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 ofjob
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
1,000 - $12.00
Over $1,000
S12.00 per$1,000 OWNER NT Ip Il fDlC/ i u.EL C EL GS
any fraction thereof
ADDRESS 9 d - F-J/Q WC-1/ A Ve
O W r, IA10s09
OWNERS PHONE#
X$-APPLICANT MA6 F LL(" C /VI 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 dw O
I aOSOR-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 OCCUPANCYMERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCYINSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESSMIXEDUSE
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
PSIMTOTALDYNAMICHEAD(TDH)OF FIRE PUP
DESCRIPTION OF WORK
I
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND ISTOCOMPLYWITHALLLOCALORDINANCESANDSTATEOFCONNBUILDINGCODESINTHE
PERFORMANCE OF
SUCHX46PLIVAolio
NAME STATE LICENSE NO. TYPE NT
PHONE NO. DATE I