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Seal of the Town of Newbury, MA
One & Two Family Demo Sign-Off
 Office of the Newbury BUILDING INSPECTOR



780 CMR 5112 DEMOLITION OF STRUCTURES

5112.1 Service connections: Before a building or structure is demolished or removed, the owner or agent shall notify all utilities having service connections within the structure such as water, electric, gas, sewer and other connections. A permit to demolish or remove a detached one- or two-family dwelling shall not be issued until a release is obtained from the utilities, stating that their respective service connections and appurtenant equipment, such as meters and regulators, have been removed or sealed and plugged in a safe manner.

UTILITY:                DATE NOTIFIED:

Sewer:          _______________

Water:          _______________

Gas:                    _______________

Electric:               _______________

Cable:          _______________

Conservation    _______________
        


I certify that the utilities have been notified of the demolition of the building or structure at ___________________________________________________
and service connections have been removed, sealed or plugged.
All applicable releases from utilities are attached.


______________________________          ____________________


Town Hall:
25 High Road, Newbury, MA 01951
ph:
978.465.0862
Mon, Wed and Thurs:
8am - 4pm;
Tues:
8am - 7pm
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