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Home My WebLink About06010065-Signed Demo Demolition Permit Requirements City of Carmel! Clay Township Building & Code Enforcement; City of Canmel 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 completeq per parcel. + Certain,inspections are required relating to private wells, septic systems, and fuel tanks, prior to demolition. . · Should approvals be required from other State or local government entities, or utilities (other than those addressed herein), it is the sole responsibility of the contractor of record to obtain such approvals. Existina well: Existiha septic: Well must be plugged according to Well Ordinance A-52. . 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. Fuel Tanks: 13 '13 U)esf" /38 il, si'& Address of demolition ~C- 7)~. //8 {U, Owner(s) Name arid Address /1-0"l-/9-t)a-oo-OC//.OtJD '{pO 7< Tax Map Parcel # (7o~~ ~ ~d;l(fl~L Additional Structure(s) on site: Yes / @ (If yes, please list the number and type(s) of structure on the lines provided. If one of the structures has a separate street address than the primary structure on the parcel-please also include that information.) ---------~---_._.__._-_.__._------_._--_.__._---_._._------.-----.---..---- 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 appropriate sianatures (ON THE REVERSE OF THIS PAGE) when you submit your application package. 1. Morris Hensley, Supervi$or: 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:Pennits\Demolition permit handout 1012 <It/'I'f., 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, regardi ame. v.. Applicant's Signature & Da e Date ft1utJO HeAlde.,l-SON (Name printed) ,575 -/90Y Applicants Phone # 1/8 1>>. rA-~ ~ Applicant's Address ~~ City, 7::iJ ' ST y&O '3 'Z- Zip STATE OF INDIANA ) ~~SS County of / ) Before me, the undersigned, a Notary Public for appeared 7;1/U?t-& A441 tiki S tF)u instrument this 9~ day of ~~v;'-~ ;:7 i/ ~d~", County, State of Indiana, personally and acknowledged the execution of the foregoing ,200& . ~N ;( pULv Notary Public ,M/.?A/l/Vl- ~. ~,,6- RC/L (Print) 9-;? "p.t:! 'f My Commission Expires: S:Pennits\Oemolition pennit handout 2012 01/12/2005 08:20 3175712255 ~l/l~I~~~b ~H:~b 31784b~~l( CARMEL UTILITIES PAGE 04/05 f""H:l:lt=. ~,j ..,3,+3 l.l~L U-I-ll..-!=.. lJU.I,U)J.I"I..., Ckt~ d,1 ~tJ5 e Signature: Morris Hensley (or repr~een Pate I-/'l-of..s, Signature; Barry McNulty (Dr ltlPr8S8ntlltlve) Date CERTIFICATE OF AUTHORITY Under thCl penaltlBS of perjll ry (IndlllOa Code 35-44-2-1), I hereby affirm, undur oath, that all of the Information I have provided In this application klr demolition pennlt 1& tru. and accurate, to the' best of my knowledge and belief, and that I have not knowingly or Intentionally provided or omitted any InformatlQn that wQUld tefld to hide, obscure, or otherwise mislead the Departmellt of CQmmunlty Services regarding the truth of the matter.! addressed thel'8ln. Further, I assert that I aln the property owner, or the authorized and 'lawfully appointed agent of the OWI1Cll'{lI;), that I haw, 9XPI'HIl authOrity and permission from the owner(s) (and anyans with a recordec:f interest Qf other Interest in tha property', to IlIke this reqllestocl aetian, and that I agree ' to IndemnifY and hold harmless the City of Carmllll from III1Y clAim, lawsuit, demand, of damages whatsoever arising out ';If, Of as a result of, this request or the actions of the City Qf Carmlll, ~I .. ~ l~ gnature & ate (-O[-rh. Date jJ/ IL-ru:J ;./4-r..d~ (Name printed) .-f"7~ /tftJi.} Applicants Phone # 118 tv. d.,.,..."Q ~ Applicant's Addnllll (;! , ,....& City, -p,. ,/fDO 3 2- ST lip STATE OF INDIANA ) ,,/. ,.; sn Countyof~ J Seton;! me, the underslgMd, a Notary Public for ~)f... County, State of Indiana, personally:: appeared ::?t M~ y,.i"'l~-UI~ and acknowledged the IlXllcuflon of th.. foregoIng Instrument this '1.4. dllYof. (2u~ ' 20 t?~ . . (/" ..k1~~~ ./ ~/~::t'AL.A./ N<Jtory Publle dA~~,/l.'" J. Ille..-I-s K'e./<.. (prtnl) 9- ,)./'. tJ if My Comm''''''n Expl..,,, !:P_IIlcmeIi\iOl1 ~ermtt hanllout :2 Df2 01/12/2006 08:35 FAX 3177768506 81/1e/2006 88:38 317846e217 HAM CO HEALTH DEPT 1132 OFFICE BUILDING ~ 007/007 PAGE 87 tpe .' Slgnaturu: Morris Henlllley (or I'IIprtStntllUVe) Data O~Q~ mS Sign ,: Sarry McNulty (or ",presenlllUVt) ..l:J~ Date CERTIFICATE OF AUTHORITY Under the penalties of perjury (Indiana Code 35-444.1), I hereby affinn, undlllr oath, that all of the Infonnation I h.ve provided in this application for demolltlonl pennlt I. true and llGCUrate, to the beat of my knowledge and belief, and that I have not knowingly or Intentionally provided or omitted any Infonnatlon thlt would tend to hid., obscu.... or otta8IWI.. mislead the Department of CommunIty Services regarding the truth of the matters addl'8SSGc:llhe...ln. ' Further. I ...rt that I am the property owner, or the authorlDd and lawfully appointed agent of the owner(s), that I have express authority and pennlsslon from the owner(.) (and anyone with a recorded Interest or other, ll1terest In OW property), to take this ntquected action, and that I 89'" to indemnify IInd hold hannle.. the City of Cannel from any claim, lawsuit, demand, or damages ::tsr~~ ~ ~~' or as a l'88ult of, this reque.t or the aotlon. of~e City of Cannel, ~ __&->- _ __ l- '\-~ . Applicant's Signature & - Date IYIUAtfl f/.a-~ (Nllme printed) 6"'7$-/900/ Appllcante Phone # ~ . ,,J Q -r:., City, ST o/'bo3 z. ZIp / /8 tv, (/JtJ L.,n,g/ L>,a ~ , Applicant'. Address .8TATE OF INDIANA ) " /. :./ SS COllntyof ~ ) Befo~ me, the IlncilmSlgntd, II Notary Public for ~ County, SI8tt CIf IndIana, personally 'appeared TJI L&I.-4 J.kk~. and aCknawledged the exeeutlon of the foregoing Instnlment this /1.4 day of ,/ ~u. J ~I ,20 il. N~.n--,;(~~ . 1l~/1 1 #~hA..e tj.J.,.()<7 My _I_on 1!JcplNS: S:PermlDllDamo/ltlCln porrll~ _out 2of2