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Home My WebLink About06030180 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--clearlyi 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 contractdr of record to obtain such approvals. Existinq well:wlll must be plugged according to Well Ordinance A-52. Existinq septic: SJptic system must be pumped and filled with sand, or removed. If septic sy~tem is to be reused, it must be plugged off until ready for re-use. FJel tanks must be pumped and removed from building andlor property. l ttOL Tolwu~ ~t::> 1l-'~-O~-OO~O:>-O'2,oo\ Address of demolition I Tax Map Parcel # M\\::.€ Rubel, e.e.c L\OQ2 \,\R$TOI4 fOllA'\C f)/L Zl()j..IJ...l\...,,! '-\L.o11 Owner(s) Name and Addre'ss ' I I ~ . 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 uctures has a separate street address than the primary structure on thb parcel-please also include that information.) \...Lj I I I I -.-.----.-..-.-..-....-..--.----..-.....T---...--.....:-...........--.....-..................-...-..-.--..-.---...--........-.........-.-.-..--......-..-.-.--.-...-....----...-...-.....-.-..- The City of Carmel and/or Hamilton County Health Oept. must perform an inspection prior to demolition. In order tokpprove 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 relrerse of this page) when you submit your application package. 1. Morris HensleJ Supervisor: Water Treatment Operations, City..ofCarme/; Phone (317) 5~1-2673. FAX (317) 571-_: 12...fe5 2. Barry McNulty; Hamilton County Health Dept.; Phone (317) 776-8500. FAX (317) 776-8506. s:pe~~\DemOtitiOn.pennit handoJt . I . . . Fuel Tanks: ... 1012 " l Derl,olition Permit Requirements City of Carmel! Clay Township I Building & Code Enforcement; City of Carmel One Civic Square; Carmel, IN 46032 Ph. (317) 571-2444 Fax (317) 571-2499 I 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-52. Existina 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. , , Address of demolition Tax Map Parcel # Owner(s) Name and Address 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.) . Tf]e City of Carmel and/or Hamilton County Health Dept. must perform an inspection prior to d~mOlition. 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 sianatiires (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. Barry McNulty: Hamilton County Health Dept.; Phone (317) 776-8500. FAX (317) 776-8506. . 2. ~ S:Permits\Demolition permit handout 1012 . 03/28/2005 ,08: 55 3175712255 .__.... ~'i;; --'-W~_'''''LU'''''''''''''.I.JU' . ' CARMEL UTILITIES j)U~SEY PAVING PAGE 04/05 I4J 004 Demolition Permit Requirements City of Carmel'! Clay Township Building & Code Enforcament; City of Carmel One I~ivlc Square: Carmel, IN 46032 Ph. (317) 571.2444 Fax (317) 571-2499 TO ~E SU~MnTe.D WITHAe.PLICATlON*: 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. (*Ap~,licatlon Is a three-part form available from the Building & Code Enforcement Office) NOTE: . A separclte permit application must be completed per parcel. , . Certain inspections are required relating to private wells, septic systems, and fuel tanks, pr'iar to demolition. . Should a,pprovals' be required from other State or local government entitles, or utilities (c)ther than those addressed herein), it is the sole responsibility of the conlractllr of record to obtain such approvals. '- . '.."" -- .... Existine well: ;- Well must be plugged according to Well Ordinance A-62. , Existlno aQDtlc: . $Elptlc sYstem must be pumped and filled with sand, or removed. If septic , s)'Stem Is to be reused, it must be 'plugged off until ready for re-,use. Fuel Tanks: F~lel tanks must be pumped and removed from building andlor property. \\\0'2- TOWJ..