HomeMy WebLinkAboutSpecial Trucking Permit - Historic Navarre Cabin Move 830 Michigan St. to 897 Thomas St.o�sourx 8d C.
227 W. JEFFERSON BOULEVARD U d' PHONE 574/235-9251
SUITE 1316 COUNTY -CITY BUILDING ' PEACE FAX 574/ 235-9171
SOUTH BEND, INDIANA 46601 x x TDD 574/ 235-5567
1865
CITY OF SOUTH BEND
DEPARTMENT OF PUBLIC WORKS
I 'Z0141► LOU 40A 1
*FAX OR MAIL FORM 3 WORKING DAYS (EXCLUDES WEEKENDS) BEFORE REQUIRED 48 FIR PUBLIC NOTICE
**48 HR PUBLIC NOTICE ANNOUNCED UPON APPROVED FORM
***THIS APPLICATION EXPIRES 30 DAYS FROM SUBMISSION DATE
Oversize ❑ Overweight ❑ Hazardous Material ❑ Superload
Z l i; L4
Submission Date:
February 5, 2024
Applicant Name:
Lykowski Construction, Inc.
Phone #:574-291-8858
Fax #:
Email: kathylykowski@aol.com
Application #:
Route:
From:
North Pumping Station, 830 N. Michigan St., South Bend, IN 46601
To:
History Museum, 897 Thomas St., South Bend, IN 46601
Travel Date:
TBD
❑ Single Lane Occupancy Multi -Lane Occupancy
Time(s):
From: 9:00 a.m.
To: 11:00 a.m.
Contact:
Kathy Lykowski
Phone # 574-291-8858
Load Description:
Navarre Log Cabin - 20'-9" in width x 19'0" in length x 19'-4" height
Length:48 FT 0 IN Width: 20 FT 9 IN Height: 24 FT 0 IN
Vehicle Description:
Weight (Gross:) 42,000 Max Weight (Single Axle): - zee - 7, 9dO — i�L
Number of Axles: Axle Spacing: 1 �.r�pe Rear Steerable Axle: 9 Yes ❑ No
Vehicle Type: ❑ Tractor -Trailer ❑ Truck -Trailer R Truck 0 Other/Towed
Has the route been driven previously?
If so, provide the date.
Yes ❑ No Jan. 16, 2024 & previously
Will the load be delivered within the City?
If so, consult Ordinance Section 21-07.05. for regulations.
R Yes ❑ No
Attach the following: M Route Map 0 Axle configuration for vehicles over 5 axles
For County route permit contact: 574-235-9626 For INDOT route permit contact: 219-325-7523
OFFICE USE ONLY:
❑ Approved V Approved as Noted ❑ Revise ❑ Revise as Noted
Comments: Engineering has reviewed and approved the route listed below. With the additional
communication to INDOT, beacon health, and other impacted entities, the City approves the application
Engineering Division Authorized Signature: Date:
CITY OF SOUTH BEND, INDIANA
OAR�DOF PUBLIC WORKS
B
Oversize/Overweight/Hazardous permits requires anon -refundable payment of $35 made pay. V�/�
%
Superload permits requires a non-refundable payment of $50 made payable to the City of Soul Eliznbeth A. Maradik, President
Gary A. Gilot, Member
Payment Method: ❑ Credit Card ❑ Check ❑ Cash M rtay L. MillegyM b r
3/15/2024
�7r1
Breana N. Mi—, Member
Attest Laura D. Hensley, Acting Clerk
Date: March 26 2024
PAYMENT:
CITY MOVING PERMIT APPLICATION CHECK#
STJOSEPH COUNTY, CITY OF SOUTH BEND BUILDING DEPARTMENT CARD E]
CASH F1
APPLICANT INFORMATION DATE: March 5,2024
APPLICANT: Lykowski Construction, Inc. ORG/BUSINESS: Lykowski Construction, Inc.
