HomeMy WebLinkAbout06050024 Application
City of Carmel/Clay Township (/ ~rmit #:OIo050o:;..f
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, 8r. Two Family: New Structures, Additions, Remodels, 8r. Accessory Structures
BUILDER'iif.
RECORD::I,j'
{:;f: ~/Y;.1
PROPERTY
OWNER:
LOCATION
8r. PROJECT
INFO:
NAME D
Scan \'-O,_.,.A" 1\ ~ J>
STREET ADDRESS
..lczq(, R-ubLrl\ Gr~~~ (ro:::.$Lf.-
BUILDER'S EMAIL ADDRESS I
'SS,"o '-'-"'0S0.....@y"'-noo_coN'
NAME '
~uS<>."~S,,,<:r\* R.OLuLINS.ON
STREET ADDRESS
In9b uL:-.l>rl\ C("Q.Q,~ C,cs,,<;.n,
LOH \ Il SUBDIVISION NAME
Lor"" &
PHONE
81364(8
FAX
CITY
'2LC.I'-~vl\\~
STATE
IN
ZIP
46077
it ~s 60S S (<."')
BEST METHOD OF CONTACT:
'8136418 h'J
PHONE
~n <613--6418
FAX
CITY
"2.LO I'S"
STATE
ZIP
N
~ ~-\o.-\ es
SECTION
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
r)CI RESIDENTIAL (For
Additions, Remodels, Etc.)
ADDRESS OF CONSTRUCTION
l\l q(, F7ul::,....r..... c\"'...~l C,C
SEWER UTILITY ClO.'\:j ~l"'''''''-( WATER UTILITY "I:.-.ol<OJ'.~ot'S
PROVIDER: \~...."s\"':1" u..Jo.G.~ PROVIDER: '-'--o.-\~
NAME OF lJTlLITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
TYPE OF IMPROVEMENT: PLUMBING CO
--{jj NEW STRUCTURE (cec~)
o ROOM ADDITION(S) Plumber's India
~ ~ORCH ADDITION(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
j)fC(- /0 tI- G IT J
Manufactured 5 ~/"-CI
Trusses: _Y...2LN
.. 0 CRAWLSPACE
Lot Split: _Y...2LN ". Sump Pump: _Y 1-N 0 SLAB
,\ '"
Does any part of the property lie within a special Flood designation area: _ Y ~N
PROJECT INFORMATION:
Early Release
Permit:
_Y---1i....N
Zl- r-Svrl.\
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LA
lilS
Y-3200&
/VI/.
Which plumbing codes will be applied to the construction:
o International Residential Code wI Indiana Amendments
o Uniform Plumbing Code w/Indiana Amendments
(Multi-Family Construction Code)
FOUNDATION TYPE: (Check all that apply for the new
construction area)
iliO POST & BEAM
o BASEMENT
WALKOUT: V Y_N
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 thRS"~~l(i)r!)N&TJi'P\~\Y INbe completed (Certificate of Occupancy issued) within 18 months of the
issuance date. Class I sSl;}~~lftiA1:ff\';,~ffl~e fAWJ.'>trative Ru~es of the Stat~ of Indiana (See 675 lAC 12) regarding expiration
- ,f ~ ,!jIlpe rr!~~9r gl H'f',g'.thd completmg construction.
I, the undersigned, agree t~.ali...ta.w an ~nm:W:~rr\~~c'clgftftic't:1btt,JM.1rgement, relocation, or alteration of a structure, or any change in the use of land or
structures requesttd by ~~icQfnt ~i:.J.Nh-nPcS5~@liSpplicable laws of the State of Indiana, and the ~Zoning Ordinance of Carmel
Indiana - 1993" (Z~ 28~IWJttfd 'Yl)tk)r w~d h.~~~~l. E!i seer General Assembly of the State of Indiana, and all Acts amendatory
thereto. I further certirytha~ o~fkit\:1,?d, ~!Ut~8 flrl'~kn~ '!n'l&'n~~lto the sanitary sewer. I further certify that the construction will not be
used or occupied until a Certificate of Occ~A:en issued by the Department of Community Services, Carmel, Indiana.
-*7~,.~
Signature of OW'ner or Authorized Agent
s uUJ. RO'--'~'f'o s.O/'-.
Print
S"-'R-oG
Date
OFFICE USE ONLY: ****** *********************** *** **************~!****'*):******************
Filing Fees: ~~. b c2..
IN.SPECTIONS REQUIRED: / /. / _ <".1 # Charged Re-
x;:: - __~ Base Inspections: _G. b _ ~ v
( Upper Footi!!jV Lower Footing Under Slab / r3./0 ReViews
Cert. of Occupancy: L..J
~h In . )Meter Base ~I sit; . / ' ,
'--.:.= ~ C.: ~ P.R.I.F.: Additional Fees
i
<? It <1-~- ~ 11/0----( <;'-1 \ ---06
___ Reviewed/Appro d: Dept. of Community ServICes (Date)
~ j S:Permits/forms/ILP RESIDENTIAL