HomeMy WebLinkAbout07020127 Application
,
,
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
& PROJECT
INFO:
SEWER UTIlITY
PROVIDER: 1
City of Carmell Clay Township Permit #:0'1 ~ 2- f{ J ZJ7
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICA'FION
,
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
I
&S
FAX: '
575'-J'Q6V
r!-horYl
PHONE:
575,)350 'f..JfX:J
rr5~DDEss: MEI8D ~.s;r :AU06L
D () BEST METHOD OF CONTACT:
. S "5 i-lfJ2JJ ~ ,LLLTG. Q.OA.-I e/vi
NAMPGGGTE /-t01vl ~
STREET ADDRESS:
-SAMe:-
SUBDIVISION NAME:
t-\ t
ADr~015STRSm~LMON Dk.
STjTEfJ
i
PHONE:
FAX:
cm:
STATE:
ZIP:
LOT #:
SECTION4
ZONING:
S <:L
t./-{y{J1
SQUARE
FOOTAGE:
033
WATER UTIUTY
PROVIDER: 'I
A -1- .sLLPf;/2-l,O~ =P"' 0.1 t):J-D I
TAX MAP PARCEL #:
-/0--2-2 D-25-03 0
PLUMBING CONTRACTOR:
H1\1vL M c1-- ~3- ,
Plumber's Indiana State License #:
(' ~Pi-OOOO I 0 (
NAME OF UTIlITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNlY WELL AND/OR SEPTIC PERMIT #'S (IF APPUCABUE):
TYPE OF CONSTRU
cY"5INGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels, Etc.)
FOUNDATION TYPE: (Check all that apply for the new
construction area) UN pi N Ls HW FULL
o CRAWLSPACE 0 POST & BEAM _PIER
o SLAB Id""8AS~~~~T,~WbLKOtn;::--7:-Y------iN)
, i ..-. '-,:........ ,_;.,~. ;.' ',}. I
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid o'nlY,llco-iistnlctioncommences w:ii::hiri I~O
days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy issued) wi~hin-18 ~onths of the issuance date. C1Fs ~ :.
structure pennits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regardipgexpi!atioll time frames for beginninglan~')
RELEA~E6'Jd.<;rim,ef"'l"ffiH~"l'~II("TII"\ Iii ii! rES 222007 .. Iii
I, the undersi~ed, ag.ree ,that a,ny construc~ion, reconst:WS9pn, enla'rgemedt, ~ah6~~[iI<tRehftlOrl ~ a ~l'ttre, or ~~~ c~~ge in the use of land, or strucru:eS .) / !
requested by thIS applIcatIOn wIll comply wIth, and col'fR:lnhJl@,ca11vrpw..n:;lt)liW516alW$Hit,mf ~Lathd* "Zompg Oid1D~nct;.,9.f.f~r:Ee.1 ~!.:d~~~ 1,993 j(Z':J I
289) and amendments, adopted under authority of I.C 36~7 et seq,~&rn1t6s~ltttf~lai~.dlana, and all Acts amendatory thereto. I furtHer certify that onlYl
kitchen, bath, and floo.r drains are connected to the sanPrl.rt9:r=rri ~fI.-he~~~~~ th.~ tk ;:qq~"q9J1." ~l.not be ~~~~~~~_~~ a Certificate of J
Occupancyhas beenred by the Department 01 CljfbF~2l"" dYin~i.4h\li~ ~~ . ~'r;O /01
/S;g.. .fOwne,.,A"th' edAgent ~A ~
FLOOD ZONE AREA D
FOR THIS PROPE
x (W1sh.cu9~
ON:
TYPE OF IMPROVEMENT:
~NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDmON(S)
o DECK ADDmON(S)
o REMODEL
Basement Finish only
o ACCESSORY BUIL!>'''-- '\
o DETACHED GARA' .
o ATTACHED GARA' ..' ,
o DEMOLITION
Which plumbing codes will be applied to the construction:
0'lntemational Residential Code wi Indiana Amendments
o Uniform Plumbing Code wi Indiana Amendments
I Nt.;
Early Release
Permit:
PROJECT INFORMATION:
Manufactured
Trusses:
", /
"'''"",~_./'
~Y_N
LY_N
Lot Split:
y/N
y/N'
Sump Pump:
OFFICE USE ONLY: * * * * * * * * * * * * * ** *** * * * * * ** * * * * * ~ ~* * ** * ** * * * * * * * * * * * * * 7f *1,.,. ,f*fJ{;I* * * * * *** * *** * ** * *
SPECTIONS REQUIRED: Filing Fees: J:+--
Upper ooting Lower Footin Slab Base Inspections: ~~ ~ 0
Cert. of Occupancy: .
# Charged Re-
ReViews
I
I
Additional Fees
~7f /d
Site
Date
Reviewed/Approved: Dept. of Community Services (Date)
S:Permits/Forms/ILP RESIDENTIAL
Fee Received by: