gown Of Toranci, Actine
CODE ENFORCEMENT OFFICE
CERTIFICATE OF OCCUPANCY
3/28/2006
CERT. DATE
CERT. NO.
2006-070
BUILDING PERMIT NO. 2004-341
DATE ISSUED 8/30/2004
ROAD LOCATION 65 SIMPLICITY WAY
MAP 1
LOT A-12
8 SUB LOT BUILDING OWNER RICHARD J. SPEAR
MAILING ADDRESS 24 FIELD VIEW DRIVE, NEw GLOUCESTER, MAINE
THIS IS TO CERTIFY THAT
28' X36' TWO STORY COLONIAL ON A FULL BASEMENT WITH AN ATTACHED 2-BAY GARAGE
HAS BEEN INSPECTED AND THE FOLLOWING OCCUPANCY THERE OF IS HEREBY AUTHORIZED
CONSTRUCTION TYPE:
OCCuPANcY NumBER:
UsE:
V-B
SINGLE FAMILY DWELLING
6
OCCUPANCIES
PERMANENT TEMPORARY NOT APPLICABLE
BASEMENT
X
FIRST FLOOR
X
SECOND FLOOR
X
THIRD FLOOR
GARAGE
X
OTHER
(SPECIFY)
INSPECTION APPROVALS
YES
STRUCTURAL
MECHANICAL
INTERNAL PLUMBING
SEPTIC SYSTEM
ELECTRICAL
FIRE DEPT.
No
MANUFACTURED
NOT REQUIRED INSPECTOR
X
X
X
X
MANUFACTURED INSPECTION TAG NOS.
SPECIAL CONDITIONS
I. DISH WASHER, WHEN INSTALLED, SHALL BE ON ITS OWN DRAIN TRAP WITH AN AIR BREAK DEVICE IN LINE.
2. LANDSCAPING SHALL BE COMPLETED BY JUNE 30, 2006.
OP' 1/
ARTHUR C. DUNLAP
CODE ENFORCEMENT OFFIC
0—own of Torancf
Code Enforcement Office
1231 Maine Street - PO Box 38
Poland, Maine 04274-0038
Tel: (207) 998-4601
BUILDING PERMIT
1 Lot #
Simplicity Way
Map #
Road Location:
8 Sublot # A-12
Permit #
Expiration DATE
2004-341
August 30, 2006
Tel. #
Richard J. Spear Land Owner
24 Field View Drive, New Gloucester, Maine
Mailing Address:
Tel. #
Applicant/Contractor: Richard J. Spear 24
Field
View
Drive,
New
Gloucester,
Maine
Mailing Address:
Project Description:
Build a 28' x 36' two-story dwelling on a full basement.
Also a 24' x 24' one-story garage with a 10' x 18' entryway attached to to the house and garage.
Also a 12' x 14' deck on the southerly side of the dwelling.
Also a 10' x 6' covered porch in front of entryway.
Permit Rates
Floor Space (Sq Ft)
1,188 $ 0.077 /Sq Ft
1,188 $ 0.150 /Sq Ft
First
37 Ac
1,008 $ 0.150 /Sq Ft
Second
1
Attc
$ 0.077 /Sq Ft
5-B
0.097 /Sq Ft
576
Garage
3
0.086 /Sq Ft
Carport
2
$ 0.080 /Sq Ft
Pool
yes
168 $ 0.077 /Sq Ft
Deck
yes
60 $ 0.077 /Sq Ft
oil FHW Patio/Porch
$ 0.086 /Sq Ft
Shed
no
Barn
no
$ 0.086 /Sq Ft
4,188 Total Sq Ft
I understand that this permit is valid only for the use specified
above. Any changes must be approved by the permitting
authority.
I hereby acknowledge that I have read this application and STATE
that the above information is correct, and AGREE to comply with
ALL Municipal Ordinances and State Laws regulating activities
covered by this permit.
Est. Value
Lot Size
Buildings
Type Const.
