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Fire Application Form Fillabl

The document is an application for a fire department permit from the Glendale Fire Department. It requests information about the applicant, contractor, project address, type of permit being requested, and description of proposed work. An applicant must complete the permit worksheet providing additional details about inspection hours, systems, devices, and other information depending on the permit type.

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Otceliban Sarl
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39 views2 pages

Fire Application Form Fillabl

The document is an application for a fire department permit from the Glendale Fire Department. It requests information about the applicant, contractor, project address, type of permit being requested, and description of proposed work. An applicant must complete the permit worksheet providing additional details about inspection hours, systems, devices, and other information depending on the permit type.

Uploaded by

Otceliban Sarl
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Glendale Fire Department - Fire Prevention Bureau

633 E. Broadway, Suite 101, Glendale, CA 91206


Phone (818) 548-3207 Fax (818) 548-3215
www.glendalefire.org

APPLICATION FOR DATE:


TO THE FIRE CHIEF: FIRE DEPARTMENT PERMIT
Application is hereby made by the undersigned for a permit as described below. All conditions surrounding this application to be
in accordance with the Glendale Building & Safety Code. A fee must accompany this application unless exempt
PROJECT / BUSINESS NAME:

PROJECT ADDRESS, SUITE #, CITY, AND ZIP

CHECK ALL APPLICABLE BOXES  New  Alteration  Removal


PERMIT TYPE  Alarm  Covered Mall  Extinguishing System  General  Haz Mat
 Hydrant  Sprinkler (comm./mfd)  Sprinkler (sfd)  UST/AST  Other
APPLICANT TO COMPLETE PERMIT WORKSHEET (On reverse )
DESCRIPTION OF PROPOSED WORK:
For installation of fire protection systems, list each component type and quantity. Use of hazardous materials requires
completion of additional forms.

APPLICANT: (Check all Applicable Boxes)


Property Owner/Business Owner Applicant Contractor Non-Profit Pilot
NAME MAILING ADDRESS PHONE NO.

E-MAIL ADDRESS

CALIFORNIA LICENSED CONTRACTOR'S DECLARATION: I herby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
CONTRACTOR'S NAME MAILING ADDRESS PHONE NO.

E-MAIL ADDRESS

LICENSE TYPE LICENSE NUMBER

Signature of Applicant Date

▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ STAFF USE ONLY ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬


P.C. FEE
UL:  Yes  No Y N
FTECH
If yes provide the UL listing number Link to Permit No. Y N
(for Fire Alarm Only) INSPECTION

OK TO SUBMIT BY: DATE: ACCEPTED BY: DATE: RECEIPT NO.: Y N


ARCHIVE FEE
[PAGES]

OK TO ISSUE BY: DATE: ACCEPTED BY: DATE: RECEIPT NO.:


SUPP. P.C. FEE
Y N
BOX NO. ITEM NO. PERMIT NO. PERMIT EXPIRATION DATE: PERMIT FEE
Y N
F-55(Rev 04/14)
PERMIT WORKSHEET
Permit Type Subtype

 Additional Plan Review Hours  Inspection After Business Hours Hours

 Additional Inspection Hours


 Re-Inspection

General

Candles & Open Flames  Filming  Not Covered Herein
in Assembly Area

 Fireworks Display  Helicopter Landing  High-piled Storage Area

 Fire Clearance Issuance  Spray Booth  Pyrotechnical / Special Effects

 Tents, Canopies, Temporary Membrane Structures

Covered Mall
 Liquid or Gas-Fueled Display  Temporary Kiosk, Booth, Concession, Barricade, etc

 General (i.e. Special Event)  Open Flame or Flame Producing Device

Fire Alarm
 Alteration to Existing System (up to 8 Devices)  New or Existing System (9 Devices or more)

 New System (Up to 8 Devices)  New or Existing System (High Rise Building)

Number of devices

Fire
Extinguishing
 New or Existing System
 Special Extinguishing System
System
 Hood System

Number of Nozzles Number of Initiation Devices

Fire Sprinkler
(Commercial /
 Alteration to Existing System (up to 10 Heads)  New or Existing System (11 or more Heads)

Industrial /
 New System (Up to 10 Heads)  Underground Supply Line
Multifamily)
No. of Sprinkler Heads No. of Risers
No. of Inlets & Outlets (FDC, Standpipe Valves, Etc).
Fire Sprinkler
(SFD)  New System  House Only or House with Attached Garage

Detached Garage,
 Existing System (Alteration)  Guest House Or Accessory Bldg.; House Not Included
House and Detached Garage, Guest House
 or Accessory Building
Hydrant
 Fire Flow Test
 Private Fire Hydrant
 Fire Flow Report

Other

Fire Code Modification  Change to Fire Permit
Request

 Fire Code Alternate Method or Materials  Search for Fire Permit

Digital Copying, Scanning of Fire Protection System Plan Sheets


 For Archiving.  Retrieval of Fire Plans

 Copying of Letter / Legal Size Document  Technical Search

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