Occupancy Permit Checklist

OCCUPANCY PERMIT CHECK LIST

STORIES_______�� BLOCK________����������������������� PERMIT#_____________

BDRMS_______���� LOT__________

PROJECT, BUSINESS, OWNER'S NAME___________________________________________

UNIT, LOT, STREET #_____________ ADDRESS__________________________________

THE ABOVE INFORMATION MUST BE FILLED OUT PRIOR TO REQUESTING SIGNATURES OF

APPLICABLE DEPARTMENTS.

ANY PERMIT TO OCCUPY A RESIDENTIAL, COMMERCIAL OR INDUSTRIAL BUILDING OR

UNIT REQUIRES THE FOLLOWING LISTED CITY DEPARTMENTS TO SIGNIFY TO THE

BUILDING INSPECTOR THAT THEIR RESPECTIVE REQUIREMENTS APPLICABLE TO THE

OCCUPANCY OF THE ABOVE CITED BUILDING,LOT,UNIT, ARE IN COMPLIANCE. YOU ARE

REQUIRED TO PRESENT THIS ORIGINAL FORM TO EACH OF THE DEPARTMENTS/BOARDS

CITED BELOW FOR THEIR APPROVAL PRIOR TO SUBMITTING THIS FORM TO THE BUILDING

INSPECTOR TO REQUEST AN OCCUPANCY PERMIT.

WATER DEPARTMENT 125 AMESBURY RD���������������������� ������������������������������������������������������ TEL.� 373-8487�����

The water department advised that the required water service (s), meter(s), lines and appurtenances to service the building/unit/lot above have been installed, inspected and meet with the Water Department's Approval.

SIGNED___________________________________ DATE_________________

WATER DEPARTMENT ROOM 300-4 SUMMER ST. HAVERHILL, MA 01830

The Water Billing Department verifies that the bldg/unit/lot above is connected to the city sewer system which will create a wastewater bill.

SIGNED___________________________________ DATE_________________

SEWER-C/O ENGINEERING DEPARTMENT ROOM 214-4 SUMMER ST�� ������������������������������������������� TEL. 374-2335

The city Engineer advised that the required engineering service (s), meter (s), line (s), and appurtenances to service the building/unit/lot above have been installed, inspected and meet the City Engineer's Approval.

SIGNED___________________________________ DATE_________________

HIGHWAY DEPARTMENT HOURS 7AM-3PM -� 500 PRIMROSE ST ����������������������������������� TEL. 374-2360

The Highway Superintendent advised that the required street/R.O.W. improvements to service the building/unit/lot above, have been installed, inspected and meetthe Highway Department's Approval.

SIGNED___________________________________ DATE_________________

CONSERVATION COMMISSION ROOM 205-4 SUMMER ST���� ������������������������������������������������������������� TEL. 374-2334

The Conservation Commission advised the required improvements approved under Order of Conditions #_____ have been substantially completed to service building/unit/lot above.

SIGNED___________________________________ DATE_________________

PRIVATE WATER SERVICE-C/O HEALTH BOARD ROOM 208-4 SUMMER ST ���������������� TEL. 374-2325

The Board Of Health advised the required private well necessary to service the building/lot/unit above has been installed, inspected and meets with the Board of Health Approval

PRIVATE SEPTIC SYSTEM - C/O HEALTH BOARD ROOM 208-4 SUMMER ST ���������������� TEL. 374-2325

The Board Of Health advises that they have on file written certification from the Disposal Installer and the Designer of the septic system necessary to service the building/unit/lot above, that the septic system was constructed in compliance with 310 CMR 15.000, the approved design plans and all local requirements, and that changes to the design plans have been reflected on as-built plans which have been submitted to the Board of Health, and meets with the Board's approval.

SIGNED_________________________________ DATE____________________

BOARD OF HEALTH APPROVAL FOR FOOD SERVICE ESTABLISHMENT������ ���������������� TEL.374-2325

The Board of Health advises that when a food establishment is to be constructed, extensively remodeled, an existing structure is to be converted to use as a food establishment, or a new operation is to be added, the

applicant must adhere to the requirements of 590.058 of the State Sanitary Code for Food Establishments. A floor plan and menu must be submitted prior to approval. FOOD ESTABLISHMENTS ARE REQUIRED TO HAVE DUMPSTERS FOR THE DISPOSAL OF THEIR REFUSE.

SIGNED_________________________________ DATE____________________

WASTE WATER DIVISION APPROVAL FOR FOOD ESTABLISHMENTS�������� ������������������ TEL. 374-2382

The Waste Water Division requires a sewer discharge permit for food establishments in accordance with City Ordinance 208-31I B (18).

SIGNED__________________________________ DATE___________________

FINAL PLUMBING & GAS INSPECTION - ROOM 210-4 SUMMER ST ��������������������������������� TEL. 374-2341

The Plumbing & Gas Inspector advises that only the licensed plumbing contractor request this inspection.

SIGNED__________________________________ DATE___________________

FINAL ELECTRICAL INSPECTION -ROOM 210-4 SUMMER ST�� ���������������������������������������������������������� TEL. 374-2341

The Electrical Inspector advises that only the electrical contractor request this inspection.

SIGNED__________________________________ DATE___________________

FINAL SMOKE DETECTOR INSPECTION - FIRE DEPT. 17 HAMILTON AVE �������������������� TEL.373-8460

The Fire Department advises that requests for final smoke detector inspections be made in advance. An inspection fee may apply.

SIGNED__________________________________ DATE___________________

FINAL RESIDENTIAL FIRE SPRINKLER INSPECTION 17 HAMILTON AVE ���������������������� TEL. 373-8460

The Fire Chief advises that requests for fire sprinkler inspections be made in advance, and only with the licensed sprinkler installer.

SIGNED_________________________________ DATE____________________

FINAL INSPECTION-BUILDING INSPECTOR ROOM 210-4 SUMMER ST ������������������������������������������� TEL. 374-2338

The Building Inspector will accept requests for final inspections from either the homeowner or the licensed contractor providing all of the above inspections have been made and meet with each Department's requirements.

SIGNED_________________________________ DATE____________________

RETURN THIS COMPLETED FORM TO THE BUILDING INSPECTOR'S OFFICE AT WHICH TIME

AN OCCUPANCY PERMIT MAY BE ISSUED.� BUILDING INSPECTOR'S ARE IN THE OFFICE

8:00 to 9:00 A.M. AND 3:00 TO 4:00 P.M. MONDAY - FRIDAY.

ALL OCCUPANCY PERMITS ARE TO BE SIGNED BY A BUILDING INSPECTOR.

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