HomeMy WebLinkAbout07090061 Signed DemoDemolition Permit Requirements
City of Carmel ! Clay Township
Building 8 Code Services; City of Carmel
One Civic Square; Carmel, IN 46x32 Ph. (317) 571-2444 Fax (317) 571-2499
TO BE SUBMITTED WITH APPLICATION*: Two copies of a site location map--clearly
identifying the structure or structures to be demolished, (on paper no larger than j11
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 entitiesl, or
utilities (other than those addressed herein), it is the sole responsibility of the
contractor of record to obtain such approvals.
Existing well. Well must be plugged according to Well Ordinance A-62.
Existing 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.
k Fuel Tanks: Fuel tanks must be pumped and removed from building andlor property.
(2.650 CLAY CE„rTErt 42-040 17- eq- 27-00 -oc- 032, 000
Address of demolition Tax Map Parcel #
13Rowroe4 C0fF5TrLvc-rtoA tn(,
Owner(s) Name and 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 parcel-please also include that information.)
- BAAJ 1, 1 s2rb
- 9 Aa,,,l 1. 7-00
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 signatures of the individuals listed below. (This can be -lone by FAX to their
offices, at the numbers listed below) include this completed form with all appropriate
signatures (ON THE REVERSE OF THIS PAGE) when you submit your application package.
1. John Mascari: Cannel Utilities.
Phone (317) 733-2855. FAX (317) 733-2053.
2. Barry McNulty: Hamilton County Health Dept;
Phone (317) 776-8500. FAX (317) 776-8506.
&Permits,'Form5lDerridi6on permit handout 1 of 2
Signature: John Mascari (or representative) Date
Signature: Barry McNulty (or representative) Date
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Code 35-44-2-1), 1 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 misiead 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 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 of, or as a result of, this request-or the actions of the City of Carmel,
regarding same.
8-3t-a7
_OLOZ? App nt's Signatuf4 & Date
Scott CAs(-y
8-31-o-)
Date
31?- 5Yb- 3366
(Name printed) Applicants Phone #
ra,? # SVb- 6bs0
5780 F, tar?y Srs4er 4NAPOLIS !NI I cz 15
Applicant's Address City, ST Zip
STATE OF INDIANA
Countyof M6XiDh 5S
]
Before me the undersigned, a Notary Public for Tr.(M"1[WV-- County, State of Indiana, personally
appeared S Ld w and acknowledged the execution of the foregoing
instr ment this day of 26 r
64, My Commission Expires:
err-I
$:Permits/FonnslDemcUon permit handout 2 of 2
Feb 08 07 03:55p Rob Lovell
S nature: John !?:scarl lw representatrveJ
Date
Signature: Barry McNulty (orrepresei,mtive) Data
CERTIFICATE OF AUTHORfry
Under the penalties of perjury (Indiana Code 35-44-2-1), 1 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 irttontianalty provided or
omitted any information that would band to hide, obscure, or otherwise !mislead the Department
of Community Services regarding this truth of the matters addressed therein-
Further, I assert that 1 am the property owner, or the auetorized and lawfully appointed agent of
the owner(s), that 1 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, that [,agree
to indemnify and hold harmless the City of Carmel from any claim, lawsuit, demand, or damages
whatsoever arising out of, or as a result of, this request or the actions of the City of Carmel,
regarding same. _
8-31-07 App nrs Signat & Date Vats
.}ever ('Arvf
(Name printed)
5780 C, 24TY STS6{Y
city,
STATE OF INDIANA )
SS
County of P rill 1
3r-7- 5v46- 3344P !•
Applicants Phone #
VA%,A SY6- b680
As 14 `r( Z46
ST Zip
Befom me, the undersigned, a Notary Public for :JtAU J:M?, -County, Slate of Indiana, personally
appeared ? and acknomtledgod the exemdon of the forQ"i3
31nn*jntth15-511-0- day of 24 Ul .
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1" I
2d WCJC-:eJ I" aT. 'dam
13171 571-2654 p.1
endow- U': 'Ow X51
2dx
msiiinalsNoc wd8ld3a-h9siti3: wa?A
OS/11/2007 1448 FAX 3177766506 HAM CO HEALTH DEPT
t¢ 003/003
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Signature: John Masoart (or rep. ntattve) Date
Slenaturs: Bhrry W c ulty (or represent tIve) Date
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Code 35-44.2-1), 1 hereby afllirm, under oath, that all of the
information 1 have provided in this application for demolition permit Is true and accurate, to the
best of my knowledge and belief, and that 1 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 1 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 of, or as a result of, this request or the actions of the City of Carmel,
regarding s_sme. ,
?0? 69/_07 8-31-01
App is Slgnat & Data Date
Scsrr l4t&y
(Blame printed)
57Ba E, as-rq
317- SY6-;36b
Applicants Phone #
FA% * S046- 6680
1i,( Yb21 a
zip
STATE OF INDIANA )
SS
County of rW i 0h _ _) , , -
Before me, the underelpad, a Notary Public for it AUAHnS County, State of Indiana, personally
appeared 4 , j`?;( and acknowledged the execution of the foregoing
5a in t this day of 200-.
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