PHONE: 574-291-8858 EMAIL, kathylykowski@aol.com
ADDRESS: 23158 Ireland Road South Bend IN 46614
Address City State Zip
PROPERTY OWNER: The History Museum C/O Brian Harding, Executive Director
PHONE: 574-235-9664 ext. 6227 EMAIL: bharding@historymuseumsb.org
ADDRESS: 808 W. Washington St. South Bend IN 46614
Address City State Zip
PROJECT INFORMATION
STRUCTURE BEING MOVED FROM: Leeper Park East/North Pumping Station (830 N. Michigan St., South Bend, IN
TO: Thomas St. west to The History Museum east of the "Worker's Home
# OF STORIES OF STRUCTURE: 1 story
DIMENSIONS OF STRUCTURE WHEN MOUNTED (please note dimensions of ALL structures separately):
LENGTH: 2T-0"
WIDTH.- 20'-9"
HEIGHT: 24'-0"
WEIGHT: 42,000#
AXLE SPACING: 45"
PROPOSED ROUTE:
FROM: enter city streets N. entry of Pump Station TO: Park Ln, west to Lafayette St.
FROM: Lafayette St. south TO: Colfax St.
FROM: Colfax St. west TO: Williams St.
FROM: Williams St. south TO: Washington St., Washington west to Chapin St., Chapin south to T1
DATE OF MOVE: TBD ALTERNATE DATE OF MOVE: TBD
MOVING CONTRACTOR: Lykowski Construction, Inc.
*Must provide Certificate of Insurance showing requirements as listed in the City or County Code or Ordinances
*Application can be emailed to us at building@southbendin.gov or provided to the address below for review.
*Application must be signed below.
*1 certify the above to be a true and accurate to the best of my knowledge.
APPLICANT SIGNATURE
Kathy Lykowski
PRINT NAME
574-291-8858
PHONE
March 5, 2024
DATE
Lykowski Construction, Inc.
ORGIBUSINESS OR OWNER
I �
kathylyKOwski@aol.com
EMAIL
EXCELLENCEACCOUNTABILITY INNOVATION I INCLUSION EMPOWERMENT
125 S. Lafayette Blvd. Suite,00 South Bend, Indiana 46601 p574.235.9554 1'574.235.55411vvvrw.southbendin.gov
FW: Map for Historic Navarre Cabin Move - South Bend, IN
From: PENDERGAST, THOMAS (tp9875@att.com) AT �- T
To: kathylykowski@aol.com
Date: Friday, January 26, 2024 at 03:25 PM EST
Kathy,
After checking the proposed attached route to move the Navarre Cabin there are no conflicts with AT&T cable along
the route.
You are all clear as far as AT&T is concerned.
Tom Pendergast
Sr. Specialist-OSP Design Engineering
AT&T Technology Operations, Construction & Engineering - MW
AT&T
307 S. Main St. South Bend, IN 46601
o 574-237-8822 j tp9875 att.com
MOBILIZING YOUR WORLD
From: cc <kathylykowski@aol.com>
Sent: Thursday, January 25, 2024 8:12 PM
To: PENDERGAST, THOMAS <tp9875@att.com>
Subject: Map for Historic Navarre Cabin Move - South Bend, IN
Tom,
Per your request here is the map of the route for the Historic Navarre Cabin move. I believe
you said you had the written route.
Please let me know if you need anything else.
Thank you,
Kathy
Lykowski Construction, Inc.
AMa • Search your mail or the web
Re: [EXTERNAL] Navarre Cabin Move C'j x
From cc <kathylykowski cz aol.com>
Today on AOL
Brian B Matthews Cc Bcc
Recipients
New Mail
Old Mail — -- _
Re: (EXTERNAL) Navarre Cabin Move
Starred _
Drafts A A B X # CM Q s E
Sent --- --- —
Spam
Recently Deleted On Wednesday, February 21, 2024 at 09:58:50 AM EST, Brian B
Matthews <bbmatthews@aep.com> wrote:
n Less
Views Show Good morning,
Unfortunately, I am unable to make the decision to do the work
Folders Show at no cost. You would need to contact customer service 1-800-
311-4634 about that if you would like to pursue no cost
However, I have figured out the cost for the work to be done
for your house move. The cost for a disconnect & reconnect
the 2 street light wires is $119.00 per wire. So the total would
be $238. 1 can put together the invoice when you are ready.
