CITY OF HAVERHILL
BUILDING DEPARTMENT

APPLICATION FOR PERMIT FOR NON-RESIDENTIAL CONSTRUCTION

PLEASE PRINT LEGIBLY               DATE:___________________

Project Location:_______________________________________________
Property Use:__________________________________________________
#of Units_________________________________________

Owner:
Owner’s Name:___________________________________________________________
Owner’s Address:_________________________________________________________
Owner’s Tel.#_________________________________________

Contractor/Architect:
Contractor/Architect’s  Name:_______________________________________________
Contractor/Architect’s Address:______________________________________________


Contractor’s Supervisor’s License #__________________ Expiration Date____________
Contractor/Architect’s Tel.#______________________________
Architect’s Reg. #____________________________
Structural Engineer of Record________________________________________________

Description of proposed project:______________________________________________
________________________________________________________________________
________________________________________________________________________


________________________________________________________________________
________________________________________________________________________

Debris Location:__________________________________________________________

Cost/Valuation:______________________________

Fire Protection Engineer 1F.P. Narrative________________________________________
________________________________________________________________________
________________________________________________________________________
Drawings/Plans Submitted:__________________________________________________

Construction Type:___________________________________________________

Controlled Construction as per CMR 780 Article 1 – 116.1-5

Square Footage_____________________    Valuation__________________

Site Plan Completed______________        City Plot Plan – Room 214__________

Conservation Dept. – Room 210__________________

Plans reviewed and approved by Building Inspector_________________________

Water Dept Review (Plans Req.) ________________________________________

Please complete the above information and attach all applicable documents and plans to this application. Applications will be date and time stamped, and reviewed by the Building Inspector in the order received. Upon review, permit applications will then be typed in the computer and the contractor/architect will be called to come in and sign, pay for and pick up the permit. Incomplete applications will not be date and time stamped.
Rev 8/26/05