HomeMy WebLinkAbout0243.98 Miscellaneous (2) �
d,�• y*.a APPLICATION FOR.INTERIM ;������,����oeFieeluseoN�v��:� �`�„��,,�il�
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�, �? REMODELING RELEASE Prolectnumoer
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i - . �• Stateform 26137(R3/4-96) !j � 0 /� �
., �� Approvedby.StateBoardofACCOUnts,1996 � n
e�"� Indiana Department of Fire and Building Services Fuing date �qp 2 9 �g98 �
PLAN REVIEW DIVISION
OKce of the State Building Commissioner Occupancy classllication � .
� 402 West Washington Sireet, Room E245 j3 �
Indianapolis, Indiana46204 �
Conslruction rype .
INSTRUCTIONS:See reverse side lor minimum qualifications and filing � � p. �R
procedures/or an Interim Remodeling Release.
NameolArchitect/Engineer � �/� /� A tiondesired:
SHA� M� �V e/�r�rr� Lpn�� ��, � ��. i� Pick-Up ❑ Mail-Out
Adtlress(number antl streef,cify,5fate,Z/P code .
a f.i , M G�'�-�►'�)��rl q� 1�'� .
Teleph(ne number ' � C��dividual� 1 � .
� ► $ �r�i9 9 ,owN
,-�'�,+,.?�'�+.�'."�.,�..°�"'�,:"�``r," 'v�"'t°.;^�P�: �*e��;��.�p'��t:`���ss�a'��*,��.,&"OWNER'SCE . FICATEPts"'.'.4 ��`��'�..� ��w.�,""� �:�''c�'�.�--F�"s�..�, z�'°-�"2�"m�." '�
I accept full responsibility fof removing and replacing any construction work found �AUthodzed �nat re(o� e� �
by plan examination or by inspection,to be in violation of ihe rules of the Fire �
Prevention and Building Safety Commission. Pfurther agree not to occupy or� Name(ry d.orpnnted�
allow occupancy until a full release has,been issued by�the State Building /'1vm� '� Ll ' M���
Commissioner and all.known code violations have.been corrected. I understand F~�� � ��
that failure to provide adequate plans and speci�ications or requested corrections 7elepnone number
thereto is a code violation. � ��� � �Iy�^) � 4 '
!���d":�;.���a.�����a�:`d�-�-.��S.:s"�'.2.ew�''�Y-�,��t ,-�a''-"�.s,-'"",ma,�'�'�'�eµPROJECTINFORMATION''=�,'�,°���^,�t. � -a'r"c'`a�` �e °�
. _, _� � ��� .Y�.,,et'�.z���°��`�,�.�„,�`w,°�"F^.���
Name ofproject � I -
H��� � ��M��,.�✓Y Faciliry �
Aatlress(numberand shee(,sulte orfloor,Gty,state,ZlPCOde)� � Coun
� 1'�� � � Ms�1,�nf�r1 �,cm.N►�L i Hcoo''�'1� H����T��1 .
Closest�i/ntersecting street or road • � Direction FROM intersection ro project
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����;���'�`-�i�a���'�4.i��$._'�"�'��NTERIM�REL°EASE,CONDITIONS;(OFF/CE.USEONL1j ,�?r.i�" "" ` "�° ""�'�� �
. �°�t�".u't�9'.�je._,*,.,u'�aYf„��"�,�.
This partial release for remodeling is granted pnor to full plan review and is subject to all the rules of ihe Fire Prevention and Building Safery Commission
and any local mtes tor issuance of a building permit by the local oNicial.As�such,this release�tloes not allow occupancy of said project until a standard
release is issued by the State Building Commissioner..THIS PARTIAL RELEASE IS NOT A PERMIT.
Comments:
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__..__ .......___._ .. . .. ............ ................. _........ ...._... _... ............. . _......... ___.... ..___ _._... ........_....._.. _...__
`;'�,',i!'�`„'�'"�,"�,��SCOPE OF�RELEASE(OFflCE�USE,ONLl����r'`��,�=�Mag`"a s`�"' �`��';3�.a?�. �a� Release Stamp
�rohitectural �� Structural ElecMcai ❑ Other
Plumbing ,l echanical ❑ Partitions ❑ Other
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IdTERIE9 REEO00�un�K't�c�a�
Cotle review oHicial $UbJQC110 COIfIp�l2flfR W1111
Z- "Z-98 Conditions herein and all Applica0le
�ocai owm�n9 on�aai Rul¢5 of th¢fIRE PREVEN?!ON 4NQ
�9vo3 - BWLDINGSAFEfYCOMMI�ION�NL
nddress(numberandsneetcrry,sratezrP�one� . ' THELOCAIAUiHORITI
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