Revised 02/22/2017 Page 2 of 2
APPLICATION FOR DEMOLITION PERMIT
When are operations to begin? _________________________________________________________________________________
Details of Demolition:
Dwelling Garage Shed Barn Business Industrial Other
Size of Structure: _____________________________ Foundation: Yes No
Demolition of in-ground pools require a letter from an electrician stating electric has been disconnected
Appropriate mitigation methods shall be employed before, during and after the demolition to control the generation of
fugitive dust, storm water run-off and erosion.
• Application must be filed out completely
• If contractor is applicant, the contractor MUST provide consent from the homeowner authorizing him to file for
• Proof of Insurance – The applicant shall file with the City of Glen Cove a Certificate of Insurance indicating
that the City has been named primary insured under an insurance policy in the amounts of ($300,000 / $500,000)
for bodily injury and ($50,000) for property.
• Worker Compensation – Proof of insurance must be submitted from the contractor and/or homeowner at the
time of submission.
IMPORTANT NOTICES: PLEASE READ & SIGN
The applicant hereby agrees to hold the City of Glen Cove harmless on account of damages of any kind which may arise
during the progress of the work authorized by this permit.
The applicant certifies all persons concerned with actual work under this permit are duly covered by Workman’s
Compensation Insurance and the City shall be harmless on account thereof.
Work under this permit shall commence within thirty (30) days of the date of this permit and shall be continued in an
The City shall have the right to select counsel to represent it for the defense of any claim, suit, or action arising hereunder,
all fees and disbursement for the same to be paid by the applicant herein.
The applicant shall be responsible for all damages caused to public utilities and shall replace any cracked or damaged sewer
or water mains with new pipe.
The applicant shall take every reasonable precaution to properly warn all persons of any danger during the course of the
The permit does not include any privileges of encroachment in, over, or under, or upon any city street or right-of-way.
In consideration of being granted this permit, the undersigned applicant accepts it subject to the conditions described.
I, __________________________________, the above-named applicant, hereby attest that I am
The lawful owner of the property described within or am the lawful Contractor/Agent of said Owner and affirm under the
penalty of perjury that all statements made by me on this application are true.
Signature: _________________________________________________ Date: _______________________
(SIGNATURE OWNER / CONTRACTOR-AGENT)