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x. <br />City of Soulh Bend Public Works Phone: 574.235.9251 <br />Engineedrig Div'Won <br />4227 W, -'elfergon, Ccunly -Ily Bulldir)q 1316 Email: dhonson@southbendin.gov <br />Sou th Bend, IN 4 e, 60 1 - 1830 <br />TRAFFIC CONTROL AND OCCUPA=REQUEST <br />"SUBMIT 5 WORKING DAYS MINIMUM PRIOR TO PROJECT START DATE <br />PLAN YOUR START DATE ACCORDINGLY TO AVOID DELAY'S <br />Complete I - 5 Incomplete Submittals Cannot Oe Processecl <br />Parking: Lane Travel Lane Full Road Closure 11 Alley [] Sidewai< Closure b(i <br />2 W] Excavai lon /Boring? > Requires Excavation Form r--,-1 Construction? > Requires Curb Cut <br />YJ application or sidewalk periflit <br />2 <br />Submission Date: 1/16/018 Appl[coni /company: KING Eddy Street Land 11, LLC <br />Name: Tony Halsey Emall Address: thalsey@kitereaIty.com <br />Phone 4:,, (317) 713-5653 Office I TBD <br />coo Contractor Performing Work: <br />3 On -Site Contact: 1_BD <br />TOD Office <br />Phone It: Call <br />Project STREET ADDRESS (eg: 110 W, Smith RDJ: 1055-1145 N. Eddy Street <br />Project Location f�Block lirnlis/Streets From and To): <br />Requested Start & End Dates: March 2018-Octobar 201,9 Requested Stod & End Times: SB standard times <br />Reason for Closure: Constructaon of Pliese 11 of Eddy Street Cornrrions <br />. .. ... . . ... ............ . ................ <br />4 <br />/VfoctedCustorners: 1006,-East St, VinQent Street, 1020 N. Frances Street, 1018 N. Frances Street <br />- Colltrc'lctars are fespl')1150-)le fi"-v rsolving Safely �ssves and occess concerns with riffec,led cl)S)0('ra1S <br />A TFACH THl FOLLOWING 1. Traif1c Control Plon 2. Detour['] an 3. Barricades, Signs, or Flashers Placerneni <br />(Refer to MUTCO for Traffic Control Device Requirements) <br />Failure to use traffic control for traffic restrictions or closures will result In stop work orders and/or delay In penrniff Ing. <br />THIS OCCUPANCY PERMIT REQUEST IS NON -TRANSFERABLE AND A SIGNATURE SUBJECTS 1HE NAMED CONTRACTOR/PIERMITTEE <br />TO ALI APPLICABLE RULES, DUTIES AND OBLIGATIONS IMPOSED BY THE CITY OF SOUTH BEND MUNICIPAL CODE AND TO ALL <br />REGULATIONS IMPOSED BY THE SOUTH SEND BOARD OF PUBLIC WORKS. <br />' Applicant Signature h)4t1'g' Date <br />ENGINEERING OFFICE USE ONLY: <br />11 Approved Approved as Noted Revise Not Approved <br />Comments: <br />City of South BendjEngineering Division Authorized Signaiure Date: <br />Veislan 3.1110/24/20171 <br />