TOWN OF MARLBOROUGH
Post Office Box 487
Marlborough, New Hampshire 03455-0487
“Equal Opportunity Employer”
Telephone (603) 876-3751 Fax (603) 876-3313
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.
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.