HomeMy WebLinkAbout07060269 Application
~City of Carmel/Clay Township Permit #: o1o(po'tAf/1
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER
OF
RECORD:
- crso
FAX:
3{1-21
NAME:
STATE:
I;JD
BEST METHOD OF CONTACT:
3.31
-/0'10
FAX:
2) - Os L,<:;"
PROPERTY
OWNER:
NAME:
CITY:
tAlC-Me
STATE:
j\J
ZIP:
L{C,092-
LOCATION
& PROJECT
INFO:
LOT#:
SUBDIVISION NAME:
SECTION:
ZONIN~ ,.l
SQUARE
FOOTAGE:2Dm
SEWER UTILITY
PROVIDER:
ADDRESS OF CONSTRUCTION:
I ( cl1 Rc)
WA~RUTILITY 'p l(
PROVIDER: Q.. ! V .vJ e
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE)
.5 err; G
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC DATE(Sl; AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TAX MAP PARCEL #:
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT:
o SINGLE FAMILY 0 NEW STRUCTURE
o TOWN HOME 0 ROOM ADDITION(S)
o TWO FAMILY 0 PORCH ADDmON(S)
# of units being 0 DECK ADDITION(S)
constructed atthis 0 REMODEL
time: _ Basement Finish only
o RESIDENTIAL (For 0 ACCESSORY BUILDING 0 International Residential Code w(Indiana Amendments
Additions. Remodels. Etc.) 0 DETAC~R\GARAGE
o !.ili'..~t;t.lerl~ARAGE~ 0 Uniform Plumbing Code w(Indiana Amendments
PROJECT INFORMATION: cn\;'\~\~~~JiIOl'l~. FOUNDATION TYPE: (Check all that apply for the new
~ '..-" .\\ ~o0 . .
E I R I ~O' \ ' ~'^ Utactured constructIon area)
ar y. e ease "c..yf'\ . ~d e a,n..."ov'" ~ I\CC<
PermIt: c\ ",,,,,,,-"-'r _,r,N,,", oT!,usses:,c:~\J : "as_N 0 CRAWLSPACE
'~~....<;- r/5"". c\ ~ -r' ',Ie- \'::?I"
Lot Split: b\eC\ \0, 1,~N'(\ ,\ '1l/!mp'pu'!'e,\!,j""~y _N 0 SlAB 0 BASEMENT (WALKOlJT:_Y_N)
SU O~~ ,,~>t\.J......\b>{\
For Single FamiJ~FajqjJy\;C{W1.lIih?~~,~~itions, remodels, and/or accessory structures, this permi~ is valid only if construction conunences within 180
days of tlle d~is~€i&f.tl\e Q\l~V\~~t, and must he completed (Certificate of Occupancy issu(>d) within 18 months of the issuance date. Class I
structure permitS1tfe'dibject to the ~her~ Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
li\ \ . completingconsuucrion.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or structutes
requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the ~Zoning Ordinance of Carmel Indiana -1993~ (Z~
289) and amendments, ado te under authority of I.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 s re connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of
OCCU~beeni d ytheDe tOICOrrnnUnityser:viCe~I,IIr;kl;JStJrJ (P-Z/-07
Signature of Owner or Authorized Agent Print Date
PLUMBING CONTRACTOR:
Plumber's Indiana State License #:
Which plumbing codes will be applied to the construction:
o POST & _ BEAM _PIER
OFFICEUSEONLY:************************************************7**~*******~*******************
INSPECTIONS REQUIRED: Filing Fees: () .3 - ''2- D
~n~~~~ 57- (5 0
,,1d.;i./~~i!l'j. g:3, () ()
Upper Footing
Lower Footing
# Charged Re-
Reviews
Meter Base
P.R.I.F.:
Additional Fees
Dept. of Community Service
PRESIDENTIAL
7
06/22/2007 15:57 FAX 3177766506
HAM CO HEALTH DEPT
~ 002
-;;
~
Demolition Permit Requirements
City of Carmel I Clay Township
Building & Code servtCl8S; C1ty of Cannel
One CM~ SqUIII\I; cermel: IN 40032 Ph. (317) 671-2444 Fax (317) 1571.24E19
TO BE S M W APPLICATION"'r Two copies of a site location map-clearly .
identifying the structure or structurn to be demolished, (on paper no larger than 11 :
Inches by 17 inches) the Tax Map parcel number for the parcel on which the demolit~n Is
to occur, and this fOrm signed by the appropriate departments. ("'Application Is a thiee-
pijrt form avaIlable from fhe BuildIng & Code Servic8$ offlce.) .
NOTE:
A separate permit application must be CQmpleted per parcel.
Certain Inspections are required relating to private wells, septic systems, and fuel
tanks, prior to demolition.
Should approvals be required from other State or local govemment entities. or:
utilities (other than those addressed herein), it is the sole responsibility of the
contractor of record to obtain such approvals.
E>tistlng well: Well mUst be plugged according to Well Ordinance A-62. .
