Building_Permit

TOWN OF ACWORTH BUILDING PERMIT APPLICATION

(Per Acworth Zoning Ordinance Article XI, Paragraph B: It shall be unlawful to erect or relocate any dwelling, building or structure or alter the bulk of any dwelling, building or structure without first obtaining a permit from the Board of Selectmen.)

APPLICANT NAME:____________________________________________________

BUILDING ADDRESS:__________________________________________________

MAP AND LOT #:_______________________________________________________

IS PROPERTY IN FLOOD ZONE (Per NFIP) (Y or N)?_________________________

If yes, applicant is responsible for documentation of Base Flood Elevation of property.

DOES PROJECT REQUIRE STORM WATER PERMIT (For construction activities that disturb one acre or more per EPA) (Y or N)?___________________________________

DOES PROJECT REQUIRE ASBESTOS DEMOLITION/RENOVATION NOTIFICATION FORM (Per NHDES) (Y or N)?______________________________

IS THERE ANOTHER DWELLING ON THE PROPERTY (Y or N)?_____________

IS THERE A DRIVEWAY PERMIT ON FILE (Y or N)?_________

IS PROPERTY ON A CLASS VI (6) OR PRIVATE ROAD (Per RSA 674:41, I(c)) (Y* or N)?______

*Application referred to Planning Board on:__________________________

*Waiver of services: Issued________________Recorded_______________

ZONING DISTRICT (Per Acworth Zoning Ordinance Article II):

Rural_____Residential_____Crescent Lake*_____Conservation*_____

*Application referred to Conservation Commission (Per BOS 9/13/99) on___________

IS PROPERTY IN CURRENT USE (Y or N)?_________________________________

(Per RSA 79-A:7 a Land Use Change Tax will be assessed on land for which the use changes, i.e.: from Forest to Residential.)

BUILDING TYPE (Per Planning Board 12/18/02 and 07/28/04):

_____Residential: Shall mean a privately or publicly owned building containing a dwelling unit or dwelling units (Acworth Subdivision Regulations Section 2:.14).

_____Accessory: Means a building subordinate to the main building on the lot and used for purposes customarily incidental to those of the main building (Acworth Zoning Ordinance Definition A) and Any combination of any materials whether portable, movable or fixed, having a roof and enclosed within exterior walls, built to form a structure for the shelter of animals or property (Acworth Subdivision Regulations 2:02).

_____Nonresidential: Any structure or use designed, intended, or used for any primary purpose other than single family residences or farms (Nonresidential Site Plan Review Regulations Section 3, B). Nonresidential uses should be submitted to the Planning Board for Site Plan Review (Acworth Zoning Ordinance Article VIII).

BUILDING DESCRIPTION (Build, Alter, Enlarge, Move):______________________

Footprint dimensions_____________________________Stories___________________

Number of rooms___________________Estimated Cost_________________________

Foundation material_________________Roof material___________________________

Chimney material___________________

For structures with pressurized water in (NHDES Septic System Approval required for occupancy): Application pending_________________Approval #________________

For structures with no pressurized water in: (Describe alternative sewage disposal system)_________________________________________________________________

Setbacks (Per Acworth Zoning Ordinance):

From: Road_____Side______Rear______Side______Streambanks, ponds, lakes*______

*Site work within 100’ Conservation Zone is prohibited

Licensed Plumber #____________________ Name______________________

Licensed Electrician #__________________ Name______________________

Sketch layout of existing and proposed buildings as they are/will be located on lot: