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Home My WebLink About50 Andrews Way - SFMO Modification - Fir DPS-0927-C Rev.I/-001 State of Connecticut, Department of Public Safety Division of Fire, Emergency&Building Services Office of State Fire Marshal APPLICATION FOR REQUEST FOR MODIFICATION OF A REQUIREMENT OF A FIRE SAFETY REGULATION ADOPTED PURSUANT TO CHAPTER 541 OF THE CONNECTICUT GENERAL STATUTES Reference No. Facility Name: Vr--R.--GZE..ehl \,6jA, Facility Address: _AN(J� W S W A�' �O• W t h1 DSo K. Q l dC 0�7 Number Street City State ZiP Facility Owner: bd W t tNl7Sge-. Telephone: Ok'1 ;!> G q S 114 LA Owner's Address: 2� T"l A t IA S"L . C t-A A-r W4 M N It d`l Number Street City State ZIP CC Applicant's Name: Z:' N S10��1�"IV Telephone: ph Applicant's Address: �ti0 �� . 7-221t> 1 . 1 4 I L..,fZ T> ` t b,� Number Street city State Zip Contact Person:is M O 7- 15 a'N Telephone: Z-. `o 5 X0 za Type of Facility: Z M U C-1 I r=1,M 1 Lam( R X S 1 Office Building,LP-Gas Bulk Planl„Automotive Service Station,etc. This Facility is:,X New;❑ Existing: ❑ Renovation; Date of Construction: ;Date of Present Use: Previous modifications for this Facility: ❑ Unknown;9 No; El Yes, Modification Numbers: XCheck if a Modification Request to the State Building Code is being submitted to the Office of State Building Inspector. I,the above named applicant, being a lawful agent of the owner, request modification/relief from a requirement of the CT: ❑ Moving Picture Theater Code pursuant to C.G.S.§29-109 ❑ Gas Equipment&Piping Code pursuant to ❑ Amusements/Tent and Portable Shelter Codes pursuant to C.G.S.§29-329(c) C.G.S.§29-140 ❑ Liquefied Petroleum Gas&Liquefied Natural Gas Code State Fire Safety Code pursuant to C.G.S.§29-296 pursuant to C.G.S.§29-333 ❑ Oil Burning Equipment Code pursuant to C.G.S.§29-317(c) ❑ Hazardous Chemical Code pursuant to C.G.S.§29-338 ❑ Fireworks and Special Effects Code pursuant to ❑ Flammable&Combustible Liquids Code pursuant to C.G.S.§29-357(c) C.G.S.§29-321 ❑ Model Rocketry Code pursuant to C.G.S.§29-368 For the requirement as prescribed in: 2 Oo5 C-`+ Regulation Number: Standard:"F�lRF '&JWF (.c*:2�3ection Number: 1 pOQj. � •2. 29-292-13d,29.317-1b (If Applicable) NFPA 30,NFPA 54,etc Identify Section Number I request this modification/relief due to the following reasons: Equivalent Alternative ❑ Practical Difficulty ❑ Requirements Unwarranted Describe area of non-conformance with the appropriate regulation.its location in the facility,and a brief description why code compliance cannot be achieved,specify dimensions as applicable. I-c S t3 3 STo Z 1-1 o is R, f= Me V j SA--U Tics(i1Z, U•N I -V S T=tr�a S�R.V ta p `r A 51 N g�,iT 1Z A`TE.t� S"'[ AI 1Z E1-4CL!P:1SU R1-= U i-4 1"C I�aI��.S orI N D 1 Q,e C'TLN LNTO ' W- S-TAOK. V.-NCL..oSUZ-F- . neC--Ti M I(-':�LlS . 9 . Z. 'E la 7T —r W F- L�a`1 R S 5 W 1 N G 11-1 -T U S P.I D-�r- ❑ Separate Sheet Attached Side 1 of 3 I intend to provide the following safeguard(s)as an alternative measure to secure public safety in lieu of strict compliance with the requirement of the 2.0 1 Z.. i N'T• "F\Rs Qgsb Section 1 CVCO?-, . I . Z. noted above: Insert Name of Regulation for which Modification/Relief is being Requested Identify section of Code/Regulation "r 1-1 E o L�Ar-• �� N o� �t�u E � E I5C�V�S •�.