HomeMy WebLinkAbout07060107 Application
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.. City of Carmel/Clay Township Permit #:~
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:
BUILDER'S EMAIL ADDRESS:
'7::>/....(Y)
NAME: ~
STREET ADDRESS:
()
LOT#:~
ADDRESS OF CONSTRUCTION:
SEWER UTILITY (\ . ()
PROVlOER: ~If\-( r1
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA I BPW DOCK
NUMBERS; TAC OATE(S); ANO/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPU
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
ON:
TYPE F CONSTRU
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:
_vL.!:l
_V XN
TYPE OF IMPROVEM NT:
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:
_V /N
-.LJ _N
-90L4
ZIP:
IoD '81-
I BEST METHOD OF CONTACT: 11 I
/'){1),COf\. J7-2~/-S2~
PHONE:
FAX:
Sump Pump:
STATE:
:l:N
ZIP:074
~g~~~E 13,3~7'
COST OF CONSTRUCTlON: 6
NG LAND VALUE) 0
~t;2~.... . :~'lOJqO. }O.~t".~/r;la}:r.;;'
crr""3S:;1:!7Eirr;Ji[eNAAJQf;;~/kI;;=\J7'
TAX MAP PARCE~ #: I j I
Il~-~<l 5:' - i~ :
III Iii 'II '
PLUMBING CONTRACTOR: I' i ,"
'I' \'1 ,(lAoI~--~..a..!1
'0CI'1L,rilbtD(,.,4 V 'P' ~&o~C-I
Plumber's Indiana ~tate License #:. I , f
'C..l)~ 0/"fJ'eAfC;0A}-'PJml-JirJ1s .
Which plumbing codes will be applied to the construction:
o International Residential Code wjIndiana Amendments
~Uniform Plumbing Code wI Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPACE 0 POST & BEAM PIER
o SLAB ~BASEMENT (WALKOUT:Lv_N )
For Single Family and Two Family dwellings. additions, remodels. and/or accessory structures, this pencit 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 pennits are subject to the General Administrative Rules of the St.atej( Indian~ (See 675 lAC 12) regarding expiration time frames for begiiming and
completmg construction.
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 law,S of the State of Indiana, and the "Zoning Ordinance of Carmel Indiana - 199r (Z-
289) and amendments, adopted under authority of 36-7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. r further certify that only
kitchen, bath, an 0 r drains are connected 0 t s nitary sewer. I further certify that the construction will not be used or occupied until a Certificate
Dccupancyh issued by Community Services, Carmel, Indiana, YV1
Sfeue,J "'. I ,/O Eo
Print
Date
# Charged Re-
ReViews
Cert, of Occupancy:
(Date)
~ Reviewed/Approved: Dept. of Community Services
~ """ s:Pem\lts/FormslILP RESIDENTIAL
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