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DEPARTMENT DECISION APPLICATION FOR SPRINKLER PERMIT
PERMIT#
TOWN OF SOUTH WINDSOR
Application is hereby: BUILDING DEPARTMENT I r I
APPROVED 1540 SULLIVAN AVENUE
� Bldg.Permit#
o0 644-2511 ext. 230 a,? V?S"'
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Lo tion of Job:
/00
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT kir Q e Ar 01)
APPLICANT DDRESS
APPLICANT PHONE# �-
W 1 $F,q OWNER o J i4-- �✓t l �s
OWNER ADDRESS 100 9 `
CO,
OWNER PHONE
C ESTIMATED COST$ Ob
U
IS THIS A CONTRACT COST? )Z�es O No
�(d FEE ENCLOSED$
011� TYPE OF JOB:
OR C
O New Installation
)SrAlteration/Addition/Repair Revised 8/99
APPLICATION FOR SPRINKLER PERMIT (Continued from reverse side)
TYPE OF BUILDING TYPE OF CONSTRUCTION USE GROUP NO. OF STORIES
❑PAIDENTIAL IS THIS APPLICATION ASSOCIATED WITH A
BUSINESS BUILDING PERMIT APPLICATION? ❑ YES ❑ NO
❑ASSEMBLY
❑MERCANTILE CURRENT USE AND OCCUPANCY D C -e
❑ EDUCATIONAL r C
❑ INSTITUTIONALTE USE AND OCCUPANCY �`
❑FACTORY
❑ STORAGE ENGINEER'S NAME �'_ C0ZC0fe o�ar4HONE 0&0
❑ GARAGE 1 f
❑MIXED USE ADDRESS IQ 1��I
PZ1
(Other please specify) CITY �0, w J (��sU STATE ZIP d 4:70 7
KIND OF INSTALLATION
❑DRY 1WET ❑ COMBINATION ❑ CHEMICAL
SIZE OF MAIN DRAIN t WATER PRESSURE AT STREET(PSI)
ARE SPRINKLER HEADS ALTERED? ❑ YES )NO
IF YES,CHECK ALL THAT APPLY: ADDED ❑ DELETED ❑ALTERED
IF MORE N 3 HEADS ARE ADDED HYDRAULIC CALCULATIONS ARE PROVIDED BY(CHECK ONE)
PROFESSIONAL ENGINEER ❑INSURANCE COMPANY
WATER FLOW ct— t WATER PRESSURE AT SPRINKLER HEADS(PSI)
ARE PUMPS REQUIRED? ❑YESNO IF YES,CHECK ALL THAT APPLY:
❑FIRE ❑BOOSTER ❑OTHER
ARE STANDPIPES PROVIDED? ❑YES b('NO IS A SPRINKLER SYSTEM PROVIDED? YES ❑NO
SPRINKLER SYSTEM MAIN WATER SUPPLY RATING q I GPM
TOTAL DYNAMIC HEAD(TDH)OF FIRE PUMP PSI
DESCRIPTION OF WORK
VU C7" 1 A.) --e-d pee in 12,0 a ueJ
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.
CONTIkACTORS LICENSE N TYPE STATE
SIGNATURE OF APPLICANT DATE rC>26 �(/