HomeMy WebLinkAbout06030092 Application
City of Carmel/Clay Township Permit #: 0 ~ 0 3 00 ~
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, 8r. Accessory Buildings
;
, BUILDER of
RECORD:
NAME
CiWf'1/f[ 6/(i.t !5<l1f!P5
STREET ADDRESS /1.- 5'
o /5f nu(L. '1./
BUILDER'S EMAIL ADDRESS
C-T /J1~A-rl;.,/;2. @ 4:1, 0"""
PROPERTY
OWNER:
NAME
(, if
C. <4 ~ 9-1tZ L
LOCATION
& PROJECT
INFO:
STREET ADDRESS
(jplZ. Ci VI<:"
ADDRESS OF CONSTRUCTION
;), {O I 5'1- lJ tdf' 5' tJ
-9-;( 1'[
Address of Shell Building (If different than Address of Construction)
BUILDING, PROJECT, OR TENANT NAME:
C"'I tf{/YlA-'"L. Fj~tz fJed!..[.s
I I>,A ~;t
(., s~\O(\)
PHONE ?fLJt:, -
Cdt 370
CITY
C.4/:.ff7I,.-t.....
48 ~SYl
FAX
~TE
hJ
ZIP
yt d:J 'L
BEST METHOD OF CONTACT:
Cell
PHONE
FAX
-
CITY
c...4~j,7i.L
STATE
:f-Iv'
ZIP c'f (, 03..2..
SUITE # (If Applicable)
Lot # and Subdivision (If Applicable)
lONING:
TAX MAP PARCEL #:
STATE COMMERCIAL SCOPE(SlOF 0 FDN 0 STR llC AROi 0 MEOi SQUARE
DESIGN RELEASE #: 3166.2 3 RELEASE: ,X mc 0 SPIQR OTHER(S): FOOTAGE: ;;Z 7tH)
WATER UTILITY . SEWER UTILITY ESllMATED COST OF CONSTRUCTION#
PROVIDER: C Iii <, J! C. 4~'I'Yi. PROVIDER: c.. i1i OP C-44'?'it (EXCLUDING LAND VALUE) 73'S 0 o. ~ C)
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUrffi' WELL AND/OR SEPTIC PERMIT #'S (If Applicable):
# of floors:
QYES
BLDG. CONSTRUCTION TYPE:
TYPE OF IMPROVEMENT:
o COMMERCIAL 0 NEW STRUCTURE
(Privately owned hospitals 0 AOOmON
and med~et~@~J FO. R CONS1-Rlo.1~9O/1!(')
/ ~recom I~ _.1:. . ..'-.' e3' Pb,th\l
00 IN .. ctt~ COtnt/.'lar!ce.v.v.Jtn a}1 rogDiJa'.'iWft9ineorDeck
Munlclpal/PlJIlOcllldQi 'In(i Lc":al ~(IREMODEL
00 $<OOPT OF Cu"'t,/;,v,' "\"'I'-GJ~NEW'''''''~~:IFINISH
~ D' :~.flU::, (:::i':ii.Ci:E~~~UILDING
FOUNDATION lW~: 1(&lfcfailiWllli:hL / L.:LJitLJ T QETA~1!plAGE
apply for the new construction are/llj DIANA 0 ATTACHED GARAGE
iz{ SLAB 0 CRAWL SPACE 0 CELL TOWER (New)
o POST & BEAM 0 BASEMENT 0 CELL TOWER CO-LOCATE
(or POST & PIER) WALKOUT:_Y_N 0 DEMOl.ITION
OCCUPANCY CLASSIFICATION:
PROJECT INFORMATION:
Early Release / Manufactured /
Permit: Y V N Trusses: _Y XN
Lot Split: Y ,~ Sump Pump: _Y VN
Does any part of the property lie within a special Flood
designation area: _Y ~
PLUMBING CONTRACTOR:
'Is / Iz-y p ( 'f df ... ~ ":1,..<,.:;\
.; "",'. ~' \,
Plumber's Indiana State License #: .....j ~\f~\ \ \~\
pL c.. 100<6/00 ~^~~/ \' \\~\
\,~?......" \\\ \\\
Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 615 IA~~arain~eXPiration t~$mes fbi-/ \
beginning and completing construction. G~\~~"" ').. l..'" .;>
I. the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, 0 \~~' /ge in t~e u of\tnCf or stru...Gttlres
requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zonnfg'Q. ce el 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 ~~ ' the eto. I furtltt1'certify J:a~'o~iy
kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be usici'~ ~\~ ied unrU'Certifica of
Occupancy or Substantial Completion has been issued by the Department of Conununity Services, Carmel, Indiana. \~ '\) 1
" ~fllJ 'J;(... J'7 I$S ",M-141,'# J '-II-06
ature of Owner or Authorized Agent Print Date
v
,
OFFICEUSEONLY:************************************************************************
---Y1 ~ # Charged Re- '/
if, ~
~-A' B _ Additional Fees
17. L;/~..l/~1&'-
INSPECTIONS REQUIRED:
Upper Footing Lower Footing Under Slab
6~ Meter Base G;5 Site
Filing Fees:
Base Inspections:
Cert. of Occupancy:
~~~\~M~Q ~4"),..
Reviewed/Approved:' Dept. of Community Services (Date)
S:Permits/Fonns!ILP COMMERCIAl
~,.;.~
TOTA~
Fee Roc_Iv by: ().1L/). h