HomeMy WebLinkAbout07030083 Application
City of Carmel/Clay Township Permit #: 070?Joo"33
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:
R
WATER UTILITY
PROVIDER: C
,
(I:\';<gs~~,
TAX MAP PARCEL #: ~~ <~)'/ ~ \;\J)
~ ({.~? // (\J'\:\ '\"
TY~:;:::u:~::NT: Pt:~I~~ ~ON~;~~~:~/ /' /
o ROOM ADDITION(S) Plumber's Indiana State Lie ' : /- //
o ~~mON(S) W,".."..\ / /'
o D ~~OR 10/777 "..,,\"..\,\/ ,
o R~\\l,fllOOel'iam~~I~ &ilitjlgl~,~~es will be .PP~~ to the ~s6uction:
o AQ:;l;SSORlf~ij\lr., L h~ 1llfi'~"""'1 Residential co}e w/lndiana Amendments
o lMllem~ rtl Deal Cfo,d _._~ v
O'~ JO.l\r.o~lMUNIT'y'--s'f'~Iform Plumbing Code w/Indiana Amendments
o D~MoI:ffi:6/lI'",RMEL / CLA Y ~~~q~N TYPE: (Check all that apply for the new
Manufactured /INDIANA ~
Trusses: ~Y_N 0 CRAWLSPAC} 0 POST& BEAM _IYR
Sump Pump: V\ _N 0 SLAB r5 BASEMENT (WAlKOUT:_Y -;./' N )
PHON:
3 7 347-
FAX:
CITY:
INb' s
STATE:
IN
ZIP:
4
go
BEST METHOD OF CONTACT:
PHONE:
-QIS3
CITY: STATE:
CA E: IN
SECTlON:
3
FAX:
. ZIP:
ZONING:
SQUARE
FCoTAGE:
ESTIMATED COST OF cONsR.urnON:
(EXCLUDING LAND VALUE)'ll '
NAME OF lJTILTTY EXCAVATION CONTRAcrOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT "S (IF APPUCABLE):
FLOOD ZONE AREA DESIGNATlON{S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
(](" SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc.)
PROJECT INFORMATION:
Early Release
Permit:
lot Split:
_ Y L"'I}-
_Y1N
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid only if construction commences wit~ 180
days of the date of issuance of the building permit, 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 r.c. 36,7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I further certify th~t 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 I
Occupancyhas been issued by the Department of Conununity Services, Carmel, Indiana. I
. : B' . lo~, A. B',RbSnN(,-- JiE),\];Iolf' 3112/07 '
Print Date
OFFICEUSEONLY:*********************************************************************************
INSPECTIONS REQUIRED: Filing Fees: . e:r / ~~
rU F~t' F t' U d SI b Base Inspections: c;2'1 '7 -> # Charged Re-
L~per ~~ ower 00 9 " er a ,.....;) ReViews
. Cert. of Occupancy: ~3 <> (/
(Ro~
lLJ~
Final
P.R.I.F.:
Reviewed/Approved: Dept. of Community Services (Date)
S:Permlts/FormS/ILP RESIDENTIAL
Additional Fees
i
Date I