Let me know and we can figure out a good date to disconnect.
Regards,
Brian Matthews
From: cc <kathylykowski@aoLcom>
Sent: Tuesday, February 20, 2024 3:07 PM
To: Brian B Matthews <bbmatthews@aep.com>
Subject: [EXTERNAL] Navarre Cabin Move
Hi Brian,
I would like to run this by you to see if you could run this
by your uppers or give me the person(s) information so I
can contact them directly.
In 2023, the History Museum paid over $60,000.00 to
Indiana Michigan Power for their service and I know AEP
has minimal work for the historic Navarre Cabin move.
Would AEPII&M be so generous and donate their time on
this project?
Please advise and thank you,
Kathy
Lykowski Construction, Inc.
574-291-8858
R Gordon Engineering Inc
2534 Detroit Rd
Niles Michigan 49120
February 8,2024
To Whom it May Concern
There are no Comcast lines in conflict for the historic Navarre Cabin move.
If you have any questions feel free to contact Robert Gordon at 269-876-0925
Thank you
Robert Gord
J P 9 n .i 1 f,S L"o
RE: Navarre Cabin Move
From: Mike Fisher (mfisher@michianacontracting,com)
To: kathylykowski@aol.com
Date: Wednesday, February 21, 2024 at 02:35 PM EST
Good afternoon Kathy,
I apologize for the delay. This will roughly be $1,160.00. This is to move the signal, follow the load, and place the
signal back in its proper orientation. Let me know if you have any questions.
Regards,
Mike Fisher
Project Manager
Michiana Contracting
Cell 574-780-1705
Office 574-936-8613
From: cc <kathylykowski@aol.com>
Sent: Friday, February 16, 2024 10:33 AM
To: Mike Fisher <mfisher@michianacontracting.com>
Subject: Navarre Cabin Move
Morning Mike,
Have you had the opportunity to arrive at any costs for the cabin move?
Thank you,
Kathy
Lykowski Construction, Inc.
574-291-8858
'A FF1 L �- Li A, -IT' J 0
Re: Historic Navarre Cabin Move - South Bend, IN
From: Coby Deal (cdeal@southbendin.gov)
To: kathylykowski@aoi.com
Date: Thursday, January 25, 2024 at 08:15 AM EST
Kathy,
We do not have any lights on Park In these are owned by AEP
From: cc <kathylykowski@aol.com>
Sent: Wednesday, January 24, 2024 2:48 PM
To: Coby Deal <cdeaI@south bend in.gov>
Subject: Historic Navarre Cabin Move - South Bend, IN
Good afternoon,
The following is a route and the extreme dimensions of a building we will be relocating in South
Bend, IN. Please acknowledge this email if this is your area or someone else handles this
area.
For your information, there is only a street light wire on Park Lane in conflict with this move,
however, I will need an acknowledgment once this is verified.
*The route we will use to relocate the historic log cabin is:
Navarre Cabin (Leeper Park east) westward to the North Pumping Station (830 N.
Michigan St.) east parking lot,
thence, enter city streets via north entry of the Pumping Station,
thence, Park Lane west to Lafayette St.,
thence, Lafayette St. south to Colfax St.,
thence, Colfax St. west to Williams St.,
thence, Williams St. south to Washington St.,
thence, Washington St. west to Chapin St.,
thence, Chapin St., south to Thomas St.,
thence, Thomas St. west to The History Museum west entry, east of the "Worker's Home"
*The extreme (loaded) dimensions are:
RE: Route (map) for Navarre Cabin Move
From: Brad Rohrscheib (brohrsch@southbendin.gov)
