PERMIT #
STREET OPENING PERMIT
BOROUGH OF MERCHANTVILLE
ONE WEST MALE AVE
MERCHANTVILLE, NJ 08109
856-662-2474
PROPERTY OWNER
STREET ADDRESS OF WORK
SIZE OF OPENING FEET LONG BY FEET WIDE (PLEASE ATTACH SKETCH OF OPENING
DETAILING SQUARE FOOTING AND DEPTH)
CONTRACTOR
CONTRACTOR’S ADDRESS
CONTRACTORS EMERGENCY PHONE NUMBER (PROVIDE 2)
APPLICANT’A NAME
HAS SITE PLAN BEEN FILED WITH PLANNING BOARD? YES NO NA
HAS APPLICANT POSTED A BOND NOR LESS THAN $15,000 AND BEEN APPROVED BY THE BOROUGH?
YES NO
The Superintendent of Public Works requires a minimum of 48 hours notice for inspection of the above-mentioned work.
Saturdays and Legal Holidays are not included. Holidays or overtime inspection rates will be deducted from the deposit fee when
necessary, and for any other work deemed by the Superintendent of Public Works. 856-665-0590
I have examined a copy of the standards for the municipality on file in the Code Enforcement Office. Failure to comply with
these Standards and the above-mentioned procedures or to correctly completely the amount of work may mean forfeiture of the
performance or maintenance guarantee.
I certify that the above information is true and correct to the best of my knowledge.
APPLICANT’S SIGNATURE DATE
SCHEDULE OF FEES:
PERMIT FEE: NON-REFUNDABLE $100.00 FOR EACH 100 LINEAR FOOT OR LESS LINEAR OPENING. A
SEPARATE PERMIT AND FEE IS REQUIRED FOR EACH 100 LINEAR SEGMENT OF DISTURBANCE
SURITY FEE: REFUNDABLE $200.00 FOR EACH PERMIT.
The Borough Clerk is hereby authorized to issue a Street Opening Permit to the above applicant.
SUPERINTENDANT OF PUBLIC WORKS DATE
NOTICE: THIS PERMIT IS NOT VALID UNLESS SIGNED BELOW BY THE BOROUGH CLERK.
RECEIVED THE SUM OF $ ON ACCOUNT OF THIS PERMIT.
BOROUGH CLERK DATE
THE HOLDER OF THIS PERMIT HAS COMPLIED WITH THE CONDITIONS AS PRESCRIBED BY CHAPTER 24,
EXCAVATION, OF THE CODE OF THE BOROUGH OF MERCHANTVILLE AND IS ENTITLED TO A RETURN OF
$ . REFUNDS ARE NOT DUE UNTIL 6 MONTHS FROM DATE OF OPENING.
