HomeMy WebLinkAbout06100189 Application
City of Carmel/Clay Township Permit #~
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
PHONE:
c.e> . 3/ 7
FAX:
(:SUr F$HoWSI<. Y
P
NAME:
BUILDER
OF
RECORD:
25" 9(. '17
C"fJ S"(/J. cJG 1101.)
A/Gj4,.f,J
STREET ADDRESS:
S 1!"1I"5r
ZIP:
CITY:
..:C Ad) ~ "~.$ .
STATE:
$IU
2:Z 1Ji> s.,
BEST METHOD OF CONTACT:
BUILDER'S EMAIL ADDRESS:Y,MCASi
L $" '2.'1 @ll "'.NIffT
PHONE:
3 / 7 - g:.u ~ 7/1',0
FAX:
NAME:
rDM + j.. Of/. I .c.u(C~S""Tfl"'"
PROPERTY
OWNER:
CITY:
ZIP:
'1c.oJ'L-
Z~lIfj~f'"
~~'i,:~'
SQUARE
FOOTAGE: 1 C. 0
STATE:
fllJ
STREET ADDRESS:
Cf(':J.9 ~y~t'JMO/Jr: /tJJ.
LOT #31
e.NI? JIf tr'-
~UBDIVISION NAME(hreerrlree 6/.tJ1itr
cr~
LOCATION
&. PROJECT
INFO:
ADDRESS OF CONSTRUCTlON:
9 (, '2.<1 :;, ycIH..""'tr ~/)
t! 4tl}.t lYL f/lj.
ESTIMATED COST OF CONSTRUcrrON:
(EXCLUDING LAND~AWE);'~-f. :.; /, r~()1.
,;l))(~~': i:
: <':
/
WATER UTILITY
PROVIDER: AJI1
SEWER UT1LfTY
PROVIDER: AI If
NAME OF UTILITY EXCAVATION CONTRACTOR; PlAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
'I! '\1
TAX MAP,PARCEL #: OCT
'1.1 II!
! I II'
! I "
I .'.,
PLUMBING CONTRACTOR:.
L
x LWt~ Iwfed
FLOOD ZONE AREA DESIGNATlON(S)
FOR THIS PROPERTY:
2 7 0(1"6
LUU
TYPE OF CONSTRU
SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
/ time:
)LJ RESIDENTIAL (For
Additions; Remodels. Etc.)
TYPE OF IMPROVEMENT:
o ..JiEW STRUCTURE
..z ROOM ADDITION(S)
o PORCH ADDmON(S)
o DECK ADDmONWi
o REM~~:~ment F. . ElEASECWl16fP)l@~'l'l!lfit;'trt'l'~fd to the construct;on:
o ACCESSORY BUI.rIO CO(!lJlIIi\llmlatWil'!!l~ld""t~l::"ode wfIndiana Amendments
o DETACHED GA~E of Slafe,ann 'nl lJUla ons
o ATTACHED GARIldEPT OF CO-U/lIfo\i\i'1"lliril_ Code wfInd;ana Amendments
o DEMOLITION CITY MMUn~[X,!:;FR\lIr.r=Q
OF CARMim!~~'(-TYPE'let\<!Ck all that apply for the new
Manufactured ,.< I~DIAI' ..e~WNSHIP
Trusses: _Y _N t!:jf'\:RAWLSPACE 0 POST& BEAM PIER
Sump Pump: _Y /N 'R SLAB 0 BASEMENT (WALKOUT:_Y=N )
Plumber's Indiana State License #:
PROJECT INFORMATION:
_Y~
_Y~N
Early Release
Permit:
Lot Split:
For Single Family and Two Family dwellings, additions. remodels, and/or accessory structures, this permit is valid only if construction conunences within 180
days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy issued) within 18 months of the issuance date. Class I
structure pennits are subject to the Gene;a" " at ,,' t' ,f?fiW~,~~t:e~(IfJn~~~ (See 675 lAC 12) regarding expiration time frames for beginni~g and
" . '. ,coll)pletII;1g.constructjon. '
I, the undersigned, agree that any construe L~~, " St llC t }arte~r\~. l, q'cafrb~ <eration of a structure, or any change in the use of land or structures
requested by this application will comply with~an con-ro~ to, all applicabl~wt oMJie ~.tl:~df Indiana, and the ~Zoning Ordinance of Cannel Indiana - 1993" (Z,
289) and amendments, adopted under authonty of I C 36~7 et seq, General Assembly of th.Of IndIana, and all Acts amendatory thereto I further certify that only
kitchen, bath, and floor drams are connected to the sanitary sewer I further certify thlA: !a:ructiM1 not ;1'gal.o7occqpIed until a Certificate of
Occupancy has Issue the Department of Community SeIVlces, Cannel, Ind,fi 'i se ca .~5- 63u for
..na...~:e'O'Au..ori k/p~'.J:/...-' ~"'e'pe~I~~,'tLE'" '-:'N~ /#,..
OFFICEUSEONLY:*********************************************************************************
INSPECTIONS REQUIRED: ~ Filing Fees: / S ;L" '70
r-:: -'. . ~ II ~Base Inspections: ;;2 ,;;22 00 # Charged Re-
0ppe, root"lg Lower Footing Under Slab 'J /C ReViews
~ Cert. of Occupancy: . ')3. ) 0
~I", Meter Base Final Site
// /' III .-/ P.R.I.F.: Additional Fees
W~ ~;!';J~~
Reviewed/Approved: Dept of Community Services (Date) /~ #~______f _
$:Permits/FormsjILP RESIDENTIAL Fee Received by: Date