Fillable TOWN OF HUDSON FIRE DEPARTMENT - INSPECTIONAL SERVICES (Town of Hudson)

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TOWN OF HUDSON FIRE DEPARTMENT - INSPECTIONAL SERVICES (Town of Hudson)

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File type: PDF

U.S.A. forms for Town of Hudson

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FCODE-1 Rev. 6/2019
TOWN OF HUDSON
FIRE DEPARTMENT - INSPECTIONAL SERVICES DIVISION
12 School Street · Hudson, New Hampshire 03051 · Tel: 603-886-6005 · Fax: 603-594-1142
Complaint Investigation Form
Address in Question: _____________________________________________________________________________
Business Name (if applicable): _____________________________________________________________________
Type of Complaint: Health Safety / Fire
Type of Occupancy:
Residential
Commercial
Industrial
Please write your question or concern below. Please be as specific as possible.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Your Name: ________________________________________ Daytime Phone #: ___________________________
Address:______________________________________________________________________________________
Signature: ________________________________________________ Date: ______________________________
For Office Use Only Date Filed: ___________________________ Map: _______________ Lot: _________________
Pending Enforcement Issues:
□
Yes
□ No
Environmental Issues:
□
Yes
□ No
Possible Site Plan Infractions:
□
Yes
□
No
Date Forwarded to Zoning: ______________
Date Forwarded to Engineering: ______________
Date Forwarded to Planning:
______________
Other Department Notifications: Department: _________________
Date Forwarded: ______________
Additional Comments:
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
N/A
N/A
N/A
Inspectional Services
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TOWN OF HUDSON FIRE DEPARTMENT - INSPECTIONAL SERVICES (Town of Hudson)

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Completed 23 January 2021

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