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PLANNING AND DEVELOPMENT

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Page 1 of 3 09/2021
PERMIT APPLICATION
NEW SINGLE
FAMILY AND TWO FAMILY RESIDENTIAL STRUCTURES
Is this a Revision?
[ ]
Yes [ ] No
If yes, permit #
PROJECT LOCATION
Property Address:
Subdivision:
Lot Number
Section
TYPE OF STRUCTURE IMPROVEMENT
Project Square Footage:
Project Valuation:
[ ]
New Single-Family Structure
[ ]
Addition
[ ]
New Two Family Structure
[ ]
Remodel
[ ]
Foundation Only
[ ]
Accessory Structure
[ ] Basement Finish
[ ] Moving Structure
# of stories
above street level:
Project Description:
Basement: [ ] Yes [ ] No
APPLICANT INFORMATION
Name:
Company Name (if applicable):
Address:
Email:
Phone:
OWNER INFORMATION
[ ]
Same as Applicant
Name:
Address:
Email:
Phone:
CONTRACTOR / BUILDER INFORMATION
[ ]
Same as Applicant
Primary Contact Name:
Company Name:
Address:
Email:
Phone:
*Name of Onsite Superintendent:
Superintendent Email:
Phone:
PLANNING AND DEVELOPMENT
16 S 10
th
Street, Suite B140 Noblesville, IN 46060
Ph. 317.776.6325 planapplications@noblesville.in.us
Page 2 of 3 09/2021
UTILITIES INFORMATION
Electrical Code being used: [ ] 2020 Indiana Residential Code [ ] 2009 Indiana Electrical Code
Plumbing Code being used: [ ] 2020 Indiana Residential Code [ ] 2012 Indiana Plumbing Code
2020 ENERGY COMPLIANCE METHOD
[ ]
Prescriptive (most restrictive)
[ ]
Total UA (allows building envelope trade offs)
[
]
Performance (most flexible, considers heating, cooling, and water heating costs only)
TYPE OF SITE IMPROVEMENT
Width:
Length:
SANITARY SEWER, TAP CONNECTION: [ ] New [ ] Repair [ ] Conversion [ ] Septic
Length:
SEA 393 DISCLOSURE
In accordance with Senate Enrolled Act No. 393 (SEA 393) regulations, all Class 2 structures must disclose
the types of advanced structural components used in the qualifying property.
Advanced Structural Components Used:
[ ]
Roof (specify below)
(check all that apply)
[ ]
Truss
[ ]
n/a
[ ] I-Joist
[ ]
Other
[ ]
Floor (specify below)
[ ]
Truss
[ ]
n/a
[ ]
I- Joist
[
]
Other
FINANCIALLY RESPONSIBLE PARTY
Person to be billed for all
expenses relating to permit :
CERTIFICATION & NOTICE OF INTENT TO COMPLY STATEMENT
I hereby certify that I have the authority to make the foregoing application, that the application is correct, and that
the construction will conform to the regulations in the Building Code, the Unified Development Ordinance, Noblesville
Construction Standards, the Stormwater Ordinances and Stormwater Standards Manual, the approved Plans and
Specifications, IDEM requirements, any and all Local, County, and State requirements including private restrictions,
if any, which may be imposed on the above described property.
I further certify the modifications to the site and erection of a structure to be completed with this project will not cause
any adverse drainage condition that would cause damage to adjoining public or private property as a result of this
construction.
I understand that I have six (6) months to request my first building inspection, and no more than two (2) years to
Page 3 of 3 09/2021
complete this project. If I do not begin or finish within the allowable time, this permit will be null and void.
I further understand that all work associated with the issuance of this permit must be inspected and approved by
the City of Noblesville, at predetermined points in the construction process, and includes inspections by both the
Planning and Engineering Departments.
I further certify that the construction for which this permit is issued will not be used or occupied until proper
Certificates of Occupancy are issued by the Department of Planning and Development.
Signature of Owner/Authorized Agent:
Date:
Printed Name:
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PLANNING AND DEVELOPMENT

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Completed 22 March 2022

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