Bedrooms
Stories
Electricity
Plumbing
Heating
Fireplace
Woodstove
$ 207,775 Basement
f+f4/
Applicant's gna ure
926-6137
04260
926-6137
04260
Location
Village - 1
No
No
District
Shoreland
Flood Zone
Commercial
No
REQUIRED SETBACKS
50 FEET FROM EDGE OF RIGHT OF WAY
40 FEET FROM SIDE AND REAR LINES
FEES:
Application
Building Permit
Septic Permit
Interior Plumbing
Electrical
Road Entry
Demolition
TOTAL
25.00
494.00
100.00
25.00
644.00 I
Date
This permit is approved on the basis of information provided by the applicant regarding his ownership and boundary
locations. The applicant has the burden of ensuring that he has legal right to use the property and that he is
measuring required setbacks from the legal boundary lines of the lot. The approval of this permit in no way relieves
the applicant of this burden. Nor does this permit approval constitute a resolution in favor of the applicant of any
issues regarding the property boundaries, ownership, or similar title issues.
30-Aug-04
DATE
PERMIT ISSUED BY:
Code Enforcement Offic
ALL STRUCTURES MUST MEET AT LEAST TH 2000 BOCA STANDARDS FOR CONSTRUCTION
Construction Must be Substantially Started Within Six Months Of Being Issued Or Permit Becomes Void.
Mobile Homes Must Be Anchored to Slab or Foundation With Proper Number of Tie Downs
Bill Willett N
404
Subject:
Location:
Richard Spear
Simplicity Drive - M - 1,
Start:
End:
Wed 3/22/2006 2:00 PM
Wed 3/22/2006 3:00 PM
Recurrence:
(none)
1.
n.
Final Inspection & Street Number
1
CEO Office Tel: 207-998-4604
Main Office Tel: 207-998-4601
@Own of Torand
Code (Enforcement Office
1231 Aaine Street, T.O. (Box 38
Totand, Xaine 04274-0038
Tuesday, March 28, 2006
Richard Spear
24 Field View Drive
New Gloucester, Maine 04060-3655
Tax Map Lot Location:
Map 1
Lot 8
Sub-lot A-12
Additional Information:
New Address:
65 Simplicity Way
Poland, Maine 04274
IF YOU WANT TO USE THIS AS YOUR MAILING ADDRESS, YOU MUST NOTIFY THE
POLAND POST OFFICE ON 965 MAINE STREET (Route 26).
The Town of Poland has a Street Naming and Numbering Ordinance. All businesses and residences in the
Town of Poland need a street number assigned to them. This form is to let you know the new street number and
address for the building located at the location indicated above.
The Ordinance requires that each property owner display a street number on their principal building.
The following are the guidelines and rules for displaying the street number on your buildings:
1. Number will be in block form and not script.
2. Numbers must be at least four inches high.
3. Numbers are to be located near the front door of the building.
4.
Numbers will be on a contrasting background to make them easy to read.
5. Numbers must be easily seen from the road.
6. Buildings more than 100 feet from the road or are not visible from the road need to install a post at
the driveway entrance to the building with the street number on it. The numbers need to follow
guidelines 1, 2, 4, & 5, above and be at least four feet above the ground but no more than eight
feet above the ground.
7. Inform the Town Tax Assessor of the mailing address you will use.
Art Dunlap, Code Enforcement Officer
Dili Willett
Subject:
Location:
Richard Spear - SSWD Inspection
Simplicity Way, Map - 1, Lot - 8A, Sub - 12
Start:
End:
Wed 7/6/2005 3:00 PM
Wed 7/6/2005 4:00 PM
Recurrence:
(none)
1.
Stopped by to ask for inspection;
2.
Paced and verify bed dementions 20' X 45';
3.
Paced Side lines to bed and septic tank from house;
4.
Pipe and Bed calculations:
a)
ERP 00
b)
Laser -25"
c)
Pipes -53"
d)
Stick -28" or 2' - 4"
5.
Approved work.
