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Home My WebLink About160582 06/10/2008 CITY OF CARMEL, INDIANA VENDOR: T361404 Page 1 of 1 ONE CIVIC SQUARE DAVID SMITH CARMEL, INDIANA 46032 14170 STACEY ST CHECK AMOUNT: $59.00 CARMEL IN 46033 CHECK NUMBER: 160582 CHECK DATE: 6/10/2008 DEPARTMENT ACCOUNT PO NUMBER I NUMBER AMOUNT DESCRIPTION 101 5023990 59.00 OTHER EXPENSES Je P 'ems r° e t 0 a,+ REFUND REQUEST "CO oR RETURN G� F Building Code Services City of Carmel Ph. (317) 571 -2444 Fax (317) 571 -2499 Building &r Code Services One Civic Square; Carmel, IN 46032 PERMIT #(s): �—V 0 4 0 lO 3 Lot Subdivision, or Address of Construction: (If more than one address needs to be listed and will not fit, please attach a printed list of all permits, with their corresponding permit Please print or type the reason for the requested refund, and specific fee or fees which are requested, in the lines below: del2c� J e perm in er ror T� on lu v� e c ha r �n�rl�Y 3. TOTAL REFUND AMOUNT REQUESTED: *5q Oo Crne G t, -F 1'Iy l 1+ ouf do Applicant Signature Date Applicant Name Printed Company Name (If applicable) APPLICANT ADDRESS: v i d Sim 4+1 l l-4 I 0 S4 Street Address Car City ST Zip (;I i) 5to� GLaO Phone Fax FOR OFFICE USE ONLY p Total amount for fees that ARE available for refund: A E D p Fees that are NOT available for refund: p Refund approved by: L m Date: M p Date submitted for Payment: a ,3 Amount Approved: s- REFUND REQUESTS MUST OCCUR WITHIN RESIDENTIAL PERMITS Within 180 days from the issuance date of the permit. COMMERCIAL /INSTITUTIONAL /MULTI- FAMILY Within 1 year of the issue date of the State Commercial Design Release (CDR) there is NO CDR they need to begin within 1 year of the issuance date of the permit. FEES WHICH MAY BE REFUNDED ARE Inspection Fees. Count the number of inspections charged on an ILP application (assessed by plan review). Certificate of Occupancy or Substantial Completion Fees. To be refunded. PRIF Fee. To be refunded. Fees (re- inspection, late fees, "other" inspection fees): Refunds can be made if it has been determined that a "clearly defined error" has been made when a re- inspection, late, and /or "other" fee has been assessed. NOTE: If an ILP has gone beyond 180 days for start of construction, no refund can be generated because the ILP is technically invalid /expired. If, however, the applicant has requested, and has been granted, an extension of time prior to the 180 day dead line, a refund could still be granted, all under the terms as outlined above. NOTE: Applicants requesting refunds for sewer and /or water permits should be directed to the utility provider. (Carmel Utilities or CTRWD.) S:Permits/ Forms/ Refund Request Form ��L�A�E�F��NSTR�� ~^t' �"'''°"^~p ��7SI�� CATION For Single Family, Town Home, &l� Family: N� Structures CONTRACTOR BUILDER NAME: P2N a: tA11!'V1ffL OF eL�-Wle(' INDIANA RECORD: STREET ADDRESS: CITY: STATE BUILDER's EMAIL ADDRESS: BEST METHOD OF CONTA IJ PROPERTy NAME: PHONE: FAX: OWNER: No T� 667 -C& "(0 ky__ STREET ADDRESS: CITY: STATE: ZIP: LOCATION L SUBDIVISION NAME: SECTION: ZONING: Oaf f PROJECT LA F ADDRESS OF CONSTRUCTION: SQUARE SEWER UTILITY WATER UTILITY ESTIMATED COST OF CONSTRUCTION: PROVIDER: 0 0 r me/ PROVIDER: rnel (EXCLUDING LAND VALUE) S'3S)03. NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION BZA BPW DOCKET NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE): FLOOD ZONE AREA DESIGNATION(S) MAP PARCEL 0 SINGLE FAMILY CD NEW STRUCTURE TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT: PLUMBING 0 /vWmnOMc 7`^ C3 mvwnwupr/Iww(S) p1wnbe,�znd�naS�to�cense#` O -4—_6g pORC*«DDDIOm(S) #or units bein9 r�i�� DECK AooJTzom(S) constructed attxis(��" REMODEL Which plumbing codes will ue applied u, the construction: time:— Basement Finish only RESIDENTIAL (For ACCESSORY BUILDING International Residential Code w/zndianaAmendments Additions, Remodels, Etc.) osT��*somAm�� C] Uniform Plumbing Code `m/zndianaAmendments c] ATTACHED GARAGE PROJECT O DEMOLITION (Check all that apply for the new Early Release Manufactured Permit: y Trusses: _--Y r construction area) [nAwLSpA[E O�' pO3T& us^mPIsn �«Split: ___Y v m Sump pump- __-y�-�-m SLAB BASEMENT (vvALm]oT:__-Y__--m) For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid ordy 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 permits are subject to the General Administrative Rules of the State of Indiana (See 675 IAC 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 ofland orstruccures 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, 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 Boor drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of occu,pancyhas been issued by the Department of Community Services, Carmel, Indiana. Signature of Owner or Autfiorizeci Agent Print Date OFFICE USE ONLY: INSPECTI REQUIRED: Filing Fees: Base Inspections: Charged me- Uppei LoxvarFooting Under Reviews Cert. of Occupancy: Rough In Meter0ase P.R.I.F.: Additional Fees Revi ed/Appro'v( ept. of Community Services (Date) CITY OF CARMEL Item 1 of 1 PERMIT RECEIPT OPERATOR: plux COPY 1 Sec: Twp:18 Rng:04 Sub:668 B1k:19 Lot:161 PARCEL ID 1610190207005000 DATE ISSUED........ 05/13/2008 RECEIPT 28086 REFERENCE ID 08040163 SITE ADDRESS 14170 STACEY ST SUBDIVISION FOSTER ESTATES CITY CARMEL IMPACT AREA OWNER NORMA J SMITH ADDRESS 14170 STACEY ST CITY /STATE /ZIP CARMEL, IN 46033 RECEIVED FROM NORMA SMITH CONTRACTOR LIC SMITNOR COMPANY SMITH NORMA J ADDRESS 14170 STACEY STREET CITY /STATE /ZIP CARMEL, IN 46033 TELEPHONE (317) 569 -0640 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL IRESFINAL FLAT RATE 1.00 59.00 0.00 59.00 0.00 IRESFTSLB FLAT RATE 1.00 59.00 0.00 59.00 0.00 IRESROUGH FLAT RATE 1.00 59.00 0.00 59.00 0.00 2ESADD SQUARE FEET 89.00 153.68 0.00 153.68 0.00 2ESC /O FLAT RATE 1.00 57.00 0.00 57.00 0.00 DOTAL PERMIT 387.68 0.00 387.68 0.00 METHOD OF PAYMENT AMOUNT NUMBER 'HECK 387.68 1307 DOTAL RECEIPT 387.68 Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee S&M Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total O 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 I N M F SU O ON ACCOUNT OF APPROPRIATION FOR Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or /0/ 56a3ggO 6q.d0 bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except lc423 200 9' i Si nat Cost distribution ledger classification if Title claim paid motor vehicle highway fund