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Home My WebLink About05090141-Signed demo Demolition Permit Requirements City of Carmel / Clay Township Buildin§ & Code Enforcement; 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 cture or structures to be demolish.ed, the T.ax Map parcel numbe.r for and this form signed by the appropriate !he Building & Code 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), iris the sole resoonsibility of the contractor of record to obtain such approvals. Fuel Tanks Well must be plugged according to Well Ordinance A-62. Septic s.ystem must be p..umped and filled with sa.n.d, or removed. If septic system is to be mused, it m~st be plugged off until ready for re-use. Fuel tanks must be pumped and removed from building and/or property. Tax Map Parcel # structure on the I st the number and type(s) of ~rate street address than the n the parcel--please also include that information.) Dept. must perform an inspection prior to to sign this form ~ their ~ of Carmel; Phone (3f7) 776.8500. FAX (3f7) 776.8506. lof2 I?:09 ~17~1508~ ILD~ = SO~O~ ~A~ 02/B~ Demolition Permit Requirements City of Carmel / Clay Township BUilding & C~e EnforCement; City of Carmel One Civl~ Square; C, arme~, IN 48082 Ph. (317) $7%2444 Fax (317) 571-2499 ~[~l.~.~JJ.~[.~*.' Two copies of a site location map--clearly identifying the structure or structures to be demolished, the Tax Map parcel number for the parcel on whl¢;h the demolition is to occur, and this form signed by the appropriate departments. (*Application is a three.part form available from the Building & Code Enforcement NOTE: A sep~rate permit application must be completed per parcel. * Certain inspections are required relating to prfvate wells, septic systems, and fuel tanks, prior to demolition. ShouIcr approvals be required from other State or local government entitles, or utilities (other than those addressed herein), it is the sole responsibility of the contractor of record to obtain such approvals. ~ Well must be plugged accord;rig to Well Ordinance A'62. ~O ~ ~¢/t ~ !lepttc system must be pumped and filled with sand, or removed. If septic ~ystom ~s to be reused, it must be plugged off untrl ready for re-use./~ ~ Fuel tanks must be pumped and ~oved_ f,~m~ b~uild~ing an~?r p~°perty, Ad~litienal $.tru?ur~s) en sife~ / No (If yes, please list the number and e a of structure on the lines provided. If one of the structures has a separate street address thant~Pteh~) pnmary structure on tl~e parcal--please also include that informa~n.) The Ct~ of Carmel an~or Hamilton CoUnty Health Dept. mu~ perform an inspect~n pr/or to demolition. In order to approve the demolition perm/f, ~he applicant is required to ~ign this form and~ s of e ' dlvidu s lis elow (This eon be done by FAX to their offices, at the numb;~s listed below) Include this cOmpleted form a~gp.p_j~ (ON THE ~EVERSE OF THIS PA GE) when you submit your application package. ~. Monks Hensle); Supervisor: Water Treatment Operations, City of Carmel; Phone(317) 071-2~T3. FAX (3fT) 57~,2~65. 2. Ban,y MeNulty: Hamilton County Health Dep[; Phone (317) 77~8500. FAX (317) 776-8506. Date 83/83 03/0B $;gnature: Barry McNulty (or representative) Date CERTIFICATE OF AUTHORITY Under the penalties .~ perjury (Indiana Code 35-44-2.1), I hereby affirm, under oath, that all of the information I have provided in thls application for demolition permit la true and accurate, to the best of my knowled;~e and belief, and that I have not knowingly or intentionally provided or omitted any informa~lon that would tend to hide, obscure, or otherwise mislead the Department of Community Services regarding the truth of the mattem addressed there;ri, (Name 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 end permission from the owner(s) (and anyone with a recorded in, rest or =~her interest in the property), to take this requested action, and that I agree to indemnify and hol~ harmless the City of Carmel from any olalm, lawsuit, demand, or damages whatseever arising cut of, or as a result of, this request or the actions of the City of Carmel, Date Applicant's Address 'b~ATE OF INDIANA County of ~__) Applicants Phone # Before me, the undersl~ ned, a Notary Public for._.