HomeMy WebLinkAbout07060252 Application
(,
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
& PROJECT
INFO:
City of Carmel! Clay Township Permit #: () 70 Cd) 7-5 ()...
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
,
SQUARE
FOOTAGE:
WATER UTILITY /' II
PROVIDER: Lli'fr~
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE)......- .
! .<J,A
SEWER UTILITY /J . _ //
PROVIDER: Ct:;r/'llbC
,-
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I 6ZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPUCABlE):
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
'l'/Llth8lr.
TYPE OF CONSTRUCTION: E OF IMPROVEMENT:
o SINGLE FAMILY NEW STRUCTURE
o TOWN HOME 0 ROOM ADDITION(S)
o TWO FAMILY 0 PORCH ADDmON(S)
# of units being 0 DECK ADDITION(S) ~\
constructed at this 0 REMODEL ...'0\"" .' .
t' . B. :.....6. \("'n1~ \ \ O,\....whlch plumbmg codes will be applied to the construction:
,me: _ ase"1en~.E'11'"'' 0 ~ \\0"""
o RESIDENTIAL (For 0 A<;CESSOR~ILqI,r,l.!,..,I.I'<l' 0 International Residential Code wi Indiana Amendments
Additions. Remodels. Etc.) O..DET~eoGARAGE' ,-: ~t::..
nciJ') iCHEolGARAGE"O' 6. l\j\C'd::1 jJniform Plumbing Code wI Indiana Amendments
\~-' '~MOIiT'iO ". - ",j\: S~\y
PROJECT INFORMATlON~~;';'t:,\..~ - ;,!:'/]," ,\,0 !'I." ,(: !; ,\ ;O'tl~ FOUNDATION TYPE: (Check all that apply for the new
E rI R I \~-~,~'y\~>,~.'"-\te\dY ~\ !,',)Z" 1 \ \ construction area)
aye ease "o0\.'lI"lanfj..actUre N:'" L ~~ I,,'
Permit: _Y _N Tr~SSj!S:, ~\::''''',:\.,,\ ,:y''', N 0 CRAWLSPACE
~; c,-U' r\;:>,:'J.i"'" ,,'7'
Lot Split: _Y _N ~~\i'm {-d3fp' \ '~;~Y:'~N 0 SLAB 0 BASEMENT (WALKOUT:_Y_N)
. (JPO
PLUMBING CONTRACTOR:
Plumber's Indiana State License #:
o POST &
BEAM _PIER
For Single Family and Two Family d gs, additions, remodels, and/or accessory structures, this permit 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 State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
completing 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 ly with, and conform to, all applicable laws of the State of Indiana, and the ~Zoning Ordinance of Carmel Indiana - 1993'~ (Z~
289) and amendments, adopte unde uthority 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 drams onnected to the samtary sewer I further cerufy that the constructton will not be used or occupIed until a Certificate of
Occ yhas been ISS cd t~epartment of Commumty Setvlces, Carmel, IndIana "'*" ~ e.2.... C.e.. ,,-,4 F 1<:.0 Ie.. 4> ~ A urtl a r L Tt
"-4.~ #l.kwA;fl!7~n /'-M-LJ7
Si ature of Owner or Authorized Agent Ptlnt 'ifa':e
# Charged Re-
ReViews
~
Additional Fees
1
Demolition Permit Requirements
City of Carmel! 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 of a site location map--c1early
identifying the structure or structures to be demolished, (on paper no larger than 11
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 permitapplication.musLbe completed 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 government entities, or
utilities (other than those addressed herein), it is the sole responsibility of the
contractor of record to obtain such approvals.
Existinq well: Well must be plugged according to Well Ordinance A-62.,tlAAm Olln f J1!J~
Existinq septic: Septic system must be pumped and filled with sand, or removed. If septic
system is to be reused, it must be plugged off until ready for re-useJ{,5tf'ftt: .
