FIRE PROTECTION SUBCODE TECHNICAL SECTION

1 Date Received Control #. FIRE PROTECTION SUBCODE . TECHNICAL SECTION Date Issued Permit #. A. IDENTIFICATION APPLICANT: COMPLETE ALL APPLICABLE INFORMATION. WHEN CHANGING C. CERTIFICATION IN LIEU OF OATH. CONTRACTORS, NOTIFY THIS OFFICE. CALL UTILITY DIG NO: 1-800-272-1000. I hereby certify that I am the (agent of) owner of record and am authorized to make this Block Lot Qualification Code application. Work Site Location Applicant/Contractor sign here: Owner in Fee: Print name here: Tel. e-mail [ ] Certified Contractor [ ] Exempt Applicant D. TECHNICAL SITE DATA. Address DESCRIPTION OF WORK: street municipality zip code Contractor: Tel.

2 Water Supply Source Address e-mail Method of Alarm/Suppression System Supervision _____. NUMBER 1234567890123456. FEE (Office Use Only). 1234567890123456. Fire PROTECTION Equipment, NJ Div of Fire Safety Permit No. Flammable/Combustible Tanks $ 1234567890123456. 1234567890123456. Fire PROTECTION Equipment, NJ Div of Fire Safety Installer No. Alarm Systems 1234567890123456. 1234567890123456. Fire Alarm Contractor No. Exp. Date [ ] System 1234567890123456. 1234567890123456. Home Improvement Contractor Registration No. or Exemption Reason [ ] 110v Interconnected 1234567890123456. 1234567890123456. [ ] CO Detectors/110v Federal Emp.

3 ID No. FAX: 1234567890123456. 1234567890123456. Alarm Devices ( , smoke, heat, pulls, B. FIRE PROTECTION CHARACTERISTICS water/flow). 1234567890123456. 1234567890123456. Fuel Storage Tank: Supervisory Devices ( , tampers, low/high air) 1234567890123456. 1234567890123456. Use Group: Present Proposed Fuel Type: [ ] Flammable OR [ ] Combustible 1234567890123456. 1234567890123456. Signaling Devices ( , horn/strobes, bells). Constr. Class: Present Proposed Capacity 1234567890123456. 1234567890123456. Other Devices 1234567890123456. 1234567890123456. Heating System: [ ] New [ ] Modification to Existing Fire Alarm System: [ ] New [ ] Existing 0 1234567890123456.

4 OR OR TOTAL. 1234567890123456. OR [ ] Conversion OR [ ] Replacement Location of Panel: Suppression Systems 1234567890123456. 1234567890123456. Fire Suppression/Standpipe System: Fire Pump GPM Type 1234567890123456. Fuel Type: [ ] Gas [ ] Oil [ ] Electric [ ] Solar 1234567890123456. [ ] Other [ ] New OR [ ] Existing Dry Pipe/Alarm Valves 1234567890123456. 1234567890123456. Location of Main Control Valve: Pre-action Valves 1234567890123456. Location: 1234567890123456. Total Cost of Fire PROTECTION Work $. Sprinkler Heads (Dry and Wet) 1234567890123456. 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890.

5 1234567890123456789012345678901212345678 9012345678901234567890121234567890 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Standpipes 1234567890123456. JOB SUMMARY (Office Use Only) INSPECTIONS Dates (Month/Day). 1234567890123456789012345678901212345678 9012345678901234567890121234567890 Pre-engineered Systems 1234567890123456. 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. PLAN REVIEW. 1234567890123456789012345678901212345678 9012345678901234567890121234567890 1234567890123456. Type: Failure Failure 1234567890123456789012345678901212345678 9012345678901234567890121234567890.

6 Approval Initial Wet Chemical 1234567890123456. [ ] No Plans Required 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Alarm System Dry Chemical 1234567890123456. 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. [ ] Partial -Underslab Utilities Approved 1234567890123456789012345678901212345678 9012345678901234567890121234567890 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890 CO2 Suppression 1234567890123456. Date: Approved by: Suppression Sys. 1234567890123456789012345678901212345678 9012345678901234567890121234567890 1234567890123456.

7 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Standpipe 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Foam Suppression 1234567890123456. [ ] Fire PROTECTION Plans Approved 1234567890123456789012345678901212345678 9012345678901234567890121234567890 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Date: Fire Pump FM200 Suppression 1234567890123456. 1234567890123456. Approved by: 1234567890123456789012345678901212345678 9012345678901234567890121234567890. 1234567890123456789012345678901212345678 9012345678901234567890121234567890.

8 Pre-Eng. System Other 1234567890123456. 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Joint Plan Review Required: 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Other Systems 1234567890123456. 1234567890123456. Mechanical Kitchen Hood Exhaust System 1234567890123456789012345678901212345678 9012345678901234567890121234567890. [ ] Bldg. [ ] Elec. [ ] Plumb. [ ] Elev. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. 1234567890123456. 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890.

9 SUBCODE APPROVAL for PERMIT Smoke Control 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Smoke Control System 1234567890123456. 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Date: TCO. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Fuel-Fired Appliances [ ] Gas [ ] Oil [ ] Solid 1234567890123456. 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Approved by: 1234567890123456789012345678901212345678 9012345678901234567890121234567890. Flam/Combust Tanks Fireplace Venting/Metal Chimney 1234567890123456.

10 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. SUBCODE APPROVAL for CERTIFICATE Fireplace Venting Other 1234567890123456. 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890 Administrative Surcharge $1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890. [ ] CO [ ] CCO [ ] CA Final 1234567890123456789012345678901212345678 9012345678901234567890121234567890. 1234567890123456. 1234567890123456789012345678901212345678 9012345678901234567890121234567890.