HomeMy WebLinkAbout07040143 Application
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BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
& PROJECT
INFO:
SEWER UTILID
P.ROvIDER:
City of Carmel/Clay Township Permit #D701 () 1Lj-3
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
PHONE:
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FAX:
LD$-Y&~-
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OTY:
STATE:
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ZIP:
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BEST METHOD OF CON~h
PHONE:
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FAX:
CITY:
STATE:
ZIP:
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SECTlON:
ZONING:
ADDRESS OF CONSTRUCTION:
JLl...,5 cross~'e..IJs e~.
t!-arrnd
SQUARE
FOOTAGE: I 0 CP.:>
tu I'Yle-I
WATER lJTlLITY C I
PROVIDER: avm6
ESTIMATED COST OF CONSTRUcnON:
(EXCLUDING LAND VALUE) \ 00 ():(). C()
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'$ (IF APPLICABLE):
FLOOD ZQNEAREADESIGNATION(S)
FOR THIS PROPERlY:
. KI1$hdat
TAX MAP PARCEL #:
TYPE OF CONSTRUcnON: TYPE OF IMPROVEMENT: d.
o SINGLE FAMILY 0 5=~~ ~f!lr'/
o TOWN HOME -rJw'I~ ROOM ADDITION(S) ")eve-r-
o TWOFAMILY 0... j(S)~'
# of units being 0 DECK ADDITION(S)
constructed at this 0 REMODEL
time: Basement Finish only
"f( RESIDENTIAL (For 0 ACCESSORY BUILDING
Additions. Remodels. Etc.l 0 DETACHED GARAGE
);:( ATTACHED GARAGE
o DEMOLITION
PLUMBING CONTRACTOR:
W, \()U ~ V-r<'I OJ f) ~
Plumber's Indiana State License #:
Iqlo~q
Which plumbing codes will be applied to the construction:
o International Residential Code w/Indiana Amendments
M Uniform Plumbing Code wI Indiana Amendments
Early Release
Permit:
PROJECT INFORMATION:
Manufactured
Trusses:
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPACE 0 POST & BEAM~PIER
M SLAB 0 BASEt1ENT(WALK -----:'1\;,.\ ~j"i'::\hN )
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For Smgle Farmly and Two Family dwellings, addItIOns, remodels, and/or accessory structures, this pernut IS vaM~;- ',\ q'i \ . \':nces within 180
days of the date of issuance of the building permit, and must be completed (Certificate of Occ~p~~y~s~ued) ~ he)~u~~_e date. Class I
structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 IAC 12 , - r n time frames f6i\beginning and
completingconsuuction. " \\, . ')(\\')1 \\\Jl \
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a st~uct , or ~ ch\ng'ein the use of land'cfr structures
requested by this application will comply with, and conform to, all applicable laws of the State of lndian~:\apd,,~h,e ~zo~i;rg..[)rdinance of C~el'Ihdlana 2\1993" (Z~
289) and amendments, adopted under authonty of l.c. 36~7 et seq, General Assembly of the State of rndia~a;'a09 all Acts amendatory, thereto. I further cqtify that only
kitchen, bath, and floor drains are connected to the sanitary sewer, I further certify that the constructio~\~I(~:9t be uS$d or~upied unt~Certificate of
ocCUpanCYh"b,(.t\;'dbYth~,partm'ntof~~:~:~~ndi~~e \e \~ "---:// /--- Lj-I~-Ol
Signature of 0 r or Autho' . Ag nt Print ~ 5 '1 \.---'--- Date
Lot Split:
_Y~N
_Y~N
Sump Pump:
_Y LN
_Y~N
OFFICE USE ONLY: ******* ** ******************* * *~~************* *******'l:.~***t'**f>* 1*****************
INSPECTIONS REQUIRED' Filing Fees: ~ ') cL ,1 k
. .' Base Inspections: / '7 d <0
pper Footing Lower Footing Under Slab I C' ~ .- d
Cert. of Occupancy: J ) . )
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# Charged Re-
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Meter Base
Additional Fees
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Fee Received by;
Date