(COMMUNITY) DEVELOPMENT PERMIT APPLICATION
*Permit Number: *Application Date:
*STRUCTURE OWNER
Optional / NAME PHONE
FAX CELL
ADDRESS
TO WHOM SHOULD PERMIT BE MAILED? ¨ PROPERTY OWNER ¨ STRUCTURE OWNER ¨ CONTRACTOR
*PROPERTY OWNER (if same as structure owner, write SAME) / NAME PHONE
FAX CELL
ADDRESS
PREVIOUS PROPERTY OWNER
Optional / If present owner has owned this property less than four years, provide name of previous property owner:
*CONTRACTOR
(company or person building, filling, erecting a sign, or setting up a manufactured home)
FOR OPI USE ONLY:
Valid Contractor License on file.
Non Contractor Affidavit on file.
Verified by: / COMPANY NAME PHONE
FAX CELL
PRESIDENT
ADDRESS
WV CONTRACTOR LICENSE #
NOTE: If setting up a manufactured home, the following number is also REQUIRED.
* WV MANUFACTURED HOUSING BOARD LICENSE #
*SITE INFORMATION
*Attach Preliminary Site Plan
(See Sample)
*911 address obtained.
(permit cannot be processed without 911 address) / SITE ADDRESS
Number [Rt/Box or House]Street/Road CityZip Code
SUBDIVISION NAME OR
MANUFACTURED HOMEPARKLOT #
TAX MAP # PARCEL # LOT SIZE:
PRIMARY/COUNTY ROAD ACCESS:
DIRECTIONS TO SITE:
TYPE OF
DEVELOPMENT:
Check and complete all that apply:
Contractor Agreement
Reviewed &Return
Not Required
Optional
*COST / ¨ RESIDENTIAL¨ Single Family (COMPLETE Single Family HomeSection page 2)
¨ Manufactured Home (COMPLETE Single Family HomeSection page 2)
¨ Single Family/Duplex (COMPLETE Multi-Family Section, page 2)
¨ Multi-family (COMPLETE Multi-Family Section, page 2)
□ ADDITION FOR RESIDENTIAL STRUCTURE:
Room(s) ¨ Porch ¨ Attached Garage ¨ Other
- ¨ Construction costs are over 50% of the market value of the existing structure
- ¨ Construction costs are under 50% of the market value of the existing structure
□COMMERCIAL (Complete Commercial Section, page 2)
□ADDITION FOR COMMERCIAL STRUCTURE: TYPE OF ADDITION:
□Construction costs are over 50% of the market value of the existing structure
□Construction costs are under 50% of the market value of the existing structure
□ INDUSTRIAL (Complete Industrial Section, page 2)
□ FILL
□WATERCOURSE ALTERATION
□STREAM CROSSING
□TEMPORARY STRUCTURE OR STORAGE
□DEVELOPMENT WITHOUT A STRUCTURE (e.g. excavation, grading, etc.)
□TELECOMMUNICATIONSTOWER
*ESTIMATED CONSTRUCTION COSTS OF PROJECT (LABOR & MATERIAL): $
COMMUNITY DEVELOPMENT PERMIT APPLICATION PAGE 2
WATER/SEWER/
SEPTIC:
Optional for Municipals
Check and complete all that apply:
New Structures: / Is the property served by public water service? ¨ yes ¨ no If yes, state the name of the public service district or water company:
Is the property served by public sewer service? ¨ yes ¨ no If yes, state the name of the sewer provider:
Town of approval is required if the Town is the sewer treatment source.
¨ APPROVE ¨ DISAPPROVE
Signature Town of Date
SEPTIC - If your structure will be served by an individual sewage disposal system, health department approval is required PRIOR to submitting this application. Contact the County Health Department, (304 ) (Address)
COUNTY HEALTH DEPARTMENT APPROVAL
¨ APPROVECONDITION(S)
¨ DISAPPROVE
SIGNATURE
County Health Department OfficialDate
COMPLETE THIS SECTION FOR NEW CONSTRUCTION OF:
COMMERCIAL, INDUSTRIAL,
MULTI-FAMILY, AND/OR LEASE COMMUNITY
Optional / WILL THE PROPERTY BE¨ LEASEDor¨ OWNED
NAME OF DEVELOPMENT
¨ MULTIFAMILY:
¨ TOWNHOUSE :NUMBER OF DWELLING UNITS:
¨ APARTMENT:NUMBER OF DWELLING UNITS:
¨ CONDOMINIUM:NUMBER OF DWELLING UNITS:
¨ COMMERCIAL:TYPE OF BUSINESS(ES) Required But Can Be Less Detailed
NUMBER OF SEPARATE BUSINESSES
¨ INDUSTRIAL:TYPE OF INDUSTRY
NUMBER OF SEPARATE BUSINESSES
¨ LEASE COMMUNITY:COMMUNITY NAME
ALL APPLICATIONS FOR PERMITS FOR COMMERCIAL, INDUSTRIAL, MULTI-FAMILY, AND FACTORY-BUILT RENTAL COMMUNITY STRUCTURES SHALL BE ACCOMPANIED BY:
- Drainage plan and drainage calculations signed by a registered professional engineer
- Designs of storm water detention facility signed by a registered professional engineer, if applicable
- WV Division of Highways Access Permit, if access is onto state highway
- State of WV NPDES General Permit for Storm water Associated with Construction Activity, of land disturbance if over one (1) acre. If land disturbance is less than one (1) acre. Notify DEP, a Sediment Control Plan is recommended.
*NOTICE: Can Be Modified for Legal Issues
I hereby certify that I have read and examined this document and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. Granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. Applicant hereby gives __ (community) _ consent to enter property to inspect for compliance.
*Signature of Property Owner, Contractor or OtherDate
RETURN APPLICATION TO: (OFFICE OF), (Address) Telephone: (304) FAX: (304) (Office Hours)MAKE CHECKS PAYABLE TO: (Community)
TO BE COMPLETED BY BUILDING PERMIT OFFICER: Can Be Modified For Financial
*FEE: AMOUNT PAID: RECEIPT #:
BUILDING: CASH¨ CHECK ¨
INVOICE #:
Optional
ZONING: CHECK #: DATE PAID:
Optional Optional
Zoning District Tax Map Parcel *FEMA Panel __ *Flood Zone *Floodway______
Optional
¨ PERMITTED PRINCIPAL USE * PERMITTED ACCESSORY USE Optional ¨ SPECIAL PERMIT USE
Use Use Use
COMMENTS:
*SEE ATTACHMENT FOR CONDITIONS