HomeMy WebLinkAbout07010160 Signed Demo
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01/24A2007 11:29 3175712265
CARMEL UTILITIES
PAGE 01/02
~~) ClemoUtion Permit Requirements
City of Carmel I Clay Township
",,~..v '""'"' & """ _mt "'" ""'~,
-. One Civlo Square: Carmel, IN 46032 Ph. (317) 571.2444 Fax (317) 571-2499
TO BE SUBMIr:r.g,QJMTH APPLlCATION*: Two copies of a site location map-clearly
identifying the structure or structures to be demol/shed, the Tax Map parcel number for
ttie parcel on which 11he demolition is to occur, and this form signed by the appropriate
departments. ('"Application is a tht't!eoparl form available from the Building & Code
Enforcement Office)
NOTE:
A separate permit application must be completed per parcel.
Certaln 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.
Exist/nQ well: Well must be plugged according to Well Ordinance A-62.
lExist#nQ se"tic: 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 Tanlc8: Fuell tanks must be pumped and removed from building and/or property.
12 0 ~7 SO:; AI? { /; r:J." ^ 'f;'. '<l--o <t J, 1"7-- 09- 32-o0-ao - o/~. CO I
Address of demolition ( Cf r I"te ( ,pl<'':'/ <e <'l J L Tax Map Parcel #
,
M\r.:ht1,~.'1 1'Yta./c.y p() /~6.x ?-::r"'7- 2t"d,:(..1url/r ,h .:y""o~
Ownel1BJ Name and AddrDi$ ( ,
.
.
.
Additional Structure(s) on site: Yes I 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.) "
lA ~ t'\('\ (J [Sa I:tY ~ s 1'1 C( II ~ lock l3u, I,J,;.) r-u ,r (A? f'<.O}.I+'....I'f
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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 epplicBfltfs required to sign this form
and obtain the slanatures of the individuals listed below.. (Tb,~ .c.i!n be done by FAX to their
offices, at the nUmbel'll listed below) Include this complet~ciftJm!,with all aD"roDria~
sianatures (ON THE RJ:VERSE OF THIS PAGE) wh~n.l!?uis~mi.t.'y'QUr l![JJ?!i~af!on package.
1.
Morris Hensley, Supervisor: Water Trea
Phone (317) 571..2673. FAX (317) 571-24
Barry McNulty: ,Hamilton County Healfli
Phone (317) n6..8500. FAX (317) nS.8f
S:~!s\Demc;11Ion pennIt IlandOllI
POSl.iC Fax Note
To m.<.I-."... (
CaJDeot
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01/24/~007 11:29
.-
3175712265
CARMEL UTILITIES
PAGE 02/02
~~7. 11 Jf~;;;~
Signature: Morris Hen$ley (ar mpresentlluV&) Date
I - ~ 4~ c.9 7
Signature: Barry McNulty (or representlltl\le) Date
CERTIFICATE OF AUTHORITY
Under the penalties of I~ljury (Indiana Code 35-44.,2.1). I herebY affinn. under oath, that all of the
infonnatlon] have pro~fded In this application for demolition permit is true and accurate, to the
best of my knowledge :lnd belief, and that I have not knowingly or intentionally proVided or
omitted any lnformatioll that would tend to hide, obscure, or otherwise mislead the Department
of Community Services, regarding the truth of the matters addrused therein.
Further, I assert that I am the property owner, or the authorized and lawfully appointed agent of
the owner{s), that I haVlt 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 agM!!
to indemnify and hold harmless the City of Cannel froin any claim, lawsuit, demand, or d3n1ages
whatsoever a~ing out of, or as a result of, thiti request or the actions of the City of Carmel,
regarding same. .
1-2.J~C,J?
Date
frt{ cJ..!t.~ I
(Name printed)'
t'V1f1.{(JY
I
30- ST":;-':'-7":/ '5
Applicant& Phone #
f 0, /? 1f7" 3~;;=?'
