HomeMy WebLinkAbout07010128 Application
City of Carmel/Clay Township Permit #:0'10/ ()/~ (
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
SEWER UTILITY
PROVIDER:
NAMJ;;...
Jo
PHONE:
<5';t'J:.{'/J-S-
FAX:
f7'<f=R/o.3
t1)
STREET ADDRESS:
IIvt'
STATE:
~
L
ZIP:
1/ 6";//cP
BUILDER'S EMAIl ADDRESS:
10il
STREET ADDRESS:
~cJ() E
If..
STATE:
LOT#:
SUBDIVISION NAME:
SEmON:
ZONING:
. sQliARE;:---
FOOTAGE:,' ~c?I"
'..-,:;/;(J\l,
, 'I --...... ,/" I
ESTIMATED COST OF CONSTRUcnON: '-,~.:,
(EXCLUDING LAND VALUE)' u'4;1( <;
I . Ii,
NAME OF UTILITY EXCAVATION COl'lTRAcrOR; PlAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); ANDIOR COUNTY WELL ANDIOR SEPTIC PERMIT #'S (IF APPUCABLE):
....,....
2007 /1/ j
I/i /,"
"'"----J f.S//
/
~
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT:
o SINGLE FAMILY 0 NEW SJ\RUCTURE
o TOWN HOME 0 !,!.Q09'A'DDITION(S)
o TWO FAMILY , ""le\.:I>o~~",",DmON(S)
# of umts beIng , ,c, cr .DECK ADDITION(S)
constructed at this", r,C .." G '~REMO~t'O.
, 0"'- '(\' A"O' ~
time: :( \' e~::" ~(\,,}\',.o _.8 1'f1.~nishonly
o RESIDEN~~ ,,(;(\C, .(:::~ ij' cACCESSQl!1'llOILDING
Additi9'l~o~\Ev.;.I\ "': ,~,;O 'DET~CHED GARAGE
f],'C-":eC\\O c..~\e '" ,d\')" Q'JATTACHED GARAGE
P:o~ ~ 0' ,,,,' (Ib-'
PROJErnl\iFOR~ii\^~! r\\' \.- \ ~p.. DEMOLmON
<>-<;~N '{'\,r>-\~
Early Release<;:;,\' G Cr " \\~V Manufactured
Permit: ~ Ny _N Trusses:
Lot Split: C\ _ Y _N Sump Pump:
_Y_N
_Y_N
TAX MAP PARCEL #:
PLUMBING CONTRACTOR:
Plumber's Indiana State License #:
Which plumbing codes will be applied to the construction:
o International Residential Code wI Indiana Amendments
o
Uniform Plumbing Code wI Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPACE 0 POST & BEAM _PIER
o SLAB .Ii;[ BASEMENT (WALKOUT:_Y_N )
For Single Family and Two Family dweUings, additions, remodels. and/or accessory structures, this pennit is valid only if construction commences within 180
days of the date of issuance of the building pennit, and must be completed (Certificate of Occupancy issued) within 18 months of the issuance date. Class I
structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
completing construction.
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 Carmel Indiana - 1993" (Z'
289) and amendments, adopted under authority of I.c. 36,7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I funber 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
Occuf;lJ1cyhas been issued by the Department of Community Services, Cannel, Indiana.
(/,<0'5<' 11!~.......- 0116(" ThtJM/J>tW
SJgnature.ot Owner or thorized Agent Print I
IkU)(c1 IrJwl?M<
IA/n
Date '
OFFICE USE ONLY: ***************** ****** ****** *********************************~*** ***************
INSPECTIONS REQUIRED: Filing Fees: !}}, "~O
U F t' L F t' Und(;)r b Base Inspections: --
pper 00 Ing ower 00 Ing
Cert of Occupan
Rough In Meter Base Final Site
P,RJ,F,:
Fee Received by:
# Charged Re-
Reviews
Additional Fees
, tYD
Date