ERP 00
Laser -25"
Bottom-64"
Stick -39" or 3' - 3";
I 40.3
SUBSURFACE WASTEWATER
DISPOSAL SYSTEM APPUCATION
MOM - ATTACH MI SPACE SEWN 44
WIDOW
POL
iioioi
$1i
30 7-ao
L.P.I.#
'
,
Local Plumbing Inspec or Sature
if
TOWN COPY :3076
uaee
Permit
!esti d:
°1 6-
Double Fee
FEE Charged
-
IY -13
I
rnto)
DIMON MOW
Z76 aeons per day
SABO Olt
AG 1.10bIs
MA Welling WIN
0 2. Table 601.2 OTOWballies)
SHOW OtaiLATIONS
— for dhow SWIM —
3 6edko-cwL/c7D
3. Won 503.0 (=Ty roodises)
ATTACH WATERT/MIR DATA
I wally est on that the proposed
a site evabudion an Ilk property and state Mattis data reported sre accurate and
(date) I 011oopieted
t Ftules (113-1W CMR 241).
Is in compilance wit the State cA Maine Subsurface Wastewater Mean
?--(4)
3
zoloq
Date
/UP 3
SUBSURFAN WASTSIDAThit DISPOSAL SYS= APPUCATION
Skeet, Road, SUbdivlidon
Town, City, Plentalion 7 4-ow'SIMs
PLAN
5kti1A,k-Scale
I"
Department of Human Services
Dhtleion of Health Englneerktg
(207) 2874872 Fa= (201) 2037-3165
Ownees Name
I** n
CAN(
CO ft. or u Shown
srrs LOCATION PLAN
Make Atka
imcacomeaded)
(map AM
,
v
SOIL DESCRIPTION AND CLASSIFICATION (Location of Observation Holes Shown Above)
1:3 Teat Pit 0 Boring
Obsetvatiam Hole
Observation Hole —al 0 Ng Test Pit DBcIhlZ
Depth
of
Organic
Horizon Above Mineral Soli
"
Depth ofOtganie Hodson Above Mineral Soil
Moiling
Cassistoney Woe Tad=
•
Color
Ji
•
.
Talon
0
11. IMW MI=
111•n•
11n0
,-,10
10
.
=
W.W.MO
^
120
A
eo = .5) (mati
k
0-0/\
11WnPW
130
30
wO.
••n•••n•••
^
40
^
40
7
^
NEM
50
WO.
SailOsaifiadsa
c-
Psellis Cold=
Sap
z-
rails
or
a_d1
fifigariMatar
VI= talge
CjlitOsok
f
881
150
Sal Chsdaratial Slope
—Tro
Pzii
?Ai
Date
—
rifts I Onord War
I I Itsiddiss Leer
Pub"
[ 1 D“rodc
• [ Ph Dece
Psge 2 of 3
1111E-201) Rev. 8101
Depadmet of Human Sendces
Division of Health Engineedng
SUBSURFACE WASTEWATER DISPOSAL SYSTEM APPLICATION
War. 1%k 1,1 Ez/4-ai4 .4)1-
R-'4f4A-4 . Secm,-
) 2-
SUBSUBFACE WASTIMATICR DISPOSAL FLAN
Note: Materials and installation shall
be in accordance with Maine Subsurface
Wastewater Disposal Rules dated 10/02
as amended.
NtLIEQUIREBEINIS
DR& ofF111 (0Page)
DLO otIPIE(Dowedope) Up
Finbiliedesie Medias
Top etniftlielian Pipe cePteFietety Device
Bottom °ram ped Axes
,LOAM S SEIID
SCALE:
y
Seale
DISPOSAL AREA CROSS SEClION
Batiseatal
Waded
2" HAY OR EQUAL
' 4" 01A. (TYR)
12" MN 3/4"-21/2"
DIA, STONE
20'-0"
5'-0"
5' - 0"
•
al"
9AL
i•it.
3' SHOULDER
(TYP)
5! -0"
"%Mk TWW1.
261`
Co AC74,-(5
(4)L-(
?
Ste Evalodor Simms
It
0
EaSseace Ekratlote 1r-12",CLEAN FILL
51 -0"
1"—
ELEVATION REPERENCII poen,.
(r?
Leetdon isDeeenotioa:
ELEVATICINS
t
pon 287-3185
Ownefs Name
Street, Road, Subdviaion
Toam, City, (31entalion J.
