HomeMy WebLinkAbout19060122 Applicationn OFFICE USE ONLY
CITY/ dab ,"a CORM "i" L PERMIT # Jq U0 142
RESIDENTIAL PERMIT APPLICATION
/MpIANN Please complete form and email to PermitsCdcarmel.in.gov as an attachment.
If you have anv Questions, Please call Building & Code Services at (317) 571-2444.
BUILDER OF
RECORD
NAME
PHONE ...�
r�hQQ STREETf,,
ADDRESS �WO� Sl �p I'C
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CITY G rtvl V
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STATE
E-MAIL �� If« I (4
ADDRESS C(,(?(�,Ij
BEST METHOD
{ ,_ �L F T CT ❑ PHONE 5a"E4AIL
PLUMBING
CONTRACTOR`
NAME
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STATE OF INDIANA
LICENSE NUMBER
UTILITIES
EXCAVATOR
NAME
PIA
SEWER
UTILITY
WATER
UTILITY
PROPERTY, ''
OWNER
NAME
(l`
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PHONE
STREET C9 01
ADDRESS
CITY
STATE ln4y_ 4
ZIP
PROJECT .
LOCATION
PARCEL
NUMBER
LOT
NUMBER 7'j�,
SUBDIVISION ,{
I /j _
FLOOD
ZONE
STREET
ADDRESS
CITY
STAT�F__k
�..v
ZIP .
DOES SUBDIVISION HAVE A
HOMEOWNERS ASSOCIATION? YES (LETTER OF H.O.A. APPROVAL REQUIRED) ❑ NO
`
TYPE OF
STRUCTURE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOME EACH UNIT WILL REQUIRE
SEPARATE APPLICATION
PROJECT
❑ NEW STRUCTURE ❑ REMODEL ❑ ACCESSORY BUILDING
DETAILS
El ADDITION �,J
ADDITION Room lkS Poroh ❑ Oeck ❑ GARAGE ❑ Attached ❑ Detached
FOUNDATION ❑ BASEMENT ❑ Walkout ❑ SLAB ❑ CRAWL ❑ POSTmEAM ❑ POST/PIER
TYPE
COST OF
CONSTRUCTION s 7
ENERGY
CODE ❑ PRESCRIPTIVE ❑ TOTAL UA ❑ PERFORMANCE
I
EXCLUDING LAND
TOTAL
SQUARE 1W
FOOTAGE
BASEMENT
FLOOR
FLOOR
PORCHES (GARAGES
ADVANCED STRUCTURAL COMPONENTS REPORTING
This section Is required In order to comply with therequirements of IC 22.11.21 (Public Law 104, 2016) as It relates to the use of Advanced Structural
Components (lightweight I -joists or lightweight roof trusses) in Class I and Class II Construction that:
1. Have less mass cross-sectlonal area than sawn lumber of equivalent proportions used In an equivalent application; and
2. Are assembled from combustible or noncombustible materials, or both
"This does not include a structural assembly, joist or truss that provides at least 1 hour of fire resistance under ASTM El19*w
Does this project Include any Advanced Structural Components? ❑ Yes (Secdon Below Required) No
Typo of Advanced Structural Component (Select all that apply)
Location(s) in Structure
❑ Lightweight I -Joists
❑ Lightweight Roof Trusses
Class I structure permits are subject to the State of Indiana General Administrative Rules (GAR 676 LAC 12) regarding expiration time frames for beginning and
completing construction.
I; the underalDRed, agree Ihat;eny conslruotion, reaonstruclion, anta(gement, relocation, or alteration of a structure, or any ohange In the use �of land or
at`ruchims requested bythi`s application will comply with end conform to ail applicable Taws of the'state of Indiana grid the Carmel Unified Development '
Ordinance (2-¢25.17) and amendments, adopted under authority of 1,0.36.7 et ssq, General Assembly of the State of Indiana, pod all Acts smentlatory
thereto.11urther certify Ina! only kitchen, bath, and door drains are connected to the sanitary asWaS, I further, certify that the construction will not be -
.used or occupied until a Certificate of Occup of Substantial Completion has been Issued by the Department of Community Services, Carmel, Indiana,
Signature of Owner or Authorized Agent "� Dale � ^ � 7 -7�/ /