Demolition Permit Application

OFFICE USE ONLY

Date Application Received:

Permit Number: Fee:

Payment Info:

Requirements

• Rodent Free Certification from Nassau County
• Water disconnect letter from Long Island American Water Corporation.
• Sewer disconnect letter from Nassau County
• Electric and gas disconnect letter from LIPA or Keyspan
• Asbestos letter from a licensed asbestos removal company (must be NYS certified)
• Contractor shall supply Workers Comp, Liability Insurance, and License
• Must provide dust control measures
• Call 811 2-3 days before work begins

Information contained herein may be investigated and verified. Any false statement will be cause for refusal and revocation of this permit. It is further understood that applicant will conform and adhere to all laws applicable, and such rules and regulations as may be promulgated by the Incorporated Village of East Rockaway regulating and relating to the use to which this permit is applicable.

HOMEOWNER NAME: TEL#/EMAIL:

HOMEOWNER ADDRESS:

ZONE: VILLAGE SECTION: VILLAGE BLOCK: VILLAGE LOT(S):

CONTRACTOR'S NAME: TEL#/EMAIL:

CONTRACTOR'S ADDRESS:

ESTIMATED START DATE: ESTIMATED END DATE:

, states that he/she is authorized to make this application and that all statements are true to the best of his/her knowledge and belief. The contractor shall have full responsibility in protecting adjacent and village property. I hereby agree to strictly follow all rules and regulations set by New York State Uniform Fire Prevention and Building Code Part 608 sections 1, 2 and 3. (If corporation, give name of corporation and name, office, and address of its responsible officers).

SIGNATURE OF HOMEOWNER

DATE

SIGNATURE OF APPLICANT

DATE