HomeMy WebLinkAbout07030065 Receipts/Permits
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City of Carmel/Clay Township J~ ~ 7- R ' Permit #: O?r2 '1 O{)~
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Hor€erteX'H~: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER
OF
RECORD:
NAME:
STREET ADDRESS:
PHONE:
FAX:
Indianapolis, IN 46250
ell!:
STATE:
ZIP:
PROPERTY
OWNER:
NAME:
STREET ADDRESS:
.MC!JJ)1:P:
PHONE:
FAX:
CITY:
STATE:
ZIP:
ZONING:
LOCATION
&. PROJECT
INFO: ADOJ;5c~crN:
SEWER UTILITYIh r ~ _ n J WATER UTILITY /j f) / r-.~ A J
PROVIDER: Lll/LI r Lf-.L PROVIDER: L[,LV I Lf-f.-
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNlY WELL AND/OR SEPTIC PERMIT ,'5 (IF APPUCABLE):
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
-6i--T0WN HOME
.-6 TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL(For
Additions. Remodels. Etc.)
PROJECT INFORMATION:
_V /., N
_v--4N
Early Release
Permit:
Lot Split:
TYPE OF IMPROVEMENT:
~EW STRUCTURE
../D ROOM ADDITION(S) Plum er's Indiana State License #:
o PORCH ADDmON(S) / 'y) LV)/.) .c:;-r.
g ~~~~'WA~~ FOR CON~{~~V /. .
_51tiiljtil'ehtl'rrililliiilh1V'ce VI\YI1'~IP/~l!imtillKlfll WIll be applied to the constructIon:
o ACCESSORY l!J:Il!;ofl\lGJnd L~tetnational Residential Code w/Indiana Amendments
o DET4C;IIIiQ,GI'RAt::Eo "A' 'N"""( <'CCQ\J'('t:<:!.
o ATrAeHff> GARia1! . ~lll'JiU I LlJ U~~f~rmPk1n'ftflp Code w/Indiana Amendments
o D~@f UJli'llEL/ACN'lffbJM>W8~hpE: (Check all that apply for the new
M uf ct d ~ INDI nconstruction area)
an a ure
Trusses: _ _N 0 CRAWLSPACE 0 PCST &
_V~N
BEAM _PIER
Sump Pump:
o BASEMENT (WALKOUT:_V_N)
)lHLAB
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid only if construction commences within 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.
1, 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 -1993n (Z~
289) and amendments, adopted under authority of LC 36~7 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 connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of
Oc pancyhas been i"ued b ,the DeBarment of Corrunmrity se~j;;i:;;;:J;;AJ I-/-zJJ mw j -5-/ 7
Sign re of ner or thorized A ent Print Date
OFFICEUSEONLY:*********************************************************************************
ANSPECTIONS REQUIRED: Filing Fees: (fl & :3 ,50
Upper Fo . g Lower Footing ~ Base Inspections: ;;< II ~ # C~:~~ee:;s Re.
~ Cert, of Occupancy: '
inal Site L ') H . () ()
P,R.I.F,: ~~ / < _ Additional Fees
TOTAL: -It /.5;),,/, &0
I
Reviewed/Approved: Dept. of Community Services (Date)
S:Permits!FormS/ILP RESIDENTIAL
Fee Received by:
Date