HomeMy WebLinkAbout100 Arnold Way (62)PERMIT#
DEPARTMENT DECISION APPLICATION FOR SPRINKLER PERMIT 1&q7
Application is hereby: TOWN of SOUTH WINDSOR
Bldg permit#BUILDING DEPARTMENT g
APPROVED 1540 SULLIVAN AVENUE
Wdr 644-2511 ext. 230
Date Building Inspector Application must be printed or typed
Location of job
00 ARNO L,d VVA `1
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
SO - $1,000 - $12.00
Over S1,000
12.00 per$1,000 OWNER
or any fraction thereof
ADDRESS l -5-4° GL f Y/-h/ 14V,0E
OWNERS PHONE#
APPLICANT G J,'1/ 1 i9/ ` ' </0 ' ' `/J'/ s 9S 4C-4I1
0 N S F
ADDRESS y,1.ws oy /.,/)
q<
ESTIMATED COST$ a "1-'
CIS THIS A CONTRACT COST? _
YES NO
FEE ENCLOSED $ (
OR-CO 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( NO
ASSEMBLY CURRENT USE AND OCCUPANCY L
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY L-
INSTITUTIONAL
FACTORY
ENGINEER'S NAME PHONE
STORAGE
GARAGE
ADDRESSMIXEDUSE
CITY STATE C-% ZIP
Other please specify)KIND OF INSTALLATION
DRY WET Zi COMBINATION CHEMICAL
SIZE OF MAIN DRAIN Z WATER PRESSURE AT STREET(PSI) 7 />S
ARE SPRINKLER HEADS ALTERED Y/N_I/
IF YES CHECK ALL THAT APPLY _ADDED _DELETED _ALTERED
IF MORE THAN 3 HEADS ARE ADDED HYDRAULIC CALCULATIONS ARE PROVIDED BY
CHECK ONE) P.E. INSURANCE CO. `!
WATER FLOW /G 4o WATER PRESSURE AT SPRINKLER HEADS(PSI) VAR)A S
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 GPM
TOTAL DYNAMIC HEAD(TDH)OF FIRE PUMP PSI
DESCRIPTION OF WORK
VSTA-L{- S//J///tl,E/2 syS.i i/L !-TTi-L/-./'
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 SUCH WORK.
C dUU/as3S
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO. S DATE