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6 RESIDENTIAL PERMIT APPLICATION
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Iso1 Please complete form and email to permlts(c.carmel.In.%ov as an attachment.
If you have any questions, please call Building & Code Services at (317) 571.2444.
BUILDER OF
RECORD
NAME A
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PHONE
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ADDRESS N OLJ L�, Id l s- -� • %`J /
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E-MAIL
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ADDRESS I W1
METHOD
El PHONE GR E-MAIL
PLUMBING
CONTRACTOR
NAME
STATE OF INDIANA
LICENSE NUMBER
UTILITIES.
EXCAVATOR
NAME
SEWER
UTILITY
WATER
UTILITY
PROPERTY
OWNER
NAME .� I rr l 77
PHONE
STREET �y �/"
ADDRESS �� �' ', (1,i �l,.h '
CITY//�� rr^
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PROJECT
LOCATION
FARCEL I t _Q 5-b3 a) bob
NUMBER "T
LOTSUBDIVISI
NUMBER q
N
FLOOD
ZONE
STREET,�r
ADDRESS /- 'P t
O
CITY
S7A�F.
Z P
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
DETAILS
❑ NEW STRUCTURE ❑ REMODEL ❑ ACCESSORY BUILDING
El�/
ADDITION ❑ Room Id Parch ❑ Dock ❑ GARAGE ❑ Attached ❑ Detached
FOUNDATION ElBASEMENT 1:1Walkout ❑
TYPE SLAB El [1POSTIBEAM ❑ POST/PIER
COST OF
CONSTRUCTION j�
ENERGY
CODE ❑ PRESCRIPTIVE ❑ TOTAL UA ❑ PERFORMANCE
EXCLUDING LAND ) I
TOTAL
SQUARE ( f
FOOTAGE,
BASEMENT
FLOOR ]FLOOR ( !PORCHES GARAGES
ADVANCED STRUCTURAL COMPONENTS REPORTING
This section Is required In order to comply with the requirements of 10 22-11.21 (Public Law 104, 2015) as it relates to the use of Advanced Structural
Components (lightweight 1-jolsts or lightweight roof trusses) In Class I and Class II Construction that:
1. Have less mass crass-secllonal area then 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, jolst artruss that provides at least 1 hour of fire resistance under ASTM El 19'
Does this project Include any Advanced Structural Components? ❑ Yes (Seetlon Below Required) ❑ No
Type of Advanced Structural Component (Selec(all that apply) Locatlon(s) in Structure
❑ Lightweight l -Joists
_
❑ Llghtwelghl Roof Trusses
Class I structure permits are subject to the State of Indiana General Administrative Rules (GAR 675 IAC 12) regarding expiration time frames for beginning and
completing construction.
1, 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 LC; 36.7 at aeq, General Assembly of the State of Indiana,. and all Acta amendatory
thereto, I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer, I further certify that the construction will not be
used or occupied until a Certificate of Occupancy f Substantial Completion hasbeen Issued by the Department of Community Services, Carmel, Indiana.
Signature of Owner or Authorized Agent - 'CIL `t ""-"'�' Date — — /