\lJ!:' e-b l'~'''&-OS"-OO-oO-OI2..06>1 Addross of demo/lOon Ta&' Map Psrcsl # _M\\'(~ R~\dc:.\l-e~O 4\O'\.'2., We~l.I PElIv.~ De.J "Z.IO\J.S>JlI..~ IJ...t '-\,10011 OWner{s) Nllmll and Addnlss \ Additional Structure(s) on site: Yes ~ (If yes, pleas!"list the number and type(s) of structure on the lines provided. If one ~res has a separate street address than the primary structure on ttle parcel-please also include that information.} . The City of Gannel and/or Hamilton County Health Dept. must perform an inspection prior to demolition. In order to approve the demolition pennit, the applicant Is required to sign this form and obtain the slanatures of the Individuals listed below. (ThIs can be done by FAX to their offices, at the numbllrs listed below) Include this completed fonn with all a"DroDrlate slanatures (ON THE REVERSE OF THIS PAGE) when you submit your application package. 1. Morris Hensle:'f, Supervisor: Water Trutment Operations, City of Carmel; Phone (317) 's:r1-2673. FAX (317) 571~226S. 2. Barry McNul~~ Hamilton County Health Dept; Phone (317) 1',76-8500. FAX (311) 776--8506. S:P.......IoIDe!T1QIIUOll ""rmlthond'"' 1 012 . 03/28/2005 ~8:55 3175712255 '. "_ U31;(:1 <U" 12.' 20 ,FAX J176861G07 , . CARMEL UTILITIES DORSIiY PAVING PAGE 05/05 ~005 -'. I. ~ ."- . ." . " , ,"3:-~'J-v ~ Date ";'.' , . Signature; Barry McNulty (or rapJ'llsentative) Date CERTIFICATE OF AUTHORITY .. ,<'.' I Under the penalties of perjury (Indiana Code 35-44-2.1), I hereby amnn, under oath, that all of the infonnatlon I have provided in this application for demolition pennlt 19 true and accurate, to the' best of my knowledge and belief, and that I have not knowingly or Intentionally provldod or omitted any InformatlCiO that would tend to hide, obscure, or otherwise mislead the Department . of Community Services regarding the truth of the matten!l addressed therein. Further. I assert that I ,1m the properly owner, or the authorized and lawfully appointed agent of the owner(s), that' have express authority and pennlssion from the owner(s) (and anyono with a recorded Interest or o1her Interest In the properly), to take this requested action, and that I agl'lHl to Indemnify and hold harmless the City of Carmel from any claim, 'Iawsult. demand.~r damages whatsoever arisIng out of. or as a result of, this request or the actions of the City of Carmel, regar Ing s e. I .~ Applical!!'s Signa & Date . 1,.:)0 ~E'~\ PA" \>.1.... ~, Q... tiS""l A- hi ~~eellL (Name pt1nted) "3 - 2-1 -o~ . Date ~ ~B- q,3'L~ Applicants Phone # ZlO1... S. ~.II\-(Zi)\\,()",. 'b,\ Applicant's Address , .J:4.D P w ::r:.L..\ City, 4\...'2-'"2.\ ST Zip' STATE OF INDIANA ) SS County of . I . --l Bofore me, the undersigned, a Notary Public for appeared County. State of Indiana, perso.!1D~1y . and acknowledged the executton of the foregoIng .20 -' Ins1n/ment this , day of -,", ,'0. '.' . ~=" . . r" . .' " Notary Public M~ Commllllon ExpI_ ;.,.'- (print) .. :'" .,' :..);:};:~, -,~ S:PBI1TlIIs\D.~!IIlOn pormi\ lr.lndolrl .2of2 ., .'..~',. ..,~~::.. O~/28/2006 10:)2 FAX 3177768506 0'37-27/0:6:,' 12:2~ FAX U76861507 HAM CO HEALTH OEPT DORSEY PAVING ~ 004/005 ~004 ~. Demolition Permit Requirements City of Carmel I Clay' Township ,,-- Building & Code Enforcement: City 01 Carmel One Civic square; Cannel, IN 46032 Ph. (317) 571-2444 Fax (317) 511-2499 TO BE SUBl3ftlTTEO WITH APPLICATIQIl:I'": Two copIes of a site locatIon map-clearl~ 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 fonn 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 tJie sole responsibility of the contractor of record to obtain such approvals. -" " .. . .' , '. . . ~. .'