HomeMy WebLinkAbout06090078 Application
~.\.\....
,. ",.1!! ,I
, <C!?/
'!.~.Q!~\!;.!"'/
CityofCarme/lClay Township Wfo'~ Permit#: [)CefJ9otY7g'
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
LLC
PHONE: ~ ~
BUILDER
OF
RECORD:
NAMEt\ .). _ ""~
" '-'()~J1 \\ 0",,", e ~
STREG t:~SL
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
,LO
.\~'1S
,#-4CJ1:::.,
CnY:
:::c
ZIP:
STATE:
METHOD OF CONTAe:~4'; I
~L(
-~;>(.,&
,
ADDRESS OF CONSTRUCTION:
I~ .
~\\2-w-S:>
SEWER UTILIlY
PROVIDER:
1J,4(,OfL
ESTIMATED COST OF CONSTRUcnON4:!. \ t'\ S r--.r-7'..
(EXCLUDING LAND VALUE) ~ CI- I ~
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
~..A-\--z. ~ ,><'~ '" y "'- -\ \ C> v>
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc.)
PROJECT INFORMATION:
Early Release - /
Permit: Y ~N
Lot Split: Y LN
TAX MAP PARCEL #:
TYPE OF IMPROVEMENT: PLUMBING CONTRACTOR:
~EWSTRU.E vJ\\\vv-.l'''Z ~\J""~\~
o ROOM ADD ) Plumber's Indiana State License #:
o PORCH AD6VJl9lfl "I "--7
o DECK ADDrr:i~>tO 'l2{) F, \> \ b S DD 01 I
o REMOD~~ C~/Z).o/,O~lumbing codes will be applied to the construction:
o Acc~~s~M~;"I)~~Honal Residential Code w/Indiana Amendments
o DETACHED '?JOA. 0' ~ 'ih-~'/i9V~;"
o ATTACHED GA 'v1il1u. ~,u(l~ ..-;.,.,dP Code w/Indiana Amendments ,
o DEMOLITION 1l1~~ 11;/h..~'{JV&1l.ir.rv'IV
It\( /01}f3 6A:nOl....'\tPI;: (Check all that apply for the new
Manufactured / ()~t\( ""i'l"'}; 1/~:a~
Trusses: y-y _N ~ O~S:;:;::~PACE 0 POST & _ BEAM _PIER
Sump Pump: ~y _N 0 S~ ~ASEMENT (WALKOUT:_Y~)
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit ~sNalid onlrifc~nstruction commences.with,in 180
days of the date of issuance of the building pennit, and must be completed (Certificate of Occupancy issuedjWitlUD.~18 mcinths'o( tlie~iss{iaiice~dite~Class I
110" IV. '\ "7.r" ,. \",. .\ . ] , ,
structure permits are subject to the General Adrrurustratlve Rules of the State of Indiana (See 675 lAC 12) reganting e?q)iratlOD time fram~sJor begmn,mg and
completmg constructIOn 111J~ \ I ~ l 11
I, the undersIgned, agree that any construction, reconstructIOn, enlargement, relocatIOn, or alteratIOn of a structurq,,Q{ Y change 10 the use of land or stf1:1~tur:~
requested by thiS applicatIOn will comply With, and conform to, all apphcable laws of the State of IndIana, and ther:Z:orpl Ord~W oijCwn~Wana -1993" ~Z~
289) and amendments, adopted under authOrity of I C 36,7 et seq, General Assembly of the State of IndIana, and aUIActls! enda'tbty thJrerO. I4Vtmer certify tHat only
II' JJ.1 I j t I
kitchen, bath, and floor drams are connected to the samtary sewer I further certify that the constructIOn will nPtlk-tE$ed or occupled until a Certifiaa.~f
Occupancy bem" byth artmentof~mmulll semce,.C;I. nd,ana \It..-) I I q.,'5-~'"
Signa
Do"
# Charged Re.
Reviews
,
Cert of Occupancy:
P.R.I.F.:
Additional Fees
Reviewed/Approved: Dept. of Community Services (Date)
S:Permits/Forms/ILP RESIDENTIAL
Date
Fee Received by: