HomeMy WebLinkAbout07030192 Application
City of Carmel/Clay Township permit#:010~Olq~
I
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:
NAME:
-\:l -ON
STREET ADDRESS:
-01
N
'l/\\ A. OM
PHONE:
::>'0- 81S -~t14-
FAX:
~ 17- 7\ ') - gb;l..f:::,
SUBDIVISION NAME:
CITY: STATE: ZIP:
INOl us. IN 4-b;;L~D
BEST MErnOD OF CONTACT:
'3,1/. 4<\0 -~54
PHONE:
:'\1.1":\
CITY:
FAX:
:, - 1\~ - &b.-~,f,
STATE: ZIP:
',(
ADDRESS OF CONSTRucrrON:
\0
lOT #:
C; IN
SECTION:
\'-.JESI
4-::<..
ZONING: C'~ ~.
Rw\DO~I,"L
SQUARE
FOOTAGE: L\-'4\-
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (For
Additions. Remodels. Etc.)
Early Release
Permit:
PROJECT INFORMATION:
y j N
y7N
S:Permits/Forms/ILP RESIDENTIAL
x
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDmON(S)
o DECK ADDITION(S)
o REMODEL
_ Basement Finish only
0/ ACCESSORY BUILDING
IlZf DETACHED GARAGE
o ATTACHED GARAGE
o DEMOUTION
Manufactured
Trusses:
Sump Pump:
~ /~
\,-.J
DOL\S,
SEWER unU1Y WATER unU1Y
PROVIDER: C \ o-J - ",J PROVIDER: c.,l(tJvtR liT, L T ( -;;
NAME OF unU1Y EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
Lot Split:
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) q 000
Nf'.,
TAX MAP PARCEl4" rs t7~~- )(,::;:-, n ~\. -;': ":'.:,::,:-'--:::.~-'.'1
. i!: \"\ l\~ \>'.0 tE'~ 1" Jj/ 0; ::';1 OJ . ,\'... :
\/_ I?:> - -, 2..~..Uo.. _'-" ..c! . <Or,: i,'
PLUMBING CONTRA&~R: ill i I]
NI~ II/lil MAR 282007 !d III
Plumber's Indiana Statie ui:rnse #: jl!:J I
Which plumbing code. wl ue ...Ii.J tu-the-conStI:w:tiun: J
o International Residential Code w/lndiana Amend~ents
o Uniform Plumbing Code w/Indiana Amendments '
FOUNDATION TYPE: (Check all that applV for thel new
construction area) I
o CRAWLSPACE 0 POST & BEAM I PIER
0' SLAB 0 BASEMENT (WALKOLIT:_y IN)
,
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid only if construction conunences wi~hin 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. ~lass 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
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 Cannel Indiana -1993" (Z~
289) and amendments, adopted under authority of l.c. 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 drams are connected to samtary sewer I further certify that the constructlOn will not be used or occupIed untd a Certificate of
Occupancy bas been ,,,ued by tbe Dep nt of Cornmurnty Se')es. cann~Indiana . . Ie
. .>j B. j. P'f1""fj-<r 3@~ 07
Signature of gent . rlnt { Da (
*********************************~~*******************
Filing Fees: /3 "{. ) U
Base Inspections: '/ .h' ,-)0
/At}
l SJ .0 v
# Charged Re.
Reviews
-~L
P.R.I.F.:
Cert. of Occupancy:
Si~
Fee Received by:
Additional Fees
~J
C/ 'Date