HomeMy WebLinkAbout07040030 Application
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City of Carmel/Clay Township Permit #:11l1i::lOO3tL
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER
OF
RECORD:
NAME:, _
'~712J?:, iBL I f-.A\J' I1P''; "
STREET ADDRESS: /) . . /7 /J
4/1 ;J. KL.iN ,_ Ly1-e. Kc~
PHONE:
FAX'
317-2;'/ 8-:5'18L/ .
CITY:
(d-rrrtc.!
STATE:
YI")
3' 17-- 'iYf',-3,/o
ZIP: -
~&03'L
BUILDER'S EMAIL ADDRESS:
'. cerb 1(-"...(
. . BEST METHOD OF CONTACT: .
([j;) U'rh,~,,+r",(.e'*,Di'\,"s', Ulyv-.. e ;1-Vi.'.J:)
PROPERTY
OWNER:
NAME:
-r; /\-........ i, L~'--rt,
(2.( c.iA.a-, (Q "
PHONE: FAX:
31/- S~, ')-- IS/',/-
STREET ADDRESS:
3S-.5' l)lr-h"'-OL.tt1" .s-\
.l CITY:
-j;: "5~Lj C,c,n'-'L-\
STATE:
IN
ZIP:
CJ .~ 7--.
LOCATION
& PROJECT
INFO:
, A)~ . '4"~ So (re~.t-tc
ADDRESS OF CONSTRUCTION: ~. i........ . ,':"~"-.?!
+63::; \ or ",,-"S, C\~.eL '{",~'~l~:'
SEWER UTILITY., , ' WATER UTILITY /....~,..\~~':\ I36I1MATED ,cO . Ft CONSTRUCTIOr;J.:
PROVIDER, Ctlmr,p' L{.!-; >h es PROVIDER C,M'r;U;.tl Ctfi~ ,,\t;V>.ls. (EXCLn .. 'ALUE) J/43r-J COO
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION (,BZAi~PW~DOcKET \\\ \ \\..,-- <- -'. - .. :;t 0 Dl.j-oo:2-'1
NUMBERS; TAC DATE(S); AND/OR COUNTY WE~:_ A~~/O,R_,~~P~y!:~t1IT"#'S (IF APPLICABL\~\ \ \v Oc.. ..) j rz-,. h><..C,cc \/c..Ji ~
FLOOD ZONE AREA DESIGNATION(S) \,\-,,\ '::::''- 1'\\'\1 \ \ \) ) TAX MAP PARCEL #:
.,/ \"'.\ \\\\ ~ I) ~,. I\:/
FOR THIS PROPERTY, ^ \.", ~\ (1-iO-2-I-ly).-).I-cOI.OOO
,\ ,\ \' ~ \
TYPE OF..lMPR VEMENTy PLUMBING CONTRACTOR:
III III /~ --;:;;- I l "I 6'
fI;~~RE '/----- Se-Y'\l-l- ,,',- I U/Y\ , ~"
. D'OO.GONS ana State License #:
o 0 K J~be with all r atl ,,\5. 05"'
[SJ...JW b'E~Me'i}nb Local CO"~ ;1
f t;J~ Ba$~ffit1! I ~ wt\fh, plumbing Tdes WIll be applied to the constructIon:
~JSSSOR,YrBVIJJ?iN"~' TY ~FlMIC&Snal Residential Code w Ilndiana Amendments
"'fJ'bETActlEDVGA\iA~ / CLAY ;L""'>il1l\""III",' .
o ATTACHED GA~JAl f ~UMfb1HI1Il~blng Code wjlndlana Amendments
o DEMOLmON N;r\
LOT #:
SUBDIVISION NAME:
SECTION:
ZONING:
I
$-1
SQUARE ., I r
FOOTAGE' .::..1 (;,':,) \.
TYPE OF CONSTRUCTION:
)YJ.
o
o
SINGLE fAMILY
TOWN HOME
TWO fAMILY
# of units being
constructed at this
time:
o RESIDENTIAL (for
Additions. Remodels. Etc.)
:I f'''-
Lot Split:
_v XN
_V )( N
Manufactured
Trusses:
Sump Pump:
FOUNDATION TYPE: (Check all that apply for the ner'
construction area)
PROJECT INFORMATION:
Early Release
Permit:
_VLN
LV_N
@
o
CRAWLSPACE 0 POST & BEAM PIER
SLAB 0< BASEMENT (WALKOUT;_V~N )
For Sjn~1e Family and Tw\) Family d\\iellill~s, additions, remodels, and/or accessory stmctures, this permit is valid only if construction commences within IRO
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_ C:hss I
structure permits are suhject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) rCj;arding expiration time framcs for beginning and
completing construction.
1, the undersigned, agree th.ll.my L"\)llstructir11l. rcc"l1struction. enLl1~gemcnt, reb.:atioll. (lr .1lteratioll of.1 strw.:turc, or .my ch.mge in tht: LiSt: of IJIHJ nr 5truclllrt's
n:cluested by this applicAion will comply \vith. amI conform w. all applic<lhle J.lws uf the SUte llf IndiaJ1<l. ,md the -:oning Onlimlllce or C;1IT;le! !ndian.l - 199)" (:.
189) and JInenchnents, Jch1plecll1ndl::r aUlhority of Ie 16-7 et 5e4. Genel'~ll A~~embly of the Sure elf Indi-allJ, and all Acts amcncbl<11'Y thcrelo J further certify thJt "nly
kitlhcn, b<lth. and fh1r dr,tin rc c'llnneClcd to the saniwry sewa. I further ccrtify that the C{m~truction will not be uscll or occupied until a Certificate (If
O<;:pilDoyh"'t>c,." '.,,"cd " ,he O,P'''''''"' of Cummu"icyScrv'",. C",'~I"d',"a . II i_'
_______ . L--- _ -1:"..11Vl Ie . '-.:..cr 'J ,-e-r 4- 5-'0-7
Signature of Own 0 u orized Agent Print Date
OFFICE USE ONLY: *********************************************************************************
INSPECTIONS REQUIRED: Filing Fees: 27"'<, '70
;;2 if 7. S-O
~:>.~d
I ;J b I 610
$iJ7"7(,.70
Base Inspections:
(ert. of Occupanc
# Charged Re-
Reviews
Reviewed/Approved: Dept. of Community Services
$:Perrnits/Forms/lLP RE$IDEfmAL
Additional ,Fees
(Date)
Date