COUNTY OF HAMPSHIRE, STATE OF WEST VIRGINIA
Permit # __________
Fee $ ____________
(All fees are non-refundable)
| Office Use Only |
|Is THE BUILDING SITE LOCATED IN THE 100 YEAR FLOOD Zone? |
|YES / NO initials:______________ |
|Is the property located in the 100 year Flood Zone? |
|yes / no initials:______________ |
Building permit Fees:
Construction costs $0 - $12,500 ……..…….…….. $25
Over $12,500………………………… $2 per thousand
Check payable to Hampshire County Sheriff
Applicant Information
Name: __________________________________________
Address: _____________________________________
City/St/Zip:___________________________________
Phone:_______________________________________
Cell: ________________________________________
□ Mail □ Call for Pick-up
Property Owner (If different from applicant)
Name: ___________________________________________
Address: ______________________________________
City/St/Zip:____________________________________
Phone:________________________________________
Property Tax ID
District _________ Map _________ Parcel ___________
Acres or Lot Size: ________________
PROPERTY location
(911 Address, or reference to roads, subdivision name & lot no.)
____________________________________________________
____________________________________________________
Contractor Information
(If different from applicant)
Contractor 1__________________________WV#_____________
City:__________________________ Ph.___________________
Contractor 2 _________________________WV#_____________
City:__________________________ Ph.___________________
Contractor 3__________________________WV#_____________
City:__________________________ Ph.___________________
Required Permits (if applicable)
Water System: DW- ___________________________________
Sewer System: ST- ____________________________________
Flood Plain Elevation Certificate: _________________________
{Attach copies of all permits, PSD Letter of Availability, certifications, etc.}
Please Include Site Plan showing
all structures, well, and septic
Receipt # ______________________
Building Information
Number of Bathrooms: Existing _____ New _____
Number of Bedrooms: Existing _____ New _____
Type of Construction: (Check One)
□ Outbuilding (detached garage, barn, shed, etc.)
□ Addition (deck, extra room, attached garage, etc.)
□ Other( renovation, pool, fence, roof, windows, solar, tower)
□ Excavation/Earthwork
Residential:
□ Stick Built □ Modular □ Manufactured □ Mobile (Yr_____)
Foundation:
□ Basement □ Crawl Space □ Slab □ Pier/Post
Commercial:
□ Stick Built □ Manufactured/Industrialized
Is this your primary residence? □ Yes □ No
Estimated Cost: ______________________________
Expected Completion Date: ____________________
Dimensions: _________________________________
Proposed Work: _____________________________
Heat Source: _________________________________
| |
|I hereby certify to the best of my knowledge that all information provided |
|for this application is true and correct, and that if property is located in |
|the Special Flood Hazard Area, I will strictly adhere to the Hampshire County|
|Floodplain Ordinance. |
| |
|_______________________________________ |
|Applicant’s Signature Date |
___________________________________________
Building Permit Officer’s Signature Date
____________________________________________
County Commission President’s Signature Date
-----------------------
COUNTY OF HAMPSHIRE, STATE OF WEST VIRGINIA
Building/Floodplain Determination Permit Application
HC Planning Office • PO Box 883, Romney, WV 26757 • (304) 822-7018 • (304)822-5115 Fax
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