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Home My WebLink About228825 1/29/2014 CITY OF CARMEL, INDIANA VENDOR: 366545 Page 1 of 1 ONE CIVIC SQUARE OLD TOWN DESIGN GROUP CARMEL, INDIANA 46032 1132 RANGELINE ROAD CHECK AMOUNT: $4,317.00 CARMEL IN 46032 CHECK NUMBER: 228825 CHECK DATE: 1/29/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 REFUND 102 . 00 REFUND 609 5023990 REFUND 2 , 615 . 00 REFUND 651 5023990 REFUND 102 . 00 REFUND 659 5023990 REFUND 1, 498 . 00 REFUND **COMPLETE est RETURN REFUND REQUEST TIS FORM TO: Building&Code Services City of Carmel Ph. (317) 571-2444 Fax (317) 571-2499 Building Code Services One Civic Square; Carmel, IN 46032 PERMIT #(s): �3t 2O0 Z� Lot & Subdivision, or Address of Construction: 12'0 TT4du daf. pr\_ (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: W F✓ (U-b4/�S ELS � tA-AJd) ''C�angt sSOO II 1� P-?C%STiA'c. 1i L �✓� 'i i� (,WAAeL rVz-6A7' lr-> TOE 1W5 rat- f*u/E(- A'-JO w A rte. TOTAL REFUND AMOUNT REQUESTED: Applica t Signature Da e MAT L*FMA-v✓ -1-0w.ti *V&Sl(V'j &L-VVP Applicant Name— Printed Company Name (If applicable) APPLICANT ADDRESS: Street Address City Zip -3(`7- Phone# Fax # FOR OFFICE USE ONLY: p Total amount for fees that ARE available for refund: p Fees that are NOT available for refund: p Refund approved by: Date: p Date submitted for Payment: Amount Approved: Prescribed by State Board of Accounts - Form No.301 (Rev.1995) ACCOUNTS PAYABLE V_OU HER TO � `tau-n.-1 S i Lf— ADDRESS Ij ( JQ Invoice Date Invoice Number Item Amount (-utia auouev. I.- ())-vc7 i S. oi) I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received cept Mo. Day Yr. / Signature Title I 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. Mo. Day Yr. elf Officer Title Voucher No. Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS MUNICIPAL WATER DEPT. ACCT. NO. CARMEL, INDIANA F or Of LCVN f I at, &4�� (,--t_ _71 Total Amount of Voucher $ Deductions pro ioa ,� Amount of Warrant $a� Month of ¢ V�1�f f y VOUCHER RECORD Acct. No. Source of-Supply Water Treatment Transmission and Dist. Customer Accounts Administrative and General Operation-Maintenance l?� Utility Plant in Service J Constr.Work in Progress ou Materials and Supplies Customers Deposits Total Allowed Board of Control Filed Official Title BOYCE FORMS•SYSTEMS 1-800-382-8702 325 ( � CA' ,7 "COMPLETE & RETURN i REFUND REQUEST TH[S FORM TO: 6City" 's�- Building c� Code Services of Carmel w;ter. Ea Ph. (317) 571-2444 Fax (317) 571-2499 Building Code Services One Civic Square; -. Carmel, [N 46032 PERMIT #(s): 131200 Z� I Lot & Subdivision, or Address of Construction: i !2v 7q4da 6%. (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: W� R.�.b4/�►51ED ; � tA-&/I) vJtt R A AOose v4 3010'1(o, .4 A)J ^ D• . �{ �>.FpM '1' i�wT, (,A&AA, r09-607' ID ',-IJJer Tg}E Afif5 r'a2- A-JO TOTAL REFUND AMOUNT REQUESTED: /t0 I� Applica t Signature Da e Applicant Name-Printed Company Name (If applicable) APPLICANT ADDRESS: Street �AddressST i -Zip Phone # Fax # FOR OFFICE USE ONLY: p Total amount for fees that ARE available for refund: p Fees that are NOT available for refund: I p Refund approved by: Date: — p Date submitted for Payment: Amount Approved: 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) "If 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). a Certificate of*Occupancy or Substantial- Completion ' Fees.- To be refunded: • PRIF Fee., To be refunded. :.._ Fees (re'46spection, late fees, "other" inspection fees): Refunds can be "made`if it.has been de'termin'ed'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 160.daydead/117e,:a'refund could-still be granted, all under the terms;as outlined above. NOTE: Applicants requesting refunds for sewer and/or water.perm.its should be directed to the utility provider. (Carmel Utilities or CTRWD.) i S:Permits/Forms/Refund Request Form Prescribed by State Board of Accounts Form No.301-S(Rev.1997) ACCOUNTS PAYABLE VOUCHER TO 0 ��U�,v��5 1 ADDRESS �� .v L,4 L« tc A-4,1rC� Invoice Date Invoice Number Item Amount F-,.)tia - uo oho f � o,to I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received e pt �.� d-( dDIL4 -� Mo. Day Yr. Sig ature Title I 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. Mo. Day Yr. Officer Title Voucher No. Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS MUNICIPAL WASTEWATER UTILITY ACCT. NO. CARMEL, INDIANA 7UwV 3)r S tvor�bf2��,G' tl'jo'� S i2/aett�E Lt,,.� _34 Total Amount of Voucher $ Deductions l0 l7 Dl7 IJLI g J vo Amount of Warrant $/(Y C)o U L Month of 4 lA / -I t. VOUCHER RECORD AcNo,-. Collection System Pumping Treatment&Dis osal<:::�— ��--- Customer Accounts l Administrative&General Reclaimed Water Treatment Jj Reclaimed Water Distribution LIV0 i. r , Total Allowed Board Members Filed BOYCE FORMS•SYSTEMS 1-800.382-8702 325 i