HomeMy WebLinkAbout07050234 Signed Demo
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Demolition Permit Requirements
'City of Ca-rmeJ 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 numberrfor
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) I
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NOTE:
· A separate permit application must be completed per parcel. I
· Certain inspections are required relating to private wells, septic systems, and fuel
tanks; prior to demolition. . i
· 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 0
. _ contractor of record to obtain such approvals. .
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Existina welf: ..:.<Well must be plugged according to Well Ordinance A-62. . '., . .j,
Existina septic: 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 and/or propeJrty.
\O~~S' "SP~\I..\I.:.MI\,L R.f:) n \3>\ 1fi)'t)0003~EX)D
Address of demolition Tax Map Parcel # I
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Owner(s) Name and Address' Q' i
Additional Structure(s) on site: Yes ~ (If yes, please list the number and type(s) of
structure on the lines provided. If one of t cures 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 sianatures of the individuals listed below. (This can be done by FAX to their
offices, at the numbers listed below) Include this completed form with aU appropriate .
sianatures (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.
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2.
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S:Permits\Oemolition permit handout
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Signature:
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Morris Hensley (or representative) . Date
Signature:
Se~ A-ilA-tl~c0
Barry McNulty (or representative) Date
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Code 35-44-2-1), I hereby affirm, under oath, t~at all Jf 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 Departmknt
of Community Services regarding the truth of the matters addressed therein.
I
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 f, or as a result of, this request or the actions of the City of Carmel,
regarding same.
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Applicants Phone #
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STATE OF INDIANA )
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and acknowledged the execution of the foregoing
Before me, the undersigned, a Notary Public for
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apPI!ahiClC .1S~-:r....,..) ~i=:FJ<>
instrument this . '3\ . . day of Iv\ r.. '(
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Notary Public
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Feb 08 07 03:55p Rob Lovell
(317) 571-2654
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Sign ure: Morris Hen::;ley (or r..presentative)
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Signature: Barry McNulty (or representativ"l
Date
CERTIFICATE OF AUTHORITY
Under the penalties of PNjUry (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
best of my knowledge and belief, and that I have not knowingly or intentionally provided or I
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 assert that I am the property ownar, 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] 2
recorded interest or other interest in the property), to take this requested aetion, and that I agree
to indemnity 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.
pplicant's Signatur
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(Name printed)
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Applicants Phone #
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Applicant's Address
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STATE OF INDIANA )
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County of )
Before me, the undersigned, a Notary Public for
appeared
County, State of Indiana, p"rsonall~
and acknowlodged th'e execution of the foregoing
instrument this
day of
,20_"
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Notary PublJc
My Commission ExpirM:
(Print)
S:P~rmits\Ocmolitlon I).:rmil tli~lntiUlJt
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OS/23/2007 07:58 FAX 3177788508
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DORSEY PAVING
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Signature: Morris Hensley (or repre911ntatlvll)
Date
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Under the penalties of perjury (Indiana Code 35-44-2-1), J hereby affirm, under oath, that all ot 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 provided or i
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 AUTHORJTY
Further, I assert that r 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 dam~ges
whatsoever ariSing out f, or as a result of, this request or the actions of the City of Carmel,
regardIng same.
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Applicants Phone #
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Applicant's Address
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STATE OF INDIANA )
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County of I
Before me, the und~rslgned, a Notary Public for
app",m;d
County, State of Indiana, perso.~.i!ly
and acknowledged the eXecution of the foregoing
Instrument this
. day of
.20
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Notary Pt;bllo
My C<.>mml.-Jon bplru:
(Prln,)
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S;PQttnil:\De~ifton permit handout
2012