HomeMy WebLinkAbout1291.98 Application (2) r
AFFIDAVIT TO`INDUCE INTERIM!REMODELING RELEASE
AND/OR EARL'Y FOUNDATION RELEASE
CITY OF CARMEUCLAY TOWNSHIP
Date: /� �/3- °�� �
�a �/ �
Building Permit No.:
Entity (Business or � /'
individuap: ��%���C,r�Kh� �S� Co.� �Nc,
Applicant-Affiant: �T �c��
Project Name: �/Uf✓� �D✓is�-5
Address/Location: �3��y �. l'IC�iDiAf� 7i �.t�2e�kt �N
I, being duly sworn upon my oath,state the following:
1. I am executing this Affidavit for myself or as the authorized agent of the
above-referenced Entity to induce tlie City of CarmeUClay Township ("DOCS") to allow me or the
Entity to proceed with development pursuant to the Plans (defined below).
2. That this,Affidayit sliall bind me or said Entity and any further reference to "I" herein shall
be considered as a-refe�ence to rrie:o�such Entity.
3. I have filed with the Office of the State Building Commissioner ("SBC") of the Indiana
Department of Fireand Building Servicesfior its review and approval, plans and specifications (the
"Plans") for development of'the above-referenced project (the "ProjecY'), which I believe to be in
compliance with a11,State of'Indiana requirements including, but not limited to, the rules of the Fire
Prevenlion:and Building Safety Commission, the Uniform Building Code, the National Electric Code,
the'National Plumbing Code and the Model Energy Code, all as amended from time to time (the
"�ules"j:�-
= :' � �r,.. -
'' = I4:"� I havepresented to DOCS a copy oflthe Plans, and that any changes submitted to or
;equirel7 py;the SBCwill be submitted to DOCS in a`timelyfashion and that the Plans stamped with
ayfinal.approval�and accompanied by a Full Design,Refease will be submitted to DOCS prior to
schad�fing;th� final inspection and issuance of a Certificate of Occupancy (C/O).
5. I' further understand that application for an interim remodeling release and/or earty
foundation relea§e will only;allow me or the Entity, after payment of the full fee to DOCS, to proceed
at my/its own risk.
6. I understand that by proceeding on an interim basis, I accept responsibility for removing
and replacing any construction found by plan examination or by site inspection not to comply with
the Rules and/orthose rules and regulations of DOCS and/or ordinances of the City of CarmeUCtay
Township.
7. I further acknowledge that I am proceeding on an interim basis at my/the Entity's own
risk and that i assume and accept all liability for the project and will indemnify and hold the Ciry of
Carmel/Clay Township,:its officers, employees and agents, harmless from any and all liability to any
person or entiry (including the Entity), resulting#rom proceeding forward without a stamped set of
Plans and a Full Design Release from the SBC.
8. I further agree that I will pay the City of Carmel/Clay Township for any and all expenses,
including reasonable attorneys'fees, it might incur in taking enforcement action against the Project.
9. I further acknowledge that, in addition to the Rules, I must comply with ail other rules
and regulations of the Gity of Carmel/Clay Town§hip and the State of indiana as such relate to the
Project including, but not limited to, buiiding codes and zoning ordinances as amended from time to
time.
DATED: �� ��3� 9�
Signat e
�r�,an-f M�Y—��
Printed Name
STATE OF INDIANA )
)SS:
COUNTY OF HAMILTON )
Personally appeared before me, a Notary Public, in and for ������� County, State of
Indiana, acknowledged the ezecution of the foregoing Affidavit and indicated that the facts stated
therein are true. The Aifiant further represented that he/she has proper authority and resolutions
to execute this Affidavit on behalf of the entity 1
Witness my hand and Notarial Seal this l-a day of (X���-k , 19��
L� � y-!��� i-
/ N tary Public � � °•=^:
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/ ��'1at/ -.�UnIK_'����=
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Printed -� = -�;
: ^:''.`; _
My commission expires: �� � ���? �
c:96docnum.1002.ghs/pg2
dg/tj/ghs
March 1996