Town of Lamoine

Construction Application

Permit Number_____ Map____Lot_______ Zone_______Date________

Shoreland Zone District______ Flood Zone_____

Owner/Applicant Information

Owner	Applicant
Name	Name
Address	Address
Home Phone	Home Phone
Work Phone	Work Phone
Contractor	Phone #

Existing Uses of Property _________________Physical Address of Property___________________

Existing Facilities:

Well	Sewer	Public Road	(name)
Public Water	Septic System	Private Road	(name)

Lot Dimensions:

Width	Length	Area (in acres)
		Area (in square feet)

Are current uses conforming?

Yes

No

If No, please explain on an attachment

Are permits required from the State of Maine or Federal Government?

Yes

No

If Yes, please attach copies to the application

Is funding for this project provided by any Federal, State, County or Local Government?

Yes

No

If Yes, please attach an explanation to the application.

Was the lot for which a permit is requested created by division from another lot within the past five years?

Yes

No

If Yes, Subdivision Name_____________________Lot #___________

If you do not know, provide a Title Attorney’s opinion or notarized statement of your own.

Proposed construction activity on the property

Residential		Commercial*		Accessory
New Dwelling Unit		New Use		Garage
Manufactured Home		Expansion		Deck
Mobile Home				Other (Describe Below)
If Mobile Home	Year		Make	Sales Tax Paid?
Building Square Footage of ground coverage

Additional Description (attach sheet if necessary)

*Commercial exceeding 2000 square feet requires Site Plan Review

Estimated Market Value of Project

Upon Completion

Census Information: Please indicate how many additional persons will inhabit any structures after completion of the project.

Number of Full Time Residents	Number of Part Time Residents
Number of Children Under 18
List any in-home occupations
Starting Date:		Estimated Completion Date

Earth Moving Activity: (check one)

Less than 10 Cubic Yards

Greater than 10 Cubic Yards

In Shoreland Zone, greater than 10-cubic yards of earth moving activity requires a DEP Permit

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Flood Zone Information

Is the proposed development located within a Flood Hazard Area?

Yes

No

If Yes, complete the information below

1. Filling _____cubic yards of fill 9. Residential Structure

2. Excavation _____ cubic yards removed 10. Non-residential Structure

3. Paving ______square yards paved 11. Water Dependent Use

4. Drilling A. Dock Dimensions_________________

5. Mining ______acres mined B. Pier Dimensions___________________

6. Dredging ______cubic yards dredged C. Boat Ramp Dimensions_____________

7. Levee ______cubic yards in levee 12. Floodproofing

8. Dam ______ acres of water surface 13. Other (explain)

Flood Zone (check one) ___A&AE ___Floodway ___V&VE ___ZO ___AH

Elevation of lowest floor (NGVD) for all structures:_______

Grade elevation at lowest grade adjacent to the existing or proposed wall: ______(NGVD)

Distance in feet of confluence or Corporate limit_______ feet

If in Flood Zone AE or A1-A30, Nearest Cross Section References

Above Site_____ Below Site________

Elevation of Base Flood at Nearest Cross Section

Above Site_____ Below Site ________

If “A” Zone: Base Flood Elevation ____________

Basis of “A” Zone BFE determination__________________________________________

If in “VE” Nearest Transect Above site_____________ Below Site______________

Provide a statement describing how each applicable development standard (set forth in ARTICLE VI of the Flood Hazard Development Ordinance) will be met. If a water course is to be altered or relocated, describe in detail and provide copies of all applicable state and federal permits. Include certification from a licensed surveyor that the proposed project is located outside of the 100-year floodplain.

Name of Surveyor/Architect/Engineer_______________________License # _______________

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Shoreland Zoning Information Affected Waterbody_________________

Distance from normal high water line for development_________feet.

Is clearing of trees and other vegetation required? Yes No (if yes, explain)

Please consult section 14 of the Lamoine Shoreland Zoning Ordinance. List the numbers of all subsections which apply to the proposed development.