To: kathylykowski@aol.com
Date: Tuesday, February 6, 2024 at 02:30 PM EST
Kathy,
I don't have any concerns on the route. Thank you
Lt. Brad Rohrscheib
Traffic, Special Events, & Strategic Intel Office
South Bend Police Department
701 W. Sample St.
South Bend, IN 46601
574-235-9817
From: cc <kathylykowski@aol.com>
Sent: Tuesday, February 6, 2024 8:36 AM
To: Brad Rohrscheib <brohrsch@southbendin.gov>
Subject: Route (map) for Navarre Cabin Move
Good morning,
Please see the attached map for the Navarre Cabin move. Let me know if you have any
questions.
Thank you again,
Kathy
Lykowski Construction, Inc.
574-291-8858
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intercepted, corrupted, lost, destroyed, arrive late or incomplete, or contain virus. Therefore, the sender does not accept
RE: Traffic Control Historic Navarre Cabin Move - South Bend, IN
From: Brad Rohrscheib (brohrsch@southbendin.gov)
To: kathylykowski@aol.com
Date: Monday, February 19, 2024 at 09:58 AM EST
1 have no objections to you contacting County Police. Thanks
Lt. Brad Rohrscheib
Traffic, Special Events, & Strategic Intel Office
South Bend Police Department
701 W. Sample St.
South Bend, IN 46601
574-235-9817
From: cc <kathylykowski@aol.com>
Sent: Monday, February 19, 2024 9:24 AM
To: Brad Rohrscheib <brohrsch@southbendin.gov>
Subject: Traffic Control Historic Navarre Cabin Move - South Bend, IN
Good morning,
We are trying to get all the details wrapped up for the Cabin move, however, we have no date
for the actual move at this time.
Would you be able to provide us with 3 officers on the day of the move or do you have
objections to us contacting the County Police?
The move will start at 9:00 a.m. and should end at about 10:30 a.m.
Please advise and thank you,
Kathy
Lykowski Construction, Inc.
IMPORTANT NOTICE! This E-Mail transmission and any accompanying attachments may contain confidential
Jf. Llog CfV. ID
Re: Route (map) for Navarre Cabin (Move
From: Jason Dziubinski Odziubinski@sjcpd.org)
To: kathylykowski@aol.com
aol.com
Date: Monday, February 19, 2024 at 03:50 PM EST
Kathy,
Received- do you know a timeline of when this will be done and approximately how long will the process take?
Thank you, Jason
Sent from my Phone
On Feb 19, 2024, at 13:05, cc <kathylykowski@aol.com> wrote:
EXTERNAL EMAIL - This email was sent by a person from outside your organization. Exercise caution when
clicking links, opening attachments or taking further action, before validating its authenticity.
Secured by Check Point
Sgt. Dziubinski,
This is the route we have proposed for moving the Cabin. I will communicate with you as
information is forwarded to us.
And thank you again!
Kathy
Lykowski Construction, Inc.
574-291-8858
----- Forwarded Message -----
From: cc <kathylykowski@aoLcom>
To: Brad Rohrscheib <brohrsch@southbendin.gov>
Sent: Tuesday, February 6, 2024 at 08:36:19 AM EST
Subject: Route (map) for Navarre Cabin Move
Good morning,
February 2, 2024
Permit #7
Department of Public Parks of South Bend Indiana
Historic Navarre Cabin Move
Permission is hereby granted to prune the (15) Trees in tree lawn on the property of
727 W Washington (Hackberry), 726 W Washington (Silver Maple), 719 W
Washington (2 Norway Maples), 715 W Washington (Oak), 711 W Washington (2
Oak & Honey Locust), 712 W Washington (Norway Maple), 714 W Washington
(Norway Maple), 704 W Washington (Sugar Maple), 630 W Washington (Sugar
Maple), 618 W Colfax on Washington(Honey Locust), 508 W Washington (Norway
Maple), 502 W Washington (Sycamore) & 301 S Lafayette (Honey Locust)
Note:112aing, of trees is NOT permitted.
