Contact Person:

Email County
City State Zip
January May Sept.
February June October
March July November
April August December
Final Invoice due
Gather documents for the first invoice
Date Complete Task
Contract begins/Pre inspection
Removal of Engine(s)
Page 1 of 4
Address
Installation of new engine(s)/ Sea Trials/ Coast Guard inspection
Scrapping of old engine(s)
First Invoice Due
Final Inspection
Contract ends
Preparation work for new engine(s)
Scrapped Engine(s) Inspection
Contact Anne Galamb for questions at 919-707-8423.
2013 Marine Diesel Repower
Applicant Information and Schedule
Alt Phone Number Phone Number
Gather documents for the second invoice
Applicant
Company or Individual Doing Business Name:
Description of Applicant's Business
Describe your company's size, location, and type of work usually performed
Schedule
Seasonal Concerns
Indicate below which months you can repower your vessel with a yes or a no. "Yes" meaning you can
repower it and "no" meaning you cant.
Official Number
2013 Marine Diesel Repower
Container, Ferry, Excursion,
Commercial Fishing,
Commercial Charter Fishing,
Workboat, Pilot, Crew, Tow
Boat, Tugboat
Contact Anne Galamb for Questions at 919-707-8423.
Vessel Usage
Fishing Permits State and Federal
State Registration Number
Cargo Carried
Frequency of Operation
Page 2 of 4
Home Port
USCG
Documentation
Hailing Port
Trade Indicator
Documentation
Waterways Used
Description of Vessel
Vessel
Hull Material
Length
Beam
Displacement
Builder
Year Built or Model Year
Hull Identification Number (HIN)
or Hull Number
Vessel Information
Vessel Name
Owner (s)
Managing
Owner Address
Page 2 of 4
Engine Family
Wet or Dry Exhaust System
Number of Engines
Quarts/Day or Week
What is the oil capacity of the engine?
Estimated Engine Life Remaining (Engines must have 3
years lifetime remaining to qualify.)
Original Engine(s) New Engine(s)
Hours
Manufacturer
Model Name
Model Year
Serial Number Engine 1
Serial Number Engine 2
Horsepower
Fuel Type: Diesel, Biodiesel,
Gasoline
Hours/Year
Is the new engine
remanufactured?
To obtain this catch records contact The
Division of Marine Fisheries 252 808-8101
* Catch records for past 3 years; and
* Copy of the owner's commercial fishing licence
Attach to Application:
Current Engines (s) Operation
2013 Marine Diesel Repower
Engine Cycle (2 or 4 cycle)
Engine (s)
Number Cylinders
Propulsion Engine Information
How much oil do you add between oil changes?
Annual Fuel Usage Gallons per year
Original vs New Engines (s)
Page 3a of 4
Vessel Name:
Year of Last Engine Rebuild
Engine (s) Operation
Attach to Application:
To obtain this catch records contact: Division of
Marine Fisheries 252 808-8101
* Catch records for past 3 years; and
* Copy of the owner's commercial fishing
3b of 4
Estimated Engine Life Remaining (Engines must
have 3 years lifetime remaining to qualify.)
Engine (s) Operation Hours/Year
Quarts/Day or Week
Annual Fuel Usage Gallons per year
Current Engines (s) Operation
Engine Hours
Year of Last Engine Rebuild
What is the oil capacity of the engine?
How much oil do you add between oil changes?
kiloWatt rating
Engine Family
Fuel Type: Diesel, Biodiesel,
Gasoline
Engine Serial Number
Model Name
Model Year
Original vs New Engines (s)
Original Engine(s) New Engine(s)
Manufacturer
2013 Marine Diesel Repower
Auxiliary Engine Information
Vessel Name:
Number of Engines
$
$
$
$
$
$
$
$
$
E-mail/mail or fax completed applications to:
NCDENR - Division of Air Quality
Mobile Sources Branch
1641 Mail Service Center
Raleigh, NC 27699-1641 Fax: 919 715-0718
A. Cost of new propulsion engine(s) including sales tax and delivery charges
B. Cost of new auxiliary engine including sales tax and delivery charges
C. Additional parts and supplies
D. Installation, including cost to remove and dispose of old engine(s)
E. Dry dock fees
F. Scrappage/Remanufactured value of all engines replaced
G. Value of any other financial incentives (e.g. tax credits or other grants)
H. Cost to the Applicant (H=A+B+C+D+E-F-G)*
Anne Galamb
919 707-8423
anne.galamb@ncdenr.gov
I. Funding Requested (H/2)
Date
Title
Signature
Printed/Typed Name
Project Cost and Signature
2013 Marine Diesel Repower
Project Costs and Funding
Page 4 of 4
Good Faith Commitment of Truth, Location of Equipment Activity
As an authorized official which owns the marine vessel described in this application, I attest that, to the
best of my knowledge, this application is truthful and at least 70% of the equipment's operation will occur
in North Carolina for the next 3 years.