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HomeMy WebLinkAbout50 Andrews Way - SFMO Modification - Fir (2) DPS-0927-C Rev.1/2001 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: T_= V Facility Address:_ A lS Z,l W y/A" O W 1 N DSO R. QT Q c(Q'7 4 Number Street City State Zip Facility Owner: Pa Telephone: q'"i Z!� F q S 1 U 'A L� Owner's Address M AI.ha _T C_. AAT 1444Nt NJ d-7 9 ZSZ Number Street City Stale Zip Applicant's Name: 2_,**;( �.1 Telephone: 2��J Q4 5 t b !j'0 Applicant's Address: 2_z4p N 2.Z. 5� h I L T,k !_I I I b 71 Number Street City State Zip Contact Person:LS M O V 1 S a Telephone: Z-.E C Q 5 lb a Type of Facility: 1Z Z M(j t~-X I r- 1-,-.M Office Building,LP-Gas Bulk Plant„Automotive Service Station,etc. This Facility is:'X New;❑ Existing; ❑ Renovation; Date of Construction: ;Date of Present Use: Previous modifications for this Facility: ❑ Unknown; No; ❑ Yes, Modification Numbers: Check 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 El Model Rocketry Code pursuant to C.G.S.§29-368 For the requirement as prescribed in: 2 Oa5 G'T Regulation Number: Standard:�FIkr SdF G&t ection Number: 1 �� • Z. 29-292-8e,20-317-lb (H Applicable) NPPA 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. but t_�1 N ►S 'R Z 's ITi:,,c 5 t3 i 3 S-to Z is R. F Me k Vic.— S PE 2 A'CE� t L—N itN c, 1 Nj-T r2— �1, $Z S C= 'F �4 y IL. U I-1 ► T _TZA`TE4� SS'A11Z EhIC_L $S.U RE 'TjZ_A VI—L I-% AN GE —T�A r_= UN 1 T 5 ,= K G'v_=E h _T W IF-7_5::�t1' T�ell ECI U 1 i1,c. 1� -Z_Y L-M s-S -r�A A.N ► ® ' 1 F Us t 'N c, o��T �d c1 At A A t_.... Niz-s -To s�-A s�e&/ -r?,ta,Y-IF= U T S ❑ Separate Sheet Attached Side I 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 the201 Z 1 NT, 1= '�F c ti,t>E Section d 0 2 , , Z( � Insert Name of Regulation for which Modification/Relief is bein Re uesteq noted above: 9 9 identify section of Cotle/Regulation S -C-T of A O F -T I I I I ❑ 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. Applicant gnature T phone Number J Date FE3R,LL?CAL Fi MAR' I, [.Support, ❑Do NOT Support, this Request for Modification to Connecticut c ri c- Identify Code by Name;W.Fire Safety Code,Oil Buming Equip Code Regulation of Connecticut State Agency 6;-��®� �(e� inclusive;as identified above to Section 12 Insert regulation Number i.e.29-292-8d,29317-3a,etc. because of the following reasons: Identify code flow i.e.occupancy chapter,core chapter as applicable a • i Yr�aY�.� ;. �°a a a%i avQ Via. �;,,a,Va., t�'a�i C�var'�?a,a b L: �f�:^ate,t��v'.sa ❑ Separate Sheet Attached Fire Marshal ewer'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 ! 2- 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:� � Z Attic: ❑ Full Basement—#of Levels: ❑ Full ❑ Finished ❑ Partial ❑ Partial El Storage None None ❑ Crawl Space Type of Occupancy (Check all that apply) JK New ❑ Existing❑ Addition ❑ Renovation of building ❑ Change of Occupancy: From to ❑ Assembly ❑ Detention ❑ Residential Board ❑ Hotel/Motel/Dorm Occupant Load: persons ❑ with locking it ❑ Large ❑ Small ❑ Lodging/Rooming ❑ Educational ❑ with locking III ❑ Prompt p ❑ 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:M Zvff�i ❑ Health Care ❑ ❑ High Rise Class A ❑ Day Care ❑ Hospital ❑ Underground ❑ Class B ❑Adult ❑ Nursing Home El Windowless ❑ Class C ❑ Family ❑ Ambulatory ❑ Other: ❑ Covered Mall ❑Group ❑ Limited ❑Other: Type of Construction per NFPA 220: (Check all that apply) ❑ Type 1 ❑ Type II ❑ Type 111 ❑ Type IV ❑ Type V ❑ 1 (443) ❑ II (222) ❑ III (211) ❑ (2HH) ❑ V 011) ❑ 1 (332) ❑ it (111) ❑ III (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 IX NFPA 13R 'K Partial: Location R—2. - ❑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 1J � %>U 'Ft ?_ra, t_j Al._L 111--17' `T\,w C_- �,��g.��.-T~� !A c_s� 2 5 F Ica t�r��5 u It. v I-- C, T�t,. 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