This permit is only visual observation of the tree to determine the scope ofthe permitted work and shall not be
considered a tree risk assessment. Tree risk assessment involves extensive evaluation ofthe tree. Trimming must be
none according to ANSI A-300 standards
Department of Public Parks
Brent ql ompson
Brent Thompson, City Forester
Sec. 19-19. Removal of hazardous trees by property owner; order, notice; emergency removal,
(a) Every owner of real estate within the City shall remove or trim any tree or shrub or any part thereof located
on such real estate or in the tree and lawn area in front of such real estate which may be dead, diseased,
unsightly, in a condition which is injurious or detrimental to the public health and safety or the growth of
adjacent trees or which may project over the public street on which such real estate abuts in such manner as
to obstruct the free passage of pedestrians and vehicular traffic on such public streets.
(b) The Board of Park Commissioners shall have the power and the authority to order and require such owner
to remove any such tree or shrub by first causing notice to be served on such owner in the manner provided
in section 19-21 not less than ten (10) days prior to the time designated in such notice for the removal or
trimming of such tree or shrub.
(c) In case of an immediate necessity for any such removal or trimming by reason of storm or other
emergency, such removal or trimming may be done by the Board of Park Commissioners or its Superintendent
of Parks, and no notice whatever need be given thereof.
Sec. 19-18. - Trimming trees overhanging streets; notice; manner.
(a) All trees and shrubs which overhang a street within the City, whether located on tree and lawn areas
or on the abutting lots, shall be trimmed either by the Board of Park Commissioners or by the owners of
the abutting lots upon the order of the Board.
(b) The trimming shall be done within the period specified in the notice given by the Board to the owners,
as provided in section 19-21; provided, however, such period shall not be less than ten (10) days.
(c) Overhanging trees shall be trimmed so that there is a clear space of ten (10) feet above the surface of
the curb and in such a manner as not to obstruct the view of any streetlight, traffic sign, signal device or
street intersection.
Any obstruction of the right-of-way for tree maintenance work of two hours or more or are closing a travel lane and
obstructing traffic would need a traffic control and occupancy request permit from the Engineering office
r �tsis tics tr stftttltli i
If a travel lane needs to be blocked for any amount of time, a permit would be required with a traffic control sketch
showing how they plan to divert traffic safely,
RE: Navarre Cabin Move Z-n i i ' nLLnn7
Frorn: Scott Kreeger (skreeger@southbendin.gov)
To: kathylykowski@aoi.com
Cc: kwidawsk@ south bendin.gov
Date: Wednesday, February 28, 2024 at 04:02 PM EST
Kathy,
Overall, I do not see any issues with the route you provided. I would recommend including "No Parking" signs along
the west side of the roadway of Lafayette near the hospital to prevent a full road closure.
Regards,
Scott Kreeger, PE.
Senior Project Engineer
(574) 235-9245
skreeger(, southbend in.gov
City of South Bend
227 W Jefferson Blvd.. Ste. 1316
South Bend, IN 46601
From: cc <kathylykowski@aol.com>
Sent: Wednesday, February 28, 2024 3:44 PM
To: Scott Kreeger <skreeger@south bend in.gov>
Cc: Kimberly Widawski <kwidawsk@southbendin.gov>
Subject: Re: Navarre Cabin Move
FYI I have the permit Tree Prunning permit from Brent Thompson, I have acknowledgement
from Traffic and Lighting, and I have acknowledgment from Sgt. Rohscheib. What other
departments are you waiting on?
Kathy
Lykowski Construction, Inc.
574-291-8858
On Wednesday, February 28, 2024 at 03:26:44 PM EST, Scott Kreeger <skreeger@southbendin.gav> wrote:
Kathy,
inIL10T"
Mis Permit
From: Hurt, Michael A (mhurt1@indot.in.gov)
To: kathylykowski@aol.com
Date: Friday, February 16, 2024 at 11:33 AM EST
Below is the link to the permit
-TCR (you can put TBA for the date/Time until you're read then attached the revised TCR with the date/time 5 day in
advance)
-MOT
-City approval
-Map
Michael Hurt
Permit Investigator
Indiana Department of Transportation
315 East Boyd Boulevard
LaPorte, IN 46350
Cell: (219) 851-1426
Email: MHurtIPindot.IN.gov
Find us on social media!
