HomeMy WebLinkAbout19100058 ApplicationOFFICE USE ONLY
CITY OF CARMEL PERMIT#
RESIDENTIAL PERMIT APPLICATION
/NOIANp Please complete form and email to permits0carmei.in.0ov as an attachment.
If you have any questions, please call Building & Code Services at (317) 571=2444.
BUILDER OF
RECORD
NAME p
aqJ PHONE �x
STREET ,r C� • I�Q
ADDRESS d �i I
CITY /
flAl
STATE
I
ZP, r0 `-
E-MAIL "�"
ADDRESS tUIjQ,Bq;lc"
BEST METHOD ,--.
FJONTACT ❑ PHONE B E-MAIL
ifti membbo
PLUMBING
NAME
STATE OF INDIANA
CONTRACTOR
LICENSE NUMBER
UTILITIES
NAME
SEWER
WATER
EXCAVATOR
UTILITY
UTILITY
PROPERTY
INAME j
PHONE
OWNER
ItQLNif
STREET <
ADDRESS S
CITY
STAT--E�^`
ZIP
a 33
V
PROJECT
PARCEL
LOCATION
NUMBER
LOT
SUBDIVISION
FLOOD
NUMBER a')s7
ZONE
STREET rsa8 r(.i
ADDRESS
CITY
STATE
S
ZIW033
,�
DOES SUBDIVISION HAVE A �
HOMEOWNERS ASSOCIATION? El YES (LETTER OF H.O.A. APPROVAL REQUIRED) Uri' NO
MMMMMMMMMMMI
TYPE OF
EACH UNIT WILL REQUIRE
❑ ❑
STRUCTURE
SINGLE FAMILY TWO FAMILY TOWNHOME SEPARATE APPLICATION
PROJECT
❑ NEW STRUCTURE ❑ REMODEL ❑ ACCESSORY BUILDING
DETAILS
❑ ADDITION ❑ Room Lt4 Porch ❑ Deck ❑ GARAGE ❑ Attached ❑ Detached
FOUNDATION TYPE El ElWalkout ❑ SLAB ❑ CRAWL ElPOSTIBEAM ❑ POST/PIER
COST OF
CONSTRUCTION $ I. 6 i0Q) Ob
ENERGY
CODE ❑ PRESCRIPTIVE ❑ TOTAL UA ❑ PERFORMANCE
EXCLUDING LAND 1
TOTAL I
SQUARE I a
BASEMENT 1ST j
' ,PORCHES GARAGES I
FOOTAGE!
FLOOR
FLOOR FLOOR I I i
ADVANCED STRUCTURAL COMPONENTS REPORTING
This section is required in order to comply with the requirements of IC 22-11-21 (Public Law 104. 2018) as it relates to the use of Advanced Structural
Components (lightweight 1-Joists or lightweight roof trusses) In Class I and Class II Construction that:
1. Have less mass cross -sectional 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 El 19'
Does this project Include any Advanced Structural Components? ❑ Yes /Section Below Required) No
Type of Advanced Structural Component (Select all that apply) Location(s) in Structure
—_-------`—!
❑ Lightweight IJoists
❑ Lightweight Roof Trusses
Class I structure permits are subject to the State of Indiana General Administrative Rules (GAR 6751AC 12) regarding expiration time frames for beginning and
completing construction.
I, the undersigned, agree that any constructlan, 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, adapted under authority of I.C. 36-7 at seq, General Assembly of the State of Indiana, and all Acts amendatory
theretoI I further certify that only kitchen, bath, antl floor tlralns are connectetl to the sanitary sewer. I further certity that the constructlan will not be
used or occupied until a Certificate of Occupancy or of Substantial Completion has been issued by the Department of Community Services, Carmel, Indiana.
LLU
Signature of Owner or Authorized Agent Date /o