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

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

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  • 22 check-boxes
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Country of origin: US
File type: PDF

U.S.A. forms for Town of Hudson

BROWSE TOWN OF HUDSON (NH) FORMS

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Fees:
Blasting Permit - $175.00
Explosive (Initial Fee) - $100.00
Fireworks Permit - $50.00
Page 1 of 5
INSP-10 - Rev. 3/2020
TOWN OF HUDSON
FIRE DEPARTMENT – INSPECTIONAL SERVICES DIVISION
12 School Street · Hudson, New Hampshire 03051 · Tel: 603-886-6005 · Fax: 603-594-1142
BLASTING AND EXPLOSIVES PERMIT APPLICATION
Applicant Name: _____________________________________
Business Name: ________________________________________ Phone #: ______________________
State of NH License to Use, Transport & Purchase Explosives #: ________________
Expiration Date: _____________________
Mailing Address:______________________________________________________________________________
Blasting Address:_____________________________________________________________________________
Authorized person in charge of/or supervising the use of explosives: ___________________________
State of NH Certificate of Competency #: ________________ Expiration Date: _____________________
Email: ________________________________________
Insurance Company: _________________________________________________________________________
Authorized to do business in the State of NH: Yes ______ No _______
Certificate of Insurance Attached: Yes _____ No______ Effective ___________Expires_____________
Mailing Address:______________________________________________________________________________
Office Phone #: ________________________________ Fax Phone #: _________________________________
NOTE: Please attach a copy of the following:
☐ State of New Hampshire License to Use, Purchase & Transport Explosives
☐ State of New Hampshire Certificate of Competency
☐ Certificate of Insurance
☐ Landowner Permission Letter
Permits will be processed once copies are received.
____
_________________________________________ _________________________
Signature of Applicant Application Date
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Page 2 of 5
INSP-10 - Rev. 3/2020
TOWN OF HUDSON
FIRE DEPARTMENT – INSPECTIONAL SERVICES DIVISION
12 School Street · Hudson, New Hampshire 03051 · Tel: 603-886-6005 · Fax: 603-594-1142
BLASTING AND EXPLOSIVE LICENSE CHECKLIST
Applicant Name: __________________________ Company Name: ________________________________
The following checklist has been created using Chapter 202 of the Hudson Town Code as a guide to
assist both the Hudson Fire Department and the blaster in the application process for a blasting
permit in the Town of Hudson. The blaster has also been provided with a complete copy of Chapter
202 of the Hudson Town Code that outlines the requirements of the Town of Hudson concerning
blasting operations.
It is important to note that the blaster has an obligation to read and comply with all the provisions
as set forth by the Town of Hudson concerning blasting operations. The blaster must also note that
this article is intended to supplement the existing federal and state laws and regulations concerning
blasting and the use of explosives.
A Hudson Fire Department Representative will review all items noted below with the
applicant. Applicant to initial in the box to the right of each statement to signify that it has
been reviewed and confirmed with them.
1. Does the applicant possess a license from the State of NH to use, purchase and
transport explosive materials? Yes_____ No _____ Expiration Date: ___________
2. Does the applicant possess a State of NH certificate of competency to conduct blasting
operations? Yes _____ N0 _____ Expiration Date: ____________
3. Does the applicant possess a certificate of insurance showing the minimum coverage
of $1,000,000 for bodily injury and $500,000 for property damage
by a carrier
authorized by the State of New Hampshire Insurance Commissioner to do business
in New Hampshire with the insurance certificate stating that the insurance company
is authorized to do business in the State of New Hampshire?
Yes _____ N ______ Expiration Date: ____________
Note: The blasting permit expiration date will be no later than the expiration
date of the blaster’s insurance certificate.
Page 3 of 5
INSP-10 - Rev. 3/2020
4.
Did the applicant provide written permission from the owner of the land on which the
explosives will occur
for the Fire Chief to inspect the land during the period of the
permit and until 20 days after the expiration of the permit?
Yes _____ N0 ______ Expiration Date: ____________
5. All applications for blasting operations must be received by the Hudson Fire Chief at
