Certificate of Occupancy

    TOWN OF MARLBOROUGH

    Post Office Box 487

    Marlborough, New Hampshire 03455-0487

“Equal Opportunity Employer”                                

 Telephone (603) 876-3751                                      Fax (603) 876-3313           

 E-mail: selectmen@marlboroughnh.org       

 Website:  www.marlboroughnh.org                                                                                  

TOWN OF MARLBOROUGH, NEW HAMPSHIRE

Requirements for a Certificate of Occupancy

APPLICATION FOR TEMPORARY/PERMANENT CERTIFICATE OF OCCUPANCY

PORTION (S) OF THE BUILDING CANNOT BE OCCUPIED UNTIL THIS FORM HAS

BEEN COMPLETED AND A CERTIFICATE ISSUED. THE CERTIFICATE CANNOT BE ISSUED UNTIL NECESSARY INSPECTIONS HAVE BEEN MADE AND DETERMINED UNFINISHED WORK WOULD NOT PROHIBIT THE SAFE OCCUPANCY OF THE AREA(S) INDICATED.

Please Print

Job Address (one building) _____________________________________

 

Proposed Use of Building ______________________________________

 

Permit Number _________________

Temporary Power Approved On?______________

 

Owner’s Name Address (City/State/Zip) Phone No. ___________________________________________________________________________________

 

Contractor’s/Agent’s Name Address (City/State/Zip) Phone No.

______________________________________________________________

 

Reason for Temporary Occupancy ________________________________________________________________________________________________

 

Portion of the building only; describe in detail the area that you are requesting

__________________________________________________________________________________________________________________________

This form when approved grants the issuance of a Temporary/Permanent Certificate of Occupancy as stipulated.

 

I, the undersigned being the owner, agree to indemnify, defend, and save free and harmless the Town of Marlborough, its officers, agents, employees and representatives from and against any and all claims, demands, loss, actions or causes of action which may be asserted, prosecuted or established against them, or any of them, or whatsoever kind or nature, arising out of or attributable to, or in any manner connected with the temporary occupancy.

I further acknowledge that the issuance of a Temporary Certificate of Occupancy requires that completion of construction be done in a timely manner and that all utilities may be turned off for any hazardous conditions or for not completing the construction permitted I intend to obtain my Certificate of Occupancy by (date):

 

Owner (signature) Address (City/State/Zip)_________________________________________________________________________________________________

 

Fire Department Approval/Date if required ______________________________

 

 

Building Inspector Approval/Date _____________________________________

 

THE TEMPORARY CERTIFICATE OF OCCUPANCY EXPIRES ON:

 

This certifies that after the above inspections are approved, this building or portions thereof as requested in items #7 and #8 complies for temporary occupancy for the use as stated.

 

Conditions: __________________________________________________________________________________________________________________________