HomeMy WebLinkAbout07030039 Application
City of Carmel/Clay Township Permit #{J?03 eN 3 y
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:
NA~J'<." ~6"
STREET ADDRESS:
/ .s:
PHO . ~~ (0,",
;x.1"/:,-e~ 30-2...8/-5'-SO,\,\ G-re
lVohf~~l~' , :::r::"X7?
P..i+o"
. 0 '"
ZIP:
6o~O
BEST METHOD OF CONTACT:
BUILDER'S EMAIl ADDRESS:
NAME: ~
lJor\'VL"'^ Lr~'^"
STREET ADDRESS: "
/0 10 CenT"<<
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
LOT#:
rl
PHONE:
FAX:
ZIP:
l/(p 2-80
ve.
SUBDIVISION NAME:
SECTION:
ZONING:
. /lHj,~i1'j;'-
'"
ADDRESS OF CO~UcnpN: (
/t>/ Jo Le"'TvA
TYPE OF CONSTRUCTION:
~ SINGLE FAMILY
To TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
~ RESIDENTIAL(For
I Additions. Remodels. Etc.)
A.ve.
~~
SQUARE 17 110'
FOOTAGE: a U
oe>
, fOO.
;;;
ESTIMATED COST,OFCONSTRUcnON:
(EXCLUDING LAND VALUE)
:11 :,'
,I
, ,
NAME OF lJTllTTY VA CONTRACTOR; PLAN COMMISSION I BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
o NEW STRUCTURE
o ROOM ADDITION(S) Plumber's Indiana State Licen
~ ~~~~=~~\S~OR CONSTRUCTION
P' REre:mli~ct to "oFnpliance wiWhil:i\ f/illilIHliI!iQblli.s will be applied to the con....uction:
_ Basem;!~, "!!~!! !l!1I~ Loca~~rJps
o AC~!jSR.a.Y t.bV,lG ' U"ln~emational Residential Code w/Indiana Amendments
o DE~D 'GEJrv1~IiUt~I-~ ~~B.YJCE~,_ .
o Arm:v~F~MEL / CLR{Cfl>wl{~lP,g Code wI Indiana Amendments
o D~OL'rrY'ON
PROJECT INFORMATION: INDIANA FOUNDATION TYPE: (Check all that apply for the new
Early Release Manufactured construction are~)-,
Permit: _Y _N Trusses: _Y ~N 0 CRAWL5~"Gn POST& BEAM PIER
Lot Split: _Y _N Sump Pump: j4-Y _N J:J.,:i,"~ .. BASEMENT(WALKOLlT;_Y \<?N)
For Single Family and Two Family dwellings, additions, remodels, andJor accessory stru~tur~s, ilit~.~t is valid only if construction commences within 180
days of the da~e of issu~ce of the building pe~t: and ~ust be completed (Certifi~~te~.Of,pC 'tQ;a~Y-i-~;ued) ~thin 18 ~o~ths .of the issuance da~e. ~lass I
structure pemuts are subject to the General Admmlstratlve Rules of the State of I~d13.ll \ 75 lAC 12) regardmg eXpiratIOn trme frames for begmmng and
completing G ". "'~,~ .
I, the undersigned, agree that any construction, reconstruction, enlargement, re 'T~ ,'l~eration of a structure, or any change in the use of land or structures
requested by this application will comply with, and c5mformto;allapplicable la .~,State of Indiana, and the ~Zoning Ordinance of Carmel Indiana - 1993" (Z'
289) and amendments, adopted under author~ty,of Cc. 36-7 et seq, General Assetpb f the State of Indiana, and all 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
Geeu eyhas been i ed b t e Dep~tmen;t 1mmuru; S;T:' :t:l.~n;:: ~" ~ ~ 1-~- 0 7
Pnnt \j Date
/'
TAX MAP'PARCEL,#:,
TYPE OF IMPROVEMENT:
PLUMBING CONTRACTOR:
(XV;;
/' " ~_.-
OFFICE USE ONLY: *****************************~******~*********************S*c:)******~********
INSPECTIONS REQUIRED: FIling Fees. /? 3. ~~jL,
Base Inspections: / / / CIO # C arged Re-
ReViews
-,>3 :)0 ..$/0780
P.R.I.F.: Additional Fees
~LD).JO
Upper Footing Lower Footing
~~ Meter Base
cuL:-
Under Slab
Cert. of Occupancy:
Final --siI
Reviewed/Approved: Dept. of Community Services
S;Pennits!Forms!ILP RESIDENTIAL
(Date)
Fee Received by:
Date