HomeMy WebLinkAbout07010073 Signed Demo
JAN-05-2007 FRI 01:06 PM
FAX NO,
p, 03
Demolition Permit Requirements
City of Carmel { Clay Township
BUilding & Code EnfDrcemen~ City of Carmel
One Civic Square: Carmel, IN 46032 Ph. (317) 571-2444 Fax (317) 571-2499
TO BE SUBMITTED WITH APPLlCA TION*: 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 sale responsibility of the
contractor of record to obtain such approvals.
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: Fuel tanks must be pumped and removed from building andlor property.
~.J\ \'5-\-- Aut. Nt: C.JTlLffi1L\ 11\\ \lc,\D3DD'50~.CC:O
Address of demolition I , Tax Map Parcel #
'Ad;1-.\ cmr~O'So.\\e LAyd\~ 1;;0\ N.'I\\;{\~\~ '5\. Trd?\'5. ,~ Ll(";}(,,O
Owner(s) Name and Address . ,
Additional Structure(s) on site: Yes /Q (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 parceJ-please also include that information.)
Existina well:
Existina septic:
-"'---'---"."~-~--'-"_~".~~___'__~"~__'_M'___.~~_.__'___~__~~'_______,_,__,__._"".~_,_,____________
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 aooropriate
siqnatures (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.
Barry McNulty: Hamilton County Health Dept.;
Phone (317) 776.8500. FAX (317) 776-8506.
.....--/
2.
S:PerrnitslDetnolltion p"tmlt handout
1012
JAN-pS-2007 FRI 01:07 PM
FAX NO.
P. 04
Signature: Morris Hensley (or representative) Date
'--'
Signature: Barry McNulty (or representative) Date
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Code 3544-2-1), 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 othelWlse 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 cl"lm, 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. ~ ,()
/'j(JR--1J1 /JmalCAtJ .(JtJ~!-I2t.JC-l-IOrJ La )Lvr2.
~/%~ _ 'W~~ ;/9/01 1)"8101
Applicant's Signature & Date I / Date
L()~~\~ Ho~~,~~ ~jllcllV1o.5\~e2..
(Name printed) ,
2l11.T7S -7400
Applicants Phone #
\Ld"\ N\(d.
Applicant's Address
~\~\'\~
City,
ItJ
ST
LJl,JloI?
Zip
-_..-.~~._----_._-_.__.,.._._-~-----".__._-
STATE OF INDIANA )
1M . S5
County of I' l.o..A..u-'/V\..> )
Before me, the undersigned, a Notary Public for
appeared
Instrumentthls ~t\-1 day of (h /Y\ J Ll'u.v-.
-f 0
~/J\J~ ~~
',~ Notary Public .
~M\-k/t\.--€- . ~\-rk-t-ivY\
(Print) . . . .
County, State of Indiana, personally
and acknowledged the executIon of the foregoing
,2007.
I-I-d-Oll
My Commission Expl....:
S:Pennits\DemoHtion.perrrylt h~n~out
. -
-'. .
.......--.-.
20f2
1/9/2007 2:08 PM FROM: Fax Hamilton County TO: 99, 13178759400, 60902 PAGE: 001 OF 003
Hamilton County
confidentla
ax
To:
Fax Number:
From:
Fax Number:
Business Phone:
Home Phone:
Pages:
Date/Time:
Subject:
Amy Vires
99, 13178759400,60902
Jeanette I. Gartner
(317) 776-8506
(317)776-8500
3
1/9/200720806 PM
621 1 st Ave. NE
Please see the attached Demo Permit.
1/9/2007 2:08 PM FROM: Fax Hamilton County TO: 99, 13178759400, 60902 Pl~GE: 002 OF 003
,/- 01/08/2007 MON 9: 29 FAX 3] 78759400 North American Const. ~ 002/003
JAN-05-2007 FRI 01:08 PM
FAX NO.
P. 03
(~~~~. '} Demolition Permit Requirements
~ City of Carmel I Clay Township
. IN. A"~ Buiding & Code EnforoemeoC City of Cannel
'-.(--'- On.. Civio Square; Carmel, IN 46032 Ph. (317) 571-2444 Fax (317) 571.2499
TO BE SUBMITTED WITH APPLICATION.: Two copies of a site location map-claarly
Identlfying the structure or structuras 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 >:iystem>:i, 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.
Existlna well: Well must be plugged according to Well Ordinance A-62.
Existlna seotic: 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 fer re-use.
Fuel Tanks: Fuel tank>> must be pumped and removed from building andlor property.
'--../ L~\ \'S\- PnJt, Nt: 1 CsrIUY\QJ IN \L\D~OOSo~.OCO
Addr8u of demo/ilion . Tax Map Parc<>l I<
\\0..'-1;>.\ nrd1.050..\ie U>.y.J\~ 1;n\ N"I\\~{~\'0 '6\. Trd~\"6. .~ L.\I..;).L,O
Own"r(..) Name and Address . .
Additional Structure(s) o~ site: Yes /G;) (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 struelure on the parcel-please also include that information.)