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IN DOT Work Zone Traffic Control Guidelines.pdf
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Lykowski Construction, Inc.
23158 West Ireland Road
South Bend Indiana 46614 "Tire best move you ever made"
Moving, shoring, and raising 1000 ton capability Bonded & insured Telephone (574) 291-8858
Fax (574) 291-8858
Email timlykowski@aol.com
L.M.I. HYDRAPOC CYLINDER DOLLY SPECIFICATIONS
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B. OVERALL LENGTH (75°) F. DOLLY TRACK (72")
C. OVERALL HEIGHT (34") G. TIRE SIZE (30x11.50x14.50) 26 PLY
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RE: Historic Navarre Cabin Move
From: Patricia Leda (pleda@beaconhealthsystem.org)
To: kathylykowski@aol.com
Date: Thursday, March 7, 2024 at 04:11 PM EST
Thank you. I will mark my calendar.
Pat Leda.
Construction Project Coordinator
Beacon ffealth System
Beacon Properties Administration
O: 574.647.1471
M: 574.910.0441
F: 574,647.1473
pleda@beaconhealthsystem.org
Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may
contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are
not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
From: cc <kathylykowski@aol.com>
Sent: Thursday, March 7, 2024 3:32 PM
To: Patricia Leda <pleda@beaconhealthsystem.org>
Subject: Fw: Historic Navarre Cabin Move
n Tihis ema I c:- _ =ted from outside of Beacon Health System. Co not click I!Inks
or t.�Ptal a s'.r33, 5y : s: t e sender and content are known as safe. NEVE- elater your Beacon
PASS?1 (--)i'?J afrer are email Web -link`
---- Forwarded Message ----
From: cc <kathy_lykowski@aol.com>
To: Shane Galloway <sgallowbeaconhealthsystem.org>
Cc: Brian Ciesiolka<bciesiolka@beaconhealthsystem.org>; Craig Whitfield
<cwhi�eldp_beaconhealthsystem.org>
Sent: Thursday, March 7, 2024 at 02:43:42 PM EST
Subject: Historic Navarre Cabin Move
Good afternoon,
I was asked to give you the courtesy to inform you of the Historic Navarre Cabin move from
Leeper Park to The History Museum. Please see the route.
*The route we will use to relocate the historic log cabin is:
Navarre Cabin (Leeper Park east) westward to the North Pumping Station (830 N.
Michigan St.) east parking lot,
thence, enter city streets via north entry of the Pumping Station,
thence, Park Lane west to Lafayette St.,
thence, Lafayette St. south to Colfax St.,
thence, Colfax St. west to Williams St.,
thence, Williams St. south to Washington St.,
thence, Washington St. west to Chapin St.,
thence, Chapin St., south to Thomas St.,
thence, Thomas St. west to The History Museum west entry, east of the "Worker's Home"
We will have all the necessary permits and traffic control in place. This move should not have
any impact on the hospital.
At this time, I can only give you a tentative time frame of the move taking place at the end of
April, the first part of May, commencing at 9:00 a.m. with the total move from beginning to end
about 1 hour to 1 1/2 hours. I can keep you informed as time progresses.
Please acknowledge this email and inform me if you have any concerns.
Thank you,
Kathy
Lykowski Construction, Inc.
574-291-8858
INDOT LaPorte District 2024 Traffic Closure/Restriction Form
Revised 1111/2024
Date: March 8, 2024 Submitter: Lykowski Construction, Inc. Phone:
Contract/Permit #: Des #: Road: SR 933
Impact to Traffic: N/A
Near City/Town/ Landmark
Restriction/Closure Details
(include description of MOT)
Maximum Vehicle Size and/or
Weight Dimensions allowable
through the Work Site safely.
