Occupancy Permit - Ziolkowski Construction - 635 S Lafayette Blvd

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City of South Bend/Public Works u'r f son Blvd South Bend, rIN 466011 Fri" F . �q�y Q"CF. Application and Permit '... 86$ Allowing Extended Occupancy of City Right of Way Applicant: Ziolkowski Construction, Inc. Date: 12-15-2017 Applicant Address: 4050 Ralph Jones Drive, South Bend, IN 46626 Project Site Address: 635 S. Lafayette Blvd. South Bend, IN Nate: Occupancy limited to street(s) immediately in front of construction site. Nature and extent of Occupancy {e.g.: proposed construction activities, equipment proposed to occupy public right-of-way, construction deliveries, etc.). - Masonry restoration and new curtainwall system, Hydromobile scaffolding Duration of Occupancy: through 4/17/2018 Signature of Applicant: - r THE TERMS AND PROVISIONS OF CHAPTER 6, ARTICLE nd CHAPTER 18, ARTICLE 7, Sec 18-62 OF THE SOUTH BEND MUNICIPAL CODE ARE INCORPORATED HEREIN IN THEIR ENTIRETY. FAILURE TO COMPLY WITH THESE PROVISIONS SHALL RESULT IN CANCELLATON OF THIS PERMIT. THIS PERMIT SHALL BE CONDITIONED UPON THE EXECUTION AND FILING WITH THE BOARD OF PUBLIC WORKS OF A BOND IN AN AMOUNT APPROVED BY THE BOARD OF PUBLIC WORKS, CONDITIONED TO INDEMNIFY, SAVE AND KEEP HARMLESS THE CITY OF SOUTH BEND, INDIANA, FROM ANY AND ALL LOSS, EXPENSE, COST OR LIABILITY OF ANY KINDS WHATSOEVER WHICH THE CITY MAY SUFFER OR BE PUT TO FROM OR BY REASON OF ANY ACT OR THING DONE OR NEGLECT TO BE DONE, OR BY VIRTUE OF THE AUTHORITY GIVEN IN SUCH PERMIT. TO BE COMPLETED BY CITY STAFF ONLY: Bond Amount: $ Date Bond Filed: Compliance with CH 6, ART 5 and CH 18, ART 7, Sec 18-62 of the South Bend Municipal Code F] Fee Paid Date Issued: / ' y 061 � BOARD OF PUBLIC WORKS President Member Issued By: � �fl Member��,�. Member 4