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Revised 6/3/16 Land Use Permit Application 1 of 2
Town of Holderness
PO Box 203, Route 3
Holderness, NH 03245-0203
Phone: (603) 968-2145
Fax: (603) 968-9954
landuse@holderness-nh.gov
Date Received
Permit Number
Permit Fee
Check #
Received By
TOWN OF HOLDERNESS LAND USE
BUILDING PERMIT APPLICATION
__________________________________________________________________________________
PROPERTY OWNER(S)
__________
________________________________________________________________________
PROPERTY LOCATION (Physical Address)
TAX MAP #_________ LOT# ________ SUB-LOT# _________
Mailing
Address____________________________________________________________________
Telephone # __________________ Email________________________________________
Contractor’s name and phone number____________________________________________
ZONING DISTRICT: Rural/Residential General Residential
Commercial Flood Hazard River Corridor
YES NO: Is there an existing living space/dwelling on the property?
YES NO: Is any portion of the property in current use or conservation easement?
YES NO: Are there wetlands located on or adjacent to the property?
YES NO: Does the proposed work include adding or upgrading a heating system?
Please describe the proposed structure and its use:______________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Please attach a drawing to scale showing location of structure on lot and the distance to each
boundary.
Total construction area square footage: Estimated project cost
Evidence of all required State and Federal permit approvals is attached.
Any violation of the Holderness Zoning Ordinance is subject to a fine of up to $275.00 for
Revised 3/19 Land Use Permit Application 2 of 2
each day of each violation (see RSA: 676:17)
Zoning Ordinance
1000.2.6: Permits issued by the Selectmen for construction or demolition shall
be good for a maximum of 2 years. The Selectmen may issue a permit for a lesser amount of time.
Permits issued for “use” or in conjunction with Special Exceptions or Variances granted by the
Zoning Board of Adjustment are valid until 1 year after the “use” or activity associated with the
Variance or Special Exception ceases.
WETLANDS: I/We understand that before any structure or other project, or portion thereof may take place
in any wetland as defined in RSA 482-A:2 X, that first I/We must apply to the New Hampshire Department
of Environmental Services, Wetlands Division. (606-271-3503).
I/We further certify that this structure or project will comply with other provisions of the Holderness
Zoning Ordinance, Subdivision/Site Plan Regulations, New Hampshire Energy Code, Subsurface
Sewage Disposal Criteria, New Hampshire Standards for significant alteration of terrain which may
affect runoff (RSA 485-A), Comprehensive Shoreland Protection Act, State of New Hampshire
Building Code and all applicable State and Federal Laws.
SIGNATURE OF APPLICANT(S) ________________________________DATE: ______________
If applicant is other than the owner(s) of the property, you must obtain the owner(s) signature.
The undersigned owner(s) of the property under application hereby authorize the below
named agent to act for me in presenting this application and furnishing all required information.
OWNER(S) SIGNATURE: _______________________________________DATE: ______________
Required of the Applicant
Yes No: At the completion of the project and before the new structure is occupied or put to
use, the applicant is required to submit to the Town Office the attached Certificate of Compliance form.
Comments or conditions of approval: ________________________________________________
OFFICE USE ONLY
Septic System Approval # ________ NH Energy Code Approval # ________
N H Wetlands Permit ___________ Lot Sketch Showing Setbacks _______
Current Use Status Change _______ Conditional Permit Approved/Denied ________
Smoke Detectors Required________ New House Number Assigned_______
New furnace or upgrade to existing furnace ________
Permission is hereby granted for the construction of the structure or project as identified on this permit.
Construction must begin within six months of the date of issuance of this permit. The permit is valid for a
period of two years from the date construction begins. The permit is only valid for the specific work set
forth in the permit.
________________________________________________ __________________
Eleanor Mardin, Compliance Officer Date
OR
________________________________________________ __________________
Michael Capone, Town Administrator Date
Revised 6/3/16 Land Use Permit Application 1 of 2
TOWN OF HOLDERNESS
PO BOX 203
HOLDERNESS, NH 03245
(603) 968-2145
www.holderness-nh.gov
landuseofficer@holderness-nh.gov
Any person, persons, partnership, trust, corporation, or LLC intending to erect, construct, alter or
reconstruct any building or structure shall first make application for a permit on forms obtained from the
Selectmen’s Office or the town web site.
The following list includes, but is not limited to, items which are exempt from the requirements of a
building permit: roof and siding replacement in-kind; window replacement, when not increasing the
header size; or changing bath fixtures in-kind. Please be aware that window replacement will require
egress compliance with the building code. Please direct questions or requests for assistance to the
Compliance Officer (landuseofficer@holderness-nh.gov).