(207) 2574872 Floc
73
SE #
Date
Page 3 of 3
MM-200 Rev. NI
Bill Willett
Subject:
Location:
Richard Spear - SSWDInspection
Simplicity Way, Map - 1, Lot - 8A, Sub - 12
Start:
End:
Wed 7/6/2005 3:00 PM
Wed 7/6/2005 4:00 PM
Recurrence:
(none)
1.
Stopped by to ask for inspection;
6K-K
5,-3
cd(1
ee —set
6,-cl-DA —64'1 s'e
stl(tiR
1
PLUMBING APPLICATION
40 1/
ad
A-IL-
Department of Human Sciences
Division of Health Engineering
ROPERTY ADDRESS
PROPERTY OWNERS NAME
Last:
RM1T
IT5RIN
311. 6
L.P.i.# First:
Mailing Address of
Owner/Applicant
(If Different)
Owner/Applicant Statement
Caution: Inspection Required
I certify that the information submitted is correct to the best of my
knowledge and understand that any falsification is reason for the Local
Plumbing Inspectors to deny a Permit.
I have inspected the installation authorized above and found it to be in
compliance with the Maine Plumbing Rules.
4 41
Signature of OWner/Applicant
C;1*Date
Local Plumbing Inspector Signature
Date Approved
PERMIT INFORMATION
This Application is for
Type of Structure To Be Served:
1. X, NEW PLUMBING
1. ig-SINGLE FAMILY DWELLING
2. 0 RELOCATED
PLUMBING
2. LI MODULAR OR MOBILE HOME
3. 0 MULTIPLE FAMILY DWELLING
4. El OTHER — SPECIFY
Plumbing To Be Installed By:
1. la
Number
HOOK-UP: to public sewer in
those cases where the connection
is not regulated and inspected by
the local Sanitary District.
OR
HOOK-UP: to an existing subsurface
wastewater disposal system.
PIPING RELOCATION: of sanitary
lines, drains, and piping without
new fixtures.
OR
TRANSFER FEE
[$6.00]
Column 2
Type of Fixture
LICENSE # jL
(7,31
Number
Column 1
Type of Fixture
Hosebibb / Sillcock
Bathtub (and Shower)
Floor Drain
Shower (Separate)
Urinal
Sink
Drinking Fountain
Wash Basin
Indirect Waste
Water Closet (Toilet)
Water Treatment Softener, Filter, etc.
Clothes Washer
Grease / Oil Separator
Dish Washer
Dental Cuspidor
Garbage Disposal
Bidet
Laundry Tub
Other. Water Heater
Fixtures (Subtotal)
Column 2
SEE PERMIT FEE SCHEDULE
FOR CALCULATING FEE
Page 1 of 1
HHE-211 Rev. 6;94
PUBLIC UTILITY EMPLOYEE
111 PROPERTY OWNER
4. Li
5.
Hook-Up & Piping Relocation
Maximum of 1 Hook-Up
MASTER PLUMBER
2. 111 OIL BURNERMAN
3. 0 MFG'D. HOUSING DEALEI9/MECHANIC
Town of Toland, Xcline
Code Enforcement Office
1231 Maine Street - PO Box 38
Poland. Maine 04274-0038
Tel:
(207) 998-4601
ELECTRICAL PERMIT
Map #
Road Location:
Lot # S
SuMat
e
-
Application
Building Permit #
A 42 Application DATE:10 1z5 I 04
itoy
Applicant / Land Owner 'R IC ita,r4
ecor
Mailing Address:
2 Li, rfek
Electrical Cont.
C e A eVectric
License Number
03 b
Mailing Address:
Dia 4-/
yvn 361
\Zcc
a00 - 3 1 )
Tel. # 24 - 13 7
Iouceciw
Tel. #
r.2_- ) 3))
"OM...X.
