Revised 02/22/2017 Page 1 of 2
Building Department
All information must be complete to initiate the processing of the application
Please refer to Chapter 136 of the Zoning Ordinance for additional requirements. Any
violations of Chapter 136 or Chapter 280 of the Zoning Ordinance may result in the issuance of
a Summons.
1) Property Information:
Street Address: _______________________________________________________________________ Section __________ Block __________ Lot ___________
2) Property Owner:
Name: _______________________________________________________________________________ Phone Number: ___________________________________
3) Contractor
Name: _______________________________________________________________________________ Phone Number: ___________________________________
License No:__________________________________________________
Description / Structure to be demolished: ___________________________________________________________________________________________________
All Tree removals associated with this application must be applied for at time of this permit application at the Department of Public Works.
I/We, _______________________________________________________ the Applicants herein, do hereby authorize the members of the Planning Board and the
Building Department to inspect our property as it relates to the foregoing Demolition application during reasonable hours and upon providing reasonable notice of said
inspection. I/We consent to the Planning Board and Building Department members to contact me/us at the phone number provided herein to arrange said inspection.
Property Owners signature: _______________________________ Date: ____________________
Contractors signature: ____________________________________ Date: ____________________
**Additional Conditions listed on the second page must also be complied with**
Fencing must be provided to the reasonable satisfaction of the Building Department to protect the root system of any
trees to be retained in the affected area
The following erosion controls measures must be installed prior to the commencement of any grading, re-grading, and/or
excavation project:
Silt Fencing
Other Methods: ____________________________________________________________________ ___________
Submittals: The following must be submitted with any application for grading/excavation:
Grading Plan: Prepared by a licensed professional drawn at a scale of not less than one (1) inch equals twenty (20) feet
and which contains the following information:
A title block including name and address of applicant and record owner of property, the properties designation on the
City Glen Cove Land & Tax Map and the title of the project. If the applicant or property owner is a corporation, the
name and address of the president and secretary shall be submitted with the application. Include Date
A written and graphic scale as well as North Arrow
Reference to any written covenants, restrictions, easements or exceptions affecting the site, a notation to the effect shall
be indicated on the site plan map.
Revised 02/22/2017 Page 2 of 2
Building Department
Outlines of all existing and proposed structures, driveways, walkways, impervious surfaces to be located on property.
Location of all existing storm drainage structures, soil erosion and sediment control measures and utility facilities
including electric, water, telephone and cable television which are located within the property lines.
Plan to include existing and proposed contours according to the U.S. Geodetic Survey Datum at intervals not to exceed
two (2) feet. Existing contours are to be indicated by dotted lines, proposed contours to be indicated by solid lines.
The location of all significant natural features such as water courses, depressions, ponds, marshes, and other wetlands,
whether or not officially mapped.
Final Sealed Topographical survey to be submitted at completion of the project
All existing vegetation (trees, brush, grass/lawn areas, landscaping) disturbed during the project shall be maintained and
corrected if damaged.
Application must be filed out completely
If contractor is applicant, the contractor MUST provide consent from the homeowner authorizing him to file for the
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. (form C-105.2)
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
expeditious manner.
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: _______________________