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Home My WebLink About06060088 Signed Demo YD/Y\J/~VVO IV.VI rl\^ .1 Iff fblj:>Vb Jun 07 06 06.37p CUSTO"' WOODWORKS INC. HAM ~U H~ALIH UoPI 317-867-283D ~ 002/003 p.l " Demolition Permit Requirements City of Carmel I Clay Township ~9 & Code Enfurcement; City of Cannel OneCMc~: Camlel.IN 46032 Ph. (317)571-2444 Fax(317)671-2499 TO BE SUBMITTED WITH APPLICATION": Two copies of a site location mapooodearty , identifying the structure or structures to be demolished, the Tax Map parcel number for the parc:el on whIch the demolition Is to occur, and this fonn signed by the appropriate deparlnlents. (-Application III a three-part tDnn available tt'om the Building & Code Enforcement OIIiee) NOTE: · A separate permit application must be completed per parcel. · Cer1ain Inspections are required relating to private wells. septic 8Ylit&ms. and fuel 1anks. prior to cIemoutlon. , · ' Should approvals be required from other Stale ot local government entitles. or utilities (other than lt10se addressed herein), it is ftle sole responsibility offtle contractor of record to obtain such approvals. - ExisfIna well: Well must be plugged according to Well Ordinance A-62.. Existlna -....-: SeptIc system must be pumped and filled with sand, or removed. If sept! sysImn 18 to be reused, It must be plUgged oft' until ready for I'fHlSe. Fuel Tanlclli Fuel tanks, must be pumped and rem~ fnmt building .,dfor property. / ;> t;. 7- ( -Sr"" "7 ~ .;il ~ (' ~/..J( AfId1ea otdanolitirm ~ T_1IIap PatceI. g". /~ ,.J JA11'b--4 ~ -f r~ A- /' OwnJ;(~Nameancl.6.t; J' -r , AddItJonal S1'tvctunI(s) on ~ ;;;;> (If yes, please Ii5t the number and type(s) of struoture on lt1e lines proVided. If one Of ~ctures has 8 separate street address ftlan the Primary ~cIure on the parcel please also inclUde that infOrmation.) ~~, . ~- , The City of Carmel and/or Hamiltxm County Health Dept. mustperform an inSpedion prior to demotiliort. /" orc/er to BpptOve the demolif/onpennit; the applicant i$ requ/r8d to sign this fDnn and obtain the sltlnafures o/tha indMduals JlatMJ below_ {This ~ be done by FAX to their o~ at the numbenl11stJed beloW} 'nducIe this completed tbnn with an BDDIlJllIfa~ slan.lures (ON THE REVERSE! OF THIS PAGe) wtren you submit your application p;Jdcage. f. Morris Hensley. SUpervisor. WlIter neelment OP8TlltJolI$. City of Cannel; Pheme (317) 1171-2673. FAX(317) 571-Z~ , I, . I 2. Barry McNulty: Hamllton County Health Dept.; ~~ ~ lJ.c..... Phone (317) 778-8500. FAX (317) 7T8-85OfJ. .L.........J t...t ~ ~ s~pormrhondoul Ov-.~ 1"'2 J-J.e--I+ 't> f\ (. ~ ~....1 0')( .., . J.. ~ ~ fk.('T.~ ~~. ~ ....- ";,, OJ"" UV..JYQ ~un D7 06 OS.37p CUSTOM WOODWORKS INC. 317-687-293D ~ 003/003 p;2 n~M ~u "tALIH Ut~l . S;g~re: Morris Hensley (orl'GlIl ~~..r..li..., Date ~~~~ ahlb~ Signature MeNu (or reprw.t- ~ Dar. CERTIFICATE OF AUTHORITY Under the penalties of perjury (Indiana Code 35 11 2-1). f hereby aftInn, under aeIh, that aU of the Information I have Provided In this appllca1lon for demolition pennlt Is true and aGCUrare. to the best of my knOWledge and belief, and that I halle not Jcnowingly or intentionally provided or omitted any infonnatlon that would tend to hide, nh.cure,. 01' otherwise mislead the DePlIrfrnent of Colnmunity SeMc:es I8ganOng the truth of the matten. addl9lrllled thervln. Further, I - I ett "'1 ;un the p~ owner. 01' the authoriud and lawfully appointecl agent of the GWher(.), that I havv 8JCprees authority and pennisslon fnlm the owner(.) (and artyClQe with a I'1ICOI1fecIlnfIImI8t or other InbHut in the 1I>......rty). to take this requested action, and that I &g11lle to indemnlf)' and hold harmless the CIty of Cannel tram any claim, Iawsui(. demancI, or damages wIIat8oev8r arising out of, or.. II result of. this req..-t or the actions of the City of Cannel, regarding SiUIle. - (A~ - ~ Applicant'e Signature & Datu /"'-- 4,-, ~ ff <i? -37;' ") (Name printed) Applicants Pflone # /7 t..{t(O WE~-f-.,c6(cP ~ f../J,. tOl!>:f4I :ref Applicant's AddAlSS City, ST t';~ 16 ~ bate , l.