Fillable DEMOLITON PERMIT APPLICATION (City of Warrensburg)

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DEMOLITON PERMIT APPLICATION (City of Warrensburg)

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DEMOLITON PERMIT APPLICATION
Date: _________________ Permit # : _______________ Construction Value $_______________
Demolition Address: ___________________________________________________________________
APPLICANT/CONTACT INFORMATION DEMOLITION CONTRACTOR INFORMATION
Owner Contractor Other_______ Same as Applicant
Name: Merchant License #:
Mailing Address Company Name:
City, State, Zip: Mailing Address:
Phone: Cell: City, State & Zip:
Fax: Phone: Cell:
Email: Fax:
Mark or click here if you would like to receive code updates OWNER INFORMATION: Same as Applicant
and information via email from the department Name:
TYPE OF DEMOLITION: Phone: _________________ Cell: _________________
Entire Structure Part of a Structure
House Interior Demolition-if you answer yes to any of the following questions a
Demolition Permit is required.
Commercial
1. Will load-bearing walls be removed? Yes No
Accessory Building
2. Is there electric wiring in any of the walls to be demolished? Yes No
Mobile Home
3. Is there plumbing pipe in any of the walls to be demolished? Yes No
Multi-Family # of Units_____
4. Do you know of any lead-based paint in the structure? Yes No
Other
5. Do you know of any asbestos used in the structure? Yes No
STRUCTURE INFORMATION:
Foundation: Basement Pad Crawl Space
Number of Stories: 1 2 3 Other
DUMPSTER INFORMATION:
What company is placing the dumpster at the location?
Where will the dumpster be located?
CITY OF WARRENSB
URG
102 S. HOLDEN ST.
WARRENSBURG, MO 64093
PHONE: 660-747-9135
FAX: 660-747-2349
www.warrensburg
-
mo.com
LAND DISTURBANCE
1. Permit Required—When soil is disturbed on a construction site, a Land Disturbance Permit is required to be
issued along with the demolition permit. If your project will disturb the soils on the site, please complete and
return the attached Land Disturbance Permit Application with the demolition permit application.
2. After the demolition of the structure as occurred, the lot must be cleared of all debris, graded for drainage, have
silt control in place and seeded before a final inspection and Certificate of Completion is issued.
ASBESTOS
The Missouri Department of Natural Resources regulates the property removal and disposal of asbestos material. To
learn more about your responsibilities for compliance with these laws please visit the DNR website at
http://dnr.mo.gov/pubs/pub2157.htm for a fact sheet on Asbestos Requirements for Demolition and Renovation Projects.
DISPOSAL OF DEMOLITION RUBBLE
The Missouri Department of Natural Resources advises that the disposal of demolition waste is regulated under Chapter
260, RSMo. Such waste, in types and quantities established by the Department, shall be taken to a demolition landfill or
sanitary landfill for disposal. Additionally, persons engaged in building demolition are required to maintain records of sites
used for disposal for a period of 1 year and present records upon request to DNR personnel. The state statutes further
allow for county and city prosecution for illegal dumping in violation of RSMo Section 260.210
RIGHT OF ENTRY
In the discharge of his/her duties, the Code Official or his/her designated representative shall have the authority to enter at
any reasonable hour any building, structure or premise in this jurisdiction to enforce the provisions of the building codes
adopted by the city of Warrensburg.
PERMIT FEES FOR NOT FOR PROFIT CORPORATIONS
In October 2012, City Council approved the waiving of building permit, zoning, and public works fees for construction
projects on property owned by any political subdivision or organization that has obtained an exemption from the payment
of federal income taxes as provided in certain sections of the US Internal Revenue Code. If you are a tax exempt entity,
please provide a copy of your tax exempt letter to see if you qualify to have your permit fees waived.
SIGNATURE OF APPLICANT/AGENT
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by
the owner to make the application as his/her authorized agent and we agree to conform to all applicable local,
state, and federal laws.
I understand and have complied with, where applicable, the following information:
1) Utility Disconnect Form – Must be submitted on all entire structure demolition permits
2) Land Disturbance Application – Must be submitted if soil is to be disturbed
3) Proper Asbestos Removal and Disposal per DNR
4) Proper Disposal of Demolition Rubble per DNR
5) Open Burning in City Limits
ADDRESS OF APPLICANT
APPLICANT NAME (PLEASE PRINT)
SIGNATURE OF APPLICANT
FOR OFFICE USE ONLY
DEMOLITION PERMIT FEE $ APPROVED
LAND DISTURBANCE PERMIT FEE $ 0.00 DATE
SEWER CAP $
BY
TOTAL
$
UTILITIES DISCONNECT FORM
DEMOLITION ADDRESS: __________________________________________________
All entire structure demolitions (including accessory buildings) are required to have the following
utilities to the structure disconnected and signed-off on by the utility provider. Service connections
shall be discontinued and capped in accordance with the approved rules and the requirements of the
authority having jurisdiction.
UTILITIES DISCONNECTS:
Signatures are required from all utility companies listed below.
EVERGY ELECTRIC (888-471-5275): ______________________________________________
720 E. Young St., Warrensburg, MO 64093
SPIRE GAS (800-582-1234): _____________________________________________________
1530 Corporate Dr., Warrensburg, MO 64093
MISSOURI AMERICAN WATER (660-628-1791): _____________________________________
1705 Montserrat Park Rd., Warrensburg, MO 64093
CITY OF WARRENSBURG SEWER CAP INSPECTION: _______________________________
