TOWN OF HAVERHILL, NH
Building Permit Application
Completed
application must be returned to the Town Selectmen’s Office for
processing. The application must be
accompanied by a check payable to the Town of Haverhill. No refund will be made if the application is
denied, and the application will not be processed until all required sections
are complete. If a question does not apply, mark N/A. (Permits Must Be Posted On Site)
SUBMISSION REVIEW CHECKLIST (Office Use)
Permit No: ___________________________
Application Received ________/________/________
By:
_______________ (initial) Total
Fees Paid:
_____________________
PROPERTY INFORMATION
Street Address:
_________________________________________________________
Tax Map No. ____________________ Tax Lot No. ______________________
Subdivision/ Development Name:
__________________________________________
Intended Use:
____Residential ____Commercial ____Industrial ____Institutional ____Accessory
____ Other
APPLICANT/ OWNER INFORMATION
Applicant’s Name:
______________________________________________________
Mailing Address:
______________________________________________________
City/ State/ Zip:
______________________________________________________
Phone: _______________________ Fax: __________________________
Email:
_______________________________________________________
Owner’s Name:
______________________________________________________
Mailing Address: ______________________________________________________
City/ State/ Zip:
______________________________________________________
Phone: _______________________ Fax: __________________________
Email: _______________________________________________________
CONTRACTOR INFORMATION – (NOT APPLICABLE TO SINGLE FAMILY OR TWO
DWELLING RESIDENTIAL UNITS)
Name
of Contractor Address/City/Zip Telephone
# License #
Architect ________________ _________________________________ _____________
Gen. Contractor ________________ _________________________________ _____________
Electrical ________________ _________________________________ _____________ ____________
Plumbing ________________ _________________________________ _____________ ____________
Sewer/Septic ________________ _________________________________ _____________
Mechanical ________________ _________________________________ _____________
Sprinkler ________________ _________________________________ _____________
Fire Alarm ________________ _________________________________ _____________
DESCRIPTION OF WORK (Please provide plans)
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Estimated Start _____/_____/_____ Estimated
Finish _____/______/_____ Estimated Value $__________
IMPROVEMENT TYPE (CHECK IF APPLICABLE)
____ New Construction ____ Addition ____ Alteration
____Repair/ Replacement ____ Demolition ____Relocation
IS WORK ON THE FOLLOWING SYSTEMS BEING PERFORMED? – (EXCEPTION: NOT
APPLICABLE TO SINGLE FAMILY OR TWO UNIT RESIDENTIAL UNITS)
Electrical ____Yes ____No Size of Service ___________AMPS
Plumbing ____Yes ____No Heating _____Yes _____No
Sprinklers ____Yes ____No
Fire Alarm ____Yes ____No
COMPLIANCE – STATE FIRE AND
LIFE SAFETY CODES
(SINGLE FAMILY OR TWO
DWELLING RESIDENTIAL UNITS MUST COMPLY ONLY WITH 911 PORTION OF THIS SECTION)
PLACE
‘X’ IN BOX IF
LIFE SAFETY / FIRE CODES DO NOT APPLY OR WAIVER PROVIDED (COMMENT)
Signature of Town Inspector ):
_________________________________ Date: ___________________
Comments (if any):
____________________________________________________________________________________________________
FOR BUILDINGS SUBJECT TO LIFE SAFETY CODE, TOWN INSPECTOR’S REVIEW
AND SIGNATURE required prior to application approval for new construction,
additions, renovations, changes and/ or expansion of uses and accessory
structures (swimming pools, decks, and sheds).
The Town Inspector MUST receive and
approve all plans for code compliance prior to applicant initiating
construction and inspect newly constructed, renovations, additions, etc. prior
to occupancy. This paragraph is
applicable to all commercial, industrial and institutional buildings, foster
homes, day care facilities and multi unit dwellings with more than two units.
