HomeMy WebLinkAbout06010067-Signed Demo
Demolition Permit Requirements
City of Carmel! 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. (*Application is a three-part form available from the Building & Code
Enforcement Office)
NOTE:
· A separate permit application must be completed 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: . Well must be plugged according to Well Ordinance A-62.
Existind septic: 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: Fuel tanks must be pumped and removed from building and/or property.
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Address of demolition
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Owner(s) Name and Address .
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Tax Map Parcel #
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Additional Structure(s) on site: @ I No (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.)
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The City of Carmel and lor 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, 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.
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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
:~~r~:'%~lngLo.t of, 0'" . ,"".It of, "'s "",.est ~ the .,"ons ot the City of Ca~I,
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Applicant's Signature & Date Date
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(Name printed)
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Applicants Phone #
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Applicant's Address
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STATE OF INDIANA )
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County of JJ-.1AJ~ Lllr/! )
Before me, the undersigned, a Notary Public for ~:JuL671 County, State of Indiana, personally
appeared )J/ L01A) ~t.!~)'U and acknowledged the execution of the foregoing
instrument this 44 day of ~~'/<A/ ,20.
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Notary Public .
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(Print)
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· Signature: Morris Henl:ley (Dr repr IVII)
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Signature: Barry McNulty (or nlprellentatlYe) D~'llte
CERTIFICATE OF AUTHORITY
Under the penalties of Flerjury (Indiana Codo 35-44-2-1), I hereby affirm, under oath, that all of the
Information I have provlided in this application for demolition pennlt Is true and accurate, W the .
~st of my knOWledge ond belief, and that I haw not knowingly or Intentionally provided or
omitted any Informat'o~1 that would tend to hide, obscure, or otherwise mislead the DeP'lrtment
of Community Servlc!!!s regarding the truth of the matters addressed theMln.
Further, IlllSsert that I aln the property owner, or the authorlz9d and lawfully appointed ag9flt of
the owner(II), that I have' express authority ancf permission from tho owner($) (and anyone with, .
. rel;:Qrded interest or other Interest In the property), to take this requested action, and that.l ag....: :; .'
to Indemnify and hold hllrmless the City of Carmel from any elalln, lawsuit, demand, or damages . "
whatsoever ariSing out '~, or as a result of, this rt!!quest or the actions of the City of Carmel,
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Applicant'. Signature & Dl\.~
Date
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(Name printed)
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Applicants Phone #
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Applicant's Address
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01/12/2006 08:34 FAX 3177768506
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HAM CO HEALTH DEPT
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PAGE 83
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Slgn.ture~ Mom. Hensley (a'tlIpnoIIllntatlve)
Date
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Signa .: Blrry McNulty (or repl'Mellta1lve)
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Date
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Qode 38-44-2-1), I hereby aninn, under oath, that all of the
InNnnatlon I have provided In this application for demoRtion\ pennlt Is true and aoeurata, to the
best of my knowlladge and belief, and that I have not knowingly or Intentionally provldad or
omitted any Information that would tend tg hide, obscure, orothelWI.. misl.ad the Department
of Community Services ...gardlng the truth of the mattei'll addl1llllll:l therein.
Further, I assert that' am the property own.... or the authorized and lawfully appointed ag.nt of
the owner(s), that I have expreM authority and perm_Jon from the owner(s) (and anyone with a
recorded Interest or other Interut 'n the property), to take this requ..tad action, and that tag,"
to Indemnify and hold hannlells the CIty of Carmel from any claim, IlWSult, demand. or damages
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Appllaanfs Signature & Date Date
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(Name printed)
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Applicants Phone #
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. AppIiGant., Address
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STATE OF INDIANA )
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Count'lofiM?,,,/k )
Befora me, the undersigned, a Notary Public for ~ County, state of Indiana, ""..-onally
appeared TJI Un '" ~M' htJand aeknowllldged the exacutlon oftha foregoing
Instrumentthls 44 dayof ~.u..b~ .20_,
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