HomeMy WebLinkAbout07050028 Signed Demo
Demolition Permit Requirements.
City of Carmel! Clay Township
. Building & Code Enforcement; City of Canmel
One Civic Square; Canmel, IN 46032 Ph. (31.7) 571-2444 Fax (317) 571-2499
TOBE SUBMITTED WITH APPLlCATION*: Two copiesofa 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. (*App/ication is a three-part form available from the Building & Code,
Enforcement Office) '.
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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 gOMernment 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-62.
Existina septic:' Septic system must be pumped and filled with sand, or removed. If ~eptic
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.
\S23.W \3\ $~ s'\
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Fuel Tanks:
. Address of demolition
gK'El-IW\ tIC DEVt--l()PM~U-'-
Owner(s) Name and Address
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Tax Map Parcel # .
12..'6'2\ E I--\-1<3J VI,.1,t.ICoe., ~'1'
C'_ Ae'M "'-'-'- 1:.1-\. '--II.. 0 's '2..
Additional Structure(s) on site: Yes. / No - . (If yes, please list the number andtype(s) of
. structure on the lines provided. If one oft -e sfrlictures has a separate street address than the
primary structure on the parcel,--please also include thatinformation.)
.;::. :the Clty:'Of'9armel and/or Hamilton County Health Dept. mtJstperform an inspection prior to
:::-" g.em,?/itiof].:in order to approve the demolitionpecmit, the applic,ant is required to sign this form.
_ - andobtaitlthe sianatures of the individuals listed below. (This can be done by FAX to their
-' . - office!j,.a.t.the numbers listed below) Include this completed ,form with all appropriate .
-'l~,'s.i~~_~.~uri;}"(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:Permlts\Demolition permit handout
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Signature: Morris Hensley (or representative)
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Signature: Barry McNulty (or"representative) Date
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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 I
best of my knowledge and belief, and that I have notknowingly 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.
CERTIFICATE OF AUTHORITY
Further, I assert that I am thlfpropertyowller; orthe 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 0 , or as a result of, this request or the actions ofthe City of Carmel, '
regardin same. .'
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STATE OF INDIANA )
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S:PermltslDemolltlon permit handout
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05/02/2007 08:28 FAX 3177788508
04/26/07 12:30 FAX 3176861507
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UndOf the JI8l1Bltf_ pI per.lury (lndtan;i Coda ~5~.1), I h.~by affinn, under atith, thllt a" ~f th~
In10rmatlcnl have ~l'Ovld.d In thIs application for darnol/tlon p4Jnn!t Is b'uellnd accu~ to th8_~
best of my b1awfedge Ilnd ballot, llrid t~t I have not knowingly, or lIIt8m.ran~lIy pr:ovlded or- .
omitted any Il'lfamiitlon .that would tend to hide, obscure, or othelWlBe mIsread the ~p;utment
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F!Jrther, I ass.rt ~t I am the P~'pGrty ~w"er. or the authOllzed and laWfully ap~lntlildaQent of
the owner(s), that IIusve express authority 'al1d Pennl-Ion fram the ownor(S) (and lII1yQnll with a
recorded lrite..- or other Ine.~Gt Ii. the pRlperty), to tak8 tJibji NqUeSted aCUon, 'and that I BS1'8s' .
to IndemnIfy and hold hitrinl8l111! the CJey of Carm.I froin any I:!!alm, lawsuit, demand, or dllftlag~:c-:
whatsoever artalng of, or as I!I nIlSult of, thIs I8qUlI8t or tho aatJons of'the City of Carin.I. . __" .
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Feb 08 07 03:55p
Rob Lovell
(317) 571-2654
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Signature: BJqrry McNulty (or reprGSentatlve)
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CERTIFICATE OF AUTHORITY
Under the penalties 91 perjury (Indiilna Code 3544-2-1). I her-::by affirm, under oath, that all of the
InfonnatIon I have provided In this application for demolition permit Is true and accurate, to the
best of my knowledge and ballef, and that I have not knowlnglY,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, 1 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 Cannel from any claim, lawsuit, demand, or damagcs
whatsoever arising out of, 0 as a result of, this request or the actions of the City of Carmel, '
rc 'g same.
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STATE OF INDIANA )
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Before me, t~~ undersigned, a Notary PubUc for
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