STRUCTURE DEMOLITION APPLICATION FORM
A building permit will cover simple demolition of interior walls and structural bearing walls and there is no
need of a separate Demolition Permit.
Provide, but not limited to, the following;
Site-plan: show construction / demolition limits, location of construction fences, barriers, railings, and
walkways etc. (can be copied from Clark County GIS)
Occupancy: Indicate whether the building or facility is to be remain open to the public, be occupied or
vacant during demolition, alteration, or remodeling. Show details of any proposed temporary
construction (walls, roofs, walkways, fences, barriers, railing, etc.). Show method of securing
temporary construction to resist any anticipated loads. (gravity, wind, snow, etc.). Method of
maintaining / providing egress, egress-lighting, exit-signage, Fire Protection Systems. (fire-alarm,
sprinklers sys, etc.)
Utilities: Indicate disconnection of utilities – water, sewer, electric, gas, if necessary.
Environmental: Verify asbestos testing and removal has been accomplished in accordance with all
Ohio EPA standards. Verify ground-water pollution has been mitigated, i.e. buried oil and gas tanks.
Comply with all Ohio EPA requirements.
Traffic control: contact local city, county or state engineer for the necessary traffic control permits.
Indicate methods of protecting adjacent property.
Project Address: ________________________________________ Residential Commercial
Square Footage: _______________________________________________________________________
Estimated Demolition Cost: $ _____________________________________________________________
Owner:
Name of Owner: _______________________________________________________________________
Address: _____________________________________________________________________________
Township / City: _______________________________________________________________________
Contractor:
Contact Person: _______________________________________________________________________
Address: _____________________________________________________________________________
Phone No.: ___________________________________________________________________________
E-Mail: _______________________________________________________________________________
Contact:
Contact Person: _______________________________________________________________________
Address: _____________________________________________________________________________
Phone No.: ___________________________________________________________________________
E-Mail: _______________________________________________________________________________
(Print) Applicant’s Name: ________________________________________________________________
Signature: ____________________________________________________ Date: _________________
Approval: _____________________________________________________ Date: _________________
Date Issue: _________________ Processed By: ________ Payment Amount: _____________________
