Applicant Certification
The applicant certifies that all information on this application is correct and the work will be completed in
accordance with PA Act 45 (Uniform Construction Code) and any additional approved building code
requirements or zoning ordinance adopted by the Municipality. The property owner and applicant
assumes the responsibility of locating all property lines, setback lines, easements, rights-of way, flood
areas, etc. Issuance of a permit shall not be construed as authority to violate, cancel or set aside any
provisions of the codes or ordinances of the Municipality or any other governing body. The applicant
certifies he/she understands all the applicable codes, ordinances and regulations. Application for a permit
shall be made by the owner or lessee of the building or structure, or agent of either, or by the registered
design professional employed in connection with the proposed work.
I certify that the code administrator or the code administrator's authorized representative shall have the
authority to enter areas covered by such permit at any reasonable hour to enforce the provisions of the
code(s) applicable to such permit.
I certify that I am aware of the municipality’s inspection requirements and have received a copy of the
required inspections. I am aware that the following inspections and/or meeting must be conducted:
Pre-job meeting with the demolition contractor and municipal representative.
After sealing and securing all storm and sanitary sewer lines leading from the structure; or
After on-lot sanitary system has been removed or abandoned in place with the tank punctured and
filled with clean material.
After the breaking of any existing basement floor and prior to backfilling.
Final inspection after property has been seeded and all course material removed.
I certify that all material removed from the demolition site will be disposed of at an approved landfill.
Finally, I am aware that a copy of the permit shall be kept on the site of the work until the completion of
the project.
________________________________________ ________________________________________
Signature of Owner or Authorized Agent Print Name of Owner or Authorized Agent
__________________________________________________________ _________________________
Address Date:
I would like to receive my demolition permit electronically.
Email Address: __________________________________________________________________
Required Project Documents:
The following must be submitted to be considered a complete application:
A Certificate of Insurance showing proof of General Liability Insurance for work performed by a
contractor.
An Affidavit of Exemption or Proof of Workers Compensation Insurance.
Payment of the required Application Fee.
A copy of Commonwealth required Asbestos National Emission Standards for Hazardous Air
Pollutants notification for the demolition of any structure for a commercial development.
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