PERMIT APPLICATION FORM SELECT ALL THAT APPLY: BUILDING DRIVEWAY ELECTRICAL PLUMBING HEATING DEMOLITION SIGN MOBILE HOME

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1 PERMIT # TOWN OF ASHLAND, NEW HAMPSHIRE 20 HIGHLAND STREET PO BOX 517 ASHLAND, NH FAX PERMIT APPLICATION FORM SELECT ALL THAT APPLY: BUILDING DRIVEWAY ELECTRICAL PLUMBING HEATING DEMOLITION SIGN MOBILE HOME Section One All applicants must fill out section one Date of Application Property Owner(s) Mailing Addres s Phone Numbers Home Work Cell Ashland Street Address Tax Map Number Is lot located in 100 yr flood plain area (maps available at town office)? Yes Property acreage No Signature of Applicant ***** Signature of Property Owner also required on page 5****** 5 Section Two For Building Permit Contractors Name/Address/Phone Number ESTIMATED COST OF PROJECT Select type of building project and describe work to be done New Construction Alteration Repairs Will this construction create an additional dwelling unit? Does this construction project meet the setbacks as defined in the Ashland Zoning Ordinance? 1

2 If new construction select use: Single Family Multi Family # of units Non Residential (define use) Garage Storage Building Type of Foundation Concrete Block Other Full Crawl Space Sono Tube Slab Exterior Walls - Clapboard Wood Shingles Stucco Brick Log Vinyl Other (explain) Heating System Type(s) (Example wood stove and monitor) Type of Sewage Disposal Private State Approval # Town Sewer Type of Water Supply Private Town Water Dimensions/Features of Construction Number of Stories Building Height Total square feet (all floors) Number of Bedrooms Number of Bathrooms Complete Plot Plan Addendum #1 Inspector James VanValkenburgh Cell CONTACT THE TOWN OFFICE AT FOR 911 ADDRESSING NUMBER AS SOON AS BUILDING HAS STARTED 2

3 Section Three For Mobile Home Permit Manufactured Home Serial Number Manufacturer s Name Model Year Location of MH (street address) Was there a unit located at this address previously? Yes No If yes Owner Name Date Removed New Used Section Four Driveway (Reference Driveway Regulations) Contractors Name/Address/Phone Number Approximate width and length Town or State road Estimated cost of project COMPLETE THE ATTACHED SKETCH Addendum #2 Inspector Contact Driveways on Town Roads Tim Paquette Application for Driveways on state roads NHDOT Section Five Electrical - ***Contact Ashland Electric Department at for any changes to service connections immediately. Electricians Name/Address/Phone Number License Number Estimated Cost of Project Describe work to be done New Construction Alteration Repair Call to arrange for inspection 3

4 Section Six Plumbing Plumbers Name/Address/Phone Number License Number Estimated Cost of Project Describe work to be done New Construction Alteration Repair Plumbing Inspector Erik Ames Section Seven Heating Installers Name/Address/Phone Number License Number Estimated Cost of Project Type of System being installed Describe work to be done New Construction Alteration Repair Make of unit being installed Serial Number of unit Size of unit Location of unit Heating System Inspector Ashland Fire Department or Jim VanValkenburgh or Section Eight - Demolition Name/Address/Phone Number of person doing demolition Address of property Property Owner s Name Map/Lot Number Date of Demolition Inspector James VanValkenburgh Cell

5 Section Nine Sign Permits - Reference section 3.3 of Zoning Ordinance Sign Installer Name/Address/Phone Property Owner Street Address Size of Sign Application for permits Town of Ashland Inspector James VanValkenburgh Cell The undersigned hereby agrees that the proposed work shall be done in accordance with the foregoing statement, and with the plans a specifications submitted; and that the work connected therewith shall conform to the building laws and regulations of the Town of Ashland (2009 IBC, 2009 IRC, NFPA most current version). Town of Ashland Driveway Regulations, Site Plan Regulations, Subdivision Regulations, Zoning Ordinance and that the owner or agent will notify the building inspector or appropriate designated inspector to inspect after each of the following are completed: 1. Foundations coated and footings drains installed (when ready to back fill; certified foundation plan before framing. 2. When framing, electrical, plumbing and heating system are ready. 3. Insulation 4. Must have Final Inspection signatures (when all work is completed) for a Certificate of Occupancy. 5. I hereby agree that this building shall not be occupied or used until a Certificate of Occupancy has been issued. Work is NOT to continue until each inspection is made and approved by the Building Inspector or his agent. 6. This application expires if the work is not started within six months or completed within 18 months. Signature of Property Owner Print Name Date Office Use Only Permit Granted Permit Denied Reason for denial Pending Zoning Board Approval Building Inspector Signature Date 5

6 PLOT PLAN INSTRUCTIONS A. Plot Plan shall be drawn on the back of this sheet or on a separate sheet of paper. It shall be neatly drawn and include the following information. A sample sketch is shown below: North Arrow Boundaries of lot with dimensions in feet Setback distances from structures to all property lines. Please remember that the front setback is measured from your property line, not from the road In campgrounds and manufactured home parks, indicate setback (distance) to nearest structures (identify type of structure) and roads in all directions from all existing and proposed structures Setback distances from all water bodies and wetlands Names and locations of roads adjacent to lot Location of all driveways. Identify if existing or proposed. Driveway application must be completed for proposed new driveways and change of use or expansions (including paving) of existing driveways Existing structures on lot; include septic system, drainage structures, wells and utilities Sketch all proposed structures and additions showing overall dimensions Location of any wetlands, floodplain, streams, etc on site Location of any on-site or adjacent cemeteries or burial sites Any additional information that will adequately describe the proposed work All proposed decks, landings, exterior stairs, porches and overhangs must be shown Lot line setbacks from roadside property lines are measured from the property line Do not measure from the pavement or traveled way. FAILURE TO SUBMIT A COMPLETED PLOT PLAN WILL DELAY PROCESSING OF YOUR APPLICATION. PLAN MUST BE IN INK AND LEGIBLE. EXAMPLE ONLY SEPTIC SYSTEM EXISTING HOUSE PROPOSED GARAGE 6

7 COMPLETE PLOT PLAN As per instructions 7

8 ASHLAND BUILDING PERMIT FEE SCHEDULE ** Fees for approved applications are non-refundable. Residential Building Single Family Alterations $35.00 Plus $.10 square foot Total Due New $50.00 Plus $.10 square foot Total Due Repairs $35.00 Plus $.10 square foot Total Due Multi Family Per Unit Alterations $35.00 Plus $.10 square foot Total Due New $50.00 Plus $.10 square foot Total Due Repairs $35.00 Plus $.10 square foot Total Due Swimming Pools $50.00 Total Due Driveway Permit Plumbing Permit Electrical Permit Heating System Demolition Permit Sign Permit Re-inspection Fee $25.00 per visit Total Due Cell Tower $75.00 Total Due Septic System Review $25.00 Total Due Commercial Alteration $75.00 plus.15 per sq.ft Total Due New $75.00 plus.15 per sq.ft. Total Due Repairs $75.00 plus.15 per sq.ft Total Due Industrial Alteration $ plus.20 per sq.ft. Total Due New $ plus.20 per sq.ft. Total Due Repairs $ plus.20 per sq.ft. Total Due Applicant Name Date Paid Received by Amount Paid 8