Fillable COMMERCIAL INTERIOR DEMOLITION PERMIT APPLICATION (City of South Bend)

Fill Online, Printable, Fillable, Blank COMMERCIAL INTERIOR DEMOLITION PERMIT APPLICATION (City of South Bend) Form

Use Fill to complete blank online CITY OF SOUTH BEND (IN) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

COMMERCIAL INTERIOR DEMOLITION PERMIT APPLICATION (City of South Bend)

On average this form takes 39 minutes to complete

The COMMERCIAL INTERIOR DEMOLITION PERMIT APPLICATION (City of South Bend) form is 5 pages long and contains:

  • 2 signatures
  • 14 check-boxes
  • 141 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of South Bend

BROWSE CITY OF SOUTH BEND (IN) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
COMMERCIAL INTERIOR DEMOLITION PERMIT APPLICATION
Applications and associated documents can be submitted in one of the following ways:
1.In person
2.By regular mail
3.PDFs through DropBox: https://www.dropbox.com/request/c3uZglvS8CO98b8xOmAw
* All digital submissions must be in pdf format
INTERIOR DEMOLITION APPLICATION CHECKLIST
☐
1. Application
☐
2. Basic plans and overview of the scope of the work
☐
3. If your project will include 100 lineal feet (or more) of demolition
OR
If there is any evidence of asbestos containing material that will be demolished, the attached
Notification of Demolition and Renovation Operations must be completed and provided to the
Building Department AND the Indiana Department of Environmental Management (see more
information on page 3, notification form on pages 4 & 5).
SUPPORTING LINKS
Building Department
https://www.southbendin.gov/government/department/building-department
Contractor Registration
https://www.southbendin.gov/government/content/contractor-licenses-0
APPLICANT INFORMATION
OWNER:
PHONE:
EMAIL:
ADDRESS:
Address
City
State
Zip
APPLICANT:
ORG/BUSINESS:
PHONE:
EMAIL:
ADDRESS:
Address
City
State
Zip
2
CONTRACTORS
All contractors must be licensed and registered with our department. For more information on this go to
http://www.southbendin.gov/government/content/contractor-licenses-0
BUILDING/DEMOLITION:
____________________________________________
I certify the above to be a true and accurate to the best of my knowledge.
APPLICANT SIGNATURE
DATE
PRINT NAME
PROJECT CONTACT
(IF DIFFERENT THAN APPLICANT)
EMAIL:
PROPERTY INFORMATION
ADDRESS:
Address
City
Zip
Township
ZONING:
SPECIAL USE/EXCEPTION
APPROVAL (IF APPLICABLE)
Zoning
Approval Date
click to sign
signature
click to edit
Indiana Demolition and Renovation Requirements
Pursuant to 326 IAC 14-10-1,prior to the commencement of a demolition or renovation activity, the
owner or operator of a facility shall use an Indiana licensed asbestos building inspector to thoroughly
inspect the affected facility, or any part of the facility where the demolition or renovation operation will
occur, for the presence of asbestos, including Category I and Category II non-friable asbestos-containing
material.
Prior to performing any renovation or demolition, the owner or operator is required to submit a
notification of demolition or renovation to IDEM-OAQ. Pursuant to 326 IAC 14-10-3, the owner or
operator of a facility where demolition or renovation activity will take place shall provide the Indiana
Department of Environmental Management Office of Air Quality with written notice of the intention to
demolish or renovate on a form provided by the department and update such notice as necessary. A
notification is required even if no asbestos is present.
• Information regarding asbestos inspections can be found at:
https://www.in.gov/idem/asbestos/2334.htm
• Information regarding notifications can be found at:
https://www.in.gov/idem/asbestos/2333.htm
• The notification with instructions as well are located under “Asbestos” at the following address:
https://www.in.gov/idem/5157.htm#oaq_compliance_asbestos
• The completed notification should be emailed to: AsbestosDemoReno@idem.In.gov
Please direct any questions to:
A
drianne Lenyo,
Office of Air Quality
Compliance Inspector
Northern Regional Office
574-245-4882 or by email at a lenyo@idem.IN.gov
Thank you for your attention to this matter.
I
)
NOTIFICATI
ON
OF
DEMOLITION AND RENOVATION OPERATIONS
State Form 44593 {R3 / 9-18)
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
I.
TY
PE
OF
NOT
IF
ICA
TI
ON
(check one):
I 0 Orioinal 0 Revised
0 Canceled
--
·~
II. FAC
ILI
TY
I
NFO
RM
AT
I
ON
-
·-
Owner I Operator:
Address: City:
Contact: Telephone:
Asbest
os
Removal Contractor:
Demolition Contractor:
Address:
Address:
Citv: Stat
e:
I ZIP: City:
Contact: Teleohone:
Contact:
E-mail: E-mail:
- -
- - - -
·-
..-
·-
IN License Number: Expiration:
~
- -
Licensed
Asbestos lnsoector: Proiect Desianer:
Address: Address:
Citv: State:
I ZIP: Citv:
Contact: Teleohone: Contact:
E-mail: E-mail:
IN License Number: Exoiration: IN License Number:
-
Il
l. TY
PE
OF
OPERAT
I
ON
-
-·-
0 Demolition
I 0 Renovation I 0 Ordered Demolition I 0 Emeroency Renovati
on
IV
.
IS
ASBEST
OS P RE
SENT?
0Yes
I
ONo
-
I 0 Courtesy
-
State: I ZIP:
E-mail:
State: I ZIP:
Teleohone:
..
-
t
Stat
e:
I ZIP:
Telephone:
Expiration:
-
I 0 Intentional Burnino
V.
PROCE
D
UR
ES I
ANA
L
YT
I
CAL
M
ETH
ODS
U
SED
TO
D
ETEC
T T
HE
P
RESENCE
AND
AMOUN
T
OF
ASBESTOS
MA
T
ERIALS
VI.
A
PPR
OX
IM
ATE A MO UNT OF
AS
BE
ST
OS
TO BE
RE
MOV
ED
A
ND
/OR
NO
T
TO
B E
REMOVED
Regulated ACM to be
- -
--
..
--
---
--
~ removed Nonfriable Asbestos Material to be removed Nonfriable Asbestos Material NOT to
be
removed
..
Cateoorv I Cateoorv II Cateoorv I Cateoorv
II
Pioes (Ln. Ft.J
Surface Area (Sa.
Ft.J
Total Volume (Cu.
Ft.J
Total amount on or off all facility
components where length or
area could not be measured
previously
VII
.
SC
HE
D
UL
ED
D
AT
E
OF
STR
I
PP
IN
G I
REMOVA
L
I Start (mmlddlyy):
I
End (mmlddlyy
):
·-1
·-
- -
--
-
-.
- -
VIII
.
SCH
E
DULED
DAT
ES
OF
RENOVATION
I
DEMO
LI
TI
ON
-
··-
-
..
-
Renovation Start (mmlddlyy): End (mmlddlwJ:
·-~
-
·-
-
-
·-
--
-
..
-
Demolition
Start (mmlddlyy):
End
(mmldd/yy):
·
~
_
..
.
'"
t
-
-- - - - - - -
IX.
FACI
LI
TY
D
ESCRI
PTI
ON
~
- -
~
•.
.-
~;
Buildino Name:
Street Address:
Citv: I State:
I County:
Location of removal within building
(includina floor
and
room numbers):
Buildino Size (Sa. Ft.): I Number
of
Floors: I Aoe I Year Buil
t:
Present Use:
I Prior Use:
Page 1
of
2
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

COMMERCIAL INTERIOR DEMOLITION PERMIT APPLICATION (City of South Bend)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 16 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document