I'VC
LI ()
Project Description:
s in (e Fool 1-601e, to
INSTALLATION DETAILS
Item
Outside Lighting & Signs
Item
Service Entrances
Temporary
Overhead, permanent
Underground, permanent
Remote & Sub Panels
Qty
Amount Rate/ ea
i
Transformers
Vaults
Tranformers
Underground J-box
Motor devices
Sewer pump
Well pump
Furnace system
Motors <= 3 HP
Motors > 3HP
Generator Transfer Sw
/1,41 rau A S Service
d
1
$
$
-
$
$
$
-
$
$
-
$
$
$
$
-
$
$
$
$
$
-
$
$
$
-
$
$
$
$
-
$
$
$
20.00
20.00
30.00
8.00
Amount
Lighted Signs
Parking Lot/Street
Lamp Posts
Non Entryway
$
$
$
$
-
$
$
$
$
4.00
4.00
4.00
4.00
Alarm Systems
$
-
$
4.00
7
4/ 6
$
$
-
$
$
30
$
-
$
I
$
-
$
$
-
$
0.30
0.30
0.30
0.30
0.30
0.30
0.30
0.30
8.00
8.00 Fixture Boxes
4.00 Smoke & CO Detectors
Recptacles
Switches
4.00 Permanent lighting
4.00 Range/ Oven
4.00 Dryers
4.00 Water Heaters
6.00 Other
8.00
26
f
-
$
$
$
SUB TOTAL $ 71
APPLICATION FEE $
Minimum Charge $20.00
I understand that this permit application is valid only for the use specified
above. Any changes must be approved by the permitting Authority.
ITotal Amount Due
DATE
Applicants signature
DATE
APPLICATION REVIEWED BY:
Code Enforcement Officer
130
10.00
$ 1l -36
I HEREBY ACKNOWLEDGE that I have read this application and state
that the above information is correct, and AGREE to comply with
tate Laws regulating activities
El
all Municipal rdina
cover b this
Electrical Inspector, Larry Cloutier - Tel: 998-2165
All wiring must meet the current National Electrical Codes
Rate/ea
0
$
$
$
Electrical Permit
ETowil of (Poralla
Code Enforcement Office
1231 Maine Street - PO Box 38
Poland. Maine 04274-0038
Tel: (207) 998-4601
ELECTRICAL PERMIT
Map #
Road Location:
Land Owner
Mailing Address:
Electrical Cont.
License Number
Mailing Address:
Project Description:
1 Lot #
8 Sublot # A-12
Simplicity Way
2004-341
Permit #
Expiration DATE
25-Oct-06
Tel. #
Richard J. Spear
24 Field View Drive, New Gloucester, Maine
Tel. #
C&A Electric
17036
264 Falmouth Road, Windham, Maine
926-6137
04260
892-1077
Wire new house
Item
Application
Service Entrances
Temporary
Permanent
Remote Panels
Qty
Amount
1 $ 10.00
1
$
FEES DETAILS
Item
Outside Lighting & Signs
Lighted Signs
Parking Lot/Street
Lamp Posts
Non Entryway
30.00
Transformers
Vaults
0 - 25 KVA
26 - 200 KVA
Over 200KVA
Motors & Generators
Sewer Pump
Water Pump
Furnace System
Motors <= 3 hp
Motors >3hp
Generator hook up
Amount
Qty
Alarm Systems
1
1
$
$
Fixture Boxes
Smoke & CO Alarms
Receptacles
Light Switches
Permanent lighting
Range/ovens
Dryers
Water Heater
Other
4.00
4.00
2.10
13.80
9.00
7.80
0.30
0.30
7
46
30
26
1
1
56.30
TOTAL
Amount
Minimum Charge $20.00
I understand that this permit is valid only for the use specified
above. Any changes must be approved by the permit-fing
authority.
I hereby acknowledge that I have read this application and STATE
that the above information is correct, and AGREE to comply with
ALL Municipal Ordinances and State Laws regulating activities
covered by this permit.
$
Due
DATE OC)
56.00
2T
Applicants si a ure
DATE
PERMIT ISSUED BY:
25-Oct-04
Code Enforcernent I ier
Contact Electrcal Inspector, Larry Cloutie or rough in and final inspections - Tel: 627 - 7036
All wiring must meet the current National Electrical odes
Page 1
Poland BP Application
Town of Tofancf, gkaine
Cock (Enforcement Office
PO Box 38, Poland, Maine 04274-0038
Tel: 207-998-4604
Residential Building /Use Application
Date Application Received:
LOT BASIC INFORMATION:
,v
Map # i
Lot # 0 Sub #
Road Location Lot Size 2, 07 Acres or Sq. Ft.
