HomeMy WebLinkAbout18100029 Signed Demo08-09-181'11:09AM;Fromj;Dorsey Paving Tc:3177332053
DemOlition Permit ReqUirements
City a' Carmel /Clay TOWnshl,
Building & Code Services
One Civic Square, Carmel, IN 46032
Ph: (317) 571-2444 Fax: (317) 57.1-24,99
# 2/ 4
I- Completed A p p Ii C'' 'Qzz-�Inar lighe fallowin mys,
on (Applicatio- at be sub Itt
n is three -Pert Sub _qA;
permit applicadon m Part form available —
Wr be completed pL.,, P,7rce, In the Building & Code office) Note.- Aseparate
2. Provide a Utility Disconnect Rec
31. elpt or Letter from each Provider on Location
*$'Df a Site location/Sine Plan (on Paper no larger than 11- X 1711) with the following information and
T" COPIL
nothing less,
• Tax Map Parcel Number for the Parcel on which the demolition is to occur
• Location Of all structures on the
0 for, with the structures dimensions
Property boundaries and dimensions including distances to the structure(s) to be demolished
• All neighboring structures Within 100 feet of the Proposed demolition
• • Streets, alleys, Other manmade or natural features, north arrow, sidewalks, aprons, etc,
Location Of proposed clumpster, if used
• Location of all Utilities
4. Provide CtrVfledP1UmbingC0ntrA7cr0rinf
5. Ormiltion (Contractor who
No Right of way Permit Needed ice (327) 571-;t441
Right Of Way Permit, from the CItY Of Carmel Engineering Offf will COP the sewer fi-ne at the property line)
6. This form m Completed and Signed by the appropriate departrnents
Mmkure Is to be removed Completely, including the
dsireded after removol unless new construction will
e completed thirty (30) days from Issuance
71P The Progress of the work shall be executed so as not to create a danger to the public
• All rubble and debris from demolition to be removed from Parcel before site inspection can be
Performed
• Must meet all' requirements of the codes and Ordinances (existing well,septic; eptic, fueltanks)
• The aPPflcOnt Or Owner is responsible for obtaining a certified Plumbing contractor to cap the sewer at
t
the PfOPerty line. NO PERMIT REQUIRED FOR SEPTIC TANK CRUSH AND FILL if appllcable, Removal
and/or crush and fill of tank to be included on demolition permit, septic tank to be Pumped and either
filled cir crushed as park of demolition Contractors respon-;wn
42. ot..GVIlFLi bKivte
Address of domalitlin
Oner(s) Name and Address;
(0 -10 - S I -00 - bra -002-,Oco
Teri MVPPVMe1#
A ddftna, Structurqs) on $;f'r.
. yes / No (If Ves,
Provided. If One of the Structures has aQ Please list the number And type(s) Of structure on the lines
include that Information.) separate Street address than the primary structure On the Parcel—Please also
08.09- 18;11a09AM,From: Dorsey Pav�ng To:3177332053,
I V I # 3,"
The
Illy of Carmel andlor uo"gitan County Health OePt- must Perform an inspection prior to
approve the demolition permit, the applicant i
11$te-d--b—el�o"O" (This can be done by F is required to sign this form n demolition, In order to
AX do I
! '12!1!511naturesNJJ)JF the Individual,
1. Brett, Ransford.. Carmel Utinties, to their offices, at the numbers listed below�i ..........
"'One (317) 733-Z85S' FAX (317) 733-2053.
Is PrOPerty on, both WaWrod sewer through the City Of Carmel Utilities?
If "yes",
t4amiltOn County Health Department signature below Is not required,2. Yes
Jason LeMaster.- Hamilton County Health Dept,
Phone (317) 77"500_ FAX (417) 776-85()6.
5,71nature• tett ansfo
o d (Or representative)
X No CD
Signaturez Jason LeMaster (or representative)
Date
Under the penalties of perjury Cj2R-TIF10E!L0—!.� �THQ�Rrry
(Indiana Code 15-44-2-1), 1 hereby affirm, under oath, that all of the information I have provided
this application for demolition permit is true and accurate,
or Intentionally Provided or om to the best of my in
CDtnmunityServlce$ Itted any information that would knowledge and belief, and that I have not knowingly
regardinj tend to bide, Obscure, or Otherwise mislead the Department of
the truth Of the Matters addressed therein.
1:u'rthQr, 1 assert that i 8M the Property owner, or the authorized and lawfully appointed agent of the owner(s), that I have express
authority and Permission frena the owner(s) '
requested actic, d (and anyOne with a recorded Interest Of other Interest In the Property), 'n- an t I agree to Indernflik and hold harmless the P rtY), t take this
dame whatsoever
es w ve,
r r2l_gOIA Of, or as a Qty Of Carmel from any claim, 13wsuit, demand, or
result of, this recluest Or the actions of the City Of Carmel, regarding same.
Applicants Signature
jAg AEX pate
NamO Printed)
2- 10 1 S. 14 Ag�oWb C r Applicants Phone #
Applir-anes Address -A LO +x.1-1
City,
STATE OF INDIANA
County Of SS
ST
LM
Before me, the undersigned, a Notary Public for
---------County, State of Indiana, personally appeared
day of and acknowledged the execution Of the foregoing instrument this
20
NZI-V�P-bll-
my cam-tysion Expkes.-
(Print)