Specific Location of Work Site:
Length of Road Affected:
Purpose of Closure/Restrict:
(Project Type: R, RS, B, Culvert etc.
with a summary of work that will be
completed.)
❑ ROAD CLOSURE
574-291-8858
County: St. Joseph
❑ LANE CLOSURE(S)
South Bend @ the North Pumping Station
Using 50' (curb to curb) of SR 933 (Michigan St.) to enter Park Lane. Traffic to be halted
(in all directions) momentarily by St. Joe County Police w/ squad cars and flags.
N/A
SR 933 (Michigan St.) at Park Ln.
Crossinq 50' of SR 933 (Michigan St.
Historic Pierre Navarre Cabin building move
Start Date/Time: TBD /9:00 a.m.
Restriction Hours: One minute or less
If phased, which phase is this? N/A
Est. Construction Completion Date N/A
End Date/Time: TBD /9:01 a.m.
Phased Construction? ❑ Yes
Is this in CARS? ❑ Yes
Contract Completion Date
Official Detour: N/A Haltinq traffic only to cross SR 933 (50' section)
N/A
❑X- No
❑x No
Dtr Length: N/A
Additional Information: There are no overhead utility obstructions, however, Michiana Contracting, Inc. of Plymouth,
(include timing of future phases, IN will be there as well. There will be NO closures, simply halting traffic in both directions.
MOT shifts, etc)
Instructions: This information is to be emailed TWO WEEKS PRIOR to the start of the work. Please give THREE WEEKS PRIOR for railroad work. This
information is passed to the Department of Revenue to assist in reroute of OS/OW vehicles:
aparkhouseoZindot.in.gov, cbaiek indot.in.gov, astanlev@indot.in.gov, lahuffman(aD_indot.in.gov Tel: (219) 851-1251
All restrictions are to be reported NO EXCEPTIONS. It is the responsibility of the project engineer, supervisor, or INDOT Sub -district and/or Unit Forman,
to contact all local community services of the above work prior to the start of project. Please fill this section out prior to submittal.
Community Service Notification (Duty of PE/PS/Foreman, etc.)
Fire South Bend Fire Department 574-235-9255 311@southbendin.gov Date:
Ambulance South Bend Fire Department EMS Division 574-235-9255 311@southbendin.gov Date:
Police City South Bend Police Department 574-235-9201 sbpd@southbendin.gov Date:
County St. Joseph County Police Department 574-235-9611 info@sjcpd.org Date:
State Indiana State Police 574-546-1020 tbohner@isp.in.gov Date:
Schools South Bend Community School Corp. 574-393-6000 Date:
Postal Service USPS 574-282-8450 Date:
INDOT 219-851-1251 Mike Hurt219-851-1426 Date:
Local Govt. Permits 574-235-9554 Date:
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 3/15/2024
Department Public
Name Scott
BPW Date 3/26/2044 Phone Extension 9245
Required Prior to Submittal to Board
BPW Attorney ® Attorney Name Michael Schmidt
Dept. Attorney ❑ Attorney Name
Purchasing
❑ Mickey Low
Check the Appropriate Item Type — Required. for All Submissions
❑ Professional Services Agreement ❑ Contract ❑ Proposal
❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA
❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet
❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes
❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA
❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution
M Other: ❑ Ease./Encroach
Company or Vendor Name
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
Information
Lykowski Construction, Inc. & Historic Landmarks Foundation of Indiana
❑ Yes ❑ If Yes, Approved by Purchasing
❑ No
❑ WBE Completed E-Verify Form Attached Yes
El No
N/A
N/A
N/A
N/A
N/A
Moving of cabin from 830 Michigan Street to 897 Thomas St.
For Change Orders Only
Amount of ❑ Increase $
❑ Decrease ($ )
Previous Amount $
Current Percent of Change:
New Amount
Total Percent of Change:
Time Extension Amount:
New Completion Date:
Increase
Decrease
Increase
Decrease