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AFFIDA VIT
To be signed by Property Owner(s) and Newly Assigned Conlractor
DATE: MDv. 1 Joor;, . BuildingPennitNumber: 0500nl31
Notice is hereby given that AI/eN e..( <<OM e5
Previous ContractOr'~ NBml!
above-referenced project and permit number, in whose name was issued for a
to be built at /3;) (p ff fA. If..! 1< I AN [ {J(s-h~'d J '( u 01 Y .
Addresi af Constructkm
As of IV {)I/. {) ;(m r:: , responsibility for the completion of this project was/will be assumed by
f/ D.,. 'I ~
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New COl\tf"Bctor'" Name
inspections will be performed and that the project will comply with, and conform to, the Building Codes and Zoning
Ordinances ofCarmellC]ay Township - ]980, adopted under the authority of Acts of ]979, Public Law 178 Sec. lot seq,
General Assembly of the State of Indiana, and all Acts amendatory thereto.
I
'{ e + I-b #e=-~ ?:JJ}j C . ~ifies that the construction will not be used Or occupied until a Certificate of
Occupancy (C/O) by the Department of Community Services, Cannel, Indiana.
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Permit Issue Date: 09 /::< q / doO S-
is no longer the responsible party for the
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, who hereby certifies by this Affida\~t that any remaining building
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STATE OF INDIANA )
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County of I 'NY (l1lh1le )
Before me, the undersigned, a Notary Public for ~County, State of Indiana, personally appeared
- I1tl(rl2P W1, and acknowi~J;Jd the execution of the foregoing instrument this ~ day of
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IMAI G. KAPPES
Tippecanoe County
My Commission Expires
July 17. 2014
(Print)
SEE REVERSE FOR NEWLY ASSIGNED CONTRACTOR INFORMATION & SIGNATURE...
Contractor's Name (Assuming responsibility for project)
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STATE OF INDIANA )
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Before me, the undersigned, a Notary Public for ---=rIwrllJ1()(, County, State of Indiana, personally
appeared ,,\n.AAtl V~ t'\ eO , and acknowledged the execution of the foregoing instrument
this ~ day of ~O\ff,~ ,20 11kz-,
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IMRI G, KAPPES
Tippecanoe County
My COmmission Expires
July 17, 2014
R~v. Oct 2003
S:PcrmiWAffidavitslNew E1uilder Affidavit
CITY OF CARMEL / CLAY TOWNSHIP
IMPROVEMENT LOCA nON PERMIT APPLICA nON
For: Residential New Stmcrurcs, Addicions, Remodels, & Accessory Buildings
Permit#: 05090131
Date: 09/29/2005
PARCEL ID #: ZBEW34
LOT & SUBDIVISION: 34 BELLEWOOD
ADDRESS OF CONSTRUCTION: 13268 MINK LN WESTFIELD, IN 46074
Township?: 18 Zoning: S1/ESTATE Flood Zone: N
PROPERTY OWNER INFORMATION:
Name: AVENEL HOMES, INC
Ph. #: 3172514100 Fax #: 3175955909
Street Address: 3820 E 79TH ST INDIANAPOLIS, IN 46240
CONTRACTOR INFORMATION:
Name: GREAT HOMES, INC
Ph. #: (765) 449-8040 Fax #: (765) 449-7565 EmaiJ:
Street Address: 1300-2 PROFESSIONAL COURT LAFAYETTE, IN 47905
Plumber's Name: KINGMA, MICHAEL T
Codes for Project: IRC
SnAdal Nntes/r.nnditinn~:
LOT 34 BELLEWOOD. SINGLE FAMILY. "11/16/2006:
CHANGE OF BUILDER. SEE NOTEPAD." As of November 5, 2006, responsibility
for the completion of this project was
assumed by Great Homes, Inc. Avenel
Homes, Inc. is no longer the builder.
Likewise, Michael Shahan is no longer
the plumber; Michael T Kingma is.
Lot Split: N
PERMIT TYPE: RESSINGLE ;
RESIDENTIAL SINGLE FAMILY
DWEL
Water Service by: CARMEL
County Well Permit #:
Sewer Service by: CTRWD
County Septic Permit #:
Foundation Type: BSTSLBCRL
Estimated Cost of Construction: $400000
Manufactured Trusses: N
Sump Pump: Y
Porch: Y
Deck:
Square Footage: 7368
Early Release ILP: N
Model Home:
This permit is valid only if construction commences within one (I) year of the date of issuance of the State Commercial Design Release. All construction
must be completed (C/O issued) vvithin two (2) years of the issuance date.
I, the undersigned, agree that any construction, reconstruction, enlargement, 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 - 1993~
(Z-289) and amendments, adopted under authority of l.c. 36-7 et seq, Gener.!l Assembly of the State of Indiana, and a]] Acts amendatory thereto. I further certify
that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a
Certificate of Occupancy has been issued by the Department of Community Services, Cannel, Indiana.
APPLICANT NAME: DAVID S.
FEES:
RES RE-INSPECTION
RES ELECTRICAUMETERB.
RES FINAL 53.50
RES FOOTING & UNDRSLB
2ND REQ'D FOOT/UNDSLAB
RES ROUGH-IN
PARK & REC. IMPACT FEE
KLAIN
55.50
53.50
53.50
53.50
53.50
1261.00
RESIDENTIAL C/O 51.50
SINGLE FAMILY DWELLING 1111.80