BENSALEM TOWNSHIP
Building and Planning Department
2400 Byberry Road • Bensalem, PA 19020
Office 215-633-3644 • Fax 215-633-3753
Uniform Construction Code (UCC)
TOWNSHIP OF BENSALEM
DEPARTMENT OF BUILDING & PLANNING
Rev 5/2009
APPLICATION FOR DEMOLITION
Permit #
Date
Tax Parcel #
LOCATION OF PROPOSED DEMOLITION WORK
Address:
City:
State:
Zip Code:
BRIEF DESCRIPTION OF BUILDING OR STRUCTURE TO BE DEMOLISHED
use
number of stores
etc
:
DEMOLITION CONTRACTOR
Name:
Address:
Phone:
Three copies of a site plan showing the proposed demolition must accompany this application.
These must be drawn to scale (no less than 1/8”=1’) on pages which are at least 18” x 24”.
Each plan must detail:
Size and location of all buildings or structures to be demolished, distances to property
lines and distances to sidewalks, pavement and curbs where they abut property lines.
Size and location of any existing buildings or structures that will remain on the site.
Area to be filled to existing grade and seeded or to be fenced and otherwise protected in
anticipation of new construction
If applicable, location dimensions and construction details for protection required in Section
3306 of the International Building Code.
A
Demolition Notification Form is required from the State of PA. For an application and more
detailed information visit PA DEP E-Library or see
Other Applications.
If applicant is someone other than the owner, you must list owner information also:
APPLICANT (if other than owner) OWNER
Name (printed)
Name (printed)
Address
Address
Phone
Phone
Owner Statement:
I/We [signatures] certify that I/we own the property described above for which this application is made
for a UCC demolition permit and that the applicant my/our approval to demolish this property or act as
our agent in the demolition of this property.
Si
nature
ate
Signature Date
OFFICE USE ONLY
APPROVED: YES NO FEE: $
APPROVED BY:
Signature
Date
Proposed
Demolition
Information
Site Plan
Requirements
Owner/Applicant
Information
A SIGNED COPY OF THIS APPLICATION IS REQUIRED PRIOR TO ISSUANCE OF PERMIT
