HomeMy WebLinkAbout1739 Ellington Road (37) i
DEPARTMENT DECISION APPLICATION FOR SPRINKLER PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: � `a� O
BUILDING DEPARTMENT
Q��PPRO 1540 SULLIVAN AVENUE Bldg.Permit#
fw
L 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000 �
or any fraction thereof Tenant Designation Apt.No.
APPLICANT J d�•� ��a�e
APPLICANT ADDRESS A-6 t-tSS Cc rc�p
ec.J n C T'
APPLICANT PHONE# F6 0 'S'__R 1 9.6
W N S F OWNER
o sra� h o�
OWNER ADDRESS cs�h (In'4S$
,x
&0) #R OWNER'PHONE
O
C ESTIMATED COST$ 1 (4 y , O® •Oct
IS THIS A CONTRACT COST? t/Yes No
r FEE ENCLOSED$
TYPE OF JOB:
OR-C�� ew Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR SPRINKLER PERMIT (Continued from reverse side)
TYPE OF BUILDING TYPE OF CONSTRUCTION USE GROUP NO. OF STORIES
❑RESIDENTIAL
❑BUSINESS IS THIS APPLICATION ASSOCIATED VV A
❑ASSEMBLY BUILDING PERMIT APPLICATION? S ❑NO
❑MERCANTILE
❑EDUCATIONAL CURRENT USE AND OCCUPANCY ra cQ S 4
❑INSTITUTIONAL
❑FACTORY FUTURE USE AND OCCUPANCY 6 v-e S'�O
❑ STORAGE
❑ GARAGE ENGINEER'S NAME Gx'A �.c�r`�" PHONE �
❑MIXED USE
(Other please specify) ADDRESS '50 C, tvrXv
CITY STATE C4— ZIP
KIND OF INSTALLATION
SIZE OF MAIN DRAIN !� WATER PRESSURE AT STREET(PSI) S�
ARE SPRINKLER HEADS ALTERED? ❑YES ISO
IF YES,CHECK ALL THAT APPLY: ❑ADDED ❑DELETED ❑ALTERED
IF MORE�� RS HEADS ARE ADDED HYDRAULIC CALCULATIONS ARE PROVIDED BY(CHECK ONE)
R�
OFESSIONAL ENGINEER ❑INSURANCE COMPANY
Sic Ga l tv T-w-deatcs
WATER FLOW Mjk,�-p� zoos WATER PRESSURE ��
ESSSURE AT SPRINKLER HEADS(PSI) yK c��.�-e� z'f
ARE PUMPS REQUIRED? LJ YES LINO IF YES,CHECK ALL THAT APPLY:
❑FIRE ❑BOOSTER ❑OTHER
�,�
ARE STANDPIPES PROVIDED? ❑ &YES O IS A SPRINKLER SYSTEM PROVIDED? 9— S ❑NO
SPRINKLER SYSTEM MAIN WATER SUPPLY RATING l0-3 GPM
TOTAL DYNAMIC HEAD(TDH)OF FIRE PUMP "w"� PSI
DESCRIPTION OF WORK
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THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. E STATE
SIGNATURE OF APPLICANT DATE 7 6Z 0 2