CERTIFICATE OF COMPLIANCE
shall not be issued unless the Town Inspector has inspected and approved all
new construction, including additions, garages, and other changes noted above
for compliance with the State of New Hampshire Fire Codes, which includes the
installation of hard-wired smoke detection system in accordance with NFPA Life
Safety Codes and the installation of all new oil-fired furnaces in compliance
with NH RSA 153:5. This paragraph is
applicable to all commercial, industrial and institutional buildings, foster
homes, day care facilities and multi units dwellings
with more than two units.
CERTIFICATE OF COMPLIANCE
shall not be issued until the property owner/ builder displays the 911address
as follows: (APPLIES TO STRUCTURES
REQUIRING 911 ADDRESS: INCLUDES SINGLE / TWO DWELLING UNITS.)
·
If the residence to be constructed can clearly be seen from the roadway,
the house number shall be affixed to the front of the home with 3 inch numbers
of contrasting color to the building.
·
If the residence cannot be seen from the roadway the numbers shall be
affixed to the mailbox, if warranted, on both sides of the mailbox and of
contrasting color, and in accordance with Postal Service guidelines, or
·
If no mailbox is necessary, the numbers shall be affixed to a post
located at the end of the driveway with 3 inch numbers affixed on both sides.
PRIVATE OR CLASS VI ROAD
If this building permit
application is for a building located on either a Private or Class VI Road, the
application must have review and comment by the Haverhill Planning Board, and
approval from the Selectboard or Agent of the Selectboard. Check the appropriate space below.
______Yes, this application
is for a building on a Private or Class VI Road.
______No, this application is
not for a building on a Private or Class VI Road.
DRIVEWAY PERMIT
Compliance
with Town of Haverhill Subdivision Regulations necessary for all projects that
require Driveway Permit connection to a town road. See Town’s Driveway
Regulations (Section 4.1.12) and Town Road Agent. Connection to a state maintained road
requires the approval of the State of New Hampshire Department of Public Works
and Highways. Driveway Permit must be
obtained prior to issuance of Building Permit.
COMPLIANCE – STATE SEPTIC
SYSTEM
If building is not hooked
into district, precinct or town sewer, applicant must provide the following
information from the New Hampshire Department of Environmental Services,
Division of Water Supply and Pollution Control (271-3503):
Construction
approval number: _____________________________
Date:
_____________________________
Size and/ or type of system:
___________________________
COMPLIANCE WITH EXISITING ZONING REGULATIONS
(To
be completed by Selectboard Agent – Town Office)
1.
WETLAND AND AQUIFER PROTECTION ORDINANCE: Is property within the Aquifer or Wetland
District? ____Yes ___No Does the building or building use require
Zoning Board approval? ______Yes ______No
If yes, Date of Approval: _____________
2.
FLOOD PRONE AREA ORDINANCE: Is
the property within a flood prone area? _____Yes ____No
If yes, applicant will be required to provide flood zone determination,
building elevation and certification that construction will conform to the
Ordinance.
3.
PERSONAL WIRELESS SERVICE FACILITIES ORDINANCE: Is this project subject to the provisions of
the PWSF Ordinance? _____Yes _____No If yes, this
application is subject to site plan review by the Haverhill Planning Board.
Date of site plan approval: __________________
4.
Does this project require Planning Board Subdivision approval? _____Yes _____No If yes, provide the date that the
subdivision was approved by the Planning Board. Approval Date: ____________________
5.
Does this project comply with the Town Sludge Spreading Ordinance? _____Yes _____No _____NA
6.
Does this project comply with the Town Airport Zoning Ordinance? ______Yes ______No ______NA
7.
Does this project comply with all other state and federal
requirements? _____Yes _____No
OTHER INFORMATION
1.
INSPECTIONS: The contractor/ builder must contact the Town Office at
787-6800 to schedule the necessary inspections.
(Applies to buildings covered by Life Safety and Fire Codes)
2.
CERTIFICATES OF COMPLIANCE: A Certificate of Compliance will be issued
upon completion of new construction, addition, repair/ replacement, alteration,
demolition, or relocation. Inspections
by the Town Inspector must be requested at least (2) weeks in advance. There is no fee for a COC; however, failure
to comply may result in additional fees as noted on the Building Permit
Application Fee Schedule. (Applies to buildings covered by Life Safety and Fire
Codes)
3.
