Demolition Permit Review Form

Date of application:

Property Information

Address of Building(s) to be Demolished

Age of Building(s)

Owner of Record

Name (print)

Contact Address

Phone Number

Authorized Agent

Name (print)

Contact Address

Phone Number

A. Provide a brief description of the building to be demolished including the known history.

B. Please attach photographs of each side of the building and field cards from the Assessors' Office

C. State the reason for the demolition.

D. Provide estimated cost of demolition.

E. Describe the proposed reuse, reconstruction or replacement of the building including the approximate time frame of the proposed work. Indicate approximate siting of the new buildings on the lot.

The delay period is six months from the application date according to Norfolk bylaw. If the commission and the owner have made a reasonable but unsuccessful effort to locate a purchaser of the building and have completed a mapping and photographic record, the period of delay may be reduced by the Commission.

Owner – Authorized Agent Declaration

I, --------as Owner – Authorized Agent, hereby declare that the statements and information I have provided on this application are true and accurate, to the best of my knowledge and belief

This section for official use only

Record of Proceedings

Norfolk Building Department. Date permit application received

Norfolk Historical Commission Date demolition delay review form received

Date response received by Building Department

Historical Commission meetings and actions

Services

Forms

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