUSETTS NATURAL RESOURCE / SHELLFISH / HARBORMASTER DEPARTMENT 1657 MAIN STREET BREWSTER, MA 02631 PHONE: (508) 896-4546 RBURCH@BREWSTER-MA.GOV RENEWAL MOORING PERMIT APPLICATION 20 Waiver of Responsibility In consideration of this application being accepted, I waive and release any and all rights and claims for personal damages against the Habormaster and the Town of Brewster. I herby absolve the Harbormaster and Assistant Harbormater from all responsibilities of liability to myself and others or damage to an vessel, equipment, or property. I certify that the information supplied above is the best of my knowledge and believe to be accurate. APPLICANT SIGNATURE DATE APPLICANT INFORMATION NAME: MOORING LOCATION: STREET: (WINTER MAILING ADDRESS) CITY,STATE: MOORING TACKLE: ZIP: Type: Weight: CELL PHONE:( ) HOME PHONE: ( ) E-MAIL: VESSEL INFORMATION SAME (if no changes, mark same & move on) NEW (if new vessel fill out info. Below) Outboard Inboard Sail Other . Vessel Name Length . Make / Model Hull Colors . State Reg. # . Hull ID # . PERMISSION FROM UPLAND OWNER (Cape Cod Bay Only) I am the upland property owner I have written permission from upland Owner. The Town of Brewster is the upland owner Other (explain on back) ENGINE / PROPULSION Type & Horsepower Make & Year Serial Number