HomeMy WebLinkAboutTG50 - Plan Amendment Application„
,<« �-_
' y of C,�9� _
U` �` ,
\ Q 9` I-'-,-�.`t t�
y — — .+°�
� `�fTOX `,O
REVISION / PLAN ,AME ,NDMENT
For New Single Family or Other Res�dential type perm�t pro�ects
City of Carmel; Department of Community Services
Permit has been issued: � Yes No. If yes, PERMIT #: � 9 � a•OD 10 0"�
BUILDER of NAME: PHONE: FAX:
RECORD: �� ��d-e-rS 3f'?- 37S - O1$�'
STREET ADDRESS: CITY: STATE: ZIP:
Ib4� W• C�.►�rn� j�r• Cczr �( ! n! �-�o a� 2.
BUILDER'S EMAIL ABDRESS: BEST MEfFiOD OF CONTACT:
k�n� , Gom 3l�-LfS�-�S�b
LOCATION LOT #: SUBDMSION NAME: SECTION:
& PRO]ECT � �� �--� � �-��- a
INFO: �DRESS OF CONSTRUCTION:
l �-f��-? 3 �r, �'.
(�EW SQUARE FOOTAGE OR NEW ESTIMATED COST NEW FOUNDATION TYPE: T/�LAB - CRAWL SPACE
AREA AFFECTED BY REVISION: � D�3 OF CONSTRUCTION: �ag /.� �� � _: POST & BEAM � BASEMENT ( Waikout _Y _ N)
IF PLANS FOR REVISION/AMENDMENT ARE PART OF THE MASTER PERMIT PROGRAM; NAME OF M�DEL AND REFERENCE #/ID OF
PLAN SPECIFICATIONS FOR THIS WORK:
DESCRIPTION OF REVISION:
�#-
NEW DESxGNA'T�ON OF AREA OF WORK SQUARE FOOTAGE:
BASEMENT 1� Floor 2” Floor 3 Ftoor Front Rear Porch Total Sq. Ft. TOTAL
(Finished and Porch or of Garages
Unfinished Sunroom
� Q 1 � /�3 (o � / �� �� 3 �1 O �� a- �
For Single Family and Z"wo Family dwellings, additions, rcmodcls, and/or accessory structures, this permit is valid only if construction commences
within 180 days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy issued) within 18 months of thc
issuance date. Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
timc framcs for bcginning and completing construction.
I, the undersigned, a�rce that any construction, reconstruction, cnlargement, rclocation, or altcration of a structure, or an}' change in the use af land or
structures requested by this application will comply �vith, and confonn to, all applicable la�vs af the State af Indiana, and the "Carmel Unified De��elopment
Ordinance (Z-62�-t7) and amendments, adopt�d under authurity of I.C. 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatary
thereto. ( also certiFy that only kitchen, bath, and flonr drains are cannectcd to the sanitary se�ver. I further certify, under the penalties of Perjury (Indiana
Code 35-44-2-1) that all of the infarmation 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 intcntionally provided or omitted any information that would tend to hide, obscure, or
otherwise mislcad thc Dcpt. of Community Scrviccs rcgarding thc truth of the matters addressed. I also agrec that the construction will not bc uscd
or occupied un il Ccr i ifa e ofOccup.znc•yhas been issued by the Department oE Community Services, Carmel, Indiana.
2a�/ (e.0 �-4-ic.1�.S `� a
Signature of Owner or Authorized Agent Print Date
OFFICE USE ONLY:************************************************************************
NEW INSPECTIONS REQUIRED:
Upper Footing Lower Footing Under Slab
Rough In Meter Base Final Site
Reviewed/Approved: Dept. of Community Serv�ces (Date)
S:Permits/Forms/Plan Amend Residential
Pl�►N AMENDMENT/REVISION FEE:
ADDITIONAL SQUARE FOOTAGE:
NEW INSPECTIONS REQUIRED:
(If additional inspections other than what already rernain on the existing permit are �eg�ired.)
TOTAL:
Fee Received by: Date