PLEASE COMPLETE DURING INSPECTION AND RETURN TO INSPECTOR. IF FORM CANNOT BE COMPLETED DURING INSPECTION THEN RETURN AS SOON AS POSSIBLE VIA Email to kaustin@fairhaven-ma.gov, Fax: 508-994-1515 OR USPS to 146 Washington Street, Fairhaven, MA 02719COMPLETE ALL SECTIONS LEGIBLY AND IN FULLThe information obtained below is used in the event of an emergency at the business location. Please provide at least 1 additional contact person in the case that an owner cannot be reached Business Information Business Name: * Business Address: * Business Phone Number: * Business Fax Number: Email Address: * Preferred Method of Receiving Report: USPS Mail Email Business Owner Owner's Name: * Owner's Address: * Owner's Cell and/or Home Phone: * Additional Business Owner Additional Owner's Name: Additional Owner's Address: Additional Owner's Cell and/or Home Phone: Property Owner Information (If different from Business Owner) Property Owner's Name: Property Owner's Address: Property Owner's Cell and/or Home Phone: Emergency Contact Numbers (persons other than the owner(s) that have access to the building) Contact Person 1 Contact Person 1 - Cell and/or Home Phone Contact Person 2 Contact Person 2 - Cell and/or Home Phone Contact Person 3 Contact Person 3 - Cell and/or Home Phone Send yourself a copy of information submitted: Name of Person Completing Form: * Date Form Completed * FFD Initials: Leave this field blank
