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PERMIT #
� RESIDENTIAL PERMIT APPLICATION
- Please complete form and email to as an attachment.
If you have any questions, please call Building � Code Services at (317} 571-2444.
BUILDER OF N�E PHONE
RECORD �����rsOn ��eGl�riC 35.'z'�7D-S,2.�8
STREET CITY STATE ZIP
ADDRESS ally � G.ia�/��r �an S�' =.,G1„�.,s .l,s �.✓ HC�201
E�AAIL BEST METHOO OF
ADDRESSdawa�����us��elcotncGtc.�o-•� CONTACT ❑ PHONE � E-MAIL
PLUMBING NAME STATEOFINDIANA
CONTRACTOR LICENSE NUMBER
UTILITIES NAME SEWER WATER
EXCAVATOR �T���TM uTi�iTM
PROJECT PARCEL
LOCATION NUMBER l 1e7�1 �10� `8�0
LOT SUBDNISION FLOOD
NUMBER k� Z� 6►CCGq.�� 20NE
STREET CITY STATE ZIP
ADDRESS ,1.0�,o c.� t36�'' s}- �,A�M� t �.N �bo3�
DOES SUBDNISION HAVE A HOMEOWNERS � YES (�F YES, LETTER OF H.O.A. NO
ASSOCIATION? APPROVAL REQUIRED) �
WAS SUBDtVIS10N OR LOT GRANTED A VARIANCE? ❑ YES lIF YES, LETTER OF GRANT(S) � NO
REQUIRED)
WILL ANY EQUIPMENT THE SIZE OF A BOBCAT OR � YES � NO
LARGER BE USED7
TYPE OF � SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOME �CH UNIT WILL REQUIRE
CTDI If'TI ID� SEPARATE APPLICATION
PROJECT ❑ NEWSTRUCTURE ❑ REMODEL ❑ ACCESSORYSTRUCTURE ❑ DEMOLITION
DETAILS pDDITION ❑ Room ❑ Poroh ❑ Deck ❑ GARAGE ❑ Attached ❑ Detached
FOUNDA710N � gqSEMENT ❑ Walkout ❑ SLAB ❑ CRAWL ❑ POST / BEAM � POST / PIER
TYPE
CONSTRUCTION � tg �j� ZS� ENERGY CODE ❑ PRESCRIPTIVE � TOTAL UA ❑ PERFORMANCE
(EXCLUDING LAND) ELECTRICAL � 2020 INDIANA RESIDENTIAI CODE � 20091NDIANA ELECTRICAL CODE
CODE
TOTAL ' '
sa�A� �33d BASEMENT FLOOR FLOOR PORCHES GARAGES
FOOTAGE
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 reiates to the use of Advanced Strudurel
Components (lightweight I-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 irom combustible or noncombustible materials, or both
`ihis does not include a structural assembly, joist or truss that provides at least 1 hour of fire resistance under ASTM E119'
Does this project include any Advanced Structural Components? ❑ Yes No
Type of Advanced Structural Component (Select all that apply) LocaUon(s) In Structure
❑ Lightweight IJoists
❑ Liphiweipht Roof Trusses
Class I structure pertnits are sub)ect to the State of Indiana General Administrative Rules (GAR 675 IAC 12) regarding expiration time frames for beginning antl eompleting construction.
I, the undersigned, agree that any construdion, reconstructlon, enlargement, relocation, or atteration of a structure, or any change in the use of land or structures requested by this appiicatlon
will comply with and conform to a�l appliwple laws of the State of Indlana and the Carmei Unifled Development Ordtnance (2�525-17) and amendments, adopted under authorlty of I.C. 36� et seq,
General Assembly of the State of Intliana, and all Acts amendatory thereto. I further certffy that only kitchen, bath, and floor dralns are eonnected to the sanitary sewer. i fuRher certify that the
construetion wlil not be used or oceupied u�til a Certiflcate qf�,0ecupancy or of Substantial Compietfon has been issued by the Department of Communiry Services, Carmei, Indiana.
Signature ot Owner or Authorized Agent � Date �
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