HomeMy WebLinkAbout07080017 Application
, City of Carmel/Clay Township Permit #: (J708 00/1
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:
SECITON:
ZONING: 6 _ ~
SQUARE . \ A
FOOTAGE: \~
ADDRESS OF CONSTRUCTION:
1
SEWER UTILITY r\ .~
PROVIDER: \.:.... 11< W j../
l ()q -r~ S-t-
\.,0
~~
ESTIMATED COST OF CONSTRUCTION;
(EXCLUDING LANO VALUE)
WATER UTILIlY
PROVIDER:
NAME OF UTILITY EXCAVATION CONTRAO'-oR; PU\N COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
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
. ~ RE~~~NTIAL (For
r Additions. Remodels. Etc.)
PROJECT INFORMATION:
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this pennit is valid only if construction commences within ISO
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 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 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 laws of the State of Indiana, and the "Zoning Ordinance of Cannel Indiana -1993~ (Z'
289) and amendments, adopted 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 drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of
Occupancyhas been issued by the Department of Community Services, Carmel, Indiana.
"~</~ .e~
s nature of Owner or Authonzed gent
Early Release
Permit:
Lot Split:
_Y VN
_Y --->CN
x
TAX MAP PARCEL #:
IIDCO
TYPE OF IMPROVEMENT:
PLUMBING CONTRACTOR:
o NEW STRUCTURE
o ROOM ADDmON(S)
o PORCH ADOITION(S)
o DECK ADDITION(S)
o REMODEL
_ Basement Finish only
o ACCESS_~~ FOR 0 International Residential Code wi Indiana Amendments
~ ~~~~m~omp/jancWi~~ibFl.Wk.liUillN Code wi Indiana Amendments
~DEMOLlTION of State d " regulatlaD!>
~ DEPT OF an LOCl3OONIIlA\,TION TYPE: (Check all that apply for the new
ManufactuelTY 0 'CfJMMUNFl"fS~/'EEh
Trusses: ---.E:~~EL / CLAY ll$w~/:ffi CE 0 POST &_ BEAM _PIER
Sump Pump: VY _NINO/ANA 0 SLAB BASEMENT (WALKOLrr: vi Y_N )
Plumber's Indiana State license #:
Which plumbing codes will be applied to the construction:
N\ : JI. E /L~ l-Li!: >"
Print
8-3'-07
o.te
OFFICEUSEONLY:***********************************************************~********************
INSPECTIONS REQUIRED: Filing Fees: I,,,:) <A. 0
Base Inspecti~~ IcLh cP
Ee~~~ta : ~ ~3.00
Upper Footing Lower Footing Under Slab
Rough,}n Meter Base ~al ' .Y
W~ &WJ-f
Reviewed/Approved: Dept. of Community Services (Date)
S:PermitsfFormsjlLP RESIDENTIAL
# Charged Re-
Reviews
P.R.I.F.:
Additional Fees
~CW:~TAL: ,
Fee Received by: m
3d-5.50
1f 1,'3(07
f Date
Feb 08 07 03'55p Rob Lovell
67/.~;;I~ee7 14:56 97332053
(317) 571-2654
CARMEL WATER
p.2
PIIGE- 02/ a3
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Demolition Permit Requirements
City of CllnAel1 Clay Ta.nqhip
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1. .101M BIll ~ t:armel UfJJJlIes.
p,- (J11J 7>> inS NX(J17J 17.1 JfXR
2. 8lirPy ~ H--"'~"""" wpt.;.
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I't<<:~
JUL~30"2007 MON 07: 45PM 10: me kn i.h t~",l!emo 1 i ti on true ki n.
PAGE: 2
.
~ f:tftt c?/~r
Signature: John l\i1ascilri (or representative)
- -"e!".. """'/
__ _/.. <~) =(...1
Date
tk~ If joQir-..
- \ I
j11~~f.tLs ..
Signature: Barry McNulty (or repre....ntlltlve)
- .....
n. . ''7.{r::I...
0:1-' ./
Date -..
CERT!F!CA.TE OF A.UTHOR!TY
Under tho penalties ot perjury (Indiana Code 35-44-2-i), i hereby affirm, um:ler oath, that all of th~
information I have provided In this application for demolition permit is true and accurate, to the
best of my knowledge and belief, and that I have not knowingly or intentionally provided or
emitted any information that would tend to hide, obscure, or otherwise mislead the Department
of Community Services regarding the truth of the matters addressed therein.
Further, I assert that I am the property owner, or the authorized and lawfully appointed agent of ,
the owner(s), that I have express authority and permission from the owner(s) (and anyone with a'
recorded interest or other interest in the property), to take this requested action, and that I agree:
to indemnify and hold hannless the City of Carmel from any claim, lawsuit, demand, or damages
whatsoever arising out of, or as a result of, this request or the actions of the City of Carmel,
regarding same.
~fd-~~
Applicant'slgnature& Date
~i-t!.LL~
( ame printed)
9:39 w.T"o~ Ave
Applicant's Address
~-.;z -6')
Date
ft(4{" \5 kt
3--11 7 8"$ ~? tf c;-
Applicants Phone #
7~f/~(~
City,
Lf~~7<
ST
Zip
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STATE OF INDIANA )
countyoiy~SI ,
Before me, the undersigned, a Notary Public fO!' :1~ County, state of Indiana, personally
,,_ fJ.,.. ,d!.t' L ~ "d ~.knOWledged the execution of the foregoing
instrument this :;l. day of ~_~ ,20 fLl.
