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CONSTRUCTI PER.NIIT ON NO. TO\\'N OF BARTLETT, NH RR 1 BOX 49 TO\\'N HALL RD. I N T E R V A L E ,N H 0 3 8 4 s (6 0 3 )356_2950

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*APPLrcArroN s 5b, 60 FEE ...-.-------(Non-refundrut.)

CO I'lSTRU C TI OlV PE RNIIT A p p LI CATI Oi,t PLEASE NOTE: SIGNED AND COMPLETED APPLICATIONSMUST BE RECETVED BY lPM THE DAY BEFOR.ETHE SELECTMEN MEET N{ ORDER TO BE RE\/IE\\IED TFIAT WEEK. ATTACH ADDITIONAL NFOfu\IATION NEEDED. IF SELECTMEN REVIEW PEzu\IITS THEIR ALL AT \\'EEKLY

N I E E T N G . A P P L I C A N T I S R E S P O N S I B L E O R S U P P L Y I N G A L L N E C E S S A R YF O f u \ I S ,P L A N S ,E T C . F AS RTQUIRED FIEREN. FAILURE TO DO SO NIAY RESULT IN THE APPLICATION BEING RETURNED OR D E L A Y E D . A P P L I C A T I O N SW I L L B E P R O C E S S E D E T W E E N 3 . 7 D A Y S , P L E A S EP L A N A C C O R D N G L Y . B VIOI-ATIONS ARE STIBJECTTO FINES.

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I' GENERAL INFORNIATION: LOCATION OF PROPERTY

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MAILING ADDRESS:

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BUILDER' S ]VIAILII{G ADDRES S

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IL TYPtr oF CONSTRUCTION: (please rvriteN/A if items do not apply)

Att crccttrate sketclt sltowittg tlre locntiotts of strttctttres witlr tlteir.setbatcks tttttstaccortpar), tltis form as well as attJ, otJter supportirtg cloctttrtents) (NOTE:

SETBACKS: Stnrcture setbact l{ is of nanreO Tt\ \ s' ft. fronr the centerlinc streer '3cr)'t Str-'.rcture properrl.lines:Side 1 [clol+ frcr..r ft. iside 2 ft. rtsack Sno Strr.rcture from rvatercorrrse: lO0 t ft. / Distaqcg betrveen stnrctures -\<DINIENSiONSOF STRUCT HEIGHT: J6::proposed: ru/S DEI{SITY; Statealiorvance fU fq <
qT ATtr qI tpf]Tvrc L l e u u t l t J r vl !o N \ A I l\O /rnl_ n l P P R \ _ ,Y A Lf _ #
T)rt'A\ y y rr v r p v lr ! ' nn n r \ r\ r lr.r"Jr L F ^ - ? 1 lur:

WHATAREYOU BUTLDT|TGZRBtr c ZONING DISTRICT'. SIZEoF LoT: pRrOR yES t4 LOTOFRECORD !$SR--5t22t8s? TO

5D nr<etq; LoT FRoNTAGmf, NO I I

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INTENDED RtW_ usE

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S T A T E A P P R O V A L F O R C O N S T R U C T I O N n r L r sa t t a c i tc o p l ' o f S t a t er w r l l l , , , ( t
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PAR}ING AREA SIZEN'IO.OF VEHICLES

ESTLVATED VALUE OF \\/ORK:

$ | 5. OOO. o"

-----contlnue on backof form------__

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IS THIS PROPERTY LOCATEDN THE FLooDpLAr,\rFLooDwAy? Y E S I ] No trl IS TF{lSPROPER.TY LoCATEDN THE zuDGEL|NE s DrsrR.rcr /aho,,eO n ' ) ? v t r q t I \ I e ) f l ,
If you anslvered"yes" to either the floodnl:in or #doelinp additional forms need to be filed.

ADD ITIONAL I^]FORMATION :

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All informationper-taining this buildingpermitmusrbe subn+itted the time of to at application. lncomplete appiications be retLrrned. rvill
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This aooroval does NOTr relieve me frorn compliance rvith other than r\v r s r r c v E r r r c l l o l l l c o t n p l l a n c e w l t n o t n e r t n a n Tow.n of Bartlett regulatio n s low'n of IJartleft regulati and/or oidinances.
f t r r t h e r u n d c - r s t a n d t h a t t h i s a p p r o v a lr d u u )s N o r o u oe rrvT r e r i e r c mle f tru lm c O mlp ll y il n g r ii 1ri hl t n e S tt lrtte - 1 e s tr::ll:ri tl il o n s t h trtt r r tr..tr,; b : q l s ve tl c l o ll on p y \ i l he . r g OnS fr

a b o v ei n f o r m r , : ; ; ; . ;ri',n^i,i" tt::."rdance r,,iththe datastLb-mirted "0" hereinand r undersrand the compliancer,.ilrr " thar be :::::itl:l,t:tl5:..""St1:.n.0 verified by the Board of Selectn.ren. (Note:Property ownerl.[[/SI sign this application)

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Bartlett wa.ter Precinct Zon.ing ordinance, Kearsarge the Lighting Zoning r d i n r n c e , o r ar y o t h e r ordinance, a n O or

