HomeMy WebLinkAbout07080113 Applicationkm 6,
City of Cartel/Clay Township Permit #: 7? R I?
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
0,tQIAO, For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER NAME: e(?? ?BM _6 PHONE: A T I/ ? t t ,-? yVl/lJ\
f-11 ?' FAX: I ?
1'th ?/'?Yr
/
OF
RECORD: STREET ADDRES : S-6 -k-WW -D(. CITY: S sTA : ztp:r/ ???
BUILDER'S EMAIL ADDRESS: BEST METHOD OF CONTACT: k
PROPERTY NAME:
?V PHONE: ?? FAX:
OWNER
: STREET ADDRESS: CITY: STATEN ZIP:
LOCATION
& PROJECT LOT SUBDIVISION NAME
31
I
I `` SECTION: ` ,l /l
y ZONING:
INFO: '
_ /
A0D ?
Z SQUARE
FOOTAGE:
[
e 1 t l(J_V
4\
SEWER UTILITY
( WATER UTILITY
PROVIDER: WW ESTIMATED COST OF CONSTRUCTION:
I (EXCLUDING LAND VALUE)1
PROVIDER: . Ill.tt?"'
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
OR COUNTY WELL AND/OR SEPTIC PERMIT u'S (IF APPLIC
ND
E
S {
ABLE): v1 ?
NUMBERS; TAG DAT
( ); A
/ Q
FLOOD ZONE AREA DESIGNATION(S) TAX MAP PARCEL #:
FOR THIS PROPERTY:
TYPE OF CONSTRUCTION:
0 ,SINGLE FAMILY
CD/ TOWN HOME
O TWO FAMILY
# of units being
constructed at this
time:
E) RESIDENTIAL (For
Additions, Remodels. Etc.)
PROIECTINFORMATION: /
Early Release /
Permit: Y N /
Lot Split: _Y
TYPE OF IMPROVEMENT:
(/ NEW STRUCTURE
O ROOM ADDITION(S)
O PORCH ADDITION(S)
O DECKADDITION(S)
O REMODEL
_ Basement Finish only
D ACCESSORY BUILDING
0 DETACHED GARAGE
ATTACH ED GARAGE
D DEMOLITION
Manufactured
Trusses: Y
Sump Pump: _Y _N
Plumber's Indiana
codes will be applied to the co&v
ial Residential Code w/Indiana
O Uniform Plumbing Code w/Indiana
FOUNDATION TYPE: (Check all that apply for the new
construction area)
O CRJLSPACE O POST & BEAM -PIER
( LLAB O BASEMENT (WALKOUT: Y_N)
For Single Family and Two Family dwellings, additions, remodels, and/or accessoy 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 IS months of the issuance date. Class I
structure pennies 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 Udirance of Cannel Inciana - 93'
289) and amendments, ado c under authority of I.C. 36-7 eL seq, General Assembly of the State of Indiana, anal all Acts amendatory thereto. I further c at oily
kitchen, bath, and floor dr ( are connected to the sanitary sewer. 1 further certify that the construction will not be used or occupied until a Cerrifi,
Occu tcyh bel`n issti by the Deparmient of Community Services, t teIpd iSna
Signature a Owner or Authorial kghnt Print M.Psv / /' Date
***xxxz**zz*xxzzxxxzxx*********x*x*xx*x***
OFFICE USE ONLY:
INSPECTIONS REQUIRED:
Upper Foot' Lower FootF de Sla
Rough In Meter Base alSite
C'Z^. Ie-IMISLX ??, -Z"7- 3
Reviewed/Approved: Dept. of Community Services (Date)
Filing Fees:
x**
Charged
Base Inspections: Y, 15U # ReviewsRe-
Cert. of Occupancy: o?S: ?b
Additional Fees
P.R.I.F.: Rip, l"al?'3
TOTAL: cly)
S:Peoartw xsial P. ESIDEN Fee ReceN•ed by: Date