HomeMy WebLinkAbout07050027 Signed Demo
APR-06-2007 FRI 12:02 PM
FAX NO,
p, 03
Demolition Permit Requirements
City of Carmel I Clay Township
Buflding & Code Services: City of Carmel
One Civic Square; Carmlli,IN 46032 Ph. (317) 571.2444 Fax (317) 571.2499
TO BE SUBMlmO WITH APPLICATION.; Two copies of a site location map..clearly
Identifying the structure or structures to be demolished, (on paper no larger than 11
inches by 17 inches) 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 Services 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.
Existino well: Well must be plugged aCCording to Well Ordinance A-62.
Existino 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 for re.use.
Fuel Tanks: Fuel tanks must be pumped and removed from building andlor property.
iq;}<.f ~ liD t!J Sf- ~, J~ J'1- I L{ - 0 b- 03-0 ]-0 I S".oOC
Addressb, demoln/on Tax Map Parcel /I e.-\ ~
:S~S I ~t( ~N..\'OL- ~ W\eqJlll ~ll s Ll\Ns I s ~O
Owner($) Name an Address
Additional Structure(s) on site: Yes / 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 I?a!cel-please also Include ,that informatio~.'g)...l _
d- ~L Lth II '"2f\~ . \' -. ~Zl"'>>~""?
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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 applicant is required to sign this form
and obtain the slanatures of the indIviduals listeel below. (This can be done by FAX to their
offices, at the numbers listed below) Include thIs completed form with a/1 aooroDriat.
sianatures (ON THE REVERSE OF THIS PAGE) when you submit your application package., \ .
::rchV\ t'V\a..s~'\i133-;:;).Ff55' -\\'-./<. '733-:).053 H.u"Ja (;)llPC4j
1. Morris Hensley, Supervisor: Water treatment Operations, City of Carmel; I VI')
Phone(317) 571.2673. FAX (317) 571-2265. ,-, 1:~q~ ~
2. Barry McNulty: Hamilton County Health Dept.; j"- ... _.
Phone (317) 776.8500. FAX (317) 776-8506.
S:pennitsIFon'nSlDemollllon P&tn1it hand'out
1012
04/1B/2007 13:30 FAX 317776B506
HAM CO HEAL TH OEPT
:317-257-2130
FAX NO.
Ii1I 003/003
p.3
P. 04
18 07 09:108 Jame~ Knauer
Flpr flPR-06-20Q7 FRI 12:02 PM
Slgnalure: Morria Hansley (or rG""'.....IlO1""'1 Date
/j'1 f.(Il-
Date
CERnRCATEOFAUTHORnY
Under the penalties of perJul)I (Indiana Code :II~-1). I hereby lIffJrm. under aath, thill aO of the
'nformatlon I hIlve prOlllcfed In this application for demolitiOn permit la true and eccul'lIte, to the
best of my knOWledge 8nd beUef, and that I have not knowIngly or Intentionally provided or
omift8d any /nfOrmatian that would tend to hide, obllcure, or otherwise mislead th. Department
of Community Sel'Ylces regarding th8 truth of the mattenl addrvlllI8d therein.
. Furthar,lllBeert that I am the Pl'OIl6rty owner. or the authorlz8d and lawfully appointed agent of
ll\e ownlllr(8), that I have lII11pl'888 authority end penalllllion from thlll ownerle) (and anyane with a
recorded Interest 0, other Intel'86t in lhe property), to take this 1'eqIle8teCl act/on, and that I 8gRID
to indelllnlfy end hold harmleBlll the City of canner hm any claim, lillWsuit, demand. or damages
whatsOever arlslng out of, or _II result of, tIlis I'llquut or the actions of the City of Carmel,
regardln Game.
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(Name prinUld) AppJ/oa Phone ,
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App"c~lnt'. Address City; . ( ST ZIp
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STAno ~~ANA sJ
County ~~ I
lIIIdarsfgnad, a Notary Public for ~ ~ COI.lnt)', Stale oflndl&ln., per50lllllly
Y7 and .cIlnowledgecl'.... 8DHlUtlon of the flll'egolng
Is 76 d.yor 20L:Z
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Mr f;cIIaml.-Jen bpfl'Dr.
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Feb 08 07 03:551"
Rob Lovell
1317J 571-2654
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CERTIFICATE OF AUTHORITY
Under u.. psnallJoI of ..."Jury IIndl"na CQcI. :I'~-1). I hOlOby lIft\Im, ..ft....r va"', lh~l an of tIl.
In,",,,,,lItIon , h_ provlded In thl. application for demollllon po",,'t I. true and DGCUIlItO. to tho
_101 my knowladgo 0,,", ....llof. ,""dlha' I ha.... not kn.....ngl)' or InlDntiolUllI)/ provided or
omittwd ""y 'nfo".....I.... th"t would lentllo hide. obeeutllP. or othorwi5<l ",'DI..d tho> Dop""ment
of Community SeNt""" rogarding tho truth of tho matto". ad_,od tho",in.
. Furthor.I.....rt thaI I DlI> "'" propootv' OW".,. Ot 1110 llt.tlllorlz.Od anll ~Uy lIpf)Cll"tad .",,"1 Of
1110 -""r(.). that I _ OtlP_II authot1l)' and PltItlksion 1rem Iho ..-vt1o) (...d a"yonD will> a
roc_ad Jnll.....t or ".... """_In..... propO"""- ID t:/Il<81h1s ro"....1A>d actAon. and thall"g"'.
to ind.mnlfy and nold hllil'mlooo the CIty of Cannel from ."y claim, I_uit. dorno"d. D.d.""'GClC
whDtsoe"8r Britllng out of. or lI& .. rotIurt vt', this /'Iqullilt or 111. a""on. of 1110 City of Carmel.
'aoardl~,_..ltlol,
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App/IGIlnt'. Add..... CII)'. . I liT Zip
STATE OF INDIANA )
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