least 10 days prior to the estimated start date of the blasting operations.
6. Is there a need to have a pre-blast survey completed on any property prior to the start
date of blasting operations? Yes ______ No ______
If yes, note address(s) here: _____________________________________________________
7. A copy of all licenses to deal in explosive materials and the current blasting permit
shall be kept available for inspection at each blasting location.
8. The holder of the permit to use explosive materials shall make a record of all
operations within the Town of Hudson and retain them for a period of 5 years. Such
records shall be made available to the Hudson Fire Chief at any time during this
period of time upon request.
9. All persons holding a blasting permit shall make a daily record to include the
following information:
a. Date, time and place of each blast
b. The amounts of explosive material fired in each blast
c. Results of seismographic test, which shall also be retained for a period of 5 years.
10. In the event of any theft or loss of explosive materials, the persons issued the
blasting permit shall notify the Hudson Fire Chief at 603-886-6021 and the
Hudson Police Chief at 603-886-6011 immediately.
11. When blasting operations are performed, precautions shall be exercised to prevent
damage and to minimize earth vibrations, air blast and thrown fragments.
12. Notification of intent to conduct blasting operations shall be published in a local daily
newspaper at least 3 consecutive days prior to the start date of the blasting. Said
notification shall also be published in the local weekly newspaper at least once prior
to the start date of the blasting. Notification shall include the area of operations and
the name of the company responsible for the blasting operations.
Page 4 of 5
INSP-10 - Rev. 3/2020
13. Persons intending to conduct blasting operations within the Town of Hudson shall
notify the Hudson Police Chief in writing 24 hours prior to the start of blasting.
14. The blaster shall notify the Hudson Fire Department dispatcher no less
than 30
minutes prior to the start of each blast at (603) 886-6021.
15.
What method of notification (signaling) will be used prior to the start of blasting
operations? ________________________________________________________________
16. The persons that have been issued the blasting permit are responsible for any
damage that may be incurred due to the blasting operations that are conducted in
the Town of Hudson. If the blaster or blasting company does not fully cooperate in
resolving any complaint received by the Hudson Fire Department as a result of their
operations, the Hudson Fire Chief may direct the suspension or termination of all
blasting operations conducted by the blaster in the Town of Hudson.
__________________________________________________________________________________________
Signature of Blasting/Explosive Applicant Date
__________________________________________________________________________________________
Signature of Hudson Fire Department Representative Date
__________________________________________________________________________________________
Signature of Hudson Fire Department Fire Chief Date
Copies Attached:
☐ State of New Hampshire License to Use, Purchase & Transport Explosives
☐ State of New Hampshire Certificate of Competency
☐ Certificate of Insurance
☐ Landowner Permission Letter
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Page 5 of 5
INSP-10 - Rev. 3/2020
TOWN OF HUDSON
FIRE DEPARTMENT - INSPECTIONAL SERVICES DIVISION
12 School Street · Hudson, New Hampshire 03051 · Tel: 603-886-6005 · Fax: 603-594-1142
BLASTING REPORT
Blast Location: ____________________________________ Grid #: __________________
Property Owner: ______________________________________________________________
Blasting Contractor: __________________________________________________________
Blaster: _______________________________________________________________________
Date of Blast: _____________________________________ Time: ____________________
Total Lbs: __________________________________ # of Holes: ______________________
Video Taped: Yes No Location: ________________________________
Seismic Reading: Yes No Location: ________________________________
Wind Speed: _______________________ Direction: _______________________________
Notes/Problems:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Reported By: ________________________________ Date: ___________________________
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TOWN OF HUDSON FIRE DEPARTMENT INSPECTIONAL SERVICES DIVISION (Town of Hudson)

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Completed 23 January 2021

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