Gas Appliance Fees: $30.00 per appliance
Gas Piping Fees: Residential $75.00, Commercial/Industrial $100.00 INSP-50 - Rev. 3/2015
TOWN OF HUDSON
FIRE DEPARTMENT - INSPECTIONAL SERVICES DIVISION
12 School Street · Hudson, New Hampshire 03051 · Tel: 603-886-6005 · Fax: 603-594-1142
GAS MECHANICAL PERMIT APPLICATION
Installation Address: _________________________________________________
Business Name: ___________________________________Unit:_____________
Type of Occupancy: Residential Commercial/Industrial
Estimated Cost: _______________ Permit Fee: _____________
Permit#: _______
Map: _______
Lot: _______
Zone: _______
Gas Piping: New Existing Above Ground Below Ground
Piping Type: Black Iron
CSST* Poly Copper Other
*Please provide a copy of your current manufacturer’s certification.
Gas Appliance: New
Replacement
Furnace Hot Water Heater Fireplace Boiler Generator**
Other*** ___________________
**Gas Generators require a gas appliance and electrical permit. Generator permit fee includes piping permit costs.
***Appliances that do not require a permit: cooking stove and gas dryers.
Make : ____________________ Model: _______________________ Serial: _____________________________
Fuel: LP
Natural Vent Type: _____________________ Install Date: ________________________
Owner: _____________________________________
Mailing Address:_____________________________
_____________________________________________
Daytime Phone #: ___________________________
Cell Phone #: _______________________________
Email: ______________________________________
Contractor: _________________________________
Mailing Address:_____________________________
_____________________________________________
Daytime Phone #: ___________________________
Cell Phone #: _______________________________
Email: ______________________________________
Installer: ____________________________________ Cell Phone #: _______________________________
License Class: __________ License #: __________________________ Expiration Date: ____________
**License/photo ID will be required at the time of application.
Permits shall be issued in accordance with Chapter 205, Section 4 of the Hudson Town Code. Installation
shall meet all applicable codes and standards. **** Note: Permit to operate the units noted above will be
issued upon final inspection and approval.****
My signature below indicates that the installation has met all applicable National Fire Protection
Association and ICC codes and standards.
_____________________________________________ _________________________
Signature of Installer Date
____________________________________________ _________________________
Signature of Permit Clerk Date
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