HomeMy WebLinkAbout07060203 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
I
BUILDER
OF
RECORD:
STREET AD[?RESS:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
SEWER UTILITY /*_ _ /f
PROVIDER: {,Url11<<
STATE:
SECTION:
ZONING:
'f,I}:3 J.-
SQUARE
FOOTAGE:
~
WATER UTIliTY /I //
PROVIDER: (.Jf/ r /11 e-r
ESTIMATED COST OF CONSTRumON:
(EXCLUDING LAND VALUE)
NAME OF UTILIlY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DA1E(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPUCABLE):
o NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDITION(S)
o DECK ADDITION(S)
,-.\,
o REMODEL Which plumbing codes-"fi'il'be..applied to the construction:
_ Basement Finish only ,r." '" . (\;)
o ACCESSORY BUILDING 0 Interna~ipn'aI'R~iill?ntial Code w/Indiana Amendments
o DETACHED GARAGE \r;".'\\:"\"c;':~\'\""" ~(".,
o Unjfd[ITI'plumbing Codew/Indiana Amendments
s..ATTACHED GARAGE 1(,':;' ','\'~' cP" ,.:,\"'. ..:x;"\
,.. DEMOUTION ~gfo~i'u:i~Ti~Nr.:JyPE;~(~eCk all that apply for the new
Manufactured ~~ . ,constr~ctior,are~)\.,.)' .
",t>..CO """We,,\). \\'" ,:,' .. -
_Y _N Trusses: _Y ~'9..' '\oQ:'."n...\,"&f.':\.~~B'C~WLSPACE
y()..'VV"Nt \. 'i- e-\::;..':' f\"I" - \ \.),.
Lot Split: _Y _N Sump Pump: _, ~\0G- o~e"g~:,,\;P;=R~~:~D BASEMENT (WALKOUT:_Y_N)
For Single Family and Two Family dwellings, additions, remodels, and/or ac~~,~~s, th\s~nnit is valid only if construction commences within 180
days of the date of issuance of the building pennit, and must be complete~I~i~te of Occupancy issued) within 18 months of the issuance date. Class I
structure pennits are subject to the General Administrative Rules of the St~diana (See 675 lAC 12) regarding expiration time frames for beginning and
completi1rg'~~nstruction.
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 laws of the State of Indiana, and the ~Zoning Ordinance of Cannel Indiana - 1993" (Z~
289) and amendments, ado ed un r 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 dra oonected to the samtary sewer I further certify that the constructIOn Will not be used or occ~ed untIl a Certificate of '-
Dec an has been ISS ~epartment of Community SeIVlces, Carmel, Indiana -*,.:J4i2-12 ~7""I;:::./ c..~:n ~ 0 tC A t.f77./t!) Y , I t
~~ !f.'1e II/A,hnlill ? -1:D-O '7
ture of Owner or Authonzed Agent Print Date I
OFFICEUSEONlY:*********************************************************************************
INSPECTIONS REQUIRED: \I~.Filing Fees: /:'i "iJ, ,") 0
~ / Base Inspections: I (J 4. 0 0
7( 'J- Cert. of Occupancy: .
'~~&d
Fee Received by: ..
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
o 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:
'or /lnJuCIJt!i..t?
TYPE OF IMPROVEMENT:
.--(}
PLUMBING CONTRACTOR:
Plumber's Indiana State License #:
o POST &
BEAM _PIER
# Charged Re-
Reviews
Lower Footing Under Slab
Meter Base Final B
Upper Footing
Rough In
S:PermitsjF
Additional Fees
1-. hi] , ~()
Date
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Demolition Permit Requirements
City of Carmel I Clay Township
Building & Code Services; City of Carmel
One Civic Square; Carmel, IN 46032 Ph, (317) 571-2444 Fax (317) 571-2499
TO BE SUBMITTED WITH APPLlCATION*; Two copies ofa site location map"-clea~ly
identifying the structure or structures to be demolished, (on paper no larger than 1;1
inches by 17 inches) the Tax Map parcel number for the parcel on which the demolition is
to occur, and this form signed by the appropriate departments. (*Application is a three-
part form available from the Building & Code Services office.)
NOTE:
A separate permit application must be completed per parcel.