. . ....... . . Exl$JJno well: : _ - Well must be plugged accordIng to Well OrdInance A-62. , ExIst/no seDtl,<: ' Septic system must be pumped and fllied wtth sarid, or removed. If septic , system Is to be reused, It must be 'plugged off until ready for ~u.se. Fuel Tanks: Fuel tanks must be pumped and removed from building andfor property. l\ \D2- TOW"I[:" ~1:> ", -'~-DS"'-OO -00 -Ol2..e>el Jl,ddnJss of delllOlltlon TalC Map Parcel # ' _\"'hK.~ ~~\"b\~\!..O 1 4\0G\.'2.. We..,Ol.l POluT'E [)~, "Z..lO.I""'l~ ~ ~l.oOl1 Owner(') Name and Address ' Additional Structure(s) on siN: Yes ~ (If yes, pleas~ list the number and type(s) of structure on the lines provided. If one o~res has a separate street address than the primary structure on the paroel-please also Include that Information.) , The City of Carmel and/o; Hamilton County Health Dept must perform an Inspect/on prior to. . demolftlon. In order to approve the demolftlon permit, the applicant is required to sign this form and obtain the s/anatures of the Individuals II$fed below. (This can be done by FAX to their offices, at the numbers listed below) Include this completed fonn wIth allaDDIODrlate . sianstures (ON THE REVERSE OF THIS PAGE) when you submit your appllcsUon package. 1. Morris Hena/ey, Supervisor: Water Tl'Qiltment OperaUons, City of Carmel; Phone (317) '511-2673. FAX (317) 511-2265. 2. Barry McNulty: Ha.mJlton County Health Dept.: Phone (317) n6-85oo. FAX (317) n6-BS06. 9:PeIlnilllllll!lrrdlllon pennII hIIndoul 1 of 2 0:3/28/2006 10:,12 FAX 3177768506 03'l27/n8: 12:2'( FAX 3176861507 ,.~ HAM CO HEALTH oEPT DORSEUAVING Ii1I 005/005 1i!I005 ---- . -" ... '" ,.- , . . ''', , , . / ':'. " .. .-1-" . .' . ." .-', ! Signature: Morrie Htlnsley (or representatlve) Date , . ~ ~~__ ~H--s. Slgnatu Barry McNulty (or reprvsentatlve) '3~;)-W<O Date . CERTIFICATE OF AUTHORI1Y ~ ,")' I Under the penalties of perjury (Indiana Code 35-44-.2-1), I hereby affirm, under oath. that all of the Information I have provided In this applicatIon for demolition permIt 18 true and accurate, to the best of my knOWledge and belief. and that I hlWe not knowingly or Intentionally provided or omItted any Infonnatlon that would tend to hide, obscure, or otherwIse mIslead the Department , of Community Services regarding the truth of the matters addl'8Ssed therein. Further, I assert that I am the property owner, or the authorized and lawfully appointed agent of the owner(s), that I have express authority and permbslon, from the owner{s) (and anyone with a rec;orded Interest or other Interest In the property), to take this requested action, and that I agree to Indemnify and hold hannless the CIty of Cannel from any claim, 'lawsuit, demand, or damages whatsoever arising out of, or as a result of, this request or the actions of the City of Carmel, rogar Ing e. ' ' ;," ':> ... 2..1. -o~ Date Appllcal!!'s !ilgna e & Date ' 1..::0 F<$e--\ PAu I \.l \." :!:u<-, Q.. ~~IA-~ <b,f)eellf....- (Name printed) f..p ~B- ct3~ lc Applicants Phone # ZlO1.. S. J..\..~\~ ~-r- Appllcant's Address .:D-t j) P L..5. :I:l_( City, \-\ \... 't.. ""2.. \ ST Zip County of .., ) :SS ) 'STATE OF INDIANA Before me, the undersigned, a Notary Public for County, State oflndlanll, perso.r,.ally, and acknowledged the execution of the foregoing appeared lnstromant this , day of -' 2~~. .. -. ,. I." ~. .~., . ","".. , ~ NoWyPutll1G My C""'~1on ......'. c ., - .. ,', ; . ~,~ . .- ~:, ,.::, .>~,;~,,><,.'~: " " '. . 2.cl2 ',! ".;",;. ~.: " If'llnt) S:Parmltll\Oomollllon polIllIl handout ":d3