HomeMy WebLinkAbout06060003 Application
City of Carmel/Clay Township Permit #:(){,Oq()()03
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
dditions, Remodels, &. Accessory Structures
BUILDER
OF
RECORD:
c'o,
BUILDER'S EMAIL ADDRESS:
o t: u.2
PROPERTY
OWNER:
a~.s -I-,(J6,
STREET ADDRESS:
/0 YO JSD:::./o ~
LOCATION
&. PROJECT
INFO:
LOT #:
SEWER LmUTY
PROVIDER:;,,;'"~ Mj, .
~:",.<~,,/... ~''''
NAME OF LmUTY EXCA ON ONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNlY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
TYPE OF IMPROVEMENT:
o NEW RUcrURE
o M ADDITION(S)
ORCH ADDmON(S)
o DECK ADDmON(S)
o REMODEL
_ Basement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
PROJECT INFORMATION: 0 DEMOLmO~
Early Release ~~~~
Permit: _Y R :~- _Y_N
Lot Split: _Y _N Sump Pump: C-ne~
TYPE OF CONSTRU
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions, Remodels, Etc,)
--.....::.:....,
FAX:
SECT10N:
-'!';,
~ SQUARE
C4el1lleL J~y~oJ2. FOOTAGE: ZS-C
ESTIMATED CO~'CONSTRUcTION:,'~-';:i';:-;l-::::::::"":O' -",
1'.,;'\.(l:XCLUDINGLAND.IVAtuE)~ ~:::-; L:-'A a'l:no,I::::':Pi,-" ;
f " I j I I - ------ _.{;/;__,C/ _L~-,::, i: 1 ,
II! I,;
ii' ",
,; I III
ijI Iii
_ iiJ31
~
TAX MAP
R
PLUMBING cONIrn...~nR:
if
I
J
--
Plumber's Indiana State License #:
Which plumbing codes will be applied to the construction:
o International Residential Code w/Indiana Amendments
o Uniform Plumbing Code w/Indiana Amendments
FOUNDATION TYPE: (Check all that apply for th7e new
construction area)
o CRAWLSPACE 0 POST & _ BEAM -'--- fER
o SLAB 0 BASEMENT (WALKOUT:_Y_N )
For Single Family and Two FaIUjJy..p'SSG .1OnMP.v~1~W or accessory structures, this pennir is valid only if construction conunences within 180
days of the date o.iipy~6:fj~\.b il ~tt\ilia~l?e completed (Certificate of Occupancy issued) within 18 months of the issuance date. Class I
structure permits ~)e~ {Bt:b~GtQ ~'&lle.~Ja e ~~ate of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
SUb\ec St3te 30 ...., S'E. coiAAl"l\iIIl<constnlction,
I, the undersigned, agree that a~\o~~li.<M\A~~r'uctipJlrtTli~<<W.Ii[lllocation, or alteration of a structure, or any change in the use of land or structures
requested by this appl!;.:~'lfil~~~i'tli.:~ndlc@~ '0, \.!r'applicable laws of the State of Indiana, and the "Zoning Ordinance of Cannel Indiana - 1993" (Z~
289) and amendments,~ed ~d,K ~W1~M 1.c..3Q~t<: et seq, General Assembly of [he State of Indiana, and all Acts amendatory thereto. I further cerrify that only
kitchen, bath, and flo9'Pt<ri(lS@t"cJmfec'ted \tM~\:~ffifY'sewer. I further certify that the construction will not be used or occupied until a Certificate of
Occ.J!jrhensd~'-'tm.ntofCOmmUnilY,Servi~'Cannel'Indiana, S- ';(1-11 'h loG.
Signature of Ow ., Autbori2ed Agent Priot Z '
***i1**~i********* *******************}~~********************
. L/' 'V ~ Filin Fees: / I .f..=- 2-2----
un;er Sla' Cl '/lP B e Inspections: ,/ (., (:,. )0 # C~:~~e~s Re-
I . rt, of Occupancy: ~ ~- -:)0
OFFICE USE ONLY: **************
INSPECTIONS REQUIR
~
Site
P,R,LF,:
ept. of Community Services
S:Permits/FormsjILP RESIDENTIAL
Fee Received by:
\,
Additional Fees
;SAL' $ '3 'if;t ;L <-
O/LM/\ 17. L ; f ja/'t()ll
q/-g/O L. 'Date