Fuel tanks must be pumped and removed from building andlor property.,A0 fuBL
~ . r{70,l-<tlf7-}---r:
"340 /f-r 4rE. 5}A1 t:rf17~ / AlIf,o fY- /"-01~fJZ.?ol-t',/-t!{}7.c:<1'" Jt1n~'
~ddress of demolition . ' Tax'Map Parcel # /
t /1Jio~ . v/h tnJ ~ ~ 64 W :/ %/p~
)wner(s) Na
.
.
.
Fuel Tanks:
4.dditional Structure(s) on site: Yes / No (If yes, please list the number and type(s) of
;tructure on the lines provided. If one of the structures has a separate street address than the
)rimary structure on the parcel-please also include that information.)
-- -_._--------_._-----,---_.__._-----------------"---~------------------.-----------------------------------
The City of Carmel and/or Hamilton County Health Dept. must perform an inspection prior to
"Jemolition. In order to approve the demolition permit, the applicant is required to sign this form
fnc{oBtain the siqnatures of the individuals listed below. (This can be done by FAX to their
)ffice-s,.at the numbers listed below) Include this completed form with all appropriate
;iqflatures (ON THE REVERSE OF THIS PAGE) when you submit your application package.
,
~
./ ",--.....
1~' -:~ :. John Mascari: Carmel Utilities.
~
.....Phone (317) 733-2855. FAX (317) 733-2053.
i. :.., ,Barry McNulty: Hamilton County Health Dept.;
Phone (317) 776-8500. FAX (317) 776-8506.
;:Permits/FormsfDemolition permit handout
1of2
~b Q8 07 03:55p Rob Lovell
06/20/2007 13 51 FAX 3178494218
(317) 571-265"1
p.2
ATC ASSOCIATES
11I 0 1/3 I 0 ~:I
~\ fftltW..,J'"
Signaturo; John M~~#i:io-;-;;p"'$ent"t;v,,)
. f ,~.-.:
'rf..".......
'7Ll'~- 2/ -0 7
Date
Date
Signature: Barry McNulty (or r"pr"~c'"l"ti".)
CERTIFICATE OF AUTHORITY
"'Wilhou~ w~.h'inK UIt' ~j(:mpti()r. of .l)uk~ l:or.ll:)' lndi;;Jn3. Inc_ under Indiana COmmon I::."", to 1('1(':.1 z(,lnil1~ and
buildinc DudJoril)' n.quirt=l....cnb, I ht=1 t:lrf 4.:ertiry th1H ] have tbe 3uthorjlY to make tht forcz,oing ~pplicatj()n and
tbot the npplicJtioll is correct.
Under th~ p.'n:tlti~ of p~rjul'Y (.In<Ji:Jll~ Code 3S-M~2~])) J hereby tlCfirm, under o2.th, that 21U fir the inro.-m..tioo J
b:at" prnvid~d in rhi.s: :lJ'lphC.3tion f-or dCJ>>Ori~ioo permit is trut' 2nd at:r.urntp, to the best of my knowledge 3nd ~lir:f.
,.nd that I I,ave not knowin21y ~r jl'.lh:fltiom:dly prnvided or omitted any in(ormllfiolJ {h.at \VOllld tencl to Mde.
Qbscurc. Or (..otherwise mislc.:zd the Deparlment of community Serviees regMdiQg tbe truth of the. m.3.tt~rs a<ldteSsed
thercil'Jo
"'.urtber.., J :I:.;S(',.{ thlll 1 ;lJn the p.-opcny owner, Or Ibe :wlhnrizcd agent and Jawfully appoinl€.'cl 3r.,f"OI (If tbe
owner(s). th",t I have npr~:r,s ~\IlhvrilY {Ind prrmi~,qon from the owner(E;) (~ncJ 9nyonc wj(h :. recorded interest Or
olhel- inlcrc:~t 11) (he propc"l"ty .. 10 t::J.k,o Ibi~ rcq\Ie-s'cd nClion~ ,lIld rhll( I aJ;TC:C to indcmniry ~nct 1'10'<1 h'::'YlIlkss lll"
City of C:tf ulc.:l f,.om y chlll)j, luwsuit, demand, or dam:lJ;t'!:5 wh:.t5oever orisjng out 0(, or 3S 21 n:snll of. thi."
