HomeMy WebLinkAbout07100065 Signed DemoDemolition Permit Requirements
City of Carmel ! Clay Township
Building 8 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 111
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.
0 6r1. 116'" Sr. 47-09 -3/ -OD -0o.-076, /a/
rA-jddress of derm?olition Tax Map Parcel #
Ya-4r nftvm Yr oPc? r+?S 977 ?65fPo? vse ?e. ?u, r? ??0 /vnaa day S ?ni ?/?ZS
Ownerrs) 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.)
`l &P_nJ5r Asplia r DRlyc
The City of Cannel 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.
i. John Mascari: Carmel Utilities.. -
Phone (317) 733-2855. FAX.(.-1.7) 733-2053.
2. Barry McNulty: Hamilton County Health Dept.;
Phone (317) 776-8500. FAX (397) 776-8506.
S:Perrnlts/rowsMnm0ht1w permit handout 1 of 2
Signature: John Mascarl (or representative)
Signature. Barry McNulty (or representative)
Date
Date
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Code 35.44-2-3), 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,
regardinq same.
9s
Signature & Date
(Name printed)
Date
2/7-366 -29-71
Applicants Phone #
9757 06-5rh1hir IN ?00 /1,uar.4+UaPo?is l1-' ?162?-6
Applicant's Address City, 5T Zip
STATE OF INDIANA )
SS
County of avnt l
Before me, the undersigned, a Notary Public for a County, State of Indiana, personally
appeared aeon Yoga Vh 2n r1 and acknowledged the execution of the foregoing
instrument this L day of O Cfo?w - 20 .
J
Notary PU61'
1 A W,,, i A,
(Print)
My Commission Expires:
S:Pennits/ForrrWDemolition permit handout 2 of 2
Cot 12 07 07:42a Rob Lovell [3171 571-2654 p.2
OCT-11-2007 THU 1223 I'M CITY OF CRRI1EL BCS FAX NO. 3175712499 F. 03
r??1? ?c?tt1P74,'il`,
/7-?7
v./?/
Signature: John Mascari (or representatW%) Date
Signature: Barry McNulty (orrepresentatrve) Data
CERTIFICATE OF AUTHORITY
Underthe penalties of perjury (Indiana Code 35-44-2.1),1 horoby afftrm, 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 t 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,
regardi g same.
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411 -
licant' Signaturo & Date Date
Sitrr'j 317-3(, G -3971
(Name printed) Applicants Phone #
9'7S--) GIES> YaiNr /},? -P&,rf 607 11051AAm ro+ is IN y62r6
Applicant's Address City, ST Zip
STATE OF INDIANA )
SS
County of mn
Before me, the undersigned, a Notary Public for y County, State of Indiana, personally
appeared .Try .T roger m an ra and acknowledged the execution of the foregoing
I
instrument this day of 20
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mycommisnwn Bo"M
S:Pa WF*Wnwowemwn psm* fwddit 20(2
10/11/2007 13:05 FAH 3177768506 HAM CO HEALTH DEPT ¢J002/002
OCT-11-2007 THU 12:28 PM CITY OF OARMEL RS FAX NO. 3175712499 P. 03/04
Signature: John Mascari (or representative) Date
?"a-? 14 11 + o
Signature: ry :Nultyforrwasent tlvo) ` Date T-r
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Code 3544-2-1),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 authorised and lawfully appointed agentof
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.
/Lturs?? 10-el-07
0011carift Signature & Data Date
STATE OF INDIANA
ss
County of ?1 d-Mi (4cn 1
Before me, the undersigned, a Notary Public for County, State of Indiana, personaily
appeared awidi _,1Ey00'r W a„ n and acknowledged the execution of the foregoing
Insttvment this ? day of n c ho k • 20 Lz-
awry Po61 Comm on =MW
$;PemiWFwm%Verno1n M o m* hwidad 2 of 2
!54arh U . gR"SZnw.>.% --,31-7-36& -39 7 /
(Name printed) Applicants Phone #