HomeMy WebLinkAbout06090048 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 fromother 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.
Existino well: Well must be plugged according to Well Ordinance A-52.
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. I
Fuel Tanks: Fuel tanks must be pumped and removed from building andlor property.
107'10 . erl7o/eel ~f"<-J( 4"le
Address of demolition
11.S j' p Pe"" 6/'<10.
i 7-13 -0'1-0 '-/-C:>I-Ot'y, 0170
Tax Map Parcel #
c../".,d 'i6"Jz.-
Additional Structure(s) on site: Yes / AD) (If yes, please list the number and type(s) of
structure on the lines provided. If one of th~ructures has a separate street address than the
primary structure on the parcel-please also include thatinformation.) .
The City of Carmel and/or Hamilton County Health Dept. must perform an inspection prior to I
demolition. In order to approve the demolition permit, the applicant is required to sign this fo,rm .
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 I
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:Permlls\Demolltlon permit handout
1of2
CARMEL UTILITIES
CARMrL FIRE:
PAGE 02/02
PAGE 05
Date
Of- '?3 r(!) C~
Signature: Barry McNulty (or repraIAntatlv.e) Date
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Code 35-44-2-1), I hereby affinn, under oath, that all of the
infonnat/onl have provided In this application for demolition pennlt 'S true and aCcufllte, to the
best of my knowledge and belief, and that I have not,knowlnglyor Intentionally provided or
omitted I.IIY Infonnatlon that would tend to hide, obscure, or otherwise mislead the Department
of Community Services l'911ardlllg the truth of the ma~erc addressed therein. '
. ,-"... .', I', . ,
F!lrther, I 8nert that I amtl~e property owner, or the authorized anCllawfully appointedagllnt of
the oWner(s), that I havee):preSll authority imd pennlssion from the QwnerCI) (and anyone with a
recorded Interest or othsr Interest i1, the property), to take this requeSted act/on, and that lagI'M
to Indemnify and hold harmless the City of Cannel from any claim, lawsuit, demand, or damages
whatsoevar arising out of, or llII a result of, this request or the actions of the City of Cannei,
regarding same~ .. , .
\,'
Applicant's Signature & Dem .
Date
(Nam'o printed)
Applicants Phone #
Appllcal)t's Address
City, .
5T
Zip
STATEOFINDlANA )
55.
County of } .
Seforo me, the undersIgned, 21 Notary Public for
appeared
County, state of Indian., Pel'$onally
'and acknowledged the executIon oftheforegolng
. I
Instrument thIs
. day of
,20_,
:"
~otalY Publle
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08/15/2008 13:35 FAX 3177788508
eB/e7/2ee6 14:37 3175712615
HAM CO HEALTH OEPT
CARI\El.. FIRE
Ii1I 003/005
PAGE 1l1/e1
"
Signature; Monis Hensley (or rap;u..ntattv.)
Date'
(or raprnentattve)
Date ~)<I,lo~
CERTIFICATE OF AUTHORITY
, '
Under the penaJtlee f)t perjury (Indiana Code 35-44-2-1), I hereby affirm, u"der oath, that all qf the
Information I have provided in this application for demolition permit Is true and accurate, to' the
beat of my knowledge and belief, and that I have not,knowlngly,or Intsntlonally pr:ovlcl.d or .
omitted any InfonnaUon that would tend to hide, obscure, or othervdee mislead the Department
of Community SeMCSS regarding th8 truth of the m.u.. acid......" therein. '
F\Jrth~~: i'~8rt that I am the prO~ OWl1er, or the authorized *'!d laWfully appOinted '''l'lt of
the oWner(s). that I h..... expl'8ll1 authority 'and p..",loslon 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 Cannel from arw claim, IllW8UIt, demand, or damages
whatsoever arising out of, or as a result of, this request or the ac:tlons of the City of c.rmel,
regarding same> ' ':,' ,.,' " , ' '
,,"
Applicant's Signature & Dat.
, 'I
r,.
"
Date
Applicants Phone ..
(Nanie prlntBd)
Applloa"t's Address
City"
,81
Zip 'I
STATE OF INDIANA )
sa.
COllnty of I
Before .me, the undlltlillilnlld, a Noti..y PubllG fQr
app8lll'ed
CQunty, 8tlde of Indian., Personally:
'and acknOWledged the execution ~th.'foregolna
Instrument'thls
, day of
,20_,
I
1 ;
i
,
Notary PI.IDUG
. ,
M)'~mlalllll ~I'M:
lJ'~nt)
S:P~ I*lTlllhonclouI
"
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