HomeMy WebLinkAbout06030084 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:
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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-62.
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 must be pumped and removed from building andlor property.
+
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Fuel Tanks:
11104 Towne Road
Address of demolition
17-03-05-00-00-012.000
Tax Map Parcel #
Mike Ruggiero 7444 Shadeland Station Way, Indianapolis, IN 46256
Owner(s) Name and Address
Additional Structure(s) on site.0s / No (If yes, please list the number and type(s) of
structure on the lines provided. If o~~ the structures has a separate street address than the
primary structure on the parcel-please also include that information.)
One detached garage. Will not be burned but will be demolished later.
The City of Carmel andlor Hamilton County Health Dept must perform an inspection prior to I
demolition. In order to approve the demolition permit, the applicant is required to sign this fqrm
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 Treatment Operations, City of Carmel;
Phone (317) 571-2673. FAX (317) 571-2265.
2. Barry McNulty. Hamilton County Health Oept;
Phone (317) 776-8500. FAX (317) 776-8506.
S:Permits\Demolition permit handout
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03/02/2005 14:40 3175712255
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CARMEL UTILITIES
CARMEL FIRE
PAGE 03/05
PAGE 05
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Slgnat . Morrie Hem~ley (
9--?' - 67{ C
Date
Signature: Barry McNulty (or r1!prOlHlnte.tlve) Date
CERTIFICATE OF AUTHORITY
Under the penalties of if)Srjury (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.
bll8t 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 ServilOBll regarding the truth of the matters addressed therein.
Further, I assert that I ~Im 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 o~her In~rest in the property), to take this requested act/on, and that I agree
to Indemnify and hold Iharmllllls the City elf Carmel from any claim, IllWllUIt, demand, or damages
whatsoever ariaing oul: of, or as a reeult of, this request or the actlonc of the City of Carmel,
regarding same.
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Applicant's Signature ,!It Date
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Date
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(Name printed)
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Applicants Phone #
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Applicant's Address
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STA.TE OF INDIANA )
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Counlyof
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BetOI'll ma, the under6iglled, a Notary Public: for
County, State of Indiana, pen;onally
and ac:knowleclged the execution of the foregoing.
appeared
instrument this
day of
,20_,
Notary PLtllic
My Commlelllon Elqllreo:
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03/10/2008 14 53 FAX 3177768506
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HAM CO HEALTH oEPT
CARMEL FIRE
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PAGE a3
Signature: Morris Hensley (or representative)
Date
6entative)
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Date
CERTIFICATE OF AUTHORITY
Under the penaltles of perjuty (Indiana Cod. 3544-2-1), I hereby affirm, under oath, that all of the
infonna.t1on I hllVCt prtlvided In thl8 application for demolition permit Is true and accurate, to tt1e
best of my knowledge and bell.f, and that I heve not knowingly or Inwntic;mally provided or
omitted any Information that would tend to hide, obscure, or otholWle. mislead the Department
of Community SelVlcu regarding the truth of the matters addressed therein.
Further, I alsen that I am the property owner, 01' 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 tako this requMted action, and that I agree
to Indemnify and hold harmless tho City of Carmel from any claim. lawsuit, demand, or damagM
whatsoever arising out of, or as a result of, this request or the actions of the City of Carmel,
regarding same.
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Date
Applicant's Signature & Date
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(Name printed)
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Applicants Phone #
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Applicant'. Add/'85s .
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STATE OF INDIANA )
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County of I
. Before me, the undersigned, (II Notary flUbllc for
ilppeared
County, state at Indiana. plIl'11onally
and aClknowledged thllllXllcution of the foregoing
Instrument this
dllY of
.20
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Notary Publlo
My c""""..... expJ,.:
(print)
S;Permlts\DBn'l~tIon I*tnit hilJ'ldrot
2012