�1 OCC. �lg�Cam; ��SS �'� �� ❑ Separate Sheet Attached In addition the following are enclosed ,.Plans/Drawings/Sketches; ❑ Photographs; ❑ Product Data Sheets ❑Supplement Information Sheet ❑Other as necessary for clarification of the information provided. p ricarifs St nature&Tel one Number Date ... . .... _ .... FoR 1t3CAt Ftt21W MaRsrIA�is1= ' I, CR Support, ❑ Do NOT Support, this Request for Modification to Connecticut C'i Identify Code by Name;I.e.Fire Safety Code,Oil Burning Equip Code Regulation of Connecticut State Agency ZI-2�z -Ice) inclusive;as identified above to Section Insert regulation Number i.e.29-292-8d,293173a,etc Z- because of the following reasons: Identify code flow i.e.occupancy chapter,core chapter as applicable Z, J� �ec•v,:j, sWvz vsvms u.v,% a► C. c to ❑ Separate Sheet Attached "wx-/�Z- , Kv Fire Marshal Rem er's Signature/Title Telephone Number Date ❑ Contact me regarding this Request STATE FIRE MARSHAL The response of the Commissioner of Public Safety/State Fire Marshal to this request in accordance with Connecticut General Statutes§29- is attached on a separate sheet Supervisor's Initials Side 2 of 3 r • APPLICATION FOR REQUEST FOR MODIFICATION OF A REQUIREMENT OF A FIRE SAFETY REGULATION SUPPLEMENT INFORMATION SHEET If Modification request is for a building or structure,please complete the following: Date of Construction: Date of Occupancy for Present Use: Number of Stories (Above grade)^ _ Dimension/Area Per Floor:f2�r BZ . t="ttc, Attic: ❑ Full Basement—#of Levels: ❑ Full ❑ Finished ❑ Partial ❑ Partial ❑ Storage None None ❑ Crawl Space Type of Occupancy (Check aft that apply) X New ❑ Existing❑ Addition ❑ Renovation of building ❑ Change of Occupancy: From to ❑ Assembly ❑ Detention ❑ Residential Board ❑ Hotel/Motel/Dorm Occupant Load: persons ❑ with locking II ❑ Large ❑ Small ❑ Lodging/Rooming ❑ Educational ❑ with locking 111 ❑ Prompt ❑ Bed &Breakfast ❑ Business ❑ with locking IV ❑ Slow ❑ 1 & 2 Family ❑ Single Tenant ❑ with locking V ❑ Impractical ❑ Industrial ❑ Multiple Tenant Apartment ❑ Storage ❑ Mercantile No. of Units:IZ A ❑ Health Care ❑ High Rise ❑ Class A ❑ Day Care ❑ Hospital ❑ Underground ❑ Class B ❑Adult ❑ Nursing Home ❑Windowless ❑ Class C ❑ Family ❑ Ambulatory ❑ Other: ❑ Covered Mall ❑Group ❑ Limited ❑Other: Type of Construction per NFPA 220: (Check all that apply) ❑ Type I ❑ Type 11 ❑ Type III ❑ Type IV ❑ Type V ❑ 1 (443) ❑ II (222) ❑ 111 (211) ❑ (2HH) ❑ V 011) ❑ 1 (332) [:111 (111) ❑ 111 (200) ❑ V(000) ❑ 11 (000) Approved Systems Provided (Check all that apply); ❑Automatic Sprinklers ❑ Fire Alarm $(NFPA 13 ❑ Throughout the Building ❑ Manual Activation ❑ Occupant Notification A NFPA 13R ji<Partial; Location R-7, ❑ Automatic Activation ❑ General ❑zoned ❑ NFPA 13D ❑ Electrically Supervised ❑ Throughout the Building ❑ Voice Evacuation ❑ CSFSC 7-7,1.2 Isolated Hazardous Area System ❑ Partial Location: Location: ❑ Water Flow ❑ Special System: ❑ Emergency Lighting❑ NFPA 96 Hood System ❑ Other Activation Means: ❑ Smoke Control ❑ Standpipe; Class: ❑ Other Systems: Other Information: $v 1 N ti ov rr- W a J ~ n NZE 'iota t t_tS t C� A" LPL @ i' y t�'1�"' t:,At i"C E , -, A-r 1+57 4Arqb t C3 r- Faue t--y y s — ----- = 6 Q --------------- �-- ,�. ju Ld �- u LI lilt Li LL LuI _-- - J F" �.i LT i i—°o 3 2 HR FIREWALL — -----�-y- _ � - W � co 11-6° i� 1_ _� MATCH LINE SK-8-31-15-B 2nd FLOOR LIFE SAFETY DRAWN BY SCALE: DATE: PROJECT NO.: EVERGREEN WALK INITIALS 3/32"=11-0" 8/31/15 1412-07 ALL RRPOM.PTAM.SPECIFICATIONS AND COMPUTER FILES RElATINGTDT1113 PROJECT ARE THE PROPERTY OFTIIH hL'1RThN SHEET NO. 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