HomeMy WebLinkAbout07120018 Signed Demo
Demolition Permit Requirements
City of Carmel 1 Clay Township
Building & Code Services; City of Carmel
One Civic Square; Carmel, IN 48032 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.
13.6? V. Mcw, 54., Qg, ?, 1709 260401 C)Or7. aoo
Address of demolition Tax Map Parcel #
C:4?o-?' Cgrme-t
Own rtsl Name and Address
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 Moscari: Carmel utilities. 4 ? 16-6(04)..
Phone (317) 733-2855. FAX (317) 733-2053::
2. Barry McNulty. Hamilton County Health Dept.;
Phone (317) 776-8500. FAX (317) 776-8506.
S:PamiwFormslDemohon pertnif handout t of 2
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.)
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), l 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.
Date
(3i7)
Applicants Phone #
Applicant's
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City, T ST
STATE OF INDIANA )
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Countyof tY)d.4titn 1
Before me, the undersigned, a Notary Public for (3m7 1 f1 County, State of Indiana, personally
appeared fihurnoS FwT. De,jl/gn and acknowledged the execution of the foregoing
instrument this 304,% day of WOQC,. , 200-7.
Notary Public
1 6v?Yi hi1A / t . 14o l ,
My 05mmission Expires:
(Print)
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NOV-30-2007 FRI 0253 PM GR.ADEY, FAX NO. 3175733971 P, 03/73
Sjyn?htin; John scantorrepresenlatve) Date
Signature; (tarry IV1cNuity for rcprosontativa) Date
CERTIFICATE OF AUTHORITY
Under the penalties of perjury (Indiana Code 3544-24), 1 hereby affirm, under oath, that all of the
infornudion I have provided in this application for demolition permit is true and accurate, to the
!Jest of tiny knowledgo and belief, and that 1 have not knowingly or intentionally provided or
ornltted any information that would tend to hide, obscure, or otherwise mislead the Department
of Community Services regarding the truth of the matters addressed thereln.
Further,; a ssart that I am the proporty owner, or the authorized and lawfully appointed agent of
the owner(s), that I havo express authority and permission from the owner(s) (and anyone with a
rnordod intnrGRt or other interest in the property), to take this requested action, and that I agree
to Inderoniry and hold harmless the City of Cormal from any claim, lawsuit, demand, or damages
whatsociv:r arising out of, or as a result of, this request or the actions of the City of Carmel,
ragardilly S-Iir11C. _?
lure & Date
Sl'e1rF Of INDIANA I
SS
County of IY neul 1 I
Date
l3efero nso, tlt(I undcrslgned, a Notary Public for --3na-, county, state of Indiana, personally
apflcued and acknowledged the execution of the foregoing
instrunleutthls.,;js1.}4, clay of 20
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Applicants Phone #
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NOV-30-2007 FP.I 0252 PH GRAEEX FAH NO. 3175733979 P. 03
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Signature, John ?µ,cari (or roprocentalivo)
Date
SSicgnatl.tret ryMcNtdty(orrepresenwtwe)
CERTIFICATE OF AUTHORITY 5.44-2.1),t hereby U for nation I I'iAvle provided in(Indiana
at alto thee
this l application fordemolit on perm is true under and oath
best of my knowledge and belief, and that 1 have not knowingly or intentionally provided or ide omitted any Info rmatlon that would tend truth of to III the matterrs addressed therein.ad the Department
of Community Services regarding the
Further, I assett th it I am the property owner, or the authorized and lawfully appointed agent of
the owflol•(s), that I have express authority and permission from the owner(s) (and anyone with a
recorded interest or othar interest in tho property), to take this requested action, and that I agree hold
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any
Carmel
of, his r quest or t e atctions of the City of Carmel,ages
, or whatsoever irflind
ing outtof, olr as tire
regarding same.
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siJnaturo e: Date
Applicant's Add(o-S
STATE OF INDIA.f•1A )
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(317 ,'?3-397D
Applicants Phone #
City,
County of IYlOn?ir.)y1?
r ,Jr1 County, state of Indiana, personally
r1Efora me, the undorsignad, a NotarY FiNIC for D
( and acknowledged the execution of the foregoing
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