,---,'
The City of Carmel and/or Hamilton County Health DepL must perform an Inspection prior to
demolition. /n orc/er to approve the demolition permit, the applicant Is required to sIgn this form
and obtain the sial/stures of the individuals listed below. (ThIs can be done by FAX to theIr
offices. at the numbers listed below) Include thiscompletecJ form with a/l aDDropriate
sic matures (ON THE REVERSE OF THIS PAGE) when you submit your application package.
1.
Morris Hensley, Supervisor: Water Treatment Operations, City of CalTTle/;
Phone (317) 571-2873. FAX (317) 511-2265.
Bany McNulty: Hamilton County Health Dept;
Phone (317) 776--8500. FAX (317) n6-8506.
,,J
2.
S~ls\Oethol1tiDn permit h3ndouf
1</2
1/9/20072:08 PM FP.O!1: Fax Hamilton County TO: 99, 13178759400, 60902 PAGE: 003 OF 003
,.~1!0812007 MON 9:29 FAX 3178759400 North American Const. ~003/003
JAN~05~2007 FRI 01:07 PH
FAX NO,
p, 04
SIgnature: Morris Hensley (or r.presont~tlve) Date
'-.--'
I/q /ZL-907
Date / '
CERTIFICATE OF AUTHORITY
Under the penalties of peljury (Indiana Code 3544-2-1),1 horeby affirm, under oath. that all of the
information J have provided in this application for demolition pormit Is true and accurate, to the
best of my knowledge and belief, and that I have not knowingly or Intentionally provided or
omitted afIY infannalion that WQuld tend to hide, obscu re, 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 Qwner(s), that I have <>xpreGS authority and permlsl>lon 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 of, or as a result of, this request or th" action.. of th.. City of Carm&I,
regardln same. , /l
/lJh IIrnU:';C#N ON~ k:Ue:l-,O~ CD.,LJI2..
,,-,,/ ~~ ~ yO
Applicant's $ignatura & Date
\):8101
Date
3\ 'l-'~'l'5 - 7 LJCo
Applicants Phone #
l6~~\e. ~o-;;,\<.:\"'~ ~j~d V1o'.l\o"(~r2..
(Namo printed) ,
4'1';)9 ~\W~~.
Applicant's Addruss '
~\~(=::t::S\'&
CIty,
nJ
$T
'--IJ.,Jk'i?
Zip
STATE OF INDIANA )
"M $S
County of ,. l<l ,u//vu )
Before me. the undersigned, a Notary PublIc for
appeared
Instrument this ~ day of (\.. oM A ,-", ,,_
-'t" If
~-,^,1t, ~t~ .
'.-, Nobry Public
~i'\,\....A}~ . ~tr-k-tiztY\
{Prlnll
County, State ar Indiana, personally
and "eknowledgod the execution afthe foregoing
.2007.
/-/-;:;'011
My Commlaalon Exp2ru;
S~PermU~\OemoIrl1cn potrnll namfcut
2012
.
01/08/2007 13:20
3175712255
CARMEL UTI LI TI ES
PAGE 01/03
CITY OF CJ\RMEL
~~~- .........-------------
WATER-WASTEWATEI~ UTILITIES
Fax
,........--..~ --
760 3RD AVENUE S.W., STE. 110 . CARMEL, INDIANA 46032
(317) 571-2443 . FAX (317) 571-2265
Ii 1>1 ~! /Ie-v<; Ie j 1'7 I <1"1~"
To, From: /?'1oR-l. I .,
Fax: ~1S"-q""e,a Pao"s: 3
Phon.., ~ns - '7'-1 "0 DatA' I ~ ~ - Or
Rel cc:
[] Urgent o F,or R..vlew D Please Comment D Pleas.- Reply o Please R"cyc:l"
Confidentiality NOllce: The, malenals endosed Wilh this facslmlla transmission are private and confidential and are the property or
the aender. The Inlotma~on oontalnad in the maleMalls pMvlleged and Is Intended only lor the use of the Indlvlduales) or enlity(l..)
named above. If you sre ncl.the Inlended reclplenL be adviSed that any unauthorized dIllclosure, copying, dlsltlblJtion or the takillg
of any acffon In rellanO! on Ihe conlants of this lelecopled InformaUon Is Strictly prohlhlled. If you have I'Ilcelvedthls facsrnUe
~al15mlsslon In em:>r, please ImmodlalBly noUfy "" by telephone to arrange lor the re!urn 01 the forwarrled dOaJmenis to us.
CARMEL UTILITIES
01/08/2007 13'20 3175712255
~11U~(2UUf MUN 9:24 FAX 3178759400 North American Const,
.. JAN~05-2007 FRI 01: 06 PM FAX NO,
PAGE 02/03
~ 0021003
p, 03
4""~
(- \~i."''''''~~ Demolition Permit Requirements
City of Carmel I Clay Township
'-~' \',[1fD ~"'- Bwildlng & Code Enforcement; City of Camrel
-.1!l..~ One Civic Square; Carmel, IN 46032 Ph. (317) 571.2444 Fax (317) 671.2499
TO BE SUBMITTEI) WITH APPLICA nON*: Two copies of Q site location map-clearly
Id!Jntlfying the structure or structurea 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 OfflCl~)
N01:g:
.. 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 govemment entities, or
utilities (other than those addressed herein), It is the sole responsibility of the
contractor of record to obtain such approvals.
