HomeMy WebLinkAbout05110039 Revision Info
I.
REVISION / PLAN AMENDl\1ENT or ADDENDUM to STATE RELEASE
For Commercial, Institutional, Industrial, or Multi-Family Projects
City of Carmel,' Department of Community Services
. Permit has been issued:
Yes
No.
If yes, PERMIT #:
05 II 00 ~!:/:~
BUILDER of
RECORD:
NAME: R i vo-v I~ / ,U
STREET ~~S- lAX)-\- ~ €- \ J
PHONE 3 n -i7l> - Ij\2.FAX
d:Jz5~ J\
STATE:
.D)
ZIP:
BEST METHOD OF CONTACT:
LOCATION
& PROJECT
INFO:
c>1
LOT # and SUBDIVISION NAME: (If applicable)
NEW SQUARE FOOTAGE OR 3 0
AREA AFFECTED BY REVISION: ( (Q
STATE COMMERCIAL
DESIGN RELEASE #: .N A
NEW FOUNDATION TYPE: e-srAB 0 CRAWL SPACE
o POST & BEAM 0 BASEMENT (Walkout _ Y _ N )
# of Floors: -----!--.-i
DATE OF AMENDED RELEASE:
fjp -
Elevator/Lift: q YES ~ BLDG. CONSTRUCTION TYPE:
NEW SCOPE(S) OF
o FDN
o STR
o ARCH
o MECH
o PLUM
RELEASE:
o ELEC 0 SPKLR OTHER(S):
v-B
OCCUPANCY CLASSIFICATION:
13
DESCRIPTION OF AMENDMENT/REVISION, AND/OR STATE RELEASE ADDENDUM/UPDATE INFORMATION:
~rl,>..l~ 2 rfLL ~c; -
RELEASFn FOR r.ONSTRIIr.TIOf\l
Subject to compliance with all regulations
or tllate and Local Codes.
OCrT or COW:'0NIW SER'v'ICE3
r.ITV O~ CARMEl,l CLAY TOWNSHIP
"
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.
1. the undersimed, 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 camplywith, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel
Indiana -1993" (Z~ 289) and amendments, adopted under authOrity of LC. 36~7 et seq: General Assembly of the State of Indiana, and all Acts amendatory
thereto. I also certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. 1 further certify, under the penalties of Perjury (Indiana
Code 35~44, 2-1) that all of the information 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 intentionally provided or omitted any information that would tend to hide, obscure, or
othet\iVise mislead the Dept. of Community Services regarding the truth of the matters addressed. I also agree that the construction will not be used
or occupi t' a Certificate of. u ancyhas been issued by the Department of Community Services, Carmel, Indiana.
\JohtJ
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2-1'3 -O~
Print
Date
SEONLY: ************************************************************************
NEW INSPECTIONS REQUIRED:
PLAN AMENDMENT/REVISION FEE: 257...!S:0
ADDmONAL SQUARE FOOTAGE:(.1Go') (0"5. 40
.
NEW INSPECITONS REQUIRED: J Cf J., E; 0
(If additional inspections other than what already remain on the existing permit are required.)
TOTAL: o/~ I ,-/0
Upper Footing Lower Footing Under Slab
Gough I~ Meter Base ~ Site
(Oate)
Fee Received by:
Date
Item
1 of
1
CITY OF CARMEL
PERMIT RECEIPT
~
OPERATOR: vdolan
COpy # 2
Sec:22 Twp:18 Rng:04 Sub:RMP Blk: Lot:1
PARCEL ID ........: 1710220022001000
DATE ISSUED.......:
RECEIPT #.........:
REFERENCE ID # ...:
535-A HAZEL DELL PKWY
RIVERVIEW MEDICAL PARK
CARMEL
SITE ADDRESS
SUBDIVISION ......:
CITY. . ........... :
IMPACT AREA ......:
OWNER.. ..........: PLUM CREEK PARTNERS, LLC
ADDRESS ..........: 11911 LAKESIDE DR.
CITY/STATE/ZIP ...: FISHERS, IN 46038
RECEIVED FROM ....:
CONTRACTOR... ....:
COMPANy..... .....:
ADDRESS ..........:
CITY/STATE/ZIP ...:
TELEPHONE .........
RIVERVIEW HOSPITAL
LIC # RIVEHOS
RIVERVIEW HOSPITAL
395 WESTFIELD RD.
NOBLESVILLE, IN 46060
(317) 773-0760
FEE ID UNIT QUANTITY
---------- ------------- ----------
CIIC/O FLAT RATE 1. 00
CIIPLAMEND FLAT RATE 1. 00
CIIREMOD SQUARE FEET 2,233.00
ICIIFINAL FLAT RATE 2.00
ICIIROUGH FLAT RATE 2.00
AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---------- ---------- ----------
103.00 103.00 0.00 0.00
325.90 0.00 325.90 0.00
697.27 697.27 0.00 0.00
192.50 96 .25 96 .25 0.00
192.50 96 .25 96 .25 0.00
---------- ---------- ---------- ----------
1511.17 992.77 518.40 0.00
TOTAL PERMIT :
METHOD OF PAYMENT
AMOUNT
NUMBER
CHECK
TOTAL RECEIPT :
518.40
0024193
~----~-~----
------------
518.40
1$
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321 East New York Street Indiartapolis, Indiana 42604
317.955,5090 955.5091 fax 877.479.5300101lIree
www.artekna.com
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321 Easl New York Street Indianapolis, Indiana 42604
317.955.5090 955.5091 lax 877.479.5300101lIree
www.artekna.com
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