HomeMy WebLinkAbout05120140-Signed Demo
Demolition Perl1i1it Requirements
. City of Carmel! Clay Township
Building & Code Enforcement; City of Carmel
One Civic Square; Camnei, 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.
ExistinQ well: Well must be plugged according to Well Ordinance A-52.
ExistinQ 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 andlor property.
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Address of demoliti n' Tax Map Parcel #
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ner(s) Na Address. XtJ !f0d-.LfI
Additional Structure(s) on site: Yes;;;;;\ (If yes, please list the number and type(s) of
structure on the lines provided. If one of~ctures 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/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 siQnatures 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
siQnatures (ON THE REVERSE OF THIS PAGE) when you submit your application package.
1. Morris Hensley, Supervisor: Water-Tfeatm~!It 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 pertnit handout
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Date
Signature: Morris Hensley (or representa !Ie)
Date
Signature: Barry McNulty (or representative)
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 truthofthe 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 oUtlf, or as a res~~t ~ this request or the actions of the City of Carmel,
regarding same. \:E)\ ~-lJ-N~ tp1
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Applicant's Sig ature & Da
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Applicant's Address
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Date
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Applicants Phone #
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STATE OF INDIANA )
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Before me, the undersigned, a Notary Public for ~KVL':# ~ County, State of Indiana, personally
appeared~~ ,7~ and acknowledged the execution of the foregoing
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instrument this l.iJ) day of . -> , 20 !25-.
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