HomeMy WebLinkAbout06030112 Signed Demo
Demolition Permif'Requirements .
City of Carmel! Clay Township
Building & Code Enforcement; City of Carmei
. 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 o~her 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.
Exist/na weJ/: I Well must be plugged according to Well\?rdinance A-52. .
Exist/na seD tic: Septic system must be pumped andfllled 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 pu~ped and removed from building andlor property.
littEr::> Sh.eIl3D11-l0e fll)l cr>r11.~"lib;~-\-, 17693/00000/700
Address of demolition Tax Map Parcel. #,
Ow~rts(N;~d~~S hhC
Additional Structure(s) on site: Yes / 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,)
The City of Carmel and/or Hamilton COu'lty,H,e,alth Dept. must perform an inspection prior to
demolition. In order to approve the demolitionpermit, the appJ/cant 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/orm with aJ/ aDDroDrlate . . .
sianatures (ON THE REVERSE OF ,THIS PAGE) when you submIt your application package.
........-
1.
, -
M(Jrr/~ Hensl!!Yl Supervisor: W~ter Treatment Operations, Cltya.f Car/1'le/; __
Phone (317) 571-2673:-'FAX (317)571-2265.' .... ...... '-./ . '.
. Barry McNplty: Hamilton County Health Dept.;
Phone (31'Z) 776-8500. FAX (317) 776-850,6.
. ,
2.
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S:Permits\Demolition permit handout
1012
3-/4-, 6&
Date
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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,
regarding same.
Applica '
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Date
ate
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Applicants Phone #
.;LZS- ,v ew6~ CD lJll)
Applicant's Address
I/U erff,' e l,i
City,
IN L/l(,07L/
ST Zip
STATE OF INDIANA )
55
County of }4n.,,;lt~J) ) /l'!o.#'lCYn.
Before me, the undersigned, a Notary Public for
appeared 5~~~n~e'
instrument this /..)~ay of . ft1o..r-~
,~-LJ~'
N}ary Public
5"~~
(PMn!)
Ati/r'If>.r1. County, State of Indiana, personally
. and acknowledged the execution of the foregoing
, 20 b" ,
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s-~ 10/ 2b/~
y Commission ExpireS:
S:Permils\Demolltlon pennit handout
2012
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