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Home My WebLink About6010057-Signed Demo Demolition Permit Requirements City of Carmel I Clay Township Building & Code Enforcement; City of Carmel One Civic Square; Carmel, IN 46032 Ph. (317) 571-2444 Fax (317) 571-2499 TO BE SUBMITTED WITH APPLlCATION*: Two copies of a site location map--clearly identifying the structure or structures to be demolished, the Tax Map parcel number for the parcel on which the demolition is to occur, and this form signed by the appropriate departments. (*Applicationis a three-part form available from the Building & Code Enforcement Office) NOTE: · A separate permit application must be. completed per parcel. · CertainJnspections are required relating to private wells, septic systems, and fuel tan.ks, prior to demolition. . · Should approvals be required from other State or local government entities, or utilities (other than those addressed herein), itis the sole responsibility of the contractor of record to obtain such approvals. Well must be plugged according to Well Ordinance A-62. . Septic syStem must be pumped and filled With sand, or removed. If septic system is to be reused, it must be plugged off until ready for re-use. Fuel tanks must be pumped and removed from building andlor property. . Ko=1-'~ if'/LJt! u.Je.S1- I.~ ~ t~~~~ 1?-(fl.:..I"-t>tJ-(J()-O~OOD Address of demolition Cl:>O 7' Tax Map Parcel # cdC2.. .~ //B w' ~ ~ feu-A .J;/ Owner(s}Name and Address . rOO r . L/(d)~2- Additional Structure(s) on site: 0, )JiJ;Jf (If yes, please list the number and type(s) of structure on the lines provided. If ~-nt' ~;Gctures has a separate street address than the primary structure on the parcel-please also include that information.) Existina.well: Existihiissotic: Fuel Tanks: The City of Carmel and/or Hamilton County Health Dept. must perform an inspection prior to demolition. In order to approve the demolition permit, the applicant is required to sign this form and obtain the sianatures of the individuals listed below. (This can be done by FAX to their offices, at the numbers listed below) Include this completed form with all aoorooriate sianatures (ON THE REVERSE OF THIS PAGE) when you submit your application package. 1. Morris Hensley, Supervisor: Water Treatment Operations, City of Carmel; Phone (317) 571-2673. FAX (317) 571-2265. 2. Barry McNulty: Hamilton County Health Dept.; Phone (317) 776-8500. FAX (317) 776-8506. S:Permits\Demolition permit handout 1of2 ,/.3 93., Signature: Morris Hensley (or representative) Date Signature: Barry McNulty (or representative) Date CERTIFICATE OF AUTHORITY Under the penalties of perjury (Indiana Code 35-44-2-1), I hereby affirm, under oath, that all of the information I have provided in this application for demolition permit is true and accurate, to the best of my knowledge and belief, and that I have not knowingly or intentionally provided or omitted any information that would tend to hide, obscure, or otherwise mislead the Department of Community Services regarding the truth of the matters addressed therein. Further, I assert that I am the property owner, or the authorized and lawfully appointed agent of the owner(s), that I have express authority and permission from the owner(s) (and anyone with a recorded interest or other interest in the property), to take this requested action, and that I agree to indemnify and hold harmless the City of Carmel from any claim, lawsuit, demand, or damages whatsoever arising out of, or as a result of, this request or the actions of the City of Carmel, regar ,ng same. ~ Applicant's Signature & ,-~-~ . Date IYl UALD flJ2-v....~ (Name printed) 6'75-/10 '-/ Applicants Phone # / /8 tv. (? .tl./wne/ ""2>.12 ~ Applicant's Address ~ City, -1-N/ ST LlbO 3 Z. Zip . STATE OF INDIANA ) " / :J 55 County of J,hf4tdm 1 Before me, the undersigned, a Notary Public for ~.c.dIM County, State of Indiana, personally appeared 7JltVJ{~ d1'1~LI~ and acknowledged the execution of the foregoing instrument this 4 A day of ~-L..t.