HomeMy WebLinkAbout100 Bidwell Road (45) DEPARTMENT DECISION APPLICATION FOR SPRINKLER PERMIT PERMI #
Application is her TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVE 1540 SULLIVAN AVENUE
644-2511 ext. 230
Date din Inspector
Application must be printed or typed
Location of job
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
$
- $1,000 - $12.00
Over $1,000
S 12.00 per$1,000 OWNER NT�Ip�I l f DlC/ i u.EL C EL GS
any fraction thereof
ADDRESS 9 d - /F-J�/Q WC-1/ A Ve
,�O W r, IA10s09
OWNERS PHONE# X�$-
APPLICANT MA6 F LL(�" C �/V I�CS -:zV�=
W N S ADDRESS !'•C'. go /0 Z11 41t#4,0
v¢i(,l �il� C� o `3 q
0/j ESTIMATED COST$
C r = IS THIS A CONTRACT COST?
. YES NO
FEE ENCLOSED S C�o A d
w O
I � a
OSO R-C0� TYPE OF JOB:
Original Installation
Alteration/Addition/Repair
Revised 10/96
APPLICATION FOR SPRINKLER PERMIT(Continued from reverse side)
TYPE OF BUILDING TYPE OF CONSTRUCTION USE GROUP NO. OF STORIES _
RESIDENTIAL IS THIS APPLICATION ASSOCIATED WITH A
BUSINESS BUILDING PERMIT APPLICATION YES NO
ASSEMBLY CURRENT USE AND OCCUPANCY -
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
_FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
(Other please specify) KIND OF INSTALLATION
DRY WET_� COMBINATION CHEMICAL
SIZE OF MAIN DRAIN / WATER PRESSURE AT STREET(PSI) l ��
ARE SPRINKLER HEADS ALTERE
IF YES CHECK ALL THAT APPLY ADDED DELETED ✓ALTERED
IF MORE THAN 3 HEADS ARE ADDED HYD ULIC CALCULATIONS ARE PROVIDED BY
CHECK ONE) Vol P.E. INSURANCE CO.
WATER FLOW WATER PRESSURE AT SPRINKLER HEADS(PSI) /
ARE PUMPS REQUIRED Y/N IF YES CHECK ALL THAT APPLY
FIRE BOOSTER OTHER
ARE STAND PIPES PROVIDED Y/N IS A SPRINKLER SYSTEM PROVIDED Y/N
SPRINKLER SYSTEM MAIN WATER SUPPLY RATING s'S GPM
PSI
M
TOTAL DYNAMIC HEAD(TDH)OF FIRE PUP /
DESCRIPTION OF WORK �I
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN BUILDING CODES IN THE
PERFORMANCE OF SUCHX46PLIVA
`olio
NAME STATE LICENSE NO. TYPE NT
PHONE NO. DATE I