HomeMy WebLinkAbout04120073 Signed Demo
...-'.
J
,
City Of Carmel
DEMOLITION PERMIT REQUIREMENTS
To be submitted with application*: Two copies of a site location map, clearly identifying the structure or
structures to be demolished, the Tax Map parcel number for each structure to be demolished, and this
form signed by the appropriate departments. (*Application is a three parl form available from Permit
Services.)
Certain inspections are required relating to private wells, septic systems, and fuel tanks, prior to
demolition.
Fuel Tanks:
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 must be pumped and removed from building andlor property.
Existina well:
Existina septic:
/~5/G" ~ & /I~<? A l/E'
Address of demolition
1713/;2.%/oz'?tJoC)
Tax Map Parcel #
Additional Structures: (ji.i) / No ) ~ / /'Vl-I 'r..; ~
**If yes, please list the address and Tax Map parcel number for each additional struct~
reverse of this form. .::5a'rrJe. I
.-kcfls,
The City of Carmel and/or Hamilton County Health Dept. must perform an inspection prior to demolition.
In order to approve the demolition permit, applicant is required to sign this form and FAX to the
individuals listed below. Include this completed form with all appropriate signatures when.you
submit your application package.
1. Morris Hensley, Supervisor: Water Treatment Operations, City of Carmel; (317) 571-2462.
2. Barry McNulty: Hamilton County Health Dept.; (317) 776-8506.
~~-~
Applicant's Signature
/z-~t4- ~
ale Signature & Date: Morris He
;i' ~,r-6' 'f
,
--?4-? t,(,//
Applicant's Telephone Number
Signature & Date: Barry McNulty (or representative)
NOTE: 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 sued
approvals.
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.
Building & Code Enforcement: One Civic Square; Carmel, IN 46032 Ph. (317) 571-2444 Fax (317) 571-2499
S:Pennits\Demolition oermit handout
U I nIl ~III IDO;JVD
~ '</Dl(O:09~200~~ 10:41 AM WEIHE CONSTRUOTION
({j!. DEM~!!X}~!R~~~~;'~EMENTS
To be submltlcd with AppIiCfltlon.; Two copIes of s site looallon map, clearly Identifying the struJlure or
structures to be demollshad, tIle Tax Map parcel number for each structure to be demolished, and this
form signod bY'Ule C1ppropr1(;1te departments. (*ApplloM/on fa 8 three part form avallabla from Pelmit
Smv{oQs.)
Ilnm lJU nl:.....L I n UL;.,.,
FAX NO, 31777630~O
't!;l ""'...., "'v~
P. 02
f
rl
~
J
,/
,
,
,
Cerlain Inspeotlons ere! required relating to private wells, septic systems, and fuel tanks, prIor to'
clalnoHtlon.
~l:itli1U~!li
€l\i~!l11l1..P~E.~
Wall must be plu9gecj aocordlng to Well OrdInance A-62,
I
Saptll~ system must be pumped and fillod with sand, or ramoved. If septic
l'Iyslarll Is to be roused, II mUst be plugged off until ready fOr m'Use. i
Fuol talll{s must be pumped and removed from buildIng andfor property.
~
FUel 7'lnkr:'
~_._- "---_::.1
I
I
-~~::?~-.-N.::"~I/ ~.,> A "'('
Addr,,_~s of demolItion
,
I
/7 /5'/.:1.0/0/ O;e.9~CJo
Tax Map Parcel fI.
_Z~~/~
,~
Addillonal Structu/"O$: <f.0/ No
,
"'It ~s, pleRse list the address and Tax Map parcel number fbr fJach additional structure on the
revolSe Oft/lis form. ...;S';;"r?-,(~ .
I
'lito c.Yly ,of Camlal flndfor HElmiflon County Hearth DIJpt. must pfilrfomJ an Inspect/on prior to demolition.
II) Prt:A,r to 8PPl1:JI/I!) tho demo/il/oll pfJrmif, appllcant 1$ requil'Qd to sign fills form and.PAX to tha~
!l!.q[Vir.Jlfa/~!Jsted befQM!., InclUde this complotecf form with all approprIate sJgnaturO$ when you
submit your QPpllr;ttt!on P:Ir:ku!!o.
1. MOrrfs H."l1/ey, Sup(.JfV/sor: Waler Treatmollt Operations, CltyofCarmeli (317) 671.2462.
2. 13{frry MoN~dty: Hamilton County Heellth lJepti (317) 776-8506.
~# -'"""I~" P'
~/1::_~~~~~..:.:k..e.
Appllc:lflt's SIgna lUre
/~~~ 4-..
a e Signature & Date: MorrIs Hansley (orrepresentijllve)
. i
_""-if :Lc:., ..0:..f!!___.._
App/fce,nl'll Telophone NUinber
- ~~.../~.A!4~ 1Irr.tld& I~}?/~
Signat OS! Barry M IJlly (orrIWesentotlve)
NOTE:;~ 8fIC)ulC/ Hpprovals b,~ I'sqUirod from othar State or local govemment antltfes, or lIfifltJes (other
thall thoso flddr~ssed flcreln), il fs tho sofa responliibi/lty of the contractor of /'Beard to obtain such
apProvals,
Undor th. nun~I!I.. 01 potJIUy Or.cI'~I1<l Cede 3$-44.2-1), I horaby nfflrm IIndor oath that 1lI1 oltheln'ormalron I havo ProY/d.clln thle
UppllcG~lo', 1<" dOmoll1"n POrnlltl. lruo And .courata to Iho b~ of my knOWI.dgc. and bOllel, nnd U1all have nOI knowingly or
Inlqntlon,IIY,f.,'oVlded Or o,l1lftqd ~ny 'nform'tronthot Would "'nd to hId., ob"cur. Or olho/WI.. """a."the Oeportment of
()Qmmulliey ~orvlc~~ l'ogol'dlng tllO 11\1111 of Iho maller. odelroneclll,.r.ln,
l'Julkilf/y & Coda Er;farcmnMt: 01/0 GMc Squarc,' CallnF)~ fN 46032 Ph. (317) 5/1-2444 Fax (31'1) 571-2499
S;P~mYllt~\nr l'IlrJlli(., rlr'~1l1& I1Qnc1rm~