HomeMy WebLinkAbout06050057 Signed Demo
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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:
· 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.
Well must be plugged according to Well Ordinance A-52.
Existina septic: Septic system must be pumped and filled with sand, or removed. If ~eptic .
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.
8/0 t:'. //,f,tf 5'6 Gore/ ,~
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Address of demolition
Existina well:
Tax Map Parcel #
./ YW"-,5'/m
Additional Structure(s) on site: Yes / fi[;;J (If yes, please list the number and type(s) of
structure on the lines provided. If one of t~ctures has a separate street address than the
primary structure on the parcel-please also include that information.)
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 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
sianatures (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 Dept.;
Phone (317) 776-8500. FAX (317) 776-8506.
S:Permits\Demolition pennit handout
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05/04/2006 13:28 FAX 3177768506
K~Y-03-2006(~EO) 15:01
'85/8112ge6 14:23 3175712265
HAM CO HEALTH OEPT
CllRIlIE1. UT%l.rT%ES
~ 004
P.004/007
PAGE fl4/e1
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Demoll~lon Permit Requirements
City of Carmel I Clay Township
Buqding 80 Olld. ~ ,~QQmBl1I; elly rst Oetm.
ClVb: 9qLJ:lI'll: QI/llIIII, IN 48032 Ph. l317) 811.2444 Fill (3'1 '1) 57'~DO
. Two copIes of II .ltIIlacatfon map-clarly
cturlil or strU~1lI8 to be demolished, the Tu MllIp parcel number for
t\ tho dlmolition IS to occur, and this farm Illned by the approprfatB
pP/la.tJon Is " three-part form fJV8/lab/e 1t'om the /Julldlng & Cod4iI
~
.
I'l!Ite permit i1J)pllcatlon must be complet$d per parc:el.
Inspections are required reJallng to private welle. septic sysISms. and fuel
prIcartD demoUtian.
d approvals be I1iIqulred from other Stat. or local gcivemrnent enllties, or
9 (othlar than those addressed herein), It Is 1I1e sole responsfblllty Df thca
ctor of record to obtain such app~ls.
Well mUGd; to. plugged .ccorcIlnCl to Well Ol'l1lnance AU. kled ~;=-J.
SeptIc system must be pumped BrIel tilled with sana. Gr /'IIITlOv&d. If ~c '1
I)'StEm Is to be reused, it must be plugD*! off until readyfor nHJSe. '
I!uel b1~ mU$t be pump~ anel n1mowd tram bulldms aru:Uor Pl'!\l~'
~;..-:L - rlll,;'T~ -+ /1,H(~)~
<)100 ~ ,,/ ~
Talc'" """"111
~ 'J':1..~~ .....J ~~hn.. ..i.
,-.(s} on site: '(es I ~ (11 yes, please rift the number and type(S) of
prg'1kWd. If one af ~e1ures tlae 1!I separate S1r88t addrees than the
the pescel please also lnCl/ude ihat information.)
.
.
&b:tlna ....If;
Exlstina SlHJtk:
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."d/or Ham//forI county HNIth Dept must perform an Inspeat/on ptiortO
to .pprove the demoltt/an psrmlt. t/7. .pplic8nt is t'IIIqulted fa sign tht. ronn
Q eIo (Ttrls can be dtJ1le by FAX tD their
mber.t' liafetI ~w /IJ$de this completed to"" wfttJ alllrltDmDlfate
C fU!VERSE 0,. THIS PAGS) when you subITJlt your IJppII~f/tJn pac:k4Jge.
lay, supatYfsor: Wsrrar 1'futmenf O~, CIty 0' carmel;
511..)S1:I. FAX (3'7) m-~ '
ulty: HamRttJn Qxrnty HIUJ/fIr Dept.;
7) 716.1500, FAX (3113 nfi-Bti06.
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05/04/2006 13:28 FAX 3177768506
fiRY~03-2006(WEO) 15: 01
~5'Bl/2BB6 ld:23 S17571226~
HAM to HEALTH OEPT
CARIIIiI. UTtL.ZTIES
~ 005
P. 005/007
~ BS'''7
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Date
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CERTIFICATE OF AUTHORIty
Under the pon
InfonnafiOn I h
belit of my kn
"milled 8n1' I
of Community
of perjury (Indiana Crxla 35-44-2.'), I hereby affirm, under oath, tt\.at aJl of 1hG
pmidecl In this appUcatlon for demclltlDn permit is true and accume. to the
9' and ballet. and thlllt I how nOt Icnowfnslly or IntllntlonBlly proVided Dr
stJon that would tend tQ hid!!, obscunI, or otherwise mislead thll Department
M08S I'Dgardlng the truth of the mllttel'$ addl1ll$8ad tMrein.
I am the Pt'OD'rty owner, or 1M authorized and IltwfuDyappoln_l;/ agent of
I haw OlCpRlSS authority and pllrmlssion from the ownerCs) (and."~ne with .
or OIlier Il1te,..t In the praperty), ID take UllG requested action, end that I agree
Did hannless tile City or CannAI from any claim, 18lIV'SuIt. demand, or dGn18S_
9 out ~, or alii a "'cult of, thIs rvqq85t or the actions of the City of Carmel,
Furthw, I asse
the owner(.), th'
rac:orded Intem
tD Indemnify..
whaIBollYOr art
ngardln
.....
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Date
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STATE OF INDI
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