HomeMy WebLinkAbout06030181 Signed Demo
.-
Demolition Permit Requirements
City of CarmeITCla{Toyinship....
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 ;s the sole responsibility of the
contractor of record to obtain such -approvals.
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Well must be plugged according to Well Ordinance A-52.
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 and/or property.
Existina well:
"
Existina septic:
Fuel Tanks:
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Address of demolition
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Tax Map Parcel # '
THe' Citj'of Carmel and/o'rHamilton County Health Dept. muslpefform 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 belt;)w) Include this comple,ted form with all appropriate I
sianatures (ON THE REVERSE OF THIS PAGE) when you submit your application pack~ge. .
1. Mprris 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.
S:Pennits\Demolitlon permit handout
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Signature: Morris Hensley (or representative)
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Date
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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 t~e
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 f, or as a result of, this request or the actions of the City of Carmel, . . ,~
regarding s me.
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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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City,
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STATE OF INDIANA }
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County of tylAet.o\...t I
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Before me, the undersigned, a Notary Public for
. C-&zl A--l
\'11.r:l.-F'lOL\
County, State of Indiana, personaUy .
appeared
'2.'') -\2..-
instrument this '0 day of
Spe.e~
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and acknowledged the execution of the fOrElgoing
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(Print)
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S:Permits\Demolition permit handout
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03/28/2008 10: 11 FAX 3177788508
,O,3z27~O~ 12:26 FAX 3176681507
HAM CO HEALTH OEPT
DORSEY PAVING
~ 002/005
1i!I002
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Demolition Permit Requirements . i"
City iif Carmel rCIa'}'-Townshlp - ... .. '::,~,'~-
Building & Code Enforcement; CIIy of Cannel
'One CMc Square; Cerrnel, IN 48032 Ph, (317) 571.2444 Fax (311) 571.2499 .
. 1
TO BE SUBMIlTED WITH APPLlCATI01!*: Two copies of a site location m2lp~learly i
Identifying the structure or structures to be demolished, the Tax Map parcel number for
the parcol on which the demolition is to occur, and this form signed by the appropriate
departments. (*Appllcatlon;s a' three-part (orm available from the BuDding & Code i
Enforcement Office) .
, .
',. .
NOTE:
A separate permit '~ppllcation must be compl~ted per par~e\.
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. - --' ."~,,,-
~.~;'..:..!._.' :. :l,~.i;r. '~'>~~..'.,- "'-t::",-~.:,o ,._a. ..li~"."J..~....,:r.~.;!;......'.-:::i.'''~' .... .
Exlstlno well: llli!TI~.Well must be plugged according to Well Ordinance A-62. '.. ,:"., "::' ,., .
. ' . .. . ..~ .~..-.'" .. 'l' .......
Exlstlno seDtlc: . Septic system must be pumped and filled with sand, "or'femoved. If septic
. system Is to be reused, It must be plugged off until ready for i'e-.~~e.
Fuel Tanks: Fuel tanks must be pumped and removed from building and/or property.
\ \ \ e"-t T~...lL"'~ f2:. (:) n ....l ~-f) s.~ 00 rOD ..,0 l'2.._ oO~
Add....;. of demolition Tall'M,p PtuCeI #
-1"'\"'~ f<.U',."U=~ L.\,Oq.z W~ f'Qlu'n! ~ 2.\OUC"'u.E" D..t 4lJo1,l
OWner(e) NlIme end Addre"" . '
. AddlUOlJal ~tru~tu~s) 'on site: y~ Q. (If yes, please list the number ~~d type(s) Of
structure on the lines provided. If one o~ures has a separate street address than the
primary structure on the parcel--please also Include that Information.)
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The' ciiy of cannel and/or Hamf/tO'n County Health Depf'in'Uiiiperform an inspection prior to "..',
de111o!itlon. In o'?~r ,f? appro."ve the. df!mofltion perrnn, the applicant ;s required to sign this form
and obtafn the Slanatu~ of the Individuals listed below,. . (ThIs can be clone by FAX to thefr
offices, at the numbers listed below) Inc:lude this c:omp/eted form ~ all aDDroDrlate ., .
sfanatures (Of'! THE REVERSE OF THIS P~GE) when you aubmft your application package. -
1. . MO(l'I$ tteJ!.5~.Y, Supe.""sor: ..water Treatment op.;"tlon$, CIty a/Cannel; --. ." ..-.-
Phon~ p17) 571~2673.IIFAX (317) 571-2265.' . -.
BarrY McNulty: HamJlton County Health Dept; '..~__..;'('lr,-: ,,"- u
.pl!.one (31?). 776-8500. FAX (317) 77U506.
s:Pe~'pem-lt,!"ndOUt
2.
~II..;=.. ,~:'o.n --:"Cit:i .'-
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03/28/200610:11 FAX 3177768506
'03/271{J6 12:27 FAX 3176861507
HAM CO HEALTH OEPT
DORSEY PAVING
Ii1I 003/005
1aI003
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Date
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Signature: MorTIs Hensley (or representative)
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: Barry McNulty (or repreaentatlve)
3-0l"6~
Date
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (IndIana Code 354i"z.1),1 here~y affirm, under oath, that all oUhe
infonnation I have provided In this application for demolition pennlt Is true and accurate, to the
best of my knowledge and belief, and that I have not knowingly or Intentionally proVided or I
,
omitted any Infonnatton that would tend to hid., obscure, or otherwise mislead the Department
of Community Services regarding the truth of the mattel'& addressed therein,
Further, I assert that I am the property owner, or the authorized and lawfully appointed agent of
the owner(s), that I have express authority and permission from the owner(s) (and anyone wtth a
recorded interest or other Interest In the property), to take this requested aetton, and that I agree
to indemnify and hold hannlesB the City of Carmel from any claim, lawault, demand, or clamages
whatsoever arisIng out of, or as a result of, this request or the actions of the City of Cannel,
regarding asme'1 . . ' .
