UCC-4 APPLICATION FOR DEMOLITION PERMIT

UCC 4 Form

APPLICATION FOR UCC DEMOLITION PERMIT

Check that applies

EXPEDITE REVIEW. ADDITIONAL FEE SUBMITTED.

ACT 24 EXEMPTION

Site Information

Political Subdivision and County names are required.

Facility Name (name of company, mall, institution, university, etc.):

Building and/or Tenant Name

Street Number and Name

City

State

Zip Code

Political Subdivision

County

Contact Name

Phone

File Number (if approved for occupancy by L & I)

Site Plan Requirements

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:

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.
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 pedestrian protections required in section 3306 of the International Building Code.

Owner and Applicant Information

Applicant Name

Street Address

City

State

Zip Code

Phone

Fax

Owner Name

Street Address

City

Zip Code

Phone

Owner Statement
I/we, signed name(s)] certify that I/we own the property described above for which this application is made for a UCC demolition permit and that the applicant has my/our approval to demolish this property or act as our agent in the demolition of this property.

Name

Date

Filing Requirements

FEE SCHEDULE: For an up-to-date listing of fees, please see the Fee Schedule listed on our website (www.dli.pa.gov/Individuals/Labor-Management-Relations/bois) or contact our office for a copy of the Fee Schedule by telephone at 717-787-3806 option 1 or by fax at 717-783-5002. Be sure to include any additional information necessary when mailing this application and the appropriate fee to the Department.

UCC 4 Form

APPLICATION FOR UCC DEMOLITION PERMIT

Site Information

Site Plan Requirements

Owner and Applicant Information

Owner Statement I/we, signed name(s)] certify that I/we own the property described above for which this application is made for a UCC demolition permit and that the applicant has my/our approval to demolish this property or act as our agent in the demolition of this property.

Filing Requirements

Owner Statement
I/we, signed name(s)] certify that I/we own the property described above for which this application is made for a UCC demolition permit and that the applicant has my/our approval to demolish this property or act as our agent in the demolition of this property.