Year lot created: 2 /
Land Owner(s): Rtcitc,S Spear-
4 I( 3 /7/
Permit # 2-
A - 1 2.
S i 4,Tio Act
0
Mobile Site #
fj LO-zr
Road Frontage: ttt9e3 2
Q03 (If unknown, give best guess with +/- after date)
tet 1)(e-,-- b /ivt
Mail Address: a(
Town/State/Zip Ak.0 6/ouc-Ailei5 f4
747
Ft.
Estimated Value of Construction $ Work Phone: Tio - 07a)
Home Phone: ci Z6 - 6 /3 7
Ce_Ct)
(round to nearest $100)
APPLICANT
Applicant is: X Landowner Contractor Renter
Iffollowing
not the information:
landowner, submit a letter of permission to construct
or contract to buy from
the landowner, along withBuyer
the
Name(s): Company
Mail Address: Work Phone:
Town/State/Zip
Alternate Phone: LOT USE:
Zoning District: (),
Current Use of Lot:
1 i 1fe
Flood Zone District: klo-
c
V. c LA 1---
a copy of any deed or subdivision restrictions
(use extra sheet of paper i f necessary): g oldie
Submit
Proposed Construction or Use of Lot
Rev 2002.10.28
Page 1 of 4
A 44
1404--Q__
Poland BP Application
EXISTING
LOT CONDITIONS
/
Grounds
Undeveloped lot
Yes No (If Yes, go to next Page)
Not applicable
Yes
No
If no, supply information of well installer.
Not applicable
No
Yes
Subsurface Wastewater System
If yes, submit a copy of a SSWS permit, or drawings showing location.
If no, submit 3 copies of a SSWS application.
No
Yes Existing Road Entry
If no, submit road entry permit signed by proper authority.
No
Yes
If yes, will there be any changes
If yes, submit road entry permit signed by proper authority
No
Yes Structures to be removed
If yes, submit information about the structure to be removed and how any debris will be disposed.
Lawns and other grounds improvements
Sq. Ft. or Acres
Size of lawns
Sq. Ft. or Acres
Size of fields
Sq. Ft. or Acres
Other open areas
Sq. Ft. or Acres
Filled wetlands
Well
Main Structure
Ground Foot Print
Total Floor Space
Road Frontage Setback
Side Setback
Rear Setback
Distance to Great Pond
Distance to Stream
Distance to Wetlands
Sq. Ft. (include drip edge of eaves.)
Sq. Ft. (exterior dimensions)
Ft.
Ft.
Ft.
Not applicable (over 250')
Ft.
Not applicable (over 250')
Ft.
Not applicable (over 250')
Ft.
Number of Bedrooms
Electric Oil
Gas
Heating system FHA FHW Type of Heat Distribution
Wood stove
Alternative Heating
Frost Walls
Full Basement Foundation
Volts
Amps
Size of Electrical Service Entrance
Accessory Structures
Total Number of Structures
Total Ground Foot Print
Total Floor Space
Closest Road Setback
Closest Side Setback
Closest Rear Setback
Distance to Great Pond
Distance to Streams
Distance to Wetlands
Rev 2002.10.28
Sq. Ft.
Sq. Ft.
Ft.
Ft.
Ft.
Ft.
Ft.
Ft.
Page 2 of 4
None
Other Radiant
Fireplace
Piers
Slab Phase(s)
Not applicable (over 250')
Not applicable (over 250')
Not applicable (over 250')
Poland BP Application
PROPOSED
CONSTRUCTION INFORMATION
Grounds—New Development: (Submit Lot Plan)
Forest Opening
Sq. Ft.
Driveway
Sq. Ft.
Lawns
Sq. Ft.
Open Space Sq. Ft.
TOTAL
Sq. Ft.
•
Well Installer A.Acte. P4Q,,e
SSWS Installer 'cl/t,,4
Ft.
Number of Bedrooms
Main Heating System* c..) n
Alternate Heating
Foundation Type** fa/
re
CUl CirAe
Pools
Above Ground In Ground
Patio/deck area
Pool house
Rev 2002.10.28
Sq. Ft.
