HomeMy WebLinkAbout07090090 Signed DemoDemolition Permit Requirements
City of Carmel. / Clay Township
Building & Code Services; City of Carmel
One Civic Square; Carmel, IN 46032 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 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.
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..
Fuel Tanks: Fuel tanks must be pumped and removed from building and/or property.
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Address of demolition Tax Map Parcel #
Name and Address
t?^
(If yes; please list the number and type(s) of
o
Additional Structure(s) on site: Yes / CN
structure on the lines provided. If one of tructures has a separate street address than the
primary structure on the parcel-please also include that information.)
ISO
403a
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 done 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: Carmel Utilities.
Phone (317) 733-2855. FAX (317) 733-2053.
2. Barry McNulty: Hamilton County Health Dept;
Phone (317) 776-8500. FAX (317) 776-8506.
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Signature: John Mascarl (or representative) Date
CERTIFICATE OF AUTHORITY
Signature: Barry McNulty (or representative) Date
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 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 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.
Applicant's Signature Sr Date
(Name printed)
Applicant's Address
Applicants Phone #
ST Zip
STATE OF INDIANA }
SS
County of )
Before me, the undersigned, a Notary Public for
appeared
instrument this
County, State of Indiana, personally
and acknowledged the execution ofthe foregoing
day of 120
Notary Public
Date
My Commission Expires;
5:°emitslFonnslDemolition aert it nandout 2 of 2
09/11/2007 10:45 FAN 3177768506 HAM CO HEALTH DEPT ? 002/003
Sep 11 07 08:48a Courtney Schlaegel 3175714143 p.3
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Signature: Jo Mascarl (or representative) Date
Q? r? L6(= ? Q l ) 110
Signature: McNu y (or representative) Date l1witru CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Code 35-44-2-1), 1 hereby affirm, under oath, that an 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 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 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.
Applicant's Signatur & Date
SAy0CF
(Name printed)
a
Address
ST
STATE OF INDIANA
County of G?' )
Before me, the undersl ned, a Notary Public for1G1?? County, State of Indiana, personally
appeared 1 0 If and acknowledged the execution of the foregoing
Instrumertt this -day of 20
Notary Pudic /
V-4 r^ C
(Print)
9-ar-a-7
Date
571-yiyy
Applicants Phone#
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My Commkwlon Eaplrea:
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