~ ,20 # &. ./ ~--<-~,;( ff~ Notary Public 1 $ehAk: 'f.cJJ-> 09 My Commission Expires: #.4~/l,(7/i (Print) S:Pennits\Demolition permit handout 2012 01/12/2005 08:15 3175712255 G1/16/2666 68:25 3178466217 CARMEL UTILITIES 1132 OFFICE BUILDING PAGE 04/04 PAGE 65 '1'N'1 ~~I-' ',Sign. 111. Morris Henl1ley (01' mprM9 Date J - 1;2 - D(P Signature: Barry McNulty (or repl'899ntl1t1vll) Date CERTIFICATE OF AUTHORITY , Under thcl penalties of fl,eljury (IndIana Code 35-44-2-1), f hereby affinn, under oath, that 11111 of the Infoml!lticm I have provided in this applicatIon for demolition pannlt IS true and accurate, to the' best of my knOWledge and belief, anel that 1 have not knOWingly or intlmtionally proVided or , omlttacl any InfQrmation that would tand to hide, obsCUI1I, or otherwise misleacl tha Department of Community Sel'lllces regarding the truth of the matters addressed therein. Further, , assert that I a~1I the property owner, or the authorized and lawfully appointed agent of the owner(ll), that I have expmss authority and permission from tho owner(s) (and anyone With a recorded Intel1l.t or othl~r interest in the property), to take this requested action, and that I agree to indemnify and hold h,lnnless the City of Camel from any claIm, lawsuIt, demand, or dlllTlagea whatsoever arising Qut (If, or all a result Of, this request or the actions of the City of Carmal, ;'TY2-l 1-"\- D'- J. ' Applicant's Signature & \~ate Date .' }11h/1) #~~. (Name printed) 575- ftfot./ AppliCllnts Phone # //8 tv &AA-1e/ Applicant's Address 7J~/IIe. &I'tn:l!/ CIty, J;1; ; ST .:j40"~ ~ ZIp --- <, STATE OF INDIANA ) . 88 County of ~/h< I ,1:,_' 'I Before me, the undersigned, a Notary Public far appeared J1fUI/JO ;/~l?1 ~"""'-' Instrument this 9fld~ of "'~ ~~ . ; County, Stme of Indiana, pI'Irsonally and acknowll!!dged the exeCUtlOIl of the fOf\!gofng ,20 () (". . x1..u~ ./ dt-t~ Notory PlJbRc . ~~ ,4 JJI..::hl''f!:-e. (p,;"~ <9. ,,21" Ci t, My Cmnm\lI$\nn E><p 1'0" " ' S:!'@ntlils\CGmcn~cn pl!!lnnft handout 2012 '1<,; 01/12/2008 08:35 FAX 3177788508 Bl/le/2006 BS:aS 317846B217 HAM CO HEALTH OEPT 1132 OFFICE BUI~DING ~ 005/007 PAGE BS 'I'I'I'f , .' .." Signature: Morrie Hensley (or ...presentdve) Date OAM~P~' eH5 Signa ; Barry McNulty (or repr_l'lbttlvu) I-I~ D-. CERTIFICATE OF AUTHORITY Under the penalties of per.lury (Indiana Coca 35~.1), I hereby amnn, under oath, that all of the Inform.t1on I have provided In this application for demolition permit Is true and accurate, to the ~st of my knowledge and benef, and that I have not knowingly or IntentlonaBy provided or omitted any Informlltlon that would tend to hide, obscure, or'otherwt.. mislead the Department of Comm!Jn/ty Servl~$ regllrdlng the truth of the mattenl addressed hueln. Further, I assert that I am the property ownar, ot the authorized and lawfully appointed agent of the owner(s), that I have express authority and parrnlalon from the owner1s) (and anyone with a reGorded Interest or other Intanl8t In the property), to take thle requested action, and thai I aUnte to indMlnlfy and hold harmless the City of Cannel from any *Im, lawsuit, demand, or damages ~:.c;ew[r .':n~ng outLot. or as a result of, this NqUlJ9t or the actions of the ,City of Carmel. ~ L_ I-~-~ Appllca t's SlgnatuN & Date )1()JtfO lleAdtA.StJN (Name printed) lIS LU. (?.4~ ~ Applicant'S Addre.. S7S -/9tJt! Applicants Phone t# r:. . .....* Q :J:;..;. Ctty, ST '-I14tJ 3' '2- Zip STATE Of' INDIANA ) ~ :ASS County of 'L I Etefore. me, the und8111lgned, a ~Dtary Public: for appellJ'8d .Mtut~ ~}'..us",>u .1i1Wumtntlhllll 9A~of ~ ~ County, Stllte of Indiana, personally and aoknowledgad the 8Xl1cutlon Of the foregoing .ZOOt. . ~~",AJ ;-( d~. ..&1.RA'.I9;€# .L.. ,dk:6 ReA' (P~nt) lS:_lelOemollllon pOIl\l~ Nll\dout 9. ;CI~' ('/ 9 MrCommIal"" !Iqll,.: 2"'2