HomeMy WebLinkAbout07040194 Application
City of Carmel! Clay Township Permit #:D7lt1 (') tq '-P
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:
'~
STREET ADDRESS:
PHONE:
FAX:
[;- 'I$:J-
1/
I
ZIP:
CITY:
STATE:
;:CJ1/
,,/
BEST METHOD OF CONTACT:
~ -- 51&- 9 ;lo:::L
PHONE: FAX;
r ,_
, '
Sui;li\lCt to compliance with [i]Ne:gulations ZIP:
U+i . n L cal~s. {'"o3
DEPT OF COMM~FfY SERV oot)<G:
SQUARE
FOOTAGE:
s - /
'5
-5
SEWER UTILITY WATER UTIUTY
PROVIDER: C W'\) PROVIDER: 00\
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC OATE(S); AND/OR COUN1Y WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
B""'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_N
_Y.A
TYPE OF IMPROVEMENT:
I3"'""NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o DECK ADDITION(S)
o REMODEL
_ Basement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
Manufactured ../
Trusses: _Y ~N
Sump Pump: /Y _N
00
TAX MAP PARCEL #:
I 7 f) 9 :3 ^ 00 0 1 000000
PLUMBING CONTRACTOR:
wi-l-t'~~F1J f~1<. ?Ult112,;vJfc, r;t/C..,
Plumber's Indiana State license #:
cP /9 700 r~ (9
Which plumbing codes will be applied to the construction:
~temational Residential Code w/Indiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
0""C"RAWLSPACE 0 POST & BEAM PIER
o SLAB ~EMENT (WALKOUT:_Y A)
,
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid~ if cO~~!rtlction,commences withip 180
days of the date of issuance of the building permit, and must be completed (Certificate of Occup~~y,i~sul~~)'~thip ~~ ~o,~t~~ ~f tih~js:fttan~e~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 con"rllction. ;: i II r~-----l \ I ! \ I
I. the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a s(ru~ture, or any change in the use of l~n~ orhtructures
requested by this application will comply with, and conEo ,a' ble laws of the State of Indiana) indtp~ "Zoniug"Qrd.ipap.ceR~~"flTIeI hl~iaMr 1993'" (Z~
289) and amendments, adopted under authority of L -7 et seq, Genera sembly of the State of India4~,\a~4 ~ll AcA:F'tttn~t~ th~io. I f4~tpet ~~rtify that only
kitchen, bath, and floor drains are connected to t sanitary sewer. I further c tify that the construction Will not be used or occupied until al Certificate of
Occupancyhas been ~ssued by the Departm t of Corrun Services, C d. Indiana. \~.i '\..\ L_,~.---~ ",,-, \
-::::> 7 "1'1/ 6 I '1- 1 ti -D 7
Signature of Owner or Au L_' Date
~~*******************~l*~**~~**~*******************
FIling Fees; U _It ~ (/
I
Bas~ Inspections; d R 7. <;?J
Cert. of Occupancy: b 5- S7J
P.R.I.F.: ;';Z G I r?O Additional Fees
~~;/ 51
Fee Received by: Date
~
ept. of Community Servl s
FormsjILP RESIDENTIAL
# Charged Re-
Reviews