Attachments (if applicable, circle all attached materials)

Record of Ownership Board of Appeals Decision Building Plans

Plot Plan Site Evaluation/HHE 200 Site Review

DEP/EPA Permits Flood Permit Other

Road Opening Permit

For all applications, please attach an elevation, floor and plot plan. For applications involving Shoreland Zoning issues, please consult page 30 of Shoreland Zoning Ordinance, and attach a letter from a registered surveyor indicating that markers have been placed to establish the 100 foot setback from the normal high water line (required only if construction is planned within 125 feet of normal high water line.

An approved plumbing permit (HHE200) is required for all dwellings or additional bedrooms. Road opening permits required for all driveways on State or Local publicly maintained roads.

Signature Section

Signature by the applicant indicates an awareness of the requirements of the Lamoine Building and Land Use Codes, the Lamoine Shoreland Zoning Ordinance, and the Floodplain Hazard Development Ordinance for the Town of Lamoine. Submission of this application constitutes an application for a Certificate of Occupancy. A Certificate of Occupancy must be obtained before the structure hereby permitted is used!. BUILDING PERMITS EXPIRE TWO YEARS FROM DATE OF APPROVAL. SHORELAND PERMITS EXPIRE IN ONE YEAR.

For those lands which fall within the Lamoine Shoreland Zoning area, a signature on this application indicates that the applicant has read the current Shoreland Zoning Ordinance and agrees to comply with all its requirements if a permit is issued.

For new structures or substantial improvements within the Flood Hazard Area, an approved permit will allow construction up to the establishment of the lowest floor. At that point, the applicant must provide an elevation certificate establishing actual floor elevation. Upon satisfactory documentation to the community (CEO), the construction may continue. The applicant understands and agrees that:

Þ the permit applied for, if granted, is issued on the representations made herein;

Þ that any permit issued may be revoked because of any breach of representation;

Þ that once a permit is revoked all work shall cease until the permit is reissued or a new permit is issued;

Þ any permit issued on this application will not grant any right or privilege to erect any structure or use any premises described for any purposes or in any manner prohibited by the ordinances, codes, or regulations of the Town of Lamoine

Þ The applicant hereby gives consent to the Code Enforcement Officer or designated Town Official to enter and inspect activity covered under the provisions of the Floodplain Management Ordinance

Þ If issued, the permit will be posted in a conspicuous place on the premises in plain view and;

Þ If issued, the permit will expire if no work is commenced within 90 days of issuance (flood hazard only)

I hereby certify that all the statements in, and the attachments to this application are a true description of the existing property and the proposed development project.

_____________________________________ __________________

Signature Date

Application Fees:

	Residential Building	Commercial Building	Shoreland		Floodplain
<500 sq’	$25	$50	CEO Review Only	$50	All Permits
500-1000 sq’	$50	$100	Planning Board Review	$100	$10
1000-3500 sq’	$100	$200
>3500 sq’	$200	$400

For Use by the Code Enforcement Officer Only

Application Number______ Date Received___________________

Fees Collected: Building Permit $________

SZO Permit $________

Flood Hazard $________

Total $________ check #________

cash

Action Taken: __________________________ _____________

Signature Date

qApproved Building Permit

qApproved Shoreland Permit

qApproved Flood Hazard Permit

qDenied Permits (explain below)

qRouted to Planning Board

qRouted to Appeals Board

Comments

Elevations - Please show a picture of the proposed development and its height and shape above ground. You may attach formal building plans and drawings if you wish.

Front or Rear View Side View

Floor Plan

Scale ___________ =_____feet

PLOT PLAN

PLEASE INCLUDE ALL SETBACK DISTANCES FROM:

Property Boundaries, Roads, Streets and rights of way, all wetlands and waterbodies, any existing wells and septic systems. Include 100 foot shoreland set back and/or flood elevations if applicable. Show all proposed decks & porches. Please identify all abutter names. (You may attach your own plot plan if you desire)

Scale ___________ =_____feet