FIRE PROTECTION SUBCODE
TECHNICAL SECTION
Pre-engineered Systems
Suppression Systems
Alarm Systems
NUMBER
FEE (Office Use Only)
Other Systems
Date Received
Control #
Date Issued
Permit #
A. IDENTIFICATION—APPLICANT: COMPLETE ALL APPLICABLE INFORMATION. WHEN CHANGING
CONTRACTORS, NOTIFY THIS OFFICE. CALL UTILITY DIG NO: 1-800-272-1000.
Other
Smoke Control System
Kitchen Hood Exhaust System
Other
FM200 Suppression
Foam Suppression
CO
2
Suppression
Dry Chemical
Wet Chemical
Standpipes
Sprinkler Heads (Dry and Wet)
Pre-action Valves
Dry Pipe/Alarm Valves
GPM TypeFire Pump
TOTAL
Other Devices
Signaling Devices (i.e., horn/strobes, bells)
Supervisory Devices (i.e., tampers, low/high air)
Alarm Devices (i.e., smoke, heat, pulls,
water/flow)
System
[ ]
[ ]
110v Interconnected
Flammable/Combustible Tanks
Fireplace Venting/Metal Chimney
Administrative Surcharge
$
Minimum Fee
$
State Permit Surcharge Fee $
TOTAL FEE $
[ ]
CO Detectors/110v
Block Lot
Qualification Code
Work Site Location
zip codemunicipalitystreet
Address
e-mail
Tel.
Owner in Fee:
Contractor: Tel.
Address
e-mail
Fire Protection Equipment, NJ Div of Fire Safety Permit No.
Fire Protection Equipment, NJ Div of Fire Safety Installer No.
Fire Alarm Contractor No.
Exp. Date
Federal Emp. ID No.
FAX:
Home Improvement Contractor Registration No. or Exemption Reason
Applicant: When submitting this form to your Local Construction Code Enforcement Office, please provide one
original plus three photocopies.
U.C.C. F140 (rev. 02/11)