Exist/or, well: Well must be plu9gecl acoordlng to Well Ordinance A-62.
Exist/no seDtic: S'9ptfC system mLlst bo pumped and filled with sand, or removed. If septic
Sllstem Is to be reused, it must be plugged off until ready for re-use.
EY.el Tanks: Fuel tanks must be pumped and removed from bUilding andlor proptlrty.
'--, ~,J\ \'5\- Aut. Nt c.Ftl1..mtJ IN J~\D3005o~.OCO
JtddlMl$ of demolition 1 , Tax MBp Psrr;.,f II
'ildINond1cso.\ie ~"d\t 1;:;0\ N."II\;I\~\~ '5\. Trdp\'fJ, ,IN L11..~("O
Ownor{s) Nome and Addre'''B , ,
AOdltlonal Stnlcture(s) 0'; site: Yes it;;) (If yes, please list the number and typa(s) of
structure on the lines provided. If one of the structures has a sepanate street address tI1an the
primary structure on the parcel-pleasa also include that infonnalion.)
TIle City of Cermel and/or Hamilton County Health Dept. must perform sn inspeotion prior to
demolition. In order to ~Ipprove the demolmon permit the applicant Is requIred to sIgn this form
and obtain the :sianatllres of the individuals Ilst~d bA/ow. (This can be done by FAX to their
omr;f$, at the numbers listed below) Include this completed form with all aIJDroorlate
sirmatures (ON THE REVERSE OF THIS PA GE) when you submit your application pac/t;Jge.
1.
,---,'
Morris Hensley, Supervisor; Wl'lter Treatment Operations, City of Cannel;
Phone (317) 571.2673. FAX (317) 571.2265.
Bat7y McNulty: Hamlltrm County Healfh Dept.;
Phom. (317) 776.8500. FAX(317) 778-8508.
S'F'llNnlb;\O<molllioo pormlt hand""l
2.
1012
3175712255 CARr"IEL UTILITIES
01/~~;UmVVnU~0 ~:Z~ t'AJ Jli8i59400 North American Const.
.' JAN-05-2007 FRI 01: 07 PM FAX NO.
PAGE 03/03
@003/003
P, 04
Ck.- ~- fl,
Signature: Moms ~lens'IlY (or repr9s9nl.~)
'-"
Cate
)- 7~ ~ '7
S;gnature~ eany MI;Nulty (or representatiVe) Oat&
CERTIFICATE OF AUTHORITY
Under the pllnalties I~f perjury (Indiana Code 3S-44.2.1). r hereby afflnn, under oath, that all of the
information I have PI'ovided in this application for demolition permit 16 true and accurate, to the
best of my knowledS'Q and belief, and that I have not knowingly or Intentionally pro."ided or
omitted any Information that would tend to hide. Obscure, or othelWlse mislead the Department
of Community SelVic:es regarding the trLIth of the mattul'!! addressed therein.
Further, I aSSert that I am ttlli p~perty owner, or the author/zed and lawfully appointed agent of
the owner(a). thllt I have expJ'Qss authOrity and permission from the owner(s) (and anyone with a
reCOrded interest or <ltherlnterest In the property), to f.:lke thIs requested action, and that I agree
to indemnifY and hOld harmless the City of Carmal from any claim, faw!luit, d"mand, or damages
whatsoeVer ari!ling OIJt of, or as a result of, this I"9quest or the actions aftha City of Cannel,
mgardin same. , f)
R..fj) /)f17U.;(!fIN . ()N~ .eucf'OiJ LD. J hvc.. .
/ ~ o;?
Applicant's Signature & Dilte
1/"8107
Date
LCl~~\e. ~O~~\l\l~ ~~o.cl Mo..llQ'3eK.
(Name printed) .
3\'7 -'315.7400
Applicants Phono #
L\.~-;:e to~\71Cl~ 1ci.
Applicant's Address '
~,~.rx:~it~
City,
ItJ
ST
~'?
Zip
STATE OF INDIANA )
~ S$
County of w., ..J
Before me, the undersfgned, a Notary Public for
"ppdared
Instrument this 9;fn clay of ~ ,if' ""'"
n . 0
U^,,,,,,!t, ~~
.............,tm~PIJ.blfC
A'^I'\-vt\-~ . '8-i:1:d::1v'n
(P~n~
County, State of Indiana, pe/'!onaD1r
and '1c:knowledged the execution of the foregOing
.20 Q1..
/-1-;;'01/
My COlhmJIItl:ton ExpJ",,:
S'P"lll1IIs\OGln<ollIlon penn!r hondoo'
20'2