NAME OF UNIT OWNER(S) _________________________________________________

UNIT # ___________________

MAILING ADDRESS _______________________________________________________
_______________________________________________________
_______________________________________________________

HOME PHONE ________________________ WORK PHONE ___________________

Summary of Alteration or Improvement Requested ________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Who will perform this work? (Provide name. Address, and phone number)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Is this firm or person(s) licensed in New Hampshire to do the type of work you wish to have done?

___________________ If yes, provide license number. _______________________

If yes, Is their license in good standing? ___________________

Is the firm or person(s) insured for the necessary liability and workmen's compensation insurance?

_________________________ (Copy of certificates must be provided)

Additional Comments _____________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________________________________________________


Attach the following to your application
1. Drawing and photos of the proposed work
2. A copy of your contractor(s) license(s) and your contract for work to be performed
.



___________________________________

Signature of Unit Owner

________________________
Date

**************************************************************************************

Reviewed by _______________________________ On ____________________________

Circle Decision: Accepted -- Provisionally Accepted -- Rejected

Signature ______________________________________

If accepted provisionally, list contingencies __________________________________________

______________________________________________________________________________

If rejected, give reason ___________________________________________________________

______________________________________________________________________________

Could this rejection be reversed if more information was provided? _________________

If yes, list what other information is needed and return to the applicant:

______________________________________________________________________________

______________________________________________________________________________

Other Comments: ______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________