Exlstlng setJtJc: Septic sY5tern must be pumped and filled with sand, or rernoved. If septic
$Y5tem Ia to be reused, it must be plugged off until ready for re-use.
Fuel Tanks: Fuel tanka must be pumped and removed from building andlor prolH'rty.
/4 II q [:)r]2( g.d.
Add_ Q''domo/fUofl
~,I ~,w>~~ 'PO 13M '292-
Owner(s) lime and Ad
Additional structure(s) on site: N:J / Np (If yes. please list the number and type(S) of
structure on the lines provided. If ~ of the structures \1liS a separate street address than the
primary structure on the parcel-please also include t1fat information.)
.1 ?ole a..R~
.
.
.
.l7~d~~<<>~O
Tax Map p;ugeI ,
The City of Carmel and/or Hamilton County Hss/th Dept.'must petform an inspection prior to
demolition, In order to approve the demolition permit, the appllcant Is required to sign this form
and obtain the sianatures 0' the Individuals l#SIted below. (This can be clone by FAX to their
offfces, at the numbers IIs,fed below) Include thIs completed form with all BODI'ODrtafe
slanatures (ON THE REV,ERSE OF THIS PAGE) when yoCl submit your application pitt;:kage.
John Mascari: Carm.1 Utilities..
Phonii (317) '733.2855. FAX (317) 733-2053.:It'
Barry McNulty: Hamilton c~ I:W"~
Phone (317) 776.8500. FAXJ ~ 116-8 .
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CARMEl WATtR
PAGE 93/94
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CEImFlCATE Of AUTHORITY
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Untllll the penIllhla of .-JUry ltncllana CQdlI 35 11 ~.1), I hereby 1Ilf1nn. \8'ldI!Ir 0Idh, that 811 at..
illfarmation IIIaW fItl- Ad~" In this ~ tcwd\wllollllOn ~ llIl1nle and --. to tJ\e
blIIt of my 1cncIWtedp IlI\d ~ and am Ih:lw not ~gJy or inllMltiamdIY ~ or
omlftlld any blfw"...-o.\ IhItwould lIIIIct 10 hide, o'*=- or o4h8rwise lIIlBINd the o-......nt
of Cemmulll&y &.. ""CGI .......... tIUlh of1tle IIIIItIlIrs 1Mld~ there/....
FI.Ir1her, 188S81't1Mt11lllt" piliP 11;y _. orfJle<<Ull,.,,1ad lmd llIwMlYappOIllbld.gent of
1he ovmur{lI), tbat IInMl expnlBlI ~ lIfIII pgnnlsSion fram lhe awnel'(e) (lVId IlI1)'OlIll wItIl8
.~dl"'\lIlIIO'I oruttlllrn"'_1n lIt8 PUr 1>>. toollibtltls'*l\llllSlllClllGl.\On. and". IIEJ"!8
to indemnify and hokIlI8I'mlelltJ the CitY ." Qo......1\'l:m\ 'lIl1V daiIft, IllW8lIIt. dema~ or clllnlIIIB8
whal8_r a\l$lng out 01'. or BlIl\IIIUIt of, lN$ JaCII,I8St or 1M dons qf tho CftJ of CIlftMI.
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Applicant's MdI1llSB
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Appllc:llltll Phone.
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STA're OF lNDlANA )
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06/22/2007 15,56 FAX 3177768506
HAM CO HEALTH OEPT
I4J 003
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Date
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CERTIFICATE OF AUTHORITY
-
Under the penalties of perjury (Indiana Code 36-44-2.1), I hereby affirm, under oath, that all o~the
information I have provided in this application for dernollUon permit Is true and accurate, to ttle
beet of my knowledge and b811~, and that I have not knowingly or Intlilntionally provided or
,omitted any Information that would tend to hide, obecure, or otherwise mislead the Department
of Community Services regarding the truth of the matters addl'8888d therein.
Further, I assert that I am the property owner, or t/Mt authorized 8.lI\d lawfully appointed agent-of
the owner(s), that I have express authority and pennisslon from the owner(s) (and anyone with a
reGg!"ded Inte...t gr gther into,...' In the property), to take this requeated adIon, and that I agree
to indemnify and hold hannless the City of Carmel from sny claim, lawsuit, demand~ or dIlmages
whatsoever arising out of, or as a mult of, this request or the IiIctlons of the City of Cannel, '
regard~ ~5
~~-
,&,ppllcant'. Signature & Date
M k/(,;J..5, {)".J
(Name printed)
'70, 130x 31'2
Applicant'. Address
t,-zz -c37
Date
311-q3~-2 "33 7
Applicants phone"
CARne(
, City,
j;:,J
ST
.i-l~l)rz.
Zip
STATE OF INDIANA )
55
County of I
Before me, the unden;lgnec:\, a Notary Public fCII'
appeared
County, State of Indiana, persOnally
Instnlment this
day of
,
and'acknowledged the execution of the foregoing
.20_"
My Cmnn_ ElCpI_:
Nolory PlIbIlo
(Print)
S;P"rmlU;lForm&'tlomolltlCln permit tla!1dcuI
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