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BUILDING DEPARTMENT
Town of AuroraNillage of East Aurora
575 Oakwood Avenue, East Aurora, NY 14052
Phone: (716)652-7591
APPLICATION FOR DEMOLITION/SUBSTANTIAL MODIFICATION
PropertyOwnerName: CC)\,V\ f<v iG\,LJ5K1 Phone#: '7//,, 71-S J5"ol
1
Property Address:,_~5"'1~7~L.,h,,1d~e""n,___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
SBL #:, _ _ _ _ _ _ _ _ _ _-c-1-_ _ _ _ _ _ Zoning District: _ _ _ _ _ _ _ _ _ _ _ __
Applicant(ifnottheOwner): Ncl\\-h<11V'\ 2;11/lM-,r Phone#: l ({. ,2.S:~ o 2.i~
I. Brief description of the demolition: P<>01'<1.\ l ~f £too( :f!'\·h(i'ar a~W\-· J.w;\ .,.,, shh
0
2. Size of demolition (feet):_ width_ length_ Height _wTotal sq. ft. or □ Entire Building/Structure
3. Demolition Threshold (Village only): □ 30% (>2,501) □ 40% (1,201- 2,500) 18150% (<1,200)
4. Disconnection of services: □ Water □ Sewer □ Electric □ Gas ~ NIA
5. Asbestos Survey: □ Yes □ No 181 N/A
6. Water use needed for dust control: □ Yes 0 No 181 N/A
7. General permit NYS DOT (state) or ECPW (county) street/road: □ Yes 181 No 181 NIA
8. Name of Contractor: f:oo( l3ro+\\,rs J>u, /J-1.B;1 Representative: N
"r,tl-\9"1 Z,1 mPl,r·
Address of Contractor: (YI '11 C,:iJ,. R'J: Cal J,"' I 'ID>'!.
Phone#: 716 ;;(-,,iJ o3 !!'5 Email: '-/ /3rofl,.H'!>. ,J 2-/M.,i✓W (zm,i~/. tau
9. Name of Asbestos Contractor: _ _ _ _ _ _ _ _ _ _ _ _ _Representative: _ _ _ _ _ _ __
Address of Contractor: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Phone#: _ _ _ _ _ _ _ _ _ _ _ _ Email: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
10. Contractor's General Liability, Workers' Compensation, and Disability Insurance Certificates with the Town of
Aurora & Village of East Aurora as Certificate holder: IX'.! Yes □ NIA
IMPORTANT
• Site Plan or Survey showing lot and buildings on premises, relationship to adjoining premises or public
streets or areas, and giving a detailed description of the layout of the property must be submitted with this
application. Indicate the distance to the nearest building on the adjoining lot.
• A written report from a licensed exterminator regarding extermination must be submitted with the
application, if applicable.
• Written verification that all utilities (i.e., gas, electric, water, and sewer) have been properly shut off and
disconnected must be submitted with the application.
• No work may commence until an asbestos survey is completed and filed with the commissioner of the
NYS Dept of Labor in accordance with the Industrial Code 56 and the rules and regulations of the Dept of
Labor (submit a copy to this Dept)
• Debris, including any in-ground storage tanks, must be systematically removed from the site and not
allowed to pile up or cause any obstruction.
• Demolition shall be carried out during daylight hours only on normal workdays.
• No explosives can be used in connection with the demolition of buildings or structures unless a special
permit is first obtained by the Village Board of Trustees (village).
• All cellars and basements of demolished buildings or structures shall be filled in and made safe. The
surface of the infill shall be level with the surrounding premises.
APPLICATION IS HEREBY MADE to the Code Enforcement Officer for tile issuance of a Building
Permit pursuant to the NEW YORK UNIFORM FIRE PREVENTION AND BUILDING CODE for tile
construction of buildings, additions, and alterations, as herein described. The applicant agrees to comply
with all applicable codes, laws, and regulations. Tile undersigned hereby certifies that all of the
information contained in this application is correct and true.
Owner Name: Co I 1'1 /<l.l11 IJ7J(,' Email: lo(/V\. Ku\O., 1JSK1'@ "'-2+(()1'\llS .c,,;w\.
(Applicant or Corp/LLC must complete the affidavit on the next page to sign as the ownefs agent.)
Owner Signatnre: &£ hd ,,,C Date: -"2➔/-'.2"'-',-s/-./.l !2<. l, ,_ _ _ _ _ _ __