Construction Setup Permit

CONSTRUCTION SETUP PERMIT

Permit No.:     Issue Date:     Expiration Date:

RECITALS

WHEREAS, Applicant represents that Applicant is responsible for temporary site setup, including but not limited to staging, fencing, temporary utilities and traffic control at the project location identified below; and

WHEREAS, the Issuing Authority has the statutory authority to regulate temporary construction setups to protect public safety, property and the environment and to impose conditions, inspections and fees; and

WHEREAS, the parties desire to set forth the terms under which the Issuing Authority grants this Construction Setup Permit and the obligations of the Applicant and any contractor performing work under the Permit.

SITE & APPLICANT INFORMATION

Contact Name:     Phone:     Email:

License / Reg. No.:     Insurance Contact:

SCOPE OF WORK

SETUP DETAILS & CONDITIONS

Staging Area Dimensions:     Fencing / Hoarding Type:

Temporary Utilities Provided:

Traffic Control Required: Yes     No     Hours of Operation:

PAYMENT TERMS

Permit Fee Amount: $     Security Deposit: $

Late Fee:     Non-Refundable Fee Acknowledgement: I acknowledge fees are non-refundable

TERM AND TERMINATION

Permitted Setup Start Date:     Permitted End Date:

Termination / Revocation: This Permit may be suspended or revoked by the Issuing Authority for noncompliance with any condition herein, applicable codes, or for failure to pay fees. The Issuing Authority will provide written notice of intent to revoke and Applicant shall have the opportunity to cure noncompliance as set forth in the notice unless immediate action is required to protect public health or safety.

Notices and Cure Period: days' written notice will be provided where feasible prior to termination when circumstances allow.

INSURANCE, INDEMNITY & SECURITY

Required General Liability Coverage: $ per occurrence. Applicant must provide certificates evidencing coverage prior to commencement of work.

Indemnity: Applicant shall defend, indemnify and hold harmless the Issuing Authority, its officers, employees and agents from and against all claims, liabilities, losses and expenses, including reasonable attorneys' fees, arising out of or resulting from Applicant's performance under this Permit, except to the extent caused by the Issuing Authority's sole negligence or willful misconduct.

INSPECTIONS, COMPLIANCE & PENALTIES

Inspections: Applicant shall notify the Issuing Authority when site setup is complete and ready for inspection. Permit compliance is subject to periodic inspections. A stop-work order may be issued for any unsafe or non-compliant condition and removal or correction may be ordered at Applicant's expense.

Penalties: Noncompliance with permit conditions may result in fines, revocation of the Permit, forfeiture of security deposit, and civil or criminal penalties as authorized by applicable law.

CONFIDENTIALITY

Confidential Information: To the extent Applicant furnishes drawings, site plans or proprietary methods marked confidential, Issuing Authority shall keep such information confidential to the extent permitted by law. Applicant acknowledges that the Issuing Authority is subject to public disclosure requirements and agrees that it will not supply materials marked confidential unless necessary.

GOVERNING LAW; ENTIRE AGREEMENT

Governing Law: This Permit shall be governed by and construed in accordance with the laws of the state or jurisdiction in which the project is located without regard to conflict of law principles.

Entire Agreement: This Permit, together with attachments, site plans and any referenced conditions, constitutes the entire agreement between the Issuing Authority and Applicant with respect to the subject matter and supersedes all prior negotiations, representations or agreements, whether written or oral.

ADDITIONAL ACKNOWLEDGMENTS

Individual     Corporation     LLC     Government     Other

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