Full Text
Hamilton County Highway Department 1700 S. 10th Street Noblesville, IN. 46060 Ph: (317) 773-7770 Fax: (317) 776-9814 www.hamiltoncounty.in.gov APPLICATION FOR HOUSE MOVING HCHD Form 1016 Revised 02/18/11 Permit Instructions 1. Form must be completely filled out using a typewriter or printed in black ink. Any non-applicable blanks must be marked N/A. 2. Contact a Permit Inspector or consult the Hamilton County “Permit Manual for County Roads” for questions concerning this application. 3. A clear, detailed plan sheet must accompany this application. The drawing must show the move route, section(s) of road to be closed, the points of closure, the nearest intersecting road at each end of the closure and the detour route to be posted. 4. The minimum permit bond amount for moving a building is $50,000 per move. A higher amount may be required upon review of the permit. The beneficiary on the permit bond shall be the “Board of Hamilton County Commissioners, Hamilton County Indiana”. 5. Permit fee shall be check or money order made payable to the “Hamilton County Treasurer”. Cash can not be accepted. When complete, mail or hand deliver this signed application, along with the permit fee, permit bond and detailed plan to the above address, Attention: “Permit Inspector”. Applicant’s Name Applicant’s Status (Must mark one) Contact Person Mailing Address City Project Owner’s Name (if different from applicant) Project Owner’s Address (if different from applicant) City Route to be followed Present location of building I hereby certify that I have the authority to bind the above named applicant and the owner of the facilities being installed under this permit to the terms, conditions and requirements of this permit. I have received a copy of the code, read and fully understand all requirements of Hamilton County Code Title 8, Article 17, Chapter 3, Section 2 concerning the permit and construction process and requirements. I also certify that I, the applicant and all persons performing the work authorized by this permit understand all requirements of the above referenced code and permit and will abide by all of their requirements and conditions. I further certify that I, the applicant and any persons performing work authorized by this permit will not make any changes in from the approved plan and permit without receiving written permission from the Hamilton County Highway Department. The applicant and owner agrees and understands that Hamilton County does not warrant the accuracy of the limits of the right-of-way shown on this permit and further that Hamilton County’s approval is limited to conveying it’s approval to install the approved facilities only within legal road right-of-ways. If the facilities as shown on this permit are not within legal road right-of-ways, it shall be the applicant’s duty to obtain the proper legal access to the property to install said facilities as shown on the plans. The applicant, owner and I agree to pay all attor- ney’s fees, court costs and other damages or costs incurred by Hamilton County in enforcing the terms of this permit, enforcing the County Code or which are a result of litigation incurred by the County as a result of this permit. The applicant, the owner of the facilities being installed under this permit and I understand that in the event Hamilton County determines that any of the facilities installed under this permit need to be repaired, relocated or removed from the right-of-way, that the owner or any subsequent owner of the facilities agrees to maintain, relocate or remove these facilities in a timely manner at no cost to Hamilton County or its successors. The applicant, owner and I agree that the commencement of work covered by this permit will serve as our acceptance of all terms, conditions and requirements of the approved permit. I hereby certify that this drive does not cross a limited access right-of-way or a non-access easement. Signature Printed Name Applicant’s Internal Control # State Zip Code E-mail Phone # Phone # Fax # State Zip Code Date Title Individual Partnership Corporation E-mail Government Agency Religious / Other Day of Week: Check or money order TOTAL PERMIT Mo Tu We Th Fr House move(s) @ $150 / each Desired Hours of Move: (circle all days that apply) AM/PM AM/PM (from): (to): Sa Su AM/PM AM/PM (from): (to): Bond Bond Amount: Bond Day of Week: Mo Tu We Th Fr AM/PM AM/PM (from): (to): AM/PM AM/PM (from): (to): Sa Su Do not write in this Section - Highway Department Use Only County Approved by the Hamilton County Board of Commissioners Auditor This permit is approved: Subject to the changes noted on the plans. Subject to the attached conditions. As submitted. Details of Traffic Control (Law Enforcement, Barricades, Signs, Detour Route, etc.) New location of building $ 0 $ 0 IN IN