~~ YV1~1j
PAv/ks
(pri:1t1'
/ /- 7 - CJ 7
My Corntrd&&lon Expires:
MC./<::"MI 'f j f
SJ'ennll:llF0Ill1010om(lIWoo pormit handOut
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JUL-li'-200'"? TUE 07:43At'l ID:nll.:;krli9ht dE-uu) Ii Lion l,ruckin~
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,
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Signature; John M~c"ri (or representative)
~~ _7:: ;p = -07
Date
INt< t fJ!ii1"-
- \ I .
~~f.tiS
Signature: BaiTY M(;NultY(~r r~pre5llntatlve)
a '7 /\.::t.
"_C:.i-V.I
Dilte
CERTIFICATE OF AUTHOR!TY
Under the penillties of perjury (Indiana Code 35-44-2-1). I hereby affirm. under oath, that all of the
information I have provided In this application for demolition permit is true and accurate, to the
best of my knowledge and belief, and that I have not knowingly or intentionally provided or
emitted any information that would tend to hide, obscure, or otherwise mIslead the Department
of Community Services regarding the truth of the matters addressed therein.
Further, I assert that lilm the property owner, or the authorized and lilwfully appointed agent of
the owner(s), that I have express authority and permissiol\ from the owner(s) (and anyone with a
recorded interest or other interest in the property), to take this requested action, and that I agree'
to indemnify and hold harmless the City of Carmel from any claim, lawsuit, demand, or damages:
whatsoever arising out of, or as a result of, this request or the actions of the City of Carmel,
regarding same.
~~i~
Applicant's gnature & Date
~I) I c.-Ll...e.-
( . ame printed)
?l~;2-() ..,
Date
9S9iV. /~
AppliC<lnt's Address
tf1c;{n 1 A1
~ ~~1-iJ
City,
-.
"
317-7f3-3BtfS-
AppliC<lnts Phone #
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'-1(, :;.j::l. _
sr-
Zip
STATE OF INDIANA )
S5
County of '/11 (; A, uv-\ I
Before me, the undersigned, a.Notary Public fot "1Y\ "A~ County, State of Indiana, personally
appeared f)a/)~.A~~f IIp /1T~~T and acknowledged the execution of the fo~gOing
instrument this ;) day of ~AA.-O"7f--- , 20CLl-.
~J70", 'YY\c..~ 1/- 7- 07
Notaty-P ic My. Commission Expires:
Phvllls M</<:Y1I'Jh1
(I!rint),
S,P"nnII:liFOImelDomolitlon permit haOOout
2of2
,;1
JUL-17-200? rUE 07:43At'1 ID:nlckni<,;hl
delllo 1 i Li on L.r'uc ki rl~
PAGE; 4
.
'.... .
"., /{ - -~ [""
{kfi;r Cr'///~.-
Signature: John Ma&c"ri (or representative)
__ _7:: 3:' ~ 07
Date
!ft~ ;; tdr-..
'(1 \ ! .
....1~~ffi5
...-..- -..- --- --- .~.. ~"..- -. .-_. ~---
Signature: Barry McNulty (or reprel;llntatlve)
.~
\} ..,.I'\:::t.
IS:..L-'UI
Date -
CERT!FICATE OF AUTHORITY
Under the penalties of perjury. (indiana Code 35-44-2-i), I hereby affirm, um.l&f oath, that all cUhe
information I have provided In this application for demolition permit is true and accurate, to the
best of my knowledge and belief,. and that I have not knowingly or intentionally provided or
omitted any information that would tend to hide, obscure, or otherwise mislead the Department
of Community Services regarding the truth of the matters addressed therein.
Further, I assert that I am the property owner, or the authorized and lawfully appointed agent of
the owner(s), that I have express authority and permission from the owner(s) (and anyona with il
recorded interest or other interest in the property), to take this requested action, and that I agree,
to indemnify and hold harmless the City of Carmel from any claim, lawsuit, demand, or damag~
whatsoever arising out of, or as a result of, this request or the actions of the City of Carmel,
regarding same.
.
jYl r'.~ D-PJA0i All.. ()Yl
Applicant's 5i n ture & Date
"b/2/0l
Date
.D2J.njgj Ie me k-nigVl +
(Name printed)
1:U-l~?:> - 33LlS.
Applicants Phone #
Sj;q bLJjr 0,1 (Ne.
Applicant's Address I
'~)IS;,
C'
,
In
ST
Lj/.tJ221
Zip .
Q2.&
NotaryPllblic
:E.f 1/ / /;'5
...rint),
STATE OF INDIANA )
- SS
County of 71~ -I
,. ,
Before me, the undersigned, a.Notary Public for ~ County, State of Indiana, personally
appeared tJ~ ~~ -,I sf-'. and acknOWledged the execution of the foregoing,
instrument this ~ daYOf~-<~ ,20/)7. .
7Yl c t-i......j'P
!r1'-/<::'" I r j f
//- 7- <27
My Cgmmlsslon Expi~:
S:F"enl1ltBJF0ffil5/~~tloo permithsnaour.
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JUL-li'-200.! rUE 07:43Ai'l ID:"llIckni9hL dC:'llluli Lion LruckinSl
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carmel, Indiana - Google Maps
Page 1 of 2
(;o'oole" Address Carmel, IN
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carmel, Indiana - Google Maps
Page I of 1
" Gooole-' Address Carmel, IN
Maps 0
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