Permit Number :___________ Town Of Lyman

Map: _____ Lot: _____ Application For Building Permit

Account # ___________ 11 South Waterboro Road

Electrical Permit # Lyman, Maine 04002 Phone 207-499-7562 ext. 15

Fee: $ ____________ Check # ________

PLEASE READ THE REQUIREMENTS ON THE LAST PAGE PRIOR TO SUBMISSION

1. Date: ________________ 5. Street Address: ________________________
2. Value of Project: $ ____________ 6. Zoning District: _______________________

3. Lot area (acres or sq. ft) _________	% Lot coverage _____________________________

(% non-vegetated surface)

4. Flood zone ___ yes ___ no

Property Owner(s) Name: __________________________________________________

Address: ______________________________ City/Town: ________________________

State: _____________ Zip: __________ Phone: ( ) _________________________

Applicant (if different from owner) ____________________________________________

Address: ______________________________ City/Town: ________________________

State: _____________ Zip: __________ Phone: ( ) _________________________

Type of permit required: Is this a Commercial use: ___ Yes ___ No

(____) New Construction (____) Additions to Existing Structure(s)

(____) Remodeling (____) Move Structure(s)

(____) Demolition (____) Other

Complete Statement of Work:

________________________________________________________________________
________________________________________________________________________

General Information: ( code enforcement will check applicable boxes )

Yes No

(__) (__) If this is new construction you must supply a complete set of plans.

(__) (__) If this is a new home you must supply (3) three complete copies

of a subsurface wastewater disposal system ( HHE – 200 )

(__) (__) If you are a new property owner you must submit a copy of the property deed.

(__) (__) Internal Plumbing requires form HHE – 212 to be completed by the

plumber along with their license number.

(__) (__) Is a new electrical service required?

(__) (__) Is the property in an approved subdivision?

(__) (__) Is the property within the Shoreland Zoning District

(__) (__) Is a DEP Permit required ( if so supply a copy )

(__) (__) Erosion Control plan and finish landscaping plans required for shoreland permits.

Contractors Information:

Building Contractor: ______________________ Address: ________________________

City / Town: _____________ State: _____ Zip: ____ Phone: (____) ________________

Plumbing Contractor: _____________________ Address: ________________________

City / Town: _____________ State: _____ Zip: ____ Phone: (____) ________________

Electrical Contractor: _____________________ Address: ________________________

City / Town: _____________ State: _____ Zip: ____ Phone: (____) ________________

Excavating Contractor: ____________________ Address: ________________________

City / Town: _____________ State: _____ Zip: ____ Phone: ______________________

Subdivision Information: ( if the property is located in a subdivision complete this section)

Name of Subdivision: __________________________________________________________

Date Subdivision was recorded at Registry: ____________ Plan Book: ______ Page ______

Any electrical work requires a separate Electric Permit prior to doing the work. Permits can be issued by the CEO. Inspections or questions can be directed to the Electric Inspector.

Site plan information: Attach a site plan or draw below a plan showing the size, location of all

new construction and all existing structures on the property. Distances from all property lines, show all streets, distances from high water marks of marshland, water, brooks, ponds and wetlands. This data must be accurate!

N

W --------- E

S

The Undersigned certifies that the plan is accurate:

______________________________ _________ _______________________________ ________

Owner Date: Applicant Date

Notes, Conditions and Certifications:

INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

The building Inspector shall have 14 days from the receipt of a complete application to grant it or refer the applicant to the proper board. If no action is taken within 14 days that constitutes a denial.

The person submitting the application is the property owner or an agent acting with a signed

affidavit from the property owner giving the agent permission.

A copy of the recorded deed must be submitted as proof of ownership.

Three copies of an HHE – 200 Subsurface Wastewater Disposal System application must be submitted signed and dated with an application for new home construction.

Shoreland permits require an erosion control plan, tree removal plan, finish landscaping plan.

Any excavation within 75 feet of the waterbody requires a Permit by Rule from DEP.

This application for a permit if granted is done so with the clear understanding on the part of the applicant that the construction will meet the standards of the Maine State Plumbing Code, the National Electrical Code, as adopted by the State of Maine, NFPA Life Safety Code 101 as adopted by the State of Maine and the Lyman Building Code, DEP regulations, and FEMA regulations.

If any changes to the plans whatsoever, in location, design, dimensions, or use are to be made the permit holder shall first submit the changes to the Code Enforcement Officer with a revised plan showing the changes and a letter explaining the reason for the change(s). The Code Enforcement officer will review the change(s) and refer them to the proper board or approve or disapprove the change(s).

It is understood that the applicant will notify the Code Enforcement Officer for the following Inspections:

Pre- pour foundation and foundation before backfill.

Rough framing, plumbing and electric before insulation and wall covering.

Insulation.

An occupancy permit must be issued before occupancy of any new structure, addition or remodel.

It is further understood and agreed by the applicant that he/she will comply with all existing codes and ordinance regulations of the Town of Lyman as well as all State and Federal regulations. Failure to do so will mean action will be taken under the appropriate section of the Lyman Ordinance and/or Federal and State laws, using Rule 80K.

Applicants are responsible for knowing where their property lines are. All setbacks are from property lines Not the edge of the road. Know where your property pins are, it is your responsibility for proper setbacks.

I the undersigned have read and understand this application and certify that it is accurate:

__________________________ _________ _________________________ __________

Signature of Owner/Applicant Date Signature of Contractor Date

__________________________ _________ _________ _____________________ _______

Building Inspector Approved Denied Planning Board Review Date