HomeMy WebLinkAbout06110121 Application
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\
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
& PROJECT
INFO:
City of Carmel/Clay Township Permit #:~I
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
NAME:
FAX:
(31
q
STATE:
T
ZIP:
'/, :17 fl
BEST METHOD OF CONTACT:
PHONE:
FAX:
CITY:
C
STATE:
I
5
ZIP:
i.f,
S
SECTION:
ZONING:
SQUARE
FOOTAGE:
50
ESTIMATED COST OF CONSTj/!mON:
(EXCLUDING LAND VALUE) 'If JOrr5 000.00
SEWER LmLlTY WATER LmLlTY
PROVIDER: PROVIDER: C.
NAME OF LmLlTY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE F CONSTRU N:
SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions, Remodels. Etc.)
PROJECT INFORMATION:
For Single Famil~[mAS~i , t s rem .~r accessory structures, this permit is valid only if construction commences 'Within 180
days of the date . - - - th9~rlHlt ijg.Q :~WIpreted (Certificate of Occupancy issued) within 18 months of the issuance date. Class I
structure pennits ~ec~&~d !troW~"ules of the St,ate of Indian~ (See 675 lAC 12) regarding expiration time frames for beginning and
l'I..II"l"V ~r::RV1G1SetlDgconstructwn.
I, the UnderSigned,~'tQ.fi:~M,\ftt:'8Mtr'uCb'o'!r. ell!1WAi~lHlocation, or alteration of a structure, or any change in the use of land or structures
requested by thIS~: . a iifl\~ . ,ap~Wn TdJlVVIJ~i;:tI5Nra.ws of the State of Indiana, and the ~Zoning Ordinance of Carmel Indiana - 199J" (Z-
289) .?-!ld amendrrb o~ e a hI. 6~7 et seq, General Assembly of the State of Indiana. and all Acts amendatory thereto. I further certify that only
kitchen~ bath, and floor drains are connec ry sewer. I further certify that the construction will not be used or occupied until a Certificate of
o upancyhas been issued by the Department of Conununity Services, Cannel, Indiana.
\ . 11' - '. j.,)ft"\ A. B;R~~l\\fT-}.jf)JI;Nt. 1//J.~DIn
Signature of Ownel' or AlIthorized A t Print Date
~FFICEUSEONLY:******************************~~*************************************************
INSPECTIONS REQUIRED: FIling Fees: Q? rf. ~O
. . Base Inspections: .') 7'? \ V # Charged Re-
, U per Footm ower Footmg Under Slab ~. -, /. ReViews
\ . Cert. of Occupancy: 6 ~- U
-1~~ ~ P.R~I.F': ;;2 G /_ '{)() Additional Fees
\\ ~-- TOTAL~ (t02flc 1tJ
, Depl. of Community Services _ ~ V.AVJ " -
.1ESIDENTIAL ' It 0
Fee Received by: ~ ate
Early Release
Permit:
Lot Split:
_V-*
_V --L.N
TYPE OF IMPROVEMENT:
~EW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDmON(S)
o DECK ADDmON(S)
o REMODEL
_ Basement Finish only
o ACCESSORY BUILOING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
Manufactured
Trusses:
Sump Pump:
~_N
IV_N
TAX MAP PARCEL if:
1.1 i
,:1
. i J
il"j
, .
PLUMBING CONTRACTOR:'
, - C:. '. !
F/u.l.l ~. "MI TH L~____...."_"
Plumber's Indiana State License #:
I
--_.."----~--j
H __._________nj -
101177
Wh~'umbing codes will be applied to the construction:
~ International Residential Code w/lndiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPA<7 0 POST & BEAM ~~R
o SLAB r2' BASEMENT (WALKOUT:_VLN )