~_~County, State of Indiana, pemonally appeared ~._._..~.~~____~ and ackllowledged the execution of the foregoing " Demolition Permit Requirements ,, City of Carmel I Clay Township ,.- ~u!d{n~ & Code Enforcement; Ci~, o: Carmel One Civic Square; ~'- ~ ' ' ~.~rme,, ~N /-6032 Ph, (317) 57%2444 Fax (317) 57%2499 TO BE SUB~I~EB WlT~ APPLIOATfON*; Two copies of a site [o~tioo map--clearly d~nb~]mg ~e structure or structures to be de~ol~sbed, the Tax Map parcel number for the parcel o~ whic~ the d~molOtlo~ is to occur, a~d this ¢or~ signed by t~e appropriate depa~ments, (~Application is a thre~pa~ fonn available from the Building & Code Enforcement Office,) NOTE: A separate permit application must be completed per parcel, * Ce~ain inspections are required relating to private wells, septic systems, and fuel tanks, prior to demolition, Should approvals be required from other State or local govemmen~ entities, or uStities (other than those addressed herein), it is the sole responsibility of the contractor of record to obtain such approvals. ~ Well must be plugg~ according to Well Ordinance A-62. ~tic: Sepdc system musJ ~ pumped and filled with sand, or remove, if septic system is to be reused, it must be ptugged 0ff until ready for m-use, Fuel Tanks~ Fuel tanks must be pumped and removed from bu~ding a~dlor prope~. Address of demolHion ~ax M~p ~e~e! ~ Ow~er(~) Name and Ad Addiffonal Sfructureds) on site~ / No ~" s&"ucture on the li~es 5roOded ~¢.~_ ~... _ U~, yes, ptease ~ist me number and t~e(s) of . .. , ..... ,,~ u. u,u ~[ru~ures nas a separate s~ee[ address than the primal' structure on ~he paroet~fease also include that information.) The City of C;~rme! and/or Ha ' ~ ' moll. on Counh./ Health Dept, must perferm an i,~specflon pr/or demo/lEon. In omar to approve the demo/it/on perm/t, the and obta~d~als listed bel;Pwfticant ls required to sign this COrm (This can be done bY F~ to o¢ices, a¢ ~e numbe~ listed beloW) Include ~is completed form ~a~ ~t~ ¢ON THE REVER~E OP THIS PAGE) when you submit your eppllca~on package. ~. ~rr/s Hensle~ Supe~isor: Water T~atment Ope~tions' Ci~ Df Ca.et; Phone (3~7) 571-~673. F~ (3~7) 57¢.2265. ~ar~/ McNuI~; Hamilton Coun~¢ Heal&~ ~pt.; Phone (3~7) 77E-85~, F~ (317) I cf2 ~ Hensley {or represen~tive) resent~t)ve) Date CERTIFICATE OF AUTHORITY Under the penalties of perjury (Indiana Code 3§-44-2-I), ) hereby affirm, under oath, that all of the information ) have provided in this application for demol[t[on permit is true end accurate, to the best of my knowledge and belief, and that ) have not knowingly or intentionally provided or omi~ed any info.etlon that would tend to hide, obscure, or othe~ise misiead the ~pa~ment of Communi~ So.ices regarding the tCath of the me.ere add~sse~ therein. FuAher, I assed that I am the prope~ owner, or the a~hoffzed and ta~¢ul~y appoint~ agent of the owner(s), that [ have express authori~ and permissio~ from the owner(s) (and anyone with a recorded ~ntems~ or other interest in the prope~), ~o take this requested action, and ~at I agree to indemni~ and hold hapless the Ci~ of Carmel from any claim, ~awsult, demand, or damages whosoever adslng out of, or as a result of, this request or the a~ions of the Ci~ ~ Carmel, Date Appllcant~ Phone Applicant's Address Ci~y, ST :STATE OF iNDiANA ) SS Before me, ~e undersigned, a Not~ Public appoared ~~ County, State of indiana, person=Jiy and acknowledged the execution of the foregoing