HomeMy WebLinkAbout07060202 Receipts/Permits
CITY OF CARMEL / CLAY TOWNSHIP
IMPROVEMENT LOCATION PERMIT APPLICATION
For: DEMOLITION
Permit #: 07060202
Date: 07/03/2007
PARCEL ID #: 1709220000004001
LOT & SUBDIVISION:
ADDRESS OF CONSTRUCTION: 986 141ST ST W CARMEL, IN 46032
Township?: 18 Zoning: Flood Zone: Lot Split:
PROPERTY OWNER fNFORMA TION:
Name: JAMES KENT GRUBAUGH
Ph. #: 3175463366 Fax #: 3175466680
Street Address: 986 W. 141ST S1. CARMEL, IN 46032
CONTRACTOR INFORMATION:
Name: CASEY-BERTRAM CONSTRUCTION INC
Ph. #: (317) 546-3366 Fax #: (317) 546-6680
Street Address: 5780 E 25TH ST INDIANAPOLIS, IN 46218
Email: SCASEY5635@AOLCOM
PERMIT TYPE: MDEMO
DEMOLITION
Water Service by: WELL
Sewer Service by: SEPTIC
Estimated Cost of Work: $0
Underground Tank(s):
Special Notes/Conditions:
986 W 141ST ST. DEMOLITION PERMIT
. NO NOTES.
County Well Permit #:
County Septic Permit #:
This permit is valid only if construction commences within one (1) year of the date of issuance of the Stare Commercial Design Release.
All construction must be completed (C/O issued) within two (2) years of the issuance date.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the u,se of
bnd or structures requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning
Ordinance of Carmel Indiana - 1993" (Z~ 289) and amendments, adopted under authority of I.c. 36~7 et seq, General Assembly of the State cif
Indiana, and all Acts amendatory thereto. I further certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I :
fureher certify that the construction will not be used or occupied until a Certificate 01 Occup,7.ncy has been issued by the Department of
Community Services, Carmel, Indiana.
APPLICANT NAME: SCOTT
FEES:
DEMO MAIN STRUCTURE
RES SITE 57.50
CASEY
138.50
Item
1 of
1
I
CITY OF CARMEL j
PERMIT RECEIPT
OPERATOR: vdolan
copy # 1
See: Twp:18 Rng:03 Sub: Blk:22 Lot:
PARCEL ID ..... ...: 1709220000004001
DATE ISSUED.......: 07/03/2007
RECEIPT #.........: 25612
REFERENCE ID # .... 07060202
SITE ADDRESS ...... 986 141ST ST W
SUBDIVISION ......:
CITY .............: CARMEL
IMPACT AREA ......:
OWNER ............: JAMES KENT GRUBAUGH
ADDRESS..........: 986 W. 141ST ST.
CITY/STATE/ZIP ...: CARMEL, IN 46032
RECEIVED FROM ....:
CONTRACTOR .......:
COMPANY.. ... .....:
ADDRESS ..........:
CITY/STATE/ZIP ...:
TELEPHONE........ .
CASEY BERTRAM CONS
LIC # CASEBER
CASEY-BERTRAM CONSTRUCTION INC
5780 E 25TH ST
INDIANAPOLIS, IN 46218
(317) 546-3366
FEE ID UNIT QUANTITY
AMOUNT PD-TO-DT THIS REC NEVi BAL
---------- ---------- ---------- ----------
138.50 0.00 138.50 0.00
57.50 0.00 57.50 0.00
---------- ---------- ---------- ----------
196.00 0.00 196.00 0.00
DEMOMAIN FLAT RATE 1.00
IRESSITE FLAT RATE 1.00
TOTAL PERMIT :
METHOD OF PAYMENT
AMOUNT
NUMBER
CHECK
TOTAL RECEIPT :
196.00
11897
------------
------------
196.00
5/18/2007 3:36 PM FROM: Fall Hamilton County TO: 99, 13175466680, 60902 PAGE: 002 OF 003
~~~..~~ .