Certain inspections are required relating to private wells, septic systems, and fuel
tanks, prior to demolition.' I
Should approvals be required from other State or local government entities, ~r
utilities (other than those addressed herein), it is the sole responsibility of the
contractor of record to obtain such approvals,
Existina well: Well must be plugged according to Well Ordinance A-52. W'~ l1Hv~/;l!e~
/.11Ij~~ -
Existina septic: Septic system must be pumped and filled with sand, or removed. If S'i!ptic
system is to be reused, it must be plugged off until rea'dy for re-us~. J/.'~lf7!i{..
.' . ,
Fuel tanks must be pumped and removed from .' i1ding aqd/or property'k~'
. .', '(J"revl.#/j ~ ks
4// )~C<1/1c1 A've. 1# Ca,met /U ';f,1l1V IJ ~7~() ~(/ >--(}()/. t't'o M
I Tax Map Parce # I
.
.
.
Fuel Tanks:
/ ,;f:e.- ellR/?(, , .,v,
wner(s) Name and Address
114
Address of demolition
,
I
I
Additional Structure(s) on site: Yes / No (If yes, please list the number and typel(s) of
structure on the lines provided. If one of the structures has a separate street address than the
primary structure on the parcel-please also include that information,) ,
" "'The cli'/or.Carmel and/or Hamilton County Health Oept. must perform an inspection prior to
'." demqlition. in,order to approve the demolition permit, the applicant Is required to sign this, form
-: and obtain the siqnatures of the individuals listed below. (This can be done by FAX to their
::' crffj'c~si!.at the numbers listed below) Include this completed form with all approwiatei
"..sicinatures (ON THE REVERSE OF THIS PAGE) when you submit your application package.
...:. .......
r ' .. , -John Mascari: Carmel Utilities.
Phone (317) 733-2855. FAX (317) 733-2053.
2. Barry McNulty: Hamilton County Health Dept.;
Phone (317) 776-8500. FAX (317) 776-8506.
S:PermitslForrrrsfDemolition permit handout
1of2
.~~b qs 07 03:55p
OG/20/2007 13:4U FA):
Rob Lov~ll
(317) 571-2654
p.1
GIJ 00'9(0 I."
:J 1'(:":4:J4~ iU
ATC ASSOCIATeS
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Date
Signature:
ohn Mascari (or ropre:;ontoltive)
Signature: B3rry MCNUlty (or r~prescnt"tlv,,)
Date
CERTIFICATE OF AUTHORITY
""Without w21"'il1~~ tile c3:mnptiQn of Onk.- ;F-ntrgy Indbn.:r, Inc. under IndjSllDa COmmon law (-v IOClJ 2oninri: an4:
bUildin:; authority rcqllire01Cnt~~ J hereby cCI"1ify th;]f I h:i'v(' thp. smthority tet ma.ke the fort'golne 3pp1k::Uior.J Rnd
thOlt the :Jppijc::.ation hi torre-ct.
Under tbe pcna.Jtic.\ 01' Jll:'rjur-y (Indiana Code 35-44-2-1), I he1"c-by :Jffjrm, und~r osth, tbat all of (he information T
bave prOyjd~d in (his apylic:.lUo,o for demtJolitiollJ;termit is trUe .nDd 3.f;C'ur.3tc, to the b~t Qf my knowledg~ 3nd bdicf.
aDd that J, botvc not klJcnfin~ly or intentionaUy prOYidaj Or omftted ;:)uy informatioD th:a.t: Would tr:ntf to hid('.
obscure. 01'" Qtbc-rwise misJp:ad the DeparnncnI 4)r eommunity Si"!n1ccs regarding the 'truth of the ma.tten addressec1
tber~in.
F~lrtber, I :a..O;Scr( 1111.11 I Jim thl~ prnpp'rty owner~ Or' the OJutfJori,ud .ecnt ,cUJd Jaw(uUy apPOintrd 3gc."Uf of tl)c:
owncr(.s), Ibat I h;tv(" upr(~."... j~uthority and permi.'\l....lon from the owner(s) (and anyone with :l I""~ol"ded jotucst Or.
othC'r in1.prt'S"t in th( property)~ to t~ke Ih.... r(.q\lr.~ted actiony and tbat I =-grcc to indemnify and hold harmless "the
City or C~rmel ft 14fi9""'"~aim, Ja'JVsuit, demand, or dam..glt!5 WhDh;ocv~r .Itrising out Qf, 0,- ~s a ....C"5ult or~ this
requC'st or the 3ctio !I: uf -tl'le City of C:Jl"mcl, regarding :iamc_ .
