HomeMy WebLinkAbout100 Bidwell Road (44) DEPARTMENT DECISION APPLICATION FOR SPRINKLER PERMIT
Application is hereby: TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg.CPermit#
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$13.00 Street No. treet Lot No.
Over$1,000
$13.00 per$1,000 C &j _LL
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESSAt
tioD 1-6 w^-1 c s- 7
APPLICANT PHONE# P-60— ,3 7— if S
0 W N $k. OWNER A t
OWNER ADDRESS S vG O
� • e ey LN
0 OWNER PHONE
,C {� : ESTIMATED COST$ 3 S� m G
'S+ IS THIS A CONTRACT COST? Yes O No
FEE ENCLOSED$ �o L
TYPE OF
�SOR CQ� JOB:
ew Installation
13 Alteration/Addition/Repair Revised 8/99
APPLICATION FOR SPRINKLER PERMIT (Continued from reverse side)
TYPE OF BUILDING TYPE OF CONSTRUCTION USE GROUP NO. OF STORIES
❑ RESIDENTIAL IS THIS APPLICATION ASSOCIATED ITH A
❑BUSINESS BUILDING PERMIT APPLICATION? 0 YES ❑ NO
❑ASSEMBLY
El MERCANTILE CURRENT USE AND OCCUPANCYLL—
❑ EDUCATIONAL
❑ INSTITUTIONAL FUTURE USE AND OCCUPANCY
❑ FACTORY
❑ STORAGE ENGINEER'S NAME PHONE
❑ GARAGE
❑ MIXED USE ADDRESS
(Other please specify) CITY STATE ZIP
KIND OF INSTALLATION &"/ .5 tl &
❑ DRY ❑ WET ❑ COMBINATION ❑ CHEMICAL
SIZE OF MAIN DRAIN WATER PRESSURE AT STREET(PSI)
ARE SPRINKLER HEADS ALTERED? ❑ YES ❑NO
IF YES, CHECK ALL THAT APPLY: ❑ADDED ❑DELETED ❑ALTERED
IF MORE THAN 3 HEADS ARE ADDED HYDRAULIC CALCULATIONS ARE PROVIDED BY(CHECK ONE)
❑ PROFESSIONAL ENGINEER ❑ INSURANCE COMPANY
WATER FLOW WATER PRESSURE AT SPRINKLER HEADS(PSI)
ARE PUMPS REQUIRED? ❑ YES ❑NO IF YES,CHECK ALL THAT APPLY:
❑FIRE ❑ BOOSTER ❑ OTHER
ARE STANDPIPES PROVIDED? ❑ YES ❑NO IS A SPRINKLER SYSTEM PROVIDED? ❑ YES ❑NO
SPRINKLER SYSTEM MAIN WATER SUPPLY RATING GPM
TOTAL DYNAMIC HEAD(TDH)OF FIRE PUMP PSI
DESCRIz
N OF WORK
'�k'5 L)L'
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. TYPE STATE
r
SIGNATURE OF APPLICANT DATE ��.2 j-- o
_y
dory§af& cSo)21 The Equi#nzent 60.
t
P.O.BOX 204,MIDDLEFIELD,CT 06455-0204
(860)347-2189
FAX:(860)343-5479
Public Act No.91-95: An Act concerning the requirement that licensed contractors as defined in Section
20-330 of the General Statutes must personally sign each building permit application has been modified
and allows a designated agent of the contractor to sign permit applications.
City of-. O Date
,��41nka a,mon
Attention: Building Official
RE: Application fbr: jb�jj
Trade Permit Desc ' tion
Estimated Cost: . I)o
Gentlemen:
In accordance with Public Act No.91-95,this letter authorizes the below named agent to sign the below
referenced permit application.
1. Project Name: I1
2. Location: S
3. Starting Date:
4. Licensed Contractors Name:
lease Print
5. Licensed Contractors Trade License No.: A�4
6. Name of Agent: C t P. Z.I. k
Please Print
7 License numbers of all contractors involved in the work if applicable: _
Sincerely,
Signature of Company Official if applicable
Signature of Licensed C n ctor equired This is to certify that under the provisions of the General Statutes
by Public Act the following person or firm is licensed or registered
FIRE LTD CONTRACTOR
jERRY F BAUER JR
PO BOX 247
ROCKFALL CT 06481
TYPE:F3
LIC/REG.NO EFFECTIVE EXPIRES
00030004 11/01/1999 10/31/2000
i
SIGNED.