Page 1 of 2 INSP-60 - 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
PLUMBING PERMIT APPLICATION - PLEASE PRINT
Address: ______________________________________________________________
Type of Occupancy: Residential Commercial/Industrial
Type of Work: New Alteration Repair Addition
Estimated Cost: _________________ Permit Fee: _________________
Office Use:
Permit # ________
Map: ____________
Lot: _____________
Zone: ___________
Owner: ____________________________________
Mailing address:____________________________
____________________________________________
Daytime phone #: __________________________
Cell phone #: _______________________________
Email: ______________________________________
Contractor: _________________________________
Mailing address:____________________________
____________________________________________
Daytime phone #: __________________________
Cell phone #: _______________________________
Email: ______________________________________
Master’s Name: _____________________________________________________________________________
Mailing Address: ____________________________________________________________________________
Daytime Phone #: ___________________________ Cell Phone #: _________________________________
N.H. Master Plumbing License #: ________________________________ Expiration: _______________
**License/photo ID will be required at the time of application.
Fixture
Quantity
Fixture
Quantity
Water Distribution System
Laundry Tray/Wash Sink
Water System
Washing Machine
Water Tank/Heater
Special Wastes
Floor Drains
Rainwater Leaders
Sewage Ejector
Blackflow Preventer
Drinking Fountain
Deduct Meter
Pump
Lavatory (toilets, urinals, shower)
Sill Cocks
Sinks
Dishwasher
Stacks
Garbage Disposal
Other
Page 2 of 2 INSP-60 - Rev. 3/2015
Instructions for Permit Applications: (All information must be printed legibly)
1. Owner name, address and phone number.
2. Location and address of work site.
3. Complete description of work to be done.
4. Number of fixtures, appliances and equipment to be installed.
5. Plans must be submitted on all new buildings and major renovations.
Notes:
The property owner of record may exercise their right to perform their own plumbing work on
their property if he or she resides there and the residence is a Single Family Dwelling occupied
by the owner of record. (Prior to property owner applying for his/her own plumbing permit,
he/she must speak with the Inspector for approval.)
It is the responsibility of all contractors, electricians and plumbers to obtain the necessary
permits from the Inspectional Services Division before ANY work has begun. Work must begin
within six (6) months of the issuance of any permit.
Plumbers must have a valid license from the State of New Hampshire to obtain a permit.
Permits are not transferable.
It is the responsibility of the contractor to obtain all inspections required. A rough-in inspection
is required before any work is covered, and a final inspection is required when all work is
complete. A twenty-four (24) hour notice is required for any inspection. This signed application
constitutes consent on the applicant’s part to allow for all inspections at the property location
listed.
Permits will not be issued until all of the required information has been furnished and all the
conditions mentioned above have been met.
INSPECTIONS REQUIRED: (24 hours notice required)
1. When under slab piping has been installed.
2. When rough-in is complete and visible (Rough).
3. When job is complete, but before occupancy (Final).
Inspectional Services approval certifies that the applicant can proceed with installation of
plumbing fixtures in accordance with specifications submitted. Any deviation from the
specifications submitted will require an amendment to this permit or additional permits.
If you have any questions, please contact the Inspectional Services Division at (603) 886-6005.
Statement of Compliance:
I have read and understand the statement and hereby agree to all of the terms stated therein. I
agree to abide by any and all codes relating to my field of work, including all national, state and
local codes. I also realize that any false statement made in the application for permit may be
grounds for revocation of said permit.
_____________________________________ ______________________
Applicant Signature Date
_____________________________________ ______________________
Signature of Permit Clerk Date
Permit fees:
Residential
$75.00
Commercial/Industrial
0-2,000 sq. ft. $200.00
2,001-3,000 sq. ft. $225.00
3,001-4,000 sq. ft. $250.00
over 4,000 sq. ft. $275.00
Deduct meter
$60.00
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