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Home My WebLink About07050244 Signed Demo .r -_I .- Demolition Permit Requirements City of Carmel! 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. Existinq well:- Well must be plugged according to Well Ordinance A-62. Existinq 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. I Fuel Tanks: Fuel tanks must be pumped and removed from building and/or property. \Os.sS- Sr~\\..\I.:.MIl.L R~ Address of demolition Ji13\ lOODDOOLQ?D Tax Map Parcel # e CLLI ~\S t., ~ l.J e..;cl-.\c.... - 10 S 'Z..\.,;, T'f<.€-~()U \ C-l (2..c.Le ~ i='\ S~~s.) :5)-\ ~'3'1 Owner(s) Name and Address , . ~ . .' Additional Structure(s) on site: . Yes No (If yes, please-list the number and type(s) of s\,,-,cture on the lines provided. If one of t s,ructures has a separate street address than the primary structure on the parcel-please also include that information.) 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 siqnatures of the individuals listed below. (This can be done by FAX tcrtheir offices, at the numbers listed below) In~lude this completed form with all appropriate 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:Permits\Oemolition permit handout lot2 .! ,dt> Signature: s~ ~"~Q.l~~1) Morris Hensley (or representative) Date s;,~ A 1\ A.b.t-l~1'J Barry McNulty (or representative) Date Signature: 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 ~ith 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 f, or as a result of, this request or the actions of the City of Carmel, regarding same. S -'2'2.-0\ S - L "7--0 I Date L. - v"L L -"Z. '0 1 '\ o -(<,2:>g. q'3L~ Applicants Phone # . '/ \OLS', l4f'l..lZ1:)\U.b Sl Applicant's Address ILl 0 P LS :r:;L.\ City, \.{ \.e 7.. L \ ST Zip STATE OF INDIANA ) 55 County of M,;~o r-l ) Before me, the undersigned, a Notary Public for tv\. r\, t'.:Lo /-l. County, State of Indiana, personally appeared c.. ~\2-iAN 5<pE:.t2(S:.> instrument this ' "3\ day of VVl "'1 and acknowledged the execution of the foregoing . 20 cl-. ~~~ Notary Public D l\E:-rJ.l.. n"lRSE':1 (Print) cl - .&:'d. -l \:) " My Commission Expires: S:Permits\Oemolitlon permit handout 2 of2 v"', 4.1..1 ...1 UO.~i r~A Ji(DOO~~U( HAM CO HEALTH oEPT 1l0RSEY PAVING , ~ 00'3/005 I ~003 I OS/23/2007 07:55 FAX 3177788508 . '. .. .--' .. . ,'. Signature: Morris Hensley (or representative) Date '~~~~ sl$-a-/()~ Signature: , cNulty or repre,.entat ) ate I CERTIFICATE OF AUTHORITY . I Under the penalties of perjury (Indiana Code 35-44-2-1), I hereby affinn. under oath, that alll:!f the infonnatlon 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 provtded or I omitted any Infonnation that would tend to hide, obscure, or othelWise 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 'awfully 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, Bnd that I agree to indemnify and hold harmless the City of Cannel from any claim, lawsuit, demand, or damages whatsoever arising out f, or as a result of, thIs request orthe actions ofthe City of Carmel,1 regarding same. S -1..'"2--0'1 s - 'L'1...-0 I Date c.. - VL.1. - 'Z"o '1 '\ 0-(02)'3- q '3.'"2.L.., Applicants Phone # ~ \ 07 S, l4.:\.€!)\l.Ll.. ~, Applicant's Address I-u 0" t..S ' 3:1...{ City, '-t \.c;. 1..'2\ ST Zip STATE OF INDIANA ) 5S Cou nj:y of I Before me, the unde~liIlgned~.l!I Notary Public for . , I ' County, State of Indiana, personally , . , . ' .~ : . . and acknowledged the execution of the foreg~lrig appeared Instrument this . day of .20_" ". ,~ , Notary Public ". . ' ,"~'..I!\,:... \ ',) . ;' .:;lo,:'~: ;" .". :".' My Commlsalon E:lq:lf~, . . ~ ' . (Pr1nlJ .,;, "\;":- :'('"'. . , . ',. '~ S;PormJ"\O~ permU han<loul 2012 , "(;;':,.'- . :.,." ".",., Feb 08 07 03:55p Rob Love II (317) 571-2654 p.2 j()'~' ~'::/tl7 0,'): I 1:\'\ :1-;"1,.';\jl:"I:: IH)I~Sl':\' 1','\ \' I NC 011 (jll:1 / \ ('- /Yill .' ...... r- L.j;ff0,.. / J 1/ t?4Ji;2/'/' " Sign,atLire: Morris Hensley (or representative) " / -)~~ ~ C)-o 7 Date /O>S))..?i',~ he 1/ " , Signature: 8;]rry McNulty (or representativI>j Date CERTIFICATE OF AUTHORITY Under the penalties of perjury (Indian;] 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 othorwise mislead the Department of Community Services regarding the truth of the matters addressed therein. Further, I asserl 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 z 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 ~f, or as a result of, this request or the actions of the City of Carmel, regarding same. /I S-'2L-O"l S - 'L "L--O"l Date c... - VL. l - 'Z ~ "1 '\ o -(..,2:>8- q3L~ Applicants Phone # pplicant's Signatur ~C\Z.siC:>\ 6,e. AI,.l (Name printed) & Date Av'IL\I.. D-\L S;9~E:'~ "'"7 \ 02-5 \"'\-r1.e{J\ulo.Sl' - Applicant's Address IUO"l.S J::I..-\ City, "-Z \c 7.... "2 \ ST Zip STATE OF INDIANA ) S5 County of ) Before me, the undersigned, a Notary Public for County, State of Indiana, personally .' . .... i and acknowlodged the execution of the fore90io.9 . 20 -=c'cf:-;-~:~~'::";:c~"'=~'i~-fJ;':;;~~~i~~fJDtlif~f{:'.'};i:t,~~\if appeared instrument this;~f'.,';1tl~~1v~f ~;;''';'~:--2;~_:i0''c - -,.~-~'-" NOtary P\lbHc \,:",". ,.' ',"'," My Comml&5lon ~pir.,s: (prine) S:P~rmit:s\OcrnoliCon l)o;rmil 1,,)nO'lut 2of2