HomeMy WebLinkAbout06040173 Application
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(:ity of Carme// Clay Township C vtJermit #: tJ(p fflO 173
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
ZIP
NAME
PHON;fy {. ,,2 y r: z...
FAX
V{- l(Z2 '(
L
PROPERTY
OWNER:
NAME
STREET ADDRESS
ZIP
LOCATION
&. PROJECT
INFO:
<:
K.
SEWER lfTILITY / ( WATER lfTIlITY /"
PROVIDER' La~~f11<- ~ PROVIDER, Lf':/l:..r?t e
NAME OF UTlU1Y EXCAVATION CONTRACTOR; PLAN COMMISSIDN / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
lah
SQUARE
FOOTAGE:
2
EsnMATED COST OF CONSTRUcnON: I~ y~
(EXCLUDING LAND VALUE) 2 d (N . ~
TY:;J; IMPROVEMENT:
NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
c
Jb. \P~ A
Y('~~.t ~
..- Jl)~
~ ".
Which plumbing codes will be applied to the construction: 1.. ~
~ternational Residential Code wI Indiana Amendm~
o Uniform Plumbing Code w/Indiana Amendments
(Multi-Family Construction Code)
(If /(f,(
PLUMBING CONTRAC OR:
~.",... ( fr.,
Plum er's Indiana State License #:
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
J!!{ TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc~)
PROJECT INFORMATION:
Early Release ..-/ Manufactured ./
Permit: Y =-~ Trusses: <..../Y N
- --=.::;;:, - <./" 0 glAWLSPACE 0
Lot Split: _Y _N Sump Pump: _Y _N ~LAB 0
Does any part of the property lie within a special Flood designation area: _Y <..--1f'
FOUNDATION TYPE: (Check all that apply for the new
construction area)
POST & BEAM
BASEMENT
WALKOUT:_Y ~
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this pe~it!s val~~'oIllyj~:c~;mstruction,colllmences
within 180 days of the date of issuance of the bui~~i?~~rJ1!.it,and must be completed (Certificate of cp,kcuparcy is~it~~) witliin;~~::m~nths?f the
issuance date. Class I structure.J]>C~teo~b;iEf~la~aw Administrative Rules of the State of 1r.:dian1a(See.675'IAC 12};r_~g~~~!!1g_~xpiration
~~EASED t"U'"' . 'El!RfffffW~~I1El;inningandcompletingconmuction. ill'!!1 ~ i'i
I. the undersl aIDfft8aeMJ'l~taO(i~tliil~\:tr.-~n~trcrction}enlargement, relo~anon, or alteratIon of a stryf~..Uf~' Of any change, In the use oflanq ~r
st~ctures req. 'drfli!.~ 1!Si~~a?,'apH ~pf~m to, all apphcable laws of the State of Ipflia?~! and ~ffomngp~~ce of ~arMel
Indiana -1993" (Z~ 289) aMI ~?n e ilm~rSttB;\f&:.iij-~ l.c. 36-7 ct seq, General Assembly of thei~tat~lof. Indmna, arid all Acts amen~tory I
thereto. I furt~~t6)fi, . h ,~At1\, ~f~{I'1'~M~.H~r"~_nectcd to the sanitary sewer. 1. furthf<cehify_t.h..a~ :~,~~~.~~~ will.Il!Q..~bt;
us~d or occu le'cf-firJ.. ~i(1RM@4c'P~hals b'een Issued by the De~artment of Commumty ServIces, Carmel, IndIana. -'-- '".. j
;:V INDIANA 1? L~ (-(Z:J CE I_~____---_. --'-/-=-7-9___,1 6
Si ture of Owner or Authorized gen Print I Date
OFFICE USE ONLY: ************************************************************************
Filing Fees: r;;, 47, ~ ()
INSPECTIONS REQUIRED: .') "'-V') ,..- 0 # Charged Re-
Base Inspections: ~ LL .> ~
Lower Footing ReViews
Cert. of Occupancy: ">-:.3. s(;J
P'R~'E . ::a/;~~'Oo o. AddibonalFees
TOTAL: ~~ J7-c:f'O
y~.)
Fee Received by:
inal
Site
/
.3 - O~
(Date)
ReviewedfAppr ed: Dept. of Community Services
S:Permits,fformsjIlP RESIDENTIAL