Me" or lh~<l;on' 0 S==l1ing .,>""'.
(p -;zo ~ C2_7_
Date (
../!J.i.j{e- hlA., J/tlu 1'7. 111--- fJ71 -- J//f
(Name printod) '"'r. /, /......PI /' f .J,. / "" Applicants Phone #
7J.;ICG--.gfi,,"l,'i)' .1/1#.&;0.<.--'( y.7f;? '~17/ r.~i'm &or"''' /
IClv bit !l!EiJI1 5/-~ P"'r"I7t'dY IN
Applicant'" Address City, ST
f/t /6 if
Zip
STATE OF INDIANA )
5S
County of ~ou..l +. ,..., )
Beforl? me, the .Jndersignod, OJ Not:.ry Public fo~<" ,'~-'-
County. State of Indj""... p&rsonally
appeared -D::u .l<','~"")\" '..~,......J
instrument thi!; ~ d:.y of IUN('_
::lnd aCknowledged the execution of the> foregoln!,!
, 20.Ql.
"
~s.!..c!n """-
(/I. ~_(>..,:>, (') I~I
MyCommisolon l-.xpm:o:;;:
(~ri tl
"
.'j:Pcrmil!>ft=orm'!';/oem'".IiliC}l"lIJ"r:nll M:mrlovl
~ _~.>LSQoI r-./Y;
20/ :>
/20/2007 15:40 FAX
/20/~007 13;55 FAX
3177788508
3118484278
HAM CO HEALTH DEPT
ATC ASSOCIATES
I€J 003/005
Ii!I008/01S
Signature: John Mascari (or repreaanlatlva)
Date
entatlve}
6- )0- 07
Date
CE:RTfFICATE OF AUTHORITY
*Wlthoul Walvlng lho "",emplion of Duke Energy Indian., Inc. umler Indlau common IA'" 10 local :waidg Blld
buildIng authority ..'quiremanlS, I hereby ecrl;ify Ihot I have the authority to make Ill. foregoiug 'pplicAtion and
thAt the Application It correeL
UDder tIl. penalties or porjury (Indla"a Code 3544-2-1), ] hereby affirm, under oalb, tht all of tho informalfo" I
bove provided in tbis appUcattoll for demolitioll permit is true aDd a""W'lIte, to tho bMt of my knowledge ad belioe,
and that I bave not Im_tngty or illtentiollally provided or ondtfed any Informalioo tbat would tmd to hId.,
obscure, or otberwll. mislead tho Department of communiI)' Servlees reprdllll: the trufb of tbe mAtto", .dd.......d
lhoreln.
Further, r .......t tbd I om tae property oWller, Or the aulbot12ed agonl and lawfully oppolnted ageot of tb.
ownerCs), tbAt I bave e:rp..- authority Aud permiss;"n from Ibe 0""'Br(.) (llIId anyollo ",ith A recorded lnt"..t or
olber InterC5t la the properly), 10 lake thIs reqlJestod .edoll, Bod tbat ] a.:ree to indemnIfy .lId bold harmless the
Clly of Cormel ~ aD afJD, I''''sult, demalld, or domages wha""o"er arlsibe out of, or A' a rcsoll of, thb'
reque.t or the .etto e CIty ofC...mel, regarding .ame.
l JAA--1 ~. ~- -~
pplicant's Signature & Pate
G:, -'<'0 ,-. CJ 7
Date
fJ1;k M:lm~1'1
lame printed) a )
(J~.&1t'refl.Jd~",,-;s-.,,11. ~mfr"~'" 74"{
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tplicant's Address
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Applicants Phone #
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City,
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---.. ..____R____..__
ATE OF INDIANA )
55
untyof .hh......L~ I
'ore mil, the undersigned, a Notary Public for ~<>"'4.
County, State of IndIana, personally
'earQd
,,,",,It..(.. IJJ,.,;T......c:>..JV
and acknowledged the execution of the foregoing
:rument this .;;1..::. day of __"'T. ,..If..
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'N/TY MAP
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Wednesday, June 27, 2007 8:46 AM
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