HomeMy WebLinkAbout06080033 Application
BUILDER of
RECORD:
\}JL. ~ \ ~
City of Carmel/Clay Township ~
'RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, 8r. TWO('El~r.t Fitl'ft1~uctures, Additions, Remodels, 8r. Accessory Structures
Shannon HinstrouJ
Permit#: (/(.gD8oo'3.3
NAME
FAX
STREET ADDRESS
STATE
ZIP
PROPERTY
OWNER:
NAME
PHONE
FAX
STREET ADDRESS
CITY
STATE
ZIP
LOCATION
8r. PROJECT
INFO:
ESTIMATED COST OF CONSTRUCT10~ 13 7
(EXCLUDING LAND VALUE) LfI,
YJu~ mMUO-
LOT #
3
/
ZONING: S -
SQUARE
FOOTAGE:
SEWER UTILITY f1 J I
PROVIDER: UL
NAME OF UTlUTY EXCAVA ON CONTRACTOR; PLAN COMMISSION I BZA I BPW DOCKET
NUMBERS; lAC DATE(S); AND/OR COUNT'( WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
TYPE OF CONSTRUCTION:
'Kj SINGLE FAMILY
/6 TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESJOENTIAL (For
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
~ NEW STRUCTURE
o ROOM ADDITION(S) Plu ber's ,ill\a S
o PORCH ADDITION(S) /OJP(~ Sf!
o REMODEL '-!if..~
o ACCESSORY BUILDING Whic~!Iil!i'U"H5@1I~ .pplied to the construction:
o DETACHED GARAGE 0 p~inJi#s~nti'l Code wflndi.na Amendments
o ATTACHED GARAGE cjIJrif.;,r/itpU":.o:.Ode wflndi.n. Amendments
o DEMOLITION (~ti~~ &~~ion Code)
PROJECT INFORMATION: ~ ~
X M f ct d 'L FO Cl:N PE: (Check.1I that apply for the new
Early Release anu a ure . c' ,Mj
Permit: _ Y _N Trusses: Y _N ~r!J.I<Jl1" e:'1
Lot Split: _Y J N Sump Pump: Ly _N ~SLA~C) E ~O POST & BEAM
-A- .;1: J:/j' V BASEMENT V
Does any part of the property lie within a special Flood designa~". a: "";:;!( A..N WALKOUT:_ Y ~N
For Single Family and Two Family dwellings, additions, remodels, and/or accesso'~ystructur this permit is '1alid.only.if.~~..::....
within 180 days of the date of issuance of the building permit, and must be completed (Certificate of Occupap~r~is,s~~~U ~irr~r.qq.n~o~~~ \
issuance date. Class I structure permits are subject to the General Administrative Rules of the State of Indiana (~ee\q75-=JA&l)~ \ \
time frames for beginning and completing construction. i ! ! ) J r !
I, the undersigned. agree that any construction, reconstruction, enlargement, relocarion, or alreration of a strucrure, tl,;n\\cpange in rhe use of land or i
structures requested by this application \\ill comply with, and conform to, all applicable Ja\vs of the State of Indiana, ~4 t!trZon~OrdiiJ.a'eMO&mellll i
Indiana - 1993" (2-289) and amendments, adopted under authority of r.c. 36~7 et seq, General Assembly of the State of lmdtana, ana':ID"'Acts amen-crat~ I L) !
thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer, I further certifY. tha2the construction will not be L.::::::.. !
us or occupied until Certificate of Occupancy has been issued by the Department of Community Services, Clrme!, ~ndlana. j
I ~Hl}ljA!t2IJ HIAlJ/-fI}W I 7- /1 D 1/ J
Print Date
OFFICE USE ONLY: ****** ************ ********.~*******************9~*n*Y:******************
Filing Fees: (lJJ.-'L 12
r INSPECTIONS REQUIRED: -')--, 7 ~O # Charged Re-
~ - ~....-=: Base Inspections: ~ ~ '-'_
C. Uooer Fnn i~I....Lowpr "^9tj"y - Under Slab :)' --1J ReViews
~ - Cert. of Occupancy: OJ
(')in. ~er Bas~ Final Si~ . (j 0
- P.R.I.F.: Additional Fees
W~ f/JJj- ;2 ~~ --1()
Reviewed/Approved: Dept. of Community Services (Date)
S:PermitsfFOI"msfILP RESIDENTIAL