APPRECIABLE START: If you do not
make an appreciable start, foundation complete, within 12 months, the applicant
may request a 12 month extension at no additional cost. All work, foundation
in and capped, must be completed within 2 years.
4.
DEMOLITION of industrial, commercial, institutional and four or more
residential units requires notice to the State of New Hampshire Environmental
Protection Agency if asbestos is involved (attach copy of notification form).
5.
FIRE RUINS: No owner or occupant of land in the town shall permit fire
or other ruins to be left on a site.
Within six (6) months he/she shall remove such ruins and fill or cap any
excavation.
6.
APPEALS: Denied applications may
be appealed to the NH Court System regarding Life Safety and Fire Code issues within
45 days of denial, and to the Town Zoning Board of Adjustment or Airport
Commission for the appropriate “Existing Town Zoning Regulation.”
7.
Fees: Permit fees are
established and may be amended from time to time by the Selectboard. (See Building Permit Fee Schedule on the
reverse side of this page to determine application fee.)
8.
If the estimated value of any non Life Safety or Fire Codes project is
less than $2,500.00 and the project is in compliance with all federal, state
and local regulations, a building permit fee shall not be required.
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Process to be followed when contacting Precinct/ District Commissioners for district/village approval. |
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Village District Or Precinct |
Commissioner contact |
Commissioners may consider |
|
Haverhill Corner |
Submit to Precinct Office
located at Haverhill Corner Fire Station, Tuesday & Thursday, 9:00am to 1:00PM.
Requires 2 Commissioner’s signatures |
Planning Board Regs Zoning Requirements Water Hook-up |
|
Mountain Lakes |
Obtain Mountain Lakes Bldg
Permit Application from District Office. Return completed Town form with Mtn Lakes Clerk signature and approved District
application to the Town Office. |
Planning Board Regs Zoning Requirements Water Hook-up |
|
North Haverhill |
If addressing water system
issue, submit application to District Commissioners at their monthly meeting,
3rd Tuesday, at 6:30PM (Town Office). 1 Commissioner must sign all other non
water system Bldg Permit applications. |
Water system issues, hook-up
etc., must be brought to a Precinct Commissioner Mtg. |
|
Woodsville |
Submit to Commissioner Dick
Guy, TV Guy, Woodsville, M-F. |
Water and Sewer |
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None Precinct or Village District |
If not living in a village/
district, this section is not applicable |
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VILLAGE DISTRICT/PRECINCT APPROVAL
The
_______________________________ officials have been notified of this project
and by their signature below, provide approval of this project. (Haverhill Corner, Mountain Lakes, North
Haverhill, or Woodsville)
____________________________________ ______________________ ____________________
Signature Date Title
WOODSVILLE FIRE DISTRICT
DRIVEWAY APPROVAL (IF IN WOODSVILLE FIRE DISTRICT)
Woodsville Fire District
applicants MUST receive driveway approval from the Woodsville Fire
District Commissioners.
____________________________________ ______________________ ____________________
Signature Date Title
APPLICANT SIGNATURE
This is to certify that the
information included in this application will be followed during construction
and any changes shall be only after notifying the Selectmen’s Office. That any permit issued based upon inaccurate
information is subject to immediate withdrawal.
That the proposed work is authorized by the owner of record and that I
have been authorized by the owner to make this application as his/ her
authorized agent and we agree to conform to all applicable laws of this
jurisdiction. I further certify that I
will comply with any regulations or conditions imposed by the Selectmen, Town
Inspector, Zoning Board of Adjustment and/ or Planning Board as it relates to
this property and the proposed use.
___________________________________ ___________________________________ _____________
Signature of Applicant
(Agent/Owner) Print Name of
Applicant Date
APPLICATION APPROVAL
Application approval is
contingent upon satisfactory completion of all sections in this form.
Application APPROVED /
DENIED:
_______________________________________________
Agent
of Selectboard
Date permit issued/ rejected:
________________
Permit expiration date:
________________
Conditions of Approval: ________________________________________________________________________________________________________________