. ,""!"~ Demolition Permit Requirements
City of Carmel' Clay Township
~. .,~ . ~,..._-~,.-
.._.J_~ One CI"c Square; Carmel. IN 46032 Ph. (317) 571-2444 Fex (317) 571-2499
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
the parcel on which the demolition Is to occur, and this form signed by the. appropriate
departments.' (.Application Is B three-part form available from the Building & Code
Enforcement Office)
NOTE:
A separate permit application must ~ completed per parcel.
Certain inspections are required relating to private wells, septic systems, and fuel
tanks, prtor to demolition. . . .
. Should approvals be required from other State or local government entitles, or
. utilities (other than those addressed herein), it is the sole responsibility of the
contractOT of record to obtein such approvals. . ,
. c)w,.,(4.. IS ~l;4'^"r
..I.- Exlstino well: Well must be plugged according to Well Ordinance A-62. -..Eo<.- "~lt IOv'-....
ExlstlnQ seDt/c: 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 and/or property.
1'lIsr Sn.tfr C~I._j,J 17-()<i-u.-QO~()O-OO'(.QtJl
. TaxM8pPatce/#
.
.
.
Fuel Tanks:
.,86 W,
Address ofdomolltlon
OWnor(s) Name and Addraaa
AddltloniJl Structure(s) on site: Yes .;({;;;) (If yes, please list the number and type(s) of
structure on the lines provIded. If one of l~ctures has a separate street address than the
primary structure on the parcel.."lease .also include that Information.)
--".,-_...._,_.__.__._-_._._._._~---~--~'~~-_.~..--~.-~,--_.,.'_.,,"---~..~--,~_.,-"--,-----'_._~---,._.--_..-.-.-........------
The City of Carmel andlor 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
IInd obtain the slQnatures of the Individuals l/stud below. (This can be done by FAX to their
offices, at the numbers listed below) . Include this completed form with all aDDroDriate
slanatures (ON THE REVERSE OF THIS PAGE) when you submit your application package_
.1. Moms 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) 776-8600, FAX (317) 77~8506. .
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5/18/2007 ):36 PM FROM: Fall Hamilton County TO: 99, 13175466680, 60902 PAGE: 003 OF 003
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Date
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CERTIFICATE OF AUTHORITY.
Under the penalties of perjury (Indiana Coda 35-44-2-1). I hereby afllnn, under oath, that all of the
InformatIon I have provided In this application for demolition permit Is true and accurate, to the
b8&t of my knowledge and belief, and tnat I have not knowingly or Intentionally provided or
omitted any Information that would tend to hide, obscure, .or otherwise mislead ths Department
of Community ServiCes regarding the truth of the matters addressed therein-
Further. I assert that' am the property owner. or the authorized and lawfully appointed agent of
the owner(s). that I have express authority and pennlssion from the owner(s) (and anyone wIth a
recorded Interest or other Interest In the proparty), to take this requested action, and that I agree
to indemnify and hold hannless the City of Cannel from any claim, lawault, demand, or damages
whatsoever arising out of, or as a res"lt of. thIs request or the actions of the City of Cannel,
regarding same.
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Applicant's Signature & Date Date
yc.rr CUff
(Name printed)
,311- >'1~ - .,~, ,
Appllcantll Phone #
["780 E- &S7tf $r,
Applicant's Address
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City,
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.~___."_._,_~_~~__~____.__._._~.___.___,__~__."_____._._'._____.________,_~_~~___n__._____
STATE OF INDlANA )
. - S8
county of \ VV.d i Of'\- I
Befor.. m.., th.. und..rslgn..d. a Notary Public for ~ I \ -\on County, Stale of Indiana. personally
(\ ~ '
appeared Sr n-K 'JY. '-{ and acknowledged the ..xecutlon of the foregoing
Inst ment this :J..o. aL day of It\/y, y(' ,\ . 20 Ol.
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