HomeMy WebLinkAbout06050040 Application
City ofCarmellC/ay Township Permit #: OCtJ05ootjo
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, &. Accessory Buildings
BUILDER of
RECORD:
NAME
,.,- cON'S"r/'l..<4.C.Tlo..J
STREEr ADDRESS
Ilo-:r 13....It..i>'S'" ""- "P\4 ""'t
PHONE J q. (; 1 't (Q II a.
(:.0. r INc...
CITY
, "'T.>,4ov4/?".... ~
FAX ), 1- ~(p". ;;!~
STATE
,tJ
ZIP
'f(p;log
BUILDER'S EMAlL ADDRESS
""Dollt!f:i2~IL.G? 'S'"'.......""....."'''''...,sr. ~o""'
NAME PHONE
4T. \/. ~,-6-;1" ~&. l+Orf.~
PROPERTY
OWNER:
STREEr ADDRESS
-)00 ~.
^~.J>. 4-tJ ~T",
LOCATION
8r. PROJECT
INFO:
ADDRESS OF CONSTRumON
.:> /'J. "'~ P 4.,./ ~ ,
Address of Shell Building (If different than Address of Construction)
BUILDING, PROJECT, OR TENAt-IT NAME:
',. 1I,,,,c6-'1' ~~
STATE COMMEROAL
DESIGN RELEASE #: 5' 5 1- 3 <{
WATER UTIlITY
PROVIDER:
BEST MErHOD OF COt-lTACT:
e=:,.. ~ <..
JI~ ~Y;l.-","51(,. FAX
"r- 51f:J -1-n
CITY
~<S--...
STATE
IN
sum # (If Applicable)
ZIP
.. "'.. ~.il
Lot # and Subdivision (If Applicable)
S...-A-wP ... p ZONING:
1+O5?~ - M~l i3-CP
SCOPE(S) OF 0 FDN 0 STR B ARCH [Ji<" MECH
RELEASE: BJ' ELEC ..: SPKLR OTHER(S):
SEWER UTIlITY
PROVIDER: e A-a-!!>-<-
lv-J'-'
PLAN COMMISSION / BZA / BPW DOCKEr NUMBERS; AND/OR
COUN1Y WELL AND/OR SEPTIC PERMIT #'S (If Applicable): II} /A
# of Roors: Elevator or Uft: Q YES Jj( NO BLDG. CONSTRUcnON TYPE:
TYPE OF CONSTRUCTION: &E OF IMPROVEMENT:
r;g COMMEROAL ()"~ ..r$"> NEW STRUCTURE
(Privately owned hospttals ."'V,y.~ ~ruON
and medical offices/centers 1(.'-. 0<0 (j ~Room(s)
are commeraal) ~.:!p ;ft' e'?' ~~ Porch
o INSTITUllONAL 0 ,,<' O(} (,~~"'fO Mezzanme or Deck
o Muniapal/Pubh~d~, ,,' -ic G--\ CJv~ REMODEL
o School O~,' c? ~. ,.(~- NEW TENANT FINISH
o ChU~rch <<,/'/ i)v ,~ ,;; 0 ACCESSORY BUILDING
FOUNDATION TYPE: ~~~I~ Wh!'=t1J \0 ~ DETACHED GARAGE
apply for the new !!Il.are;l):v oj' 0 ATTACHED GARAGE
(g SLAB ~ tJ "" ~(S~~E ~ 0 CELL TOWER (New)
o POST & :O~D ~E~' ~ 0 CELL TOWER CO-LOCATE
(or POST & PI .' Y N 0 DEMOLITION
TAX MAP PARCEL #:
i OODOOoO' ooOL
~ PLUM SQUARE
FOOTAGE: ~, ~ 0 D
ESITMATED COST OF CONSTRUmON:
(EXCLUDING LAND VALUE) ft (PS 0 "., 0
OCCUPANCY CLASSIFICATION:
PROJECT INFORMATION:
Early Release Manufactured
Permit: _Y ~N Trusses: _Y x: N
Lot Split: _Y ~N Sump Pump: _Y ~N
Does any part of the property Ue within a special Flood
designation area: _Y ~N
PLUMBING CONTRACTOR:
~"'''''VA-J'' -r ?C>D~
Plumber's Indiana State License #:
C. i'" '8 , 0 D "3 I ltO
Class I structure 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.
It the undersigned, 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 comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Carmel Indiana - 199r (Z~
289) and amendments, adopted under authority of I.c. 36~7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I fumer certify that only
kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of
Occupancy or Substantial CompleJr( h'lf heT issued hy the Department of Community Services, Carmel, Indiana.
b~ l"2- ~b 1>,...M~.... "\2.. <::>III!:.,'Z.i3E:.c:..I'" S/-S/D(p
Signature of Owner or Authorized Agent Print 01;; I
OFFICE USE ONLY: ********************************************~*************************
INSPECTIONS REQUIRED: 0 Filing Fees: 7 ;< q. 0 0
Upper FOO~ng Lower Footing Under Slab ~\ \/}/ Base Inspections: ~ t'J~ ' 0 0 # ~::J.~ Re-
~g0 Meter Base ~ Site Cert, of Occupancy: / () I . 00
3&.0
Additional Fees
~7 / b~
Reviewed Approved: Dept. of Community Servi
S:Permits/FormS/lLP COMMEROAl