HomeMy WebLinkAbout06040177 Application
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City of Carmel! Clay Township Permit #: fJre ()4 0/7-7
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
I'
BUILDER of
RECORD:
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STREET ADDRESS 9' () ;Z )" /I
PHONE
FAX
I;Y(- ~22Y
NAME
STATE
I</.
ZIP
Ybl-VO
PROPERTY
OWNER:
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BEST METHOD O~NTACT: ,
(..I p. p:: - fr' ,,; /
AX
NAME
STREET ADDRESS
ZIP
LOCATION
&. PROJECT
INFO:
LOU /00 I
CTJDN
o (,), fJ1-<M,f.", '"
. NING:
~,,:"
SQUARE 2
FOOTAGE: )- J J
SEWER UTILITY /
PROVIDER: L "-tt- WI l
WATER UTILITY
PROVIDER:
ESTIMATED COST OF CONSTRUCTlON:
(EXCLUDING LAND VALUE)
NAME OF lJT1UTY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
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TYPE OF IMPROVEMENT:
~EW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
PLUMBING CONTRACTOR:
;.:; "-r I (}-ste I7c V
Plumller's Indiana State License #:
/0.1 9(/ '1
Which plumbing codes will be applied to the construction:
~temational Residential Code w/Indiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
(Multi-Family Construction Code)
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
"'D<i TOWN HOME
ID TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
PROJECT INFORMATION:
Early Release
Permit:
Manufactured FOUNDATION TYPE: (Check all that apply for the new
_Y / /N . ./ construction area)
(./" Trusses: ~Y_N
o CRAWLSPACE 0 POST & BEAM
Lot Split: _Y...LN Sump Pump: _Y ~ I9-Si:AB ~ -,- ,-.0 _ BASEMENT _ /
Does any part of the property lie within a special Flood designation area: _ Y ~ - WALKOu-r:_ if ~
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For Single F, am ly' we Im:;~ a t'QW1~affi3~ls, and/or accessory structures, this PHrri.i~lis valid on"ly if~~ns"tructiOll c?tn~e,hces
within 180 ~h~MQm' s€gltt:~ ~'rf1b% i a'fflgpermlt, and must be completed (Certificate 6fp~cJpancy issued) within 18 moriths of the
issuance date. Class I &{fu~t~~6QRQ~the General.Ad,ministrative Ru~es of the Stat~ ~f !n~i~na (~F1r5 ~C12rOOO"rding ~XPt~ation
Dr=PT O.OM M U N ITlIrSffiii\lII'l;@ESgmnmgandcompletmgconstructIon.,:'i,',I::
I, the under~~a~~ t itI1JCp.qn^~~1\r;w~.:n:ae mem, relocation, or alteration of a ~t'rUctU[~,gE.,~y.~_hange i~ the use of ~al1~..:.pr I
structures r~i;tdd ~lfu :Jt..\~brfiPly ~~dhlJl~bt1MTI to, all applicable laws of the State qf Indiana, and the uZonirig Ordinance of ea~el
Indiana - 199r (Z- 289) and amendtM~~d under authority of I.e. 36~7 et seq, General Assembly oflE~e State of Indiana, and all Acts amendatory
thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further~crniffth~at theconstruction.will,notlbe
used or occu Oed until a Cereif}c ce of Occupancy has been issued by th epartment of Community Services, Carmel, Indiana,
'7 l ~.J7(1(G l(-L?-O~
Print
Date
Sig
OFFICEUSEONLY:************************************************.*~'****~***************
Filing Fees: {, z..7. OV
INSPECTIONS REQUIRED:
Base Inspections: ~ '77 :>'0
Cert. of Occupancy: S- 3. SO
/ ,;2 {./ 00
. :f 2c?- ]~ cYO
Lower Footing
nder Slab
# Charged Re-
Reviews
nal
P.R.I.F.:
Additional Fees
v
b'-'"3
(Date)
TOTAL:
ReviewedfApprov Dept. of Community Services
S:Permits/FormS/ILP RESIDENTIAL
Fee Received by;