HomeMy WebLinkAbout17110054 ApplicationREVISION / PLAN AMENDMENT or ADDENDUM to STATE RELEASE
For Commercial, Institutional, Industrial, or Multi�Family Projects
City of Carmel; Department of Community Services
OFFICE USE ONLY: ************************************************************************
BUILDER of
RECORD:
NAME: PHONE: FAX:
LOCATION
& PROJECT
INFO:
STREET ADDRESS: CITY: STATE: ZIP:
BUILDER’S EMAIL ADDRESS: BEST METHOD OF CONTACT:
PROJECT NAME: LOT # and SUBDIVISION NAME: (If applicable)
ADDRESS OF CONSTRUCTION:
NEW SQUARE FOOTAGE OR
AREA AFFECTED BY REVISION:
NEW ESTIMATED COST
OF CONSTRUCTION:
POST NEW FOUNDATION & BEAM TYPE: BASEMENT SLAB ( Walkout CRAWL __Y __ SPACE N )
Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 IAC 12) regarding expiration time frames for
beginning and completing construction.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or
structures requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the Carmel Unified Development
Ordinance (Z�625�17) and amendments, adopted under authority of I.C. 36�7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I also certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify, under the penalties of Perjury (Indiana
Code 35�44�2�1) that all of the information I have provided in this Application and other documentation is true and accurate to the best of my
knowledge and belief, and that I have not knowingly or intentionally provided or omitted any information that would tend to hide, obscure, or
otherwise mislead the Dept. of Community Services regarding the truth of the matters addressed. I also agree that the construction will not be used
or occupied until a Certificate of Occupancy has been issued by the Department of Community Services, Carmel, Indiana.
_______________________________________________ _______________________________________________ _________________
Signature of Owner or Authorized Agent Print Date
DESCRIPTION OF AMENDMENT/REVISION, AND/OR STATE RELEASE ADDENDUM/UPDATE INFORMATION:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____________________________________________________
Reviewed/Approved: Dept. of Community Services (Date)
S:Permits/Forms/Plan Amend Commercial, Ind, Inst, Multi
NEW INSPECTIONS REQUIRED:
Upper Footing Lower Footing Under Slab
Rough In Meter Base Final Site
PLAN AMENDMENT/REVISION FEE: _____________________
ADDITIONAL SQUARE FOOTAGE: ______________________
NEW INSPECTIONS REQUIRED: ______________________
(If additional inspections other than what already remain on the existing permit are required.)
TOTAL: ___________________
____________________________________________
Fee Received by: Date
STATE COMMERCIAL
DESIGN RELEASE #:
DATE OF AMENDED RELEASE: NEW SCOPE(S) OF FDN STR ARCH MECH PLUM
RELEASE: ELEC SPKLR OTHER(S):_______________________
# of Floors: ___________; Elevator/Lift: 兟兟 YES 兟兟 NO BLDG. CONSTRUCTION TYPE: OCCUPANCY CLASSIFICATION:
Permit has been issued: ______ Yes ______ No. If yes, PERMIT #: ________________________
MacDougall Pierce Construction, Inc. 317�596�6371 317�596�6381
X 17110054
12720 Ford Drive Fishers IN 46038
dowens@mpconstr.com email or mobile phone (317�496�5862)
VCA Village Park The Range Pet Lodge
1045 N. Range Line Road Carmel, IN 46032
< 1,000 sf
Original: $450,000
Revise: $505,000
395402 10/26/2018
x
x x
2
block basement
wood framed
Change Family Toilet room to Lab/Rx. Change Lab/Rx to additional Exam Room.
Reduce size of Office 107. Create new Restroom.
________ __ ______ __ __ __________
nature of Ow Owner ner or Autho tho thoriz riz rized ed Ag Agent ent
Dean Owens 10/31/2018