Applicant's Address
"
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City,
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Zip
STATE OF INDIANA
County of 8 01'hu
)
sn
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DIJ&v../
County, State of Indiana, personally
and ackngwledged the eXecution of the foregoing
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01/2~/2007 13:08 FAX 3177788508
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Demoliti'on Permit Requirements
City of Carmel f Clay Township
Building & COd. Enforcement; City of carmel
One CIvtc Square: Cermfll, IN 48032 Ph. (317) !7t-2444 Fex (317) 571-2400
TO BE.lIUBM.mD WIlJI APPLICATlON-: Two copies of a site location map-clearly
Identlfylng the structure or atnlctu.... 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. rAppllcatlon is a t1r~part fo"" available from the BuIlding & Cod.
Enfol"Cflment OffIce)
NOtE:
HAM CO HEALTH OEPT
Ii!I 002/003
A separate pelTTllt applloatlon must ~J:O:~I-''''''''''---- ."2-
Certain Inspectlon$.J'll!D---~-- 7811 Oa-r...zJ-Q /kQl
tanks, prior to den post-<r f'elt NoIe I""" (<:J....(H
.Should approvals b 'TO i"r /\III CO. ltIes. or
utilities (other than t CQJoopI. . ... I.~ l- ~'" ~J, _01 ~j,I"~.J: of the
contractor of record _' 77' - ::I r<' .., .3 - 3 "r'~
8' -0 c.:.
Ibdllt/IJD well;, Well must ~ IF'" 7"7 ~..-.._1W:I2.
6x/StlfID -tlF: Septic s)'Stem ......., ue pumped and filled with sand, or removed. If septic
synam 18 to be naused, it must be plugged off until ready fOr re-use. .
BJeI T.nkJs.~ FUel tanks must be pumped IUId removed from building aridlor property.
/26 '9'S :~A.~ [6([ i- ^~ \'4Jq.l 17:- 09-32-0CJ-OQ-O/t.. oal
AddlUS ofrlwrlollrJon c ct I"l"1e ( :p.,r 4' 4> oJ l... Tax Map Patw/'
, ,
Mlr::kD..1 Yl'/iJltw Po n6X <7r "2("ClIi.JI;I,Ift',~ '7''''''~
Owner{s) NameMd~ ( ,
~ " '"
, . '" - .~. ~.
. .-.,' 1_ . ~~: ~
IS. and fuel
.
.
.
Additional structure(s) on slt8: Yes I No (If yes. please list the number and type(s) of
Structure on the lines pro\llded. If one of the structures has a separate street address than the
prfmary structure on th. parcal--please also Include that 'I'\!Ormatlon.) ,
iAMt'I tJ Bar,,!.JI.s 1f1(.{1f R/6c1~ Bu,I;,:..., ~u" (.2!> fl<Q).I+,"UI"/
S7f'(./C.,( ...r~j
+L.....I-- wd( .s7o.y - (I'1~~J l3aoy
I
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The City of Carmfll and/or Hamilton County H~81th Dept. must perform an Inspection prior to
demolition. In orderto approve the demolitfon permit, the appll~1$.'!'fIulred to sl9n this fDrm
and obtaIn the aianatures of the Ind/'LkJua/s IIsfrJd b~1fb4..r;ai;''be done by FAX to thei~
offlt;es, at the numbers listed b8i0w) Include this comt:./fe!.ttf'&.niiJidtft-aIIIlDDTO""a~
slanatures (ON THE REVERSE OF THIS PAGE) When iPU.istsbrriTrYt;!ilr a'pplledon pack8ge.
''; : .....--- ,-. ..... . .
:; ':: -."" --.........:: .
1. Morris Hensley, Supervisor: Water Ttufment ~i.orrs,..Cj!iofc.rmel;
Phone (317) 571-2173. FAX (317) 571-2285. \,', _..............,. .
Bany McNulty: HamIlton County Health o.pt.; "'" ::"....~'"
Phone (317) 77fi.8600. FAX (317) nWSOB.
S:P~Ptm1Il~
2.
tu Lv-UL f\..-L ~
~ lc::t2~""O
01/24/2~07 13:08 FAX 3177768506
HAM CO HEALTH OEPT
III 003/003
/ .~.
Signature: Monia Hensley (or ,..preuntllttve) DlIt8
~~_h'Jh:r 1/~'-fJo'7
Signature MoN Ity (or... maUVe) Date I r
CERTIFICATE OF AUTHORITY
Under the penalties Of perjl,lry (Indiana Code 35-44-2.1), I hereby afflnn, under oath, that all of the
Infonnation I have provided In thle application for demolition pennlt 18 true and ~urate, to the
best of my knClWledge and belief, and that I have not knowingly or in1Dntfonally provided or
omitted any Informaton that would tend to hid.. obscure, or otherwise mislead the Department"
. of Community Services regarding the truth of the mathtl1l addressed therein.
