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

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Appliance Fees: $30.00 per appliance
INSP-51 - Rev. 7/2020
TOWN OF HUDSON
FIRE DEPARTMENT - INSPECTIONAL SERVICES DIVISION
12 School Street · Hudson, New Hampshire 03051 · Tel: 603-886-6005 · Fax: 603-594-1142
MECHANICAL PERMIT APPLICATION
Installation Address: _________________________________________________
Business Name: ___________________________________Unit:_____________
Type of Occupancy: Residential Commercial/Industrial
Estimated Cost: _______________ Permit Fee: _____________
Office Use:
Permit#: _______
Map: _______
Lot: _______
Zone: _______
Appliance: New Replacement
Type of Appliance: ____________________________________________________________________
Make : ____________________ Model: _______________________ Serial: _____________________________
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 Authorized Representative Date
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TOWN OF HUDSON FIRE DEPARTMENT - INSPECTIONAL SERVICES (Town of Hudson)

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Completed 18 February 2021

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