Public Works (660-262-4421) 102 S. Holden St., Warrensburg, MO 64093
The sanitary sewer service connection must be CAPPED at the property line with concrete. An
inspection is required once the sanitary sewer has been capped. Public Works will sign off on the
Utilities Disconnect Form after the inspection is approved.
PERMIT APPLICANT/AGENT SIGNATURE:
Permit applicant/agent required to sign below.
I have made contact with all of the utility companies and have their signature acknowledging that
utilities have been disconnected or a connection never existed at this location. I am applying for a
permit to demolish or remove the structure at the following address:
____________________________________________.
Applicant/Agent Signature: ____________________________ Date: ____________
LAND DISTURBANCE PERMIT APPLICATION
I. Location of Structure
Address of Project:
IV. Description of BMP’s
The following methods of erosion control will be established and maintained at all times where soil is
exposed on the construction site and shall remain in place for the duration of the construction project.
Check all that apply:
Storm Water Detention
□ Temp. Sediment Trap
□ Nets and Blankets
□ Pipe Slope Drains
□ Check Dams
Slope Protection:
□ Silt Fence
□ Surface Roughening
□ Straw Bale Barrier
□ Gradient Terraces
□ Interceptor Dike and Swale
□ Grass-Lined Channels
□ Pipe Slope Drain
□ Subsurface Drains
□ Level Spreader
□ Check Dams
Sediment Controls
□ Straw Bale Barrier
□ Brush Barrier
□ Silt Fence
□ Vegetative Strip
□ Sediment Trap
□ Temp. Sediment Basin
Storm Drain Inlet
Protection:
□ Bale & Filter Fabric
Filters
□ Gravel and Wire Mesh
Sediment Filters
□ Excavated Drop Inlet
Sediment Trap
□ Gravel Curb Inlet
Sediment Filter
□ Block & Gravel Curb
Inlet Sediment Filter
Slope Protection
□ Surface
Roughening
□ Gradient Terraces
□ Interceptor Dike &
Swale
□ Grass-Lined
Channels
□ Pipe Slope Drain
□ Subsurface Drains
□ Level Spreader
□ Check Dams
Soil Stabilization
□ Seeding with Straw
Cover
□ Hydro-seeding
□ Grass Turf
Storm Water Outlet
Protection:
□ Riprap Channel
Lining
□ Outlet Protection
If disturbing more than one acre, a professional SWPPP Plan and MDNR Land Disturbance Permit are required.
II. Identification
Name of Property Owner:
Home Phone: ( )
Work Phone: ( )
Cell Phone; ( )
Street Address:
City:
State:
Zip Code:
Email:
Name of Contractor:
Business License Number:
Work Phone: ( )
Cell Phone: ( )
Email:
Fax:
Street Address:
City:
State:
Zip Code:
III. Proposed Work (Stormwater Pollution Prevention Plan)
1. Date Land Disturbance Activity is to Begin: _____ / ____ / ____
2. Total Land Area to be Disturbed (sq. ft.):
A. Residential:
4. [ ] Site Grading
5. [ ] Multi-Family Structure
6. [ ] Detached Accessory
Structure
7. [ ] Vegetation Removal
8. [ ] Demolition
9. [ ] Other
__________________
B. Commercial:
10. [ ] Site Grading
11. [ ] Site Development
12. [ ] Multi-Family Structure
13. [ ] Commercial Structure
14. [ ] Detached Accessory Structure
15. [ ] Vegetation Removal
16. [ ] Demolition
17. [ ] Other ________________
C. Subdivision:
18. [ ] Site Grading
19. [ ] Site Development
20. [ ] Vegetation Removal
21. [ ] Other
___________________
VI. Sequence of Erosion Control Activities
Provide anticipated dates for the following land disturbance activities:
1. Identify and mark areas to be protected from land disturbance: ____/ ____ / _____
2. Clearing and grubbing of site: ____ / ____ / ____
3. Construction of perimeter erosion and sediment control devices: ____ / ____ / ____
4. Installation of permanent and temporary stabilization measures: ____ / ____ / ____
5. Installation of concrete foundation work: ____ / ____ / ____
6. Final soil stabilization (Seeding/Hydro-seeding/Turf): ____ / ____ / ____
7. Removal of temporary erosion control devices (after permanent vegetation is in place):
____ / ____ / ____
Sequencing shall identify the expected date(s) on which clearing will begin, the estimated duration
of exposure of cleared areas, areas of clearing, installation of temporary erosion and sediment
control measures, and establishment of permanent vegetation.
_____ (Initial) I understand that the removal of mud, debris and other construction-related mater-
ial from City streets is required daily or immediately as directed by the City of Warrensburg.
______ (Initial) I understand that a temporary wheel wash station where trucks enter and leave
the jobsite shall be established and maintained from start to finish of the land disturbance and
construction activity and the location of the station shall be indicated on the site plan. The follow
ing specifications will be required for the wheel wash station:
______ (Initial) I understand that an engineered soils report may be requested on the site where
land is to be disturbed and this requirement shall be at the City’s discretion.
______ (Initial) I understand that the designated job superintendent of this construction project
will be trained or will train other individuals to perform all inspections, maintenance and repair
activities, and filling out inspection and maintenance reports related to erosion and sediment con
trols and stabilization measures.
_____ (Initial) I understand that prior to approval of the Land Disturbance Permit, the City shall be notified to perform an
inspection after all erosion controls are in place as identified in the permit application.
NAME OF APPLICANT (Print):
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this
application as his/her authorized agent and we agree to conform to all applicable codes and ordinances of the City
of Warrensburg.
DATE:
SIGNATURE OF APPLICANT:
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DEMOLITON PERMIT APPLICATION (City of Warrensburg)

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Completed 17 July 2020

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