TOWN OF CHINCOTEAGUE
DEMOLITION PERMIT
DATE: __________ PERMIT # __________
PROPERTY OWNER: _______________________________________ PHONE # ___________
ADDRESS: _____________________________________________________________________
CONTRACTOR: ____________________________________________ PHONE # ____________
ADDRESS: _____________________________________________________________________
STATE LICENSE # : _____________________ LOCAL LICENSE # ____________________
LOCATION OF BUILDING: _________________________________________________________
TYPE OF BUILDING: RESIDENTIAL____ COMMERCIAL____ ACCESSORY BUILDING____
SQUARE FOOTAGE OF BUILDING: ____________________
PROPOSED USE OF SITE AREA UPON REMOVAL OF STRUCTURE: _______________
ESTIMATED COST OF DEMOLITION: $_____________________________________________
I THE UNDERSIGNED AFFIRM THAT THE OWNER OR OWNER’S AGENT HAS OBTAINED A RELEASE FROM ALL
UTILITIES HAVING SERVICE CONNECTIONS TO THE BUILDING STATING THAT ALL SERVICE CONNECTIONS &
APPURTENANT EQUIPMENT HAVE BEEN REMOVED OR SEALED & PLUGGED IN A SAFE MANNER; AND
WRITTEN NOTICE HAS BEEN SENT TO OWNERS OF ADJOINING LOTS AND TO THE OWNERS OF OTHER LOTS
AFFECTED BY THE TEMPORARY REMOVAL OF UTILITY WIRES OR OTHER FACILITIES CAUSED BY THE
DEMOLITION; AND
WHEN A BUILDING IS DEMOLISHED OR REMOVED, THE ESTABLISHED GRADES SHALL BE RESTORED AND
ANY NECESSARY RETAINING WALLS AND FENCES SHALL BE CONSTRUCTED AS REQUIRED BY THE BOCA
CODE, CHAPTER 33.
I ALSO ACKNOWLEDGE FOR WHICH THE AFFECTED PORTIONS TO BE DEMOLISHED BY THIS PERMIT
COMPLIES WITH THE CODE OF VIRGINIA SECTION 36.99.7 & THE VIRGINIA UNIFORM STATEWIDE BUILDING
CODE , HAS BEEN INSPECTED FOR THE PRESENCE OF ASBESTOS BY AN INDIVIDUAL LICENSED TO
PERFORM SUCH INSPECTIONS PURSUANT TO SECTION 54.1-503 OF THE CODE OF VIRGINIA AND THAT NO
ASBESTOS CONTAINING MATERIALS WERE FOUND OR OTHERWISE HAVE BEEN RESPONDED TO IN
ACCORDANCE WITH THE REQUIREMENTS OF THE CLEAN AIR ACT NATIONAL EMISSION STANDARD FOR THE
HAZARDOUS AIR POLLUTANT (NESHAPS) (40 CFR 61, SUBPART M) OR IS EXEMPT AS NOTED IN THE
EXEMPTIONS LISTED BELOW:
_____ SINGLE FAMILY DWELLING
_____ RESIDENTIAL HOUSING WITH 4 OR FEWER UNITS
_____ LESS THAN 260 LINEAR FEET ON PIPES
_____ LESS THAN 160 SQUARE FEET OF EFFECTED AREA
_____ LESS THAN 30 CUBIC FEET OF AREA
_____ STRUCTURE BUILT AFTER JANUARY 1, 1985
APPLICANT (PRINT) : ____________________________________________ DATE: __________
APPLICANT SIGNATURE: _________________________________________________________
BUILDING OFFICIAL: _____________________________________________________________
_____ APPROVED _____ DENIED DATE: ________________
SITE PLAN OF PROPERTY
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