(i___~ - ~ ~-7..:1-0~
Applicant's Signa & Date Date
bORsei fAv ,~'- ;c......L.
c.. {$-e.. lAl..l &'>~~
(Name printed)
~ 3SS-~3?~
Applicants phone #-
2.t OL S. l4Atz-(),\J.i~ ~\
Applicant's Address
J:u. OPl.S. .:o-l
City,
'-\.~"l..~,
ST
Zip
.STATE OF INDIANA )
sa
County of ) .
Before ma, the undersIgned; a Notary PUblic for
appeared
County, state of Indiana, perSonally
and acknowledged the execution of the foregoing
Instrument this
day of
.20_"
NotIly PlIIlIlo
. .
IIoIJ' CommIMIon Exjllrw:
(PrtnII
S;F'oIm~ permll '-"<lollt
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03/28/2006 08:56 3175712265
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PAGE 02/05
~002
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CARMEL UTILITIES
VUI<Sl>Y PAVING
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/IIDI~ll
.-
C'emolition Permit Requirements
City of Carmel'(Clay-Townshlpn- , ... '-:'j, ,',
BuDding & Code Er1forcement; City of Carmel
'One Glvic Square; Carmel, IN 46032 Ph. (317) 5714444 Fax (317) 571.2499 .
TO BE SUBMllTED Wl1:!:i.AfebICATION*: Two copies of a site loeation map-clearly
Identifying the struclture 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. (*ApF-,lication is a three-part form available from the Building & Code
Enforcement Otflce) .
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 enlltles, or
, utilities (eIther than those addressed herein), it Is the sole responsibility of the
contractclr of record to obtain such approvals. .. ',.. '.,'
.',.,;'.~ .'..'~' .~.;...~~;'~~ ~.,..r,. '...,'i.~""_'d"'~ e"U 1,,;;;i~-~.:....l;.~:'j,:<;~~ ,;~,.: ...
Exlst/na well: ,~,,!> ,WI!lI must be plugged according to Well Ordinance A-62. ' ., . r
. . . " " . c. _\ ~.._'_.'.,. ... ..,.., :
Exist/no Bentle: 'Septic system rhust be pumPed and filled with sand, or removed. If septic
, system Is to be reused, It must be pl,ugged off until ready for re"':lse.
Fuel Tanks: Fuel tanks must be pumped and removed from building and/or property.
'.
.
.
I \ \ \9 "-l jO-JL\,18 ~ (:)
Address 01 dtJtrlolJtia/l
j-' -\ ~-t) s.~ 00 -00 -012.000
Tar Map PIJrr:e1 #
-""'K'€. f<,Ub{..l~=i<.~ UOCl'2, W61O\.\ t'Olu'T'c!" ~ Z\OUt.r\u€ D-I 4c..o11
Owner(s) Name and Addl'llllS ." , '
, Additional Structure~s) 'on site: y~ Q. (If yes, please list the number and typl!(s) ~ .
structure on the lines provided. If one o~tures has a separate street address than the ,
primary structure on the parcel-please also include that Information.) i
(""A:eA l."E: W ~€l\I\""II_\
"
~ ".
,," . ,
1. Morris ff.t!f!~/e)~ SUpelVlsor: _Water Treatment Operations, City of Carmel; .,.-,
Phone (317) 51'1-2673. I(FAX (317) 571.2265. ' '
2. Barry McNulty: Hamilton CountY Health Dept; : ,_,__-,~;:i.L-, ,
p'h!,ne (317) 776-8500. FAX (317) 776.8506,
, ' '
~'PAl'ml"l~~RJon'oermlt handot.it ':l:r::~~':::~':'r "''-''1'd2' ~'."
03/28/2005 08:55
3175712Z.E?~,
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.:-----.----.
CARMEL UTILITIES
IJUH~t;~ t-'A VING
PAGE 03/05
14100.1
"
~~ ;44-1~'
Signature: Morris Hellsley (or ",pre..nta
Date
3:"~~ ~V7""
Slgnatul'9: Bany McNulty (or repf8llentatlve) Date
CERTIFICATE OF AUTHORITY
Under the penalties 01' perjury (Indiana Code 35-44-2-1). I here,by affirm, under oath, that all of the
Information I have pravided 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 Service$ regarding tI1e truth of the matters addressed thel'8in.
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 requestad action, and tI1at I ag~
to indemnify and hold hannless the City of Cannel from anyelalm, lawsuit, demand, or damages
whatsoever arising out of, or as a result of, this request or the actJons of the City of Carmel,
regarding same. , .' , ,
C-- ___
Applicant's Signat 1'9 ,8. Dati'
DORSrei e;1.V14'- .;r:u..L
c.- 'BeL iAL'l &P~~
(Name printed)
3>-"Z..."1 -O~
Data
!.t, 3S~-q 3~L..
Applicants Phone #
Ll OL S. t..:\-~~ro'~.l ~\
AppliCant's Address
.J::.u O~ l..S. .J:l-l
City,
L{. ~L '"Z. \
ST
Zip
STATE OF INDIANA )
~;.s
County of .. -- .J.
Before me, the undersigned; a Notary Public far
appeared
County, state oflndlana, P&l'9onal/y .
I
, . J
and acknowledged the execution of the foregoIng
Instrument this
day af
.20_,
Notaly PUblic
My Camml..lon flCpf_
lP~nl)
S:PormIIllIDemoIII!on permll hsn<lO\l!
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