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4SpUTH & <br />U d <br />W a <br />PEACE <br />x x <br />1865 <br />City of South Bend/Public Works <br />227 W. Jefferson Blvd., Suite 1316 <br />South Bend, IN 46601 <br />Application and Permit <br />Long Term Occupancy of City Right -of -Way <br />Applicant: RealAmerica Construction <br />Applicant Address: 8250 Dean Road, Indianapolis, IN 46254 <br />Project Site Address <br />520 S. Lafayette Blvd., South bend, IN 46601 <br />Date: 3/7/2024 <br />Note: Occupancy limited to street(s) immediately in front of construction site. <br />Nature and extent of Occupancy (e.g.: proposed construction activities, equipment proposed <br />to occupy public right-of-way, construction deliveries, etc.): <br />We will be installation sewer and water connections. equipment that we are planning on using will <br />be excavators, loaders, crane, skid steers and dump trucks. We will also have deliveries in Semi's and box trucks. <br />Duration of Occupancy: 16 months <br />Signature of Applicant: ���' D• Ceeiz, <br />THE TERMS AND PROVISIONS OF CHAPTER 6, ARTICLE 5 and CHAPTER 18, ARTICLE 7, Sec 18-62 OF THE <br />SOUTH BEND MUNICIPAL CODE ARE INCORPORATED HEREIN IN THEIR ENTIRETY. FAILURE TO COMPLY <br />WITH THESE PROVISIONS SHALL RESULT IN CANCELLATON OF THIS PERMIT. <br />THIS PERMIT SHALL BE CONDITIONED UPON THE EXECUTION AND FILING WITH THE BOARD OF PUBLIC <br />WORKS OF A BOND IN AN AMOUNT APPROVED BY THE BOARD OF PUBLIC WORKS, CONDITIONED TO <br />INDEMNIFY, SAVE AND KEEP HARMLESS THE CITY OF SOUTH BEND, INDIANA, FROM ANY AND ALL LOSS, <br />EXPENSE, COST OR LIABILITY OF ANY KINDS WHATSOEVER WHICH THE CITY MAY SUFFER OR BE PUT TO <br />FROM OR BY REASON OF ANY ACT OR THING DONE OR NEGLECT TO BE DONE, OR BY VIRTUE OF THE <br />AUTHORITY GIVEN IN SUCH PERMIT. <br />TO BE COMPLETED BY CITY STAFF ONLY: <br />Bond/Fee Amount: $ 11,055.00 Date Bond/Fee Filed: <br />Compliance with CH 6, ART 5 and CHI 8, ART 7, Sec 18-62 of the South Bend Municipal Code <br />❑ Fee Paid <br />Date Issued: June 1, 2024 to September 16, 2025 Issued By: Permit Manager <br />CITY OF SOUTH BEND, INDIANA <br />BOARD OF PUBLIC WORKS <br />7w�a <br />Elizabeth A. Maradik, President <br />, 6fs&-A-- <br />Gary A. Gilot, Member <br />Joseph R. Molnar, Vice President <br />Briana Micou, Member <br />Murray L. Miller, Member <br />Attest: Theresa M. Heffner, Clerk <br />Date: May 14, 2024 <br />V 1.11.19 <br />