City of Bedford, Indiana



Home »   Street Department ยป  Encroachment Permit Application

Encroachment Permit Application
City of Bedford, Indiana

  • The The applicant name below requests permission to encroach the following public right-of-way, street, sidewalk, alley or other public space at the location described below.
  • Applicant shall submit one original application, with plans attached, either in person, mail or email.
  • No verbal transmissions will be accepted.



Encroachment Permit - Applicant Information
General Information:
Application Date *
Work Address *
Subdivison
Name of Permittee/Contractor:
Name of Permittee/Contractor
     
Contact Name *      
Street Address * City * State * Zip *
Email Address Phone Number * Fax  
Name of Sub-Contractor:
Name of Permittee/Contractor
     
Contact Name
     
Street Address
City
State
Zip
Email Address
Phone Number Fax  

Location
Type
Other Explain
Construction Type
Type Category
Please describe proposed work: *
SIZE OF STREET OR RIGHT-OF-WAY CUT:
Traffic Lanes:
Length
Width
Depth within Lanes
Sidewalk:
Length
Width
Depth within Sidewalk
Type
Other Explain
TRAFFIC PORTION AFFECTED BY PERMIT:
Width
Length
# of Lanes
# of Lanes Closed
# of hours Closed
Vehicles/equipment left on site unattended?
Unattended for:
# weekdays
# weekends
Estimated Start Date
Estimated Completion Date


Supporting File Upload(s):

Click Browse and Upload to select file(s) associated with Sign Installation, such as the Site Plan or Photo.

Clear selectionBrowse...
Remove
Clear selectionBrowse...
Remove
Clear selectionBrowse...
Remove
Clear selectionBrowse...
Remove
Add
Upload
Allowed file extensions: .jpg, .jpeg, .gif, .png.
Maximum file size: 4 MB.
Uploaded files (.jpg, .jpeg, .gif, .png.)




Authorization

TERMS AND CONDITIONS FOR ENCROACHMENT PERMIT
  1. It is understood that any permit by virtue of this request is revocable at the discretion of the City of Bedford and that the same shall be voided if the terms and conditions below are not fulfilled by the applicant. The applicant hereby agrees to observe all requirements of the Encroachment Standards Ordinance, the submitted drawings, Bedford Standards, and al! other applicable local/country/state/ federal laws and regulations.
  2. The undersigned shall notify the Designated Department a minimum of 48 hours prior to the time that work is to be performed. The undersigned will furnish placards identifying equipment, flashers, barricades and/or other warning devices at the construction site. When two-way traffic is confined to one lane, flagging personnel shall be required. Permittee must follow Chapter XVII of Title 29, Code of Federal Regulation, Part 1926 known as Safety & Health Regulation for Construction.
  3. In cases where the work authorized by the permit will cause major interference with traffic flow on streets, Permittee shall provide a uniformed traffic officer when requested by the Designated Department to provide traffic control at the construction site. Work shall not be performed on any major arterials, streets and thoroughfares during rush hours or peak hours of vehicular traffic flow, unless in case of emergencies.
  4. The Permittee shall not create a hazardous or unsafe situation at construction sites, which wou!d cause injury or damage to vehicular and pedestrian traffic. The Permittee shall not leave unattended open cuts unprotected overnight or during weekend periods. Permission to use temporary steel plates or any authorized substitutes shall be requested at open cuts or construction sites. The Designated Department shall be notified of these steel plates or substitutes by the Permittee.
  5. All construction equipment and/or vehicles left unattended for any length of time shall be parked in locations as to not create hazardous and unsafe situations to vehicular and pedestrian flow. The construction equipment and/or vehicles shall be parked in such a manner as to not restrict sight distance to vehicular traffic.

ALL CONSTRUCTION EQUIPMENT AND/OR VEHICLES ARE PROHIBITED FROM DRIVING ON NAMED TRAILS. NEIGHBORHOOD PERIMETER TRAILS, AND SIDEWALKS.

  1. The Permittee shall hold harmless and indemnify the City of Bedford from, for and against any claim of any person in tort, contract or otherwise arising out of the act or omissions of the Permittee, their agents, representatives, servants, contractors and the latter's subcontractors, whenever such acts or omissions or any rights or performance or exercise thereof of the Permittee arise unde.r this permit from alteration, modernization, replacement, operation, maintenance, change or removal of any part or portion of the public right-of-way, or facility thereof. All existing utilities must be identified and located prior to al! boring operations. Permittee shall be responsible for consequential damages to residents and businesses who are damaged during outages caused by these untimely accidents experienced by poorly coordinated utility borings and construction activities in the City right-of-way.
  2. The Permittee shall stipulate the type of materials and method of repair utilized to close any open cuts, subject to the Director or his/her representative's approval.
  3. The Permittee shall begin work within 45 working days from the date of application approval, and work must be completed within 60 working days of the application approval. Any construction and/or work not completed by this date shall be grounds to nullify and void this permit. Re-application would then be necessary.
  4. The Permlttee shall be required upon completion of construction and/or work to notify the Director or his/her representative for inspection and verification. The construction and/or work shall be inspected prior to being accepted by the City of Bedford as being complete. The Director or his/her representative shall perform the inspection.
  5. Upon the completion of all open street cuts, permanent patches shall be in place no later than 20 working days from the temporary patch inspection date. Any construction work or repair measures utilized to close any open cuts made under this permit that are found to be unsatisfactory shall be corrected within 10 working days by the Permittee. The Permittee shall be responsible to maintain and repair any and all open cuts granted by this permit for a period of one year upon final acceptance, unless the City of Bedford and/or other utilities, contractors or subcontractors or other parties remove, damage, modernize, replace, change any part or portion of the public right-of-way or facility or thereof granted under this permit.



AUTHORIZATION
I certify that information contained in this application is true and accurate to the best of my knowledge. I understand that any false information given by me to obtain a permit can result in denial of the permit and criminal action against me for providing false information.

After your application is reviewed you will be contacted for the next step in the process. If Approved, you will be required to come to the Bedford Street Department, 1614 L street Bedford, IN. 47421 to pay for your permit. Acceptable means of payment will be cash and Money Order.

** IF YOU DO NOT RECEIVE A MESSAGE THAT YOUR APPLICATION WAS SUCCESSFULLY SUBMITTED, PLEASE REVIEW THE FORM TO MAKE SURE YOU COMPLETED ALL REQUIRED FIELDS**


Printed Name *
Title
Company Name
Phone Number * Email Address *
Please Enter Name as Signature:*
Security Verification

Please enter the security verification below. Click the "show another code" button if you have trouble reading the verification code.

Captcha image
Show another codeShow another code

Submit Application



Bedford Street Department
1614 L Street
Bedford, IN 47421
Phone: 812-279-9222
dflinn@bedford.in.us