Sq. Ft.
Sq. Ft.
Sq. Ft.
Will new construction meet standard setback
requirements?
%./. Yes
No
If no, submit information to substantiate reasons to
allow closer setbacks.
CO? **Indicate Full walls, frost walls, slab,
Heating System
Foundation Type
Heating System
Foundation Type
Basement Area: (Submit drawing)
Unfmished IPS Sq. Ft.
Finished
Sq. Ft.
Garage
Sq. Ft.
First Floor Area: (Submit drawing)
Main structure 1 FS'
Sq. Ft.
Decks
Sq. Ft.
Porches
CO
Sq. Ft.
574
Garage
Sq. Ft.
Sheds
Sq. Ft.
Second Floor Area: (Submit drawing)
Main Structure Sq. Ft.
Balcony
Sq. Ft.
Storage area Sq. Ft.
Attic or higher floor areas: (Submit drawing)
Main Structure
Sq. Ft.
Over Garage Sq. Ft.
*Indicate oil, gas, wood and FlIW, FHA, RADiant
piers, etc. and
Sq. Ft.
Sq. Ft.
Sq. Ft.
Sheds / Gazebos / Barns (Submit drawing)
Basement
Sq. Ft.
Main Floor Sq. Ft.
Second Floor Sq. Ft.
Loft
Sq. Ft.
Main Structure (Submit Lot Plan)
Lot width at bldg. location
Detached Accessory Structures
Garages / Carports (Submit drawing)
Main Floor ' Second Floor Attached shed Is new project within 250 feet of a pond,
stream, or wetland?,
Yes
%, No
Total Building Floor Area 2/ / citc• Sq. Ft.
type of material
Page 3 of 4
Poland BP Application
DISCLOSURE: (READ CAREFULLY BEFORE SIGNING)
I hereby acknowledge that I have read this application and state that the information in this document is to
the best of my knowledge correct and accurate. I agree to comply with all the Town of Poland's ordinances and the
State of Maine's statutes regulating the activities sought in this application as well as any permit(s) approved for this
application.
I understand that all construction of structures shall conform to the BOCA Building Codes of 1978, or later
edition, and the NFPA-101 Life Safety Codes of 1997.
I understand that any permit(s) approved is/are valid for only the use(s) as specified in the application(s).
The permitting authority must approve any change(s) made to the use(s) sought in this application. Any permit(s)
issued for this application is/are approved on the basis of truthful information provided by the applicant(s) listed in
this document, and as allowed by the ordinances of the town.
I understand that it is my responsibility to assure that the lot description herein accurately describes its
ownership, its boundary lines, and the setback measurements from the legal boundary lines.
I understand that I have the burden of proof as to the legal right to use the property, and approval of this
application in no way relieves me of this burden. Any permit approval issued does not constitute a resolution in
favor of myself or the landowner in any matters regarding the property boundaries, ownership, or similar titles.
I understand that if I fail to comply with the aforementioned statements, a "STOP WORK" order may be
issued for which I will immediately halt any use(s) that are approved for this application. This failure may also
require that I return the property to its natural state or as closely thereto before the use(s) were approved.
I understand that a Certificate of Occupancy or Compliance shall be required prior to the start of
any use or occupancy associated with this application unless a signed written waiver is issued with the permit. Fines
and penalties may be issued if use or occupancy is started prior to the issuance of the certificate.
I understand that the issued permit becomes invalid if: construction or use has not commenced
within six (6) months; construction is suspended for more than six (6) months and no notice for just cause is
submitted prior to the end of the six (6) months; or it is found that false statements have been furnished in this
application.
I understand that all state and federal permits are the responsibility of the applicant.
Pi 0/ Of'
D te
Applicant ignature
04/
This application received first review by the Code Enforcement Office on Date
This application is:
/// Approved
Disapproved
Incomplete
Referred to the Planning Board
Re
—al-arrfelf4lea-ap1,rovg! /2/mad A/0-0-el
ctrynriA
Code Eiforcement Officer '
Rev 2002.10.28
."--d
Date
Page 4 of 4