~~-~
~ -.20 --- 0 7
Date
L.<__
plicant's Signature & Date
;l1,~~.t2
(Name printed) . a')
V.:J,.b1,'rty .F,.Iw"...(i;vfi. C;",lf,,,d,..... "P'40'
/Ot;<:> .f~t11 //1/[/11 -;-r .
Applicant's Address
2/1- g313-~/f
Applicants Phone #
P1,fi :f;U
City,
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ST
n//-'t'
Zip
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".----.~_._-" ,,. ,__ n_._....__ .__.....___.
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STATE OF INDIANA )
SS
County of ..!:.k.t:.",. l ~, )
Before me, the undcrsign~d, a Notary Public fo~~-,o~
County, State of Indi"na. personally
appe3rcd _(\'\ ,\c,".
\ J.) h: r c~.S./>).
and ""knowledged tho oxecution of the foregoing
jnstrnment this d'o d<lY of , _~.._
,200'1 .
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T-;:",I. ...J,--.Sw~,
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-YC\.._uJ~ -l ",-""..(1 c" =--
(1)'1:,')
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-My Commi:....:::.iM l;;r;pires:
S.Pcrmilvf Got"tl)90C"K-,I;r;0r'I!J('rmll t'lClndoul
;! of.<
08/20/2007 15:40 FAX
9-8/20/2'007 13 :.58 FAX
3177788508
3178494278
HAM CO HEALTH OE?T
ATC ASSOCIATES
I4J 005/005
1lI014/019
I
f
,
Signature: John Mascari (or representative)
Date
6- ;)/)-07
Date
CERTIFICATE OF AUTHORITY
.Without wAlvllI~ lbe ..emption of Jluke Energy Indiona, Inc. under Indian. cnmmon law 10 10C21 %onlngi a"d
bulldlng autb"riTy r~qujrements, J bereby ~rl1ry Ibal J bave Ibe authority 10 make tbe (oregolag application' and
Ib.l tIle application is torred.
Vnder the penalties o{perJ...., (Indiana Code 35-44..2-1), 1 hereby ImrlD, under oalh, Ihat all of tbe IDfornmtlOh I
bave provided in tbis application tor d~lIt1on permll I, 1m. and a<:curale, to the best of my bOWled," Bnd belief,
and IlIat I have Dal Jcnowingly or h'leIltlonllUy provided or omllled any Inrormation tbat wo"Jd t""d to hide,
oblClln, or otbel"O!lle mI.l...., tbe lkparlmeot of colIIMllnlty Servl_ relardlnlllbe truth of the _tte... add"issed
tbereln.
FlIrther, I assert that 1 am lbe p.-openy oWDer, or Ibe aUlborl""" agent and lawfully appointed 3J:..nl ofj tb.
_ner(s), thaI I h'''e e.press authority and permlqlOn Itom the 1JWJ18r(s) (and anyone wlIb R ..corded inlerest or
otber Interest In Ihe prop-er 10 tsrke Ib's requosted action, Jilt1d tbat J agnc to Indemnny .oInd hold harmless tbe
City of Cannel from y etaJ laWBuil. dernaad, or dam2.~~ Wb::lltJDever arising oul o~ or 36 a r-esult of~ 'thb
I"'8quelit or lhe action$ 0 .ty of C....meI7 regnrding Same.
jd)M~. c;.-;W-Df
~Pllcant'5 Signature & Date Date
/i1lk~ hlj.;-flJ'Mn JIJ-- fflf -~/1
(Name printed) ~ I. /r-..h /' 1._..t ./ "'" Applicants Phone #
7).;~.g"..r~ /111"";"""-( )J'7f'1 l.>9H.1rr"o/'M &-t~7 /
/&710 bpI- !1l"',n 51-; p~,'~t'dfJ fA.!
Applicant's Address City, ST
ftY61
Zip
,
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STATE OF INDIANA )
ss
County ofl:lo......." 1-1-0 ""' I
Before me, the undersigned. a Notary PublJcfo~~.,_ ,
County, state of Indiana, perso~allY
Ilppeared Y'n,k... W"'\~
instrument thIs ~ ~ day of hJ"'''-
and aeknowll'ldged the execution of the foregoing
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~:PermI~orm:iIOlIlT'dition pgrml1.l'Iandout
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'N/TY MAP
WEL SUBSTATION
el, IN
DrawingFlie"
Vicini!
Dale
6/07
Scale:
1" 2000'
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App'd By:
~ATC
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Abc State HwyT ext
:lClI Interstate Highways
= U.S. Highways
- State Highways
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- Minor Roads
Parcels
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