FIJrther, 1"811 that I am the property owner, or the auth~ lIf1CIlawfUl/y appointed agent of
the OWJIer(.), thllt I hIM! expl9ll8 authority 'and penn""on from tI'l. owner(s) (and anyone with a
recorded inlelWSt or other 1n1DlUlIt In the property), to take thla requeeted action, and thai I agnlB
10 Indemnify and hold harml.. the City of Cannel from any claim, lawsuit, demand, or damages,
wlla150ever al1.'ng out Of, or as a result of, thl. tequest or tile sedans of the City of Cannel,
regarding same~
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Appllcanfs I gnatur'!t & Date
--..P1 { cl...1l. {d rvr ...1 a v
(Name plinted)' I
!-.2.3-()r
Date
?o- s-r+ ~~ ,(/5
Applh;;ants Phone #
P.o, /?,.(f~37'~
AppllCllnt'S AcIdl'888
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City,
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8T
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Zip
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STATe OF INDIANA )
County of (5 o1h.u ss)
Before me, the undersIgned, a Notary Public for
appeared rn,. (h ().t / fYI a.1 '
Instrument thle ;1.3r;" day of
5~
County, ~ of Indian.. personally
1Ind aCkl10wledged the execution ofthefaregolll9
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2of2
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i
Demolition Permit Requirements
City of Carmel I 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.
Existina well: Well must be plugged according to Well Ordinance A-52.
Existina selJtic: 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.
/2 6 :=; S ,5A.e i6 d n\f~
Address of demolition C Ci' r rr E (
YV\ Ir:!-,,)<, 'I mcd G Y
Owner(s) Name and Address I
'(Lu c{ ~
:[::::u L-Il€ u.j L
Po l~ 6;>< <:::;7-
,
Ir' 09-32-0U-CO-OIc', 001
Tax Map Parcel #
"
'Z,- o/{..j Or 1(1'" ,:J''7( <("00?-7--
Additional Structure(s) on site: Yes I 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.)
Ln (\() KJ Ref f' AI :f S /l1 cd r /s lock J3u. /J,;., f Po r (k f1-t ut/+,'U!
.-$71 uei v ,r." ,f-!- L.<. t- i.AJ', I ( S7 c< 'y'
/
(VI.;: 1-"1 / {Sa. r ^I :?( I~ C! u,J <::....-
The City of Carmel andlor Hamilton County Health Dept. must perform an inspection prior to
demolition. In order to approve the demolition permit, the applicant isr.l?quired to sign this form
and obtain the sianatures of the individuals listed below.y(This..c,an'be done by FAX to their
offices, at the numbers listed below) Include this compJetedforrriwitfj-'all aOlJrooriate
sianatures (ON THE REVERSE OF THIS PAGE) when y-ousubmifYQur application package.
~ . -,-..":---'::,. ~', -
1. Morris Hensley, Supervisor: Water Treatment Operationsi-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:Pennits\Demolition permit handout
1012
Signature: Morris Hensley (or representative) Date
Signature: Barry McNulty (or representative) Date
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 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 the actions of the City of Carmel,
regarding same.
c~~J A4a~
Applicant's ignature & Date
/-25'-cJr
Date
IV1IC~Q,p1
(Name printed)'
(}1u.!U'l
/
.., /) -S-:J,-7- - s ? c/...J
J .
Applicants Phone #
p. c), 136 y< ::t+
Applicant's Address
,
7~6'Y.J ui//I'
City,
';PI
C/6677-
ST Zip
-~-~-----_.._._._._._---------_._._----"-_."-_.__._._-------_._._----_._._-----_._----'----_._-------~_._.__.--_..,._.~
STATE OF INDIANA )
fJ.. 615f'cU 55
County of U )
Before me, the undersigned, a Notary Public for
appeared rn I (h r~ I ,,~~ or
instrument this l3 dayo~ J0rUJo"'J
{3 oDlV
County, State of Indiana, personally
and acknowledged the execution of the foregoing
,20{l.
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I My Commission Expires:
S:Permits\Demolition permit handout
2012