HomeMy WebLinkAbout06100103 Application
City of Cannell Clay Township Permit #: fJre f 001123
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of
RECORD:
FAX
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ZIP
~
STATE
&l
ctfYl Bm~\~NTACT
PROPERTY
OWNER:
<&\ i':'101 Y
ZIP
Co~
STATE
\...04
LOCATION
& PROJECT
INFO:
ZONING:
-S
SQUARE
FOOTAGEc93
SEWER UTI
PROVIDER:
c,qo
()olo7
NAME OF lITllfTY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
TYPE OF CONSTRUCTION:.....A. TYPE OF IMPROVEMENT:
o SINGLE FAMILY '2 "~~ 'M NEW STRUCTURE
..:a TOWN HOME J 6 ROOM ADDITION(S)
(J' TWO FAMILY ~\ 0 PORCH ADDITION(S)
# of units: 0 REMODEL
o MULTI-FAMILY 0 ACCESSORY BUILDING Which plumbing codes will be applied to the const,ucOon:
O R#ESoIDf UENnits: ( 0 DETACHED GARAGE 0 Intemational Residential Code wi Indiana Amendments
TIAL For 0 ATTACHED GARAGE ~-'1n
Additions, Remodels, Etc.) 0 DEMOLITION RELEASE~~_~~~~~_diana Amendments
PROJECT INFORMATION: Subjoct '0 complianc8 vI, 'th all ~!!.l.l.ulations
E I R I Manufactured i of Stf;OUNDAnQN-g~: (Check all that apply for the new
P:~~it:e ease _Y" N Trusses: ~;r~'"ij- OF ~JtJ!~m1~M"~)SERVICES
+ "rrv ,-, C' r' \ - GJ ,;<i~WI.sgA~5- ~Q RQST & BEAM
lot Split: _Y'1-N Sump Pump: ... _1'1',-' 'J"~"""$4\fl;l:.i-1:'11 WI~H\!A.SEMENT
Does any part of the property lie within a special Flood designation~i-'.r\J~i\ N WALKOUT:_y'.~N_1
For Single Family and Two Family dwellings. additions. remodels. and/or accessory structures, this perm!t;.JsYali~tonJ'~trp,ctio" d?&~~ni~\
within 180 days of the date of issuance of the building permit, and must be completed (Certificate ofOccupan.cy:iSsJcdrwithin'l8.ri{onths~of\~h6 \~
issuance date. Class I structure permits are subject to the General Administrative Rules of the State of Indiana \(SI'=C 67S"IAC.12) regarding cxptrati1' 0'
time frames for beginning and completing construction. \ \ \)1 \ \ \ WJ\
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a srrucrJrcronahY ch~n tfteijkse~fUB.d or\ \
structures requested by this application \\ill comply WIth, and conform to, all applicable laws of the State of lndiahh\ ahB\the ~E'Mtng 6rdInance of carri. V
Indiana - 1993'" (Z~ 289) and amendments, adopted under authority of l.c. 36~7 ct scq, General Assembly of the Sta~b pflf~~iana, and all Acts a~
thereto. I further certify that only kirchen, barh, and floor drains are connected to the sanitary se\ver. I further ce~~ify that.tAc.eon:srfiictTOi1will not be J
use . cu ie~ Cercjfjca 0 Dc pancy,h been issue, ~p~lr servicesl..mel, Indiana~
Signature of Owner or Authorized Agent Print Date
PLUMBING CONTRACTOR:
~~Q ~ ~~
Plumber's Indiana State L ense #:
,~
OFFICE USE ONLY: *********************************************,**************************
Filing Fees: .b Jo:<, b 0
INSPECTIONS REQUIR . ..,...., 7. ~O
Base Inspections: r-./ / ~
~., ----0
Cert, of Occupancy: --5 ...> . 0
P,R.I.F.: /,;z (;./O()
!1u TOTAL: ff ,;J;J-
Fee Rece,:ed bvi a 11 Jd.dr J
# Charged Re-
Reviews
Additional Fees
(Date)
/;r:Co
/~/.:20/0h