HomeMy WebLinkAbout06050162 Signed Demo
Demolition Permit Requirements
City of Carmel r Clay Township
Building & Code Enforcement; City or 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 State6r local government entities, or
utilities (other than those addressed herein), it is the sole responsibility of the
contractor of record to obtain such approvals.
Existino welt: Well must be plugged according to Well Ordinance A-62.
Existino 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.
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Address of demolition
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Tax Map Parcel #
C.. ...WI@/ C/~~s C (Uj" /.5,
OWner(s) Name and Ad ess .
. Additional Stru~ture(s) ~n site(y!s) 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.) .
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. The City of Carmel and/or Hamilton County Health Dept. must perform an inspection prior to
df3molition. In order to approve the demolition permit, 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 numbers Usted below) Include this completed form with all apnronrlate
slanatures (ON THE REVERSE OF THIS PAGE) when you submit your application package. "
1. MoirlsHensley, SuperVisor: Water Treatment Operations, City of Caime/;
Phone (317) 571-2673, FAX (317) 571-2265.
2. "Barry McNulty: Hamilton County Health Dept.;
Phone (317) 776-8500. FAX (317)776-8506.
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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 witha
recorded interest or other interest in the property), to take this requested action, and that I agree
to Indemnify and hold hannless 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.
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APplicant'sSignature & Date
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Date
(tIau~tQ ., / . {-IeHw95"'1
. ( ame printed)
317- 7?3-(pIS'/
Applicants Phone #
2) !?' :3 L/ S E/ner"<J rj,v
Applicant's Address .
:t:"J,.......oolts'
, City,
:TN. . 'Ib 203
ST Zip
, STATEOF INDIANA
, c~unty of 1(),iof}
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55
)
tla.miffon
County, State of Indiana, personally
and acknowledged the execution of the foregoing
'. .
. 20 /)0.
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My Commission Expires:
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