PAGE 1 of 1 | CONTRACTOR REGISTRATION | REV. 3.6.2018
BUILDING DIVISION
200 S. Hamilton Road
Gahanna, Ohio 43230
Phone: 614-342-4010
Fax: 614-342-4117
building@gahanna.gov
www.
ahanna.
ov
CONTRACTOR REGISTRATION NO.
_________________________________
RECD. BY _______ DATE: __________
INTERNAL
CONTRACTOR ANNUAL REGISTRATION
☐ NEW ☐ RENEWAL
REGISTRATION YEAR:
TYPE OF REGISTRATION: ☐ General Contractor ☐ Gas Piping
☐
Electrical ☐ Fence Erector ☐ Remodeling
☐ Plumbing ☐Sign Erector ☐ HVAC
CONTRACTOR Name:
Contractor Address:
Contractor E-mail: Contractor Phone No.:
BUSINESS Name:
Business Address
Business E-mail: Business Phone No.:
OHIO OR OTHER MUNICIPAL LICENSE OR REGISTRATION INFORMATION (Include a copy of all licenses)
MUNICIPALITY/OHIO TYPE OF LICENSE/REGISTRATION LICENSE NO. EXPIRATION DATE
LIABILITY INSURANCE Company: Expiration Date:
Policy No.: Amount:
☒
LIABILITY INSURANCE SUBMITTED – a Certificate of Insurance showing current liability in the amount of
$100,000/$300,000, with a listed expiration date and the City of Gahanna a “Certificate Holder”.
REGISTRATION FEE reference: Building & Zoning Fee Schedule
$ 100
TOTAL FEES - payment due at time registration is submitted
reference: Building & Zoning Fee Schedule
INTERNAL USE: PAID ☐
PAYMENT: ________________________
RECD. BY/DATE: ___________________
CERTIFICATION
I certify that that the information on this registration is complete and accurate to the best of my knowledge, and
agree to conform to and abide by all the rules and regulations of the City of Gahanna Building Code and
Chapter 1311 of the Codified Ordinances of the City of Gahanna.
Name: ______________________________________________________ Title: ___________________________________________
Signature: ___________________________________________________ Date: ___________________________________________
THIS FORM IS AVAILABLE TO BE SUBMITTED ONLINE: HTTPS://OHGA.ONLAMA.COM
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