HomeMy WebLinkAbout06110001 Application
City of Carmel/Clay Township Permit #: O~ 1/ (X){)/
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
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BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
& PROJECT
INFO:
NAME:
(A.tl()
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STREET ADDRESS:
C51 (j7
BUILDER'S EMAIL ADDRESS:
NAME: I Uti n
STREET ADDRESS:
LOT #:
SUBDIVISION NAME:
))
ADDRESS OF CQNSTRUCTlON:
i ,:?,1
SEWER lITllTTY,
PROVlDER: ~
WATER UTIlITY / J
PROVIDER: ~.
PHONE:
FAX: Sg,00?'/;;1..
ZIP:
LJ 6' ,1[2..
CITY:
!5sr; 0102.
fl},
STA):' JZ}
BEST METHOD OF CONTACT:
PHONE: FAX:
'-~ ';;;: /J..~~i':-:-;-[. ::/YJ) ZIP:
-"'.-::.z 6 1, ';ll(.~ --.,
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'il/ f;,
'06' IIMARr.
,iIFo6tAGE: f
! I III
11"-./ 'L
ESTIMATED COS1:..0F CONSTRUCTION::/' 3
(EXCLUDING LAND\7AW~ 0 0 00
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS: TAC DATE(S); AND/OR COUNTY WELL ANDIOR SEPTIC PERMIT #'S (IF APPLICABLE):
/
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERrY:
'TYPE OF CONSTRUcnON:
~ SINGLE FAMILY
I~ TOWN HOME
o TWO FAMILY
# of units being
constructed at this
~. time:
RESIDENTIAL (For
Additions. Remodels. Etc.)
PROJECT INFORMATION:
Early Release
Permit:
Lot Split:
_Y+N
_Y-l:-N
TYPE OF IMPROVEMENT:
o NEW 3[RUCTURE
~M ADDITION(S)
o PORCH ADDmON(S)
o DECK ADDmON(S)
~ML
./ _ ~_B:asement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATIACHED GARAGE
o DEMOLmDN
Manufactured
Trusses:
Sump Pump:
_Y~N
_yX-N
TAX MAP PARCEL #:
PLUMBING CONTRACTOR: ~ --z... 11 /J, J
-It Fe Nt OQ;J..'-j).. . Ir~
Plumber's Indiana State License #.
Which plumbing codes will be applied to the construction:
o Intemational ResIdential Code w/Indlana Amendments
o Uniform Plumbing Code wI Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
~ t&: CRAWLSPACE 0 POST & _ BEAM _PIER
SLAB 0 BASEMENT (WALKOUT:_Y_N )
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid only if construction commences within 180
days of the~a f i ijff the bUilD in permit, and must be completed (Certificate of Occupancy issued) within 18 months of the issuance date. Class I
structure pe '. at (lilt. les of the State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
completing construction.
I, the undersigne ,agree that any cons i, r C n ron, rgement, relocation, or alteration of a structure, or any change in the use of land or structures
requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the ~Zoning Ordinance of Cannel Indiana - 1993ft (Z~
289) and amendments, adopted underauchority of I.C. 36-7 et se*Gener: I Assembly of the State of Indiana, and all Acts amendatory thereto. I further certify that only
kitchen, bath, and floor drains are connected to the sa . arer. I furth . that the construction will not be used or occupied until a Certificate of
Occupan h' been issued by th De'partmen 0 0 ty Servie, eI ndiana. La /" n VI ), I () /;;LfJ' ~ t .
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Oale
**********************~~*~,*~~~?~****************
Filing Fees: .:A. 7 j'; /0.
'/ t C 5'0
/ S-3, .50
INSPECTIONS REQUIRED:
U~~Lower Footing Under Slab
01fugh ~ Meter Base ~ 9
Base Inspections:
# Charged Re-
Reviews
P.R.I.F,:
Cert. of Occupancy:
Addi"onal Fees
S:Permlts/Form5{IlP RESIDENTIAL
-Cl-06
(Dale)
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