HomeMy WebLinkAbout1535 John Fitch Boulevard (16)DEPARTMENT DECISION APPLICATION FOR SPRINKLER PERMIT
PERMIT#
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext.230
Dat wilding Inspector Application must be printed or typed
Location ofjob
r-, CL-, z I.c
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER u,c r. e
or any fraction thereof
ADDRESS 1 S
Sor C.
r
OWNERS PHONE#
APPLICANT
OWN S f ADDRESS b 90Y,
Ci e
ESTIMATED COST$
C . . IS THIS A CONTRACT COST?
S NO
CJ FEE ENCLOSED S La o
TYPE OF JOB:OR-Co Original Installation
Alteration/Addition/Repair
Revised 10/96
APPLICATION FOR SPRINKLER PERMIT(Continued from reverse side)
FIT3YZPEF BUILDING TYPE OF CONSTRUCTION USE GROUP NO.OF STORIES
SIDENTIAL 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)
ARE SPRINKLER HEADS ALTERED Y/N
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 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 YIN
SPRINKLER SYSTEM MAIN WATER SUPPLY RATING GPM
TOTAL DYNAMIC HEAD(TDH)OF FIRE PUMP PSI
DESCRIPTION OF WORK
S kE S rL) L3cx
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.
NAME STATE LICENSE NO. TYPE SIGNA OF APPLICANT
PHONE NO. y 3 DATE l T1