Date: Approved bv

Orvner/Applicant

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H o u s eo r C o n d oU n i t s25.00/Lrnit Garage Addi tions/S heds,Decks

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paid OO. cr5 Fee

Majorcommerciai

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C h e c k s h o u l db e made payable to the Tow,rtof Burtlett, N,FL s T h e r ea r es e p a r a tpemritapplication e formsfor changes useand sisr-]s of

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DFNIEd
CONSTRUCTION PERMIT I.{O. TOWN OF BARTLETT, NH RR 1 BOX 49 TOWN HALL RD. INTERVALE,NH 03845 (603)356-2950 EXPIRES
*APPLICATION FEE $---_.-.(Non-refund able)

COIVS TRUCTI ON PERMIT A PPLI CATI OIY PLEASE NOTE: SIGNED AND COMPLETED APPLICATIONS MUSTBE RECEIVED IPM BY THE DAY BEFORE THE SELECTMEN MEET IN ORDERTO BE REVIEWED THAT WEEK.
ATTACH ADDITIONAL TNFORIVIATION NEEDED. SELECTMEN REVIEW ALL PERMITS AT THEIR WEEKLY IF MEETING. APPLICANT IS RESPONSiBLEFOR SUPPLYING ALL NECESSARYFORMS,PLANS,ETC. AS REQUIREDHEREIN. FAILURE TO DO SO MAY RESULT IN TIIE APPLICATION BETI\*G RETURNED OR DELAYED. APPLICATIONS WILL BE PROCESSED BETWEEN 3-7 DAYS, PI-EASEPLAN ACCORDINGLY. VIOLATIONS ARE SUBJECTTO FINES,
* * * * * {< >k * ,F >{< * {< x * * * * * ,k {< * *< x * >t< * * {< * * * * * * * * * >k * * * {< 4< * >t *,t< * ,t< * * * * * * {< * * {< {< {< * t( * tr<{< {< * * * * + t< t< * ,k * * * * * * *

I. GENERAL INFORMATION: LOCATIONOFPROP.ERTV

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MAILING ADDRESS : R o * L/(i ? BUILDER: 5n m( BUILDER'S MAILING ADDRESS f,,&za.g

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II. TYPE OF CONSTRUCTION:

(Pleasewrite N/A if items do not apply)

(NOTE: An accurate sketch showing the loccrtions of structures with their setbacks must &ccompeny this form as well as any other supporting documents)

WHATAREYoU BUILDINGIEfUaZ
ZONINGDISTzuCT' Aa.n . SIZEOF LOTI

INTENDED USE

C,4 /3Ia)

'I LOT OF RECORD PRIOR TO 5122185? YES INo[ ] SETBACKS: Stmctureis setback 32f ft from the centerline streetnamed 3 AJof Structurefrom property lines: Side 1 7{ ft. /Side 2 ,/ zS" ft. /Back Alrzzt. r ,t ZO 1t. Stnrcture from watercourse: /,,11 ft. / Distance between structures ft. DIMENSIONS OF STRUCTLIRE: /{ >. 7.4 HEIGHT: y *p DENSITY: Stateallowance /{ Proposed: STATE SLIBDIVISIONAPPROVAL # DArE /r - fSTATE APPROVAL FOR CONSTRUCTION(must attachcopy of Stateform) # DateApproved What for? (eg.No. of bedrooms, gallons/day, use)

/ , F6

LOT FRONTAGE

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PARKINGAREA SZEAIO. OF VEHICLES ESTIMATEDVALUE OF WORK'. /F, A,.tf , e a

-----continue on backof form--------

IS THISPROPERTY LOCATEDIN THE FLOODPLAIN/FLOODWAY? [ ] YES NO [ ] IS THISPROPERTY LOCATEDN THE RIDGELINE (above DISTzuCT 800')?YES [ ] NO I "yes"to either floodplain ridgeline, If you answered the or additional formsneed befiled. to A D D I T I O N A L | N F O R M A T I O N7 a s * : rzs,.rna/E(,J, nta --rt, r

All informationpertaining this buildingpermitmustbe submitted the time of application. to at Incomplete applications be rettrrned. wiil
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This approval doesNOT relieveme from compliance with otherthanTown of Bartleftregulations and/orordinances. I fi-rrther understand that this approvaldoesNOT relieveme from complyingwith the Stateregulations that may be applicable, Lower BartleftWaterPrecinctZoningOrdinance, Kearsarge the the Lighting Zonrngordinance, any other or duly constihrted and enactedregulationsor procedures.I herebycertify that the aboveinformationis hue and that the above verified by the Board of Selectmen. (Note: Property ownerMLTST
construction will be accomplished in accordance with the data submitted herein at.rd understandthat the compliance will be I

pplication)

Date:

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Owner/Appli Date
Fee paid

Approvedby

*Application FeeSchedule (Non-refundable) : Houseor CondoUnit $25.OO/unit Garage Additions/Sheds/Decks Major Commercial $100.00 M i n o rC o m m e r c i a l S 5 0 . 0 0 Misc./Renewals S 10.00

Checksshouldbe madepayable the Townof Bctrtlett, to NH. There are separate permit application forms for changes useand signs. of