Application for Demolition of Structure Permit

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Complete the form on screen, print it, and sign it. Nothing is transmitted from this page.

Site and activity

Site address

Application date

Square feet to be demolished

Start date

Finish date

Description of demolition activities

Type of structure

Masonry
Wood Frame
Post & Beam

Other type of structure — specify

Residential

One Family
Two Family
Three Family

Other residential — specify

Commercial

OBC use group

Mixed use?

The following information must be completed to process the application.

Property owner

Name

Address

City / State / Zip

Telephone

Other phone

Demolition contractor

Name

Local registration number

Address

City / State / Zip

Telephone

Other phone

All contractors must be registered before a permit will be issued. See Contractor / Sub-Contractor Registration.

Applicant

Name

Address

City / State / Zip

Telephone

Other phone

Instructions

Contact all utility service providers including city utility departments and request to have all services disconnected and removed from the property.
Submit application and permit fees to the Pickaway County Building Department along with a copy of the asbestos survey, if it is a commercial structure.
After structure is demolished, remove all debris from site.

I fully understand that no excavation, construction, demolition of any structure shall be undertaken or performed until the permit applied for herein has been approved and issued by the Pickaway County Building Department.

I hereby certify that I am the owner of the named property, or 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. In addition, if this permit is issued, I certify that the code official shall have the authority to enter areas covered by such permit to enforce the provisions of the code applicable to such permit.

I hereby acknowledge that I have read and fully understand the instructions that are explained above and agree to comply with the instructions as written or orally given by the Pickaway County Building Department for this project.

Owner / Agent

Signature (sign after printing)

Date

Commercial fees

Commercial demolition fees
Item	Amount
A. $100 per structure plus $10 per every 100 square feet. For example, 103 sq. ft. rounds up to 200 sq. ft.	Amount for this line
B. Board of Building Standards (BBS) fee — 3% of subtotal	Amount for this line
C. Municipal and Township Surcharge, where applicable — 10% of subtotal	Amount for this line

Residential fees

Residential demolition fees
Item	Amount
A. House — $50 per structure	Amount for this line
B. Garage — $25 per structure	Amount for this line
C. Board of Building Standards (BBS) fee — 1% of subtotal	Amount for this line
Total permit fee	Amount for this line

Make check or money order payable to: Pickaway County Building Department.

Building department use

Inspector approval (office use)

Date (office use)

Permit void after 60 days.

Nothing on this page is transmitted to the county. Print it, sign it, and deliver it as the form directs.