(6tJ7I Zip STAlE OF INDIANA ) 8S County of ) Before me, dlelll1ders'gnect, a NotaIy Public for lIPP8lUed ~, stabt of 'ndiana. pen,oh.,,1y and ~-wIoedged lhelDl8Clltion of the foregoing .20_. IDsIrument OIls day of . NOIiiY ..... MyCClll....~I~.~ /IIIlnO s~_"",- 2"'2 OO/o~/~oao Of:Qb .:H f:Jf.lLLb:J CARMEL UTILITIES Jun 07 06 06:35p CUSTOM WOOD WORKS INC. 317-867-2930 PAGE 01/02 p.l . ;;~~ /~'k1fr.'T~", ~ '! .' '-..!t!OI~.J/ Demolition Permit Requirements City of Carmel f Clay Township . BuDding & Code Enfllr"","en~ City of 0""""1 One Civic Square: Carmel, IN 46032 Ph. (317) 571-2444 Fax (317) 571-2499 TO BE SUBMITTElD WITH APPLICATION': Two copies of a site location map~learly . identifying the stmcture Or structures to be demolished, the Tax Map parcel number for the parcel on whic:h the demolition is to occur, and this form signed by the appropriate departments. ('A,pplication is a three-part fonn available from the Building & Code Enforcement Offie:e) NOTE: · A sep~lIate 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 entilles, or utilities, (other than those addressed herein), it is the sole responsibility of the contral::tor of record to obtain such approvals. - EKistina well: 'Well must be plugged according to Well Ordinance A-62. ___ C' I 5-'(, , . Wa( T~-I 10 I ,old. -.,..'e. Existina selJtic:Septic system must be pumped and filled W1ttl sand, ()r J1!moved. If septi IJ.. :system Is to be reused, it must be plugged off until ready for re-use. fk'~a Fuel Tanks: 'Fuel tanks must be pumped and removed from building and/or property. /?C-,?_ ( SfU"r~ __ <:i l...tZcI. ('~/"...{ . AddnlssofdemDIiliOll ./? / ./ Ta>clllapPamel' ~/~ (~ jA114;y-:zof r~fr1.&4-1? . Own s) Name and AdU",ss Additional Structure(s) on s~ Q (If yes, please list !he number and type(s) of structure on the IinEllI provided. If one of the structures has a separate slreetaddress than the prfrmuy s ure on the paroef--please also include that information.) The City of Carme/ elndlor Hamilton County Health Dept. must perform an inspection prior to demotition. In order It> approve the Clemo/ition permit, the applicant is requiTed to sign this fomt and obtain the sianatures or the individuals listed below. (This can be done by FAX to their offices, at the num,rJers listed below) Im:lude this completed form with all alJlJTOl1rlate sianatures (ON THE REVERSE OF THIS PAGE) when you submit your application p;ickage_ 1. Monis HenSley, Supervisor. Water Treatment Operations, City of Carmel; Phone (317) S71-2673. FAX (317) 571-2266. 2. Bany McNully: Hamilton County Health Dept.; Phone (317) 776-8500. FAX (317) 776-8506. S:Pe:~Ofition permI handout 1012 ~b/~"L~~b ~/:qb 31/~/ILLb~ CARMEL UTILITIES Jun 07 OS OS. asp CUSTOM WOODWORKS IHC. 317-eS7-2930 PAGE 82/82 p.2 . , t.e --"-~- OCr> ~ SIgnature: MorTis Hens oy (or ",presentatlve) Date Signaturv: Barry McNultr (....~_) Date CERTIFICATE OF AUTHORITY Under the penalties of PE'rjury (Indiana Code 35,"",,"2.1). J hereby affinn, under oath, that all of the information J have provi~led in this application for demolition pennit is true and accurate, to the best of my knOWledge and belief, and that J have not knowingly or intentionally provided or omitted any intOtmatlon :that would lend to hide, obscure, or othelWise 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 OWIler(S), that I have express authority and pennission from the owner(s) (and anyone with a recorded interest or other interest in the property), to take this requested action; and that I agn!e to indemnify and hold hannless the City of Cannel from any claim, lawsuit, demancl, or damage& whatSoever arising out of, or as a result of. this mquesl or the actions of the City of Cannel, regarding same. !~ ~. t:~/c~ Applicant's Signature & llate Date CfJ(",7-.J. C'(.;:Ilf !~v<^- kcrrr ~'S IT'V7-J72')' (Name printed) Applicants Phone # /7 L(rO CUE5l-k'4 r/ jJ~ ~ iJ,. ?Ol~{~ ref Applil;lUlfs Address City, ST f.{ 6 rJ7f Zip ~ STATE OF INDIANA J SS County of ) Bero", me, the undersigned, a Notary Public for appeared County, State of Indiana, personally and acknOWledged the execution Of thtI foregotng instrument this da:t of .20_. Not;ry PublIc MyComtn_ Ellplros: (prin~ S:P"""I1sWomclltian oermlt_ 2of2