HomeMy WebLinkAbout06050100 Application
City ofCarme//Clay Township uN'-- Permit #:fJ6tJf)O l/}tJ
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of NAME
RECORD:
PROPERTY
OWNER:
NAME
STREET ADDRESS
LOCATION
& PROJECT
INFO:
LOT # ?J
SEWER UTIlITY
PROVIDER:
l-
SUBDMSION NAME
PHONE
2/:F-'1 '1 dO
FAX
.20)- 9'YYu
cm
ZIP
V6< Vi)
h
,t1. (')
BEST METHOD OF CONTACT:
(:,,,,,,
'" '/
FAX
PHONE
cm
STATE
ZIP
SECTION
ZONING: r
J -j
.evclJ-(/L Ie". 1/
"
TYPE OF IMPROVEMENT:
~EW STRucrURE
o ROOM ADDmON(S)
o PORCH ADDmON(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
ADDRESS OF CONSTRUCTIOji.
2- tt /V ew ;'., Iv j/I L/1
C r. 0 WATER UTIlITY r-
f IC c-v PROVIDER: L CoI.A A ( I
SQUARE
FOOTAGE: ;]>7)
ESTlMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) '/1 00 o. ~
rYl"J ill ~ =#=0605()tJ9
NAME OF UTIlITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUN'TY WELL AND/OR SEPTIC PERMIT #'S (IF APPUCABLE):
TY~ CONSTRUcnON:
SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Ett.)
,
PROJECT INFORMATION:
FOUNDATION TYPE:
Early Release ./ Manufactured ../':: construction area)
Permit: Y N Trusses: y. N
Y V:;N 7, - UYtRAWLSPACE
Lot Split: Sump Pump: _Y _N ~LAB
Does any part of the property lie within a special Flood designation area: _Y ~
"I
Q &'~
;.;- .> n-, . fA 'V" ~'+ .0
ber's Indiana State License #: @ ~
( 6 nll "'<t>
Which plumbing codes will be applied to the construction: ~ ~
c:Y'Intemational Residential Code w/Indiana Amendmen~
o Uniform Plumbing Code w/Indiana Amendments
(MUlti-Family Construction Code)
(Check allll1at apply for ll1e new
o POST & BEAM
~;~<\N
,,_m:: II \.' I.'-'='''' II \1\
For Single Family @cl..Tw~ f~d}EY~~~qi~~Or accessory structures, this . -~4fii>>t~E>n~ttion co~nunln~es
within 180 days o~ t&JJali"Je..UIithe bM) . , ila D1ust be completed (Certificate 0 ~ y iSsued) Witliin 18 month f thl::
issuance date. Clas,giJ~~~ liNilllbjilt~fu;;; .r '.i/Blfurustrative Rules of the State of i (S~75 lAC 12) regarding \ rr~tion
of State and Lti1lI'l~6l1>eldllr beginning and completing construction. h ~nlJ'O I il I! \
I. the undersigned. a_~<;I:.Ih'i'~c:oJ'$ft\lflti~HE'f'1'l>}Iotil>Dm\lt{g<E&t. relocation. or alteration of a srm anwllfillge 10 tHe a-se oflandW,::i ,
structures requested ~ bM dpplidati'ori..wu1IMi i Mm, afilrcoDlRrro...tp: UJ..applicable laws of the State of In d th~IJZ~rung Ordinance o.[Qumel \
Indiana -1993" (Z-~jpI!it~t O'IIumwlllll:tt~ et seq. General Assembly of the e diana. an amendatory \
thereto. I further cenny tha~iuy Iit~h~l'R~~~ 1fflR~r drains are connected to the sanitary sewer. I funher e construction will t.~
used or occupied until a Certificate 0/ dC~y'h'i\ been issued by the Depanment of Community Servic , Carmel, Indiana.
Z. ~ . 12 L. ?(L() cL
ature of Owner Dr Autho Agent Prff.t
~ /r-vC>
Date ~
OFFICE USE ONLY: ***********************************************~_*''li**~****************
Filing Fees: L?r, .>
INSPECTIONS REQUIRED: r? /7 ~/,\
Base Inspections: ~ :L /. ') (/ # Charged Re-
Upper Footing Lower Footing Under Slab ___ '3 )'0 Reviews
~I oi;" ) Cert. of Occupancy: , ") .
~ ~ S~ P.R.I.F.: !t;;" /)(. ;)r) Additional Fees
3/; .
(lY'~;~ f1J;~ S-/l-D6
Reviewed/App ved: Dept. of Community Services (Dale)
5: PermIt:s/Form~Il.P RESIOENTIAL