HomeMy WebLinkAbout07100084 Signed Demo
Demolition Permit Requirements
City of Carmel I 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.
Existinq 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 #
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Owner(s) Name and Address
Additional Structure(s) on site: Yes /(-?-?o) (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.)
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.
S:Pe nitslFormslDemolition permit handout 1 of 2
Sig ture: John Mascari (or representative)
Barry McNulty (or representative)
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 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.
nt's SignaUirh & Date
(Name printed)
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Date
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Dat
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Date
Applicants Phone #
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Applicant's Address'' City, ST Zip
STATE OF INDIANA )
County of n(UnW+)1 SS
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Before me, the pundersiggned, a Notary Public for PdAk :?lY' 1 County, State of Indiana, personally
appeared U1,Y1 luT L oaw and acknowledged the execution of the foregoing
instrument this I day of bG-66 _,20 61
Notary Publ c .
Koxusgj?Av bobi n
(Print)
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My Commission Ex0fres:
S:Perrrits/Fonns/Demoli ion perrnit handout 2 of 2