HomeMy WebLinkAbout06010127-Application
City of Carmel/Clay Township ~ Permit #:O~ 01 O/:J.-1
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
NAME
a/v
ZIP
Y6D32-
PHONE
FAX
Ofl/d/cf
STREET ADDRESS
C(
PROPERTY
OWNER:
NAME
STREET ADDRESS
LOCATION
&. PROJECT
INFO:
LOT #
1
-UnS
STATE]: IV
CITY
",'lL
""r. UJ iV\
PHONE
FAX
D ve:..---
CITY
ZIP
STATE
SUBDIVISION NAME
C-r-o.
SECTION
.~ZONING: ~.-l __
,.,.--c;" ,-","';';r:~"TJ
SQUARE 7' i)
FOOTAGE:. tJ
F,'efJ
ADDRESS OF CONSTRumON
SEWER UTILITY
PROVIDER:
ESTIMATED COST OF CQNSTRUcnON:
(EXCLUDING lANDiIiALutF....;...:.,;...,.
!1.---,\:. . i
'000
\
r, v<=---
I: i ,I) r.::---::~~,._-'-.
J"j'l
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PLUMBINGCONT~dtORJAN 252006 iii ,;:
WaNe- iU Ul ibJ'1
Plumber's Indiana State license #:
I ____, _... _ __
NAME OF LfTILITY EXCAVATION CONTRA OR; PLAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
TYPE OF IMPROVEMENT:
o NEW STRUcrURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o REMODEL
'Q/ ACCESSORY BUILDING Which plumbing codes will be applied to the construction:
9:" D..~A_. HIm...GA. RAG o. 'R .tional Residential Code wI Indiana Amendments
~/fiI.;i; '" . PlumbingCodew/llJ!li'l't"~ments
~l W. - a[1Jj)y.cQll,ilf~Ie'lt<l<Si1)HU -" .
~tO rU\'"\ ":" ~,\I to\JiJ:au:,na
M f ct d iIW'." Pl!: ''tS\;':Ck :'t!~th.t apply for the new
anu a ure ct ) nO O(;\li-C<;J" ""6
Y XN Trusses: Y ~N b~'b'l!'lll! a \~UJ"V SEf"\\1\CGC
~\M\.;ILJ '~q~,Il<J~\fl
Lot Split: _Y ~N Sump Pump: _Y ~N :~tburc~ \.1 @ABASEMENT
Does any part of the property lie within a special Flood designati.e~a9 CA IANA WALKOUT: Y....k..N
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
PROJECT INFORMATION:
Early Release
Permit:
For Single Family and Two Family dwellings, additions, remodels, 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 the
issuance date. Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
time frames for beginning and completing construction.
I, the undersigned, agrce that any construction, reconstruction, enlargcmcnt, 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 thc State of Indiana, and the UZoning Ordinance of Carmel
Indiana - 1993" (Z~ 289) and amendments, adopted under authority of I.c. 36~7 et seq, General Assembly of the State of Indiana, and all Acts amendatory
thereto. I furthcr 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 unti! a Certificate of Occupancy has been issued by the Department of Community Services, Carmel, Indiana.
;tLuk- 'j) () ('la./ cI T }'Y1lf I J
Signature of Owner or uthorized Agent Print -
OFFICEUSEONLY:***************************************************~**>*****************
Filing Fees: q; d-.S
INSPECTIONS REQUIRED: ,/' / . /','
Base Inspections: _ f::1 () :;, u
C Upper Footing'"::lower Footing Under Slab . ~) <'0
~ Cert of Occupancy: ,'5 _ --'
~ MeterBase ~Sitl!~
~ P(~R'LF': .000TAl:
~c7-Z/,f-?' :.
Fee Received by:
# Charged Re-
Reviews
Additional Fees
Re iewed/Ap 0 d: Dept. of Community Services
S:Permits/Forms/IL ESIDENTlAL
( at )
ff 303, e>2 ~
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