Building Permit Procedure
Please be sure the application form is complete with all information pertinent to your project. In addition,
the following must be completed or provided, if applicable:
o The proposed building/structure location must be staked out with side and back property lines
marked.
o Copies of any Zoning and/or Planning approvals, or dates of such approvals and requirements.
o A signed statement of the intended use of said structure or alteration on the Building Permit
Application.
o A plot plan to scale with all setbacks from new construction to include, lot lines, septic, well,
wetlands, lake and roads, and any other pertinent setbacks. The plan should show all existing
structures on the lot and the distance between the existing building and any new construction,
road frontage and / or shore frontage of the lot, any rights-of-way or easements, steep slopes area,
whether the road is a class VI or private road, and if the property is in current use. Please review
the Zoning Ordinance to be sure you have met all the standards required for your Zoning
district.
o Total square footage of the construction which must include all floors, including basement and
loft areas. This total is used for fee calculation.
o Septic System, (state “approval for construction” number), if required by state or town
regulations (see page 2).
o Approved driveway permit: town road - contact the Holderness Department of Public Works at
536-2932; state road - contact the NH Department of Transportation, 2 Sawmill Road,
Gilford NH 03246 (603) 524-6667.
o New Hampshire Energy Code approval number, unless exempt by Energy Code: contact NH
Public Utilities Commission, 21 S. Fruit Street, Suite 10, Concord, NH 03301-2429, (603) 271-
2431,www.puc.nh.gov/EnergyCodes/energypg.htm
o If applicable, copies of any state or town required NH DES permit approvals, including, but not
limited to, Comprehensive Shoreland Protection Act, Wetland Permit, Alteration of Terrain,
Dredge and Fill Permit.
o Lot coverage for residential and commercial increases must be shown on the scaled plan to
include all buildings, walkways, and driveways.
The applicant shall make the premises accessible to the Selectmen, or their agent, at reasonable times for
the performance of their duties.
Revised 3/19 Land Use Permit Application 2 of 2
The applicant shall attest to the fact that the structure or building erected, constructed, altered, or
reconstructed shall comply with all ordinances and regulations. The structure shall be used only for the
purpose stated on the application.
It is also required that all construction must meet the present NH Building Code adopted by the State of
NH:
All new and substantially rehabilitated habitable residential structures shall be equipped with hard wired
battery back-up automatic fire warning system (smoke detectors), one in each bedroom and in the vicinity
of the bedrooms, and at least one on each level including basements. The one for each level could be a
combination smoke / carbon monoxide detector. As of January 1, 2010, you are required to have a carbon
monoxide detector on each level if you have an attached garage or an appliance or device that uses a
combustion method of burning solid, liquid, or gas fuel. If the system is added to the structure later, a
carbon monoxide system would be required at that time.
All rental or hotel / motel units are required to have the above systems, regardless of any construction
work.
If you are building a new structure, expanding an existing structure or replacing or relocating an existing
structure, you must meet all of the following NH Department of Environmental Services requirements or
submit a new state septic “approval for construction” number with your building permit.
1. The structure, other than a new structure, is served by an existing septic system that is less
than 20 years old on the date the building permit will be issued.
2. If the existing system is more than 20 years old, on the date of the building permit issue, there
can be no increase in the size of the footprint of an existing or former structure.
3. If it is a new structure, requiring a state approved septic system, and any existing septic
approval for the structure is less than 4 years old on the date the building permit, it may be
issued.
4. There is no increase in the load on a sewage disposal system as per Env – Wq 1002.41.
5. It is a nonresidential property and no waivers were issued by NH DES for total wastewater lot
loading, depth to groundwater, or horizontal distances to surface water, water supply systems,
or very poorly drained soils.
6. When applicable, the proposed expansion, relocation, or replacement complies with the
requirements of the Comprehensive Shoreland Protection Act, RSA 483-B.
This information is not meant to cover every situation where a septic system may be required by the State
of NH or the Town of Holderness, but is only a guide to help in determining some of the state and town
requirements. You should contact a licensed designer if you have any questions regarding the
requirements for your property.
Installation or Alteration of Oil Burning Equipment requires a permit from the Holderness Fire Chief.
Building Permits will be reviewed upon submission and every effort will be made to complete the process
within one week to ten days. The Compliance Officer may request further documentation before
finalizing the application. The applicant or agent will be notified when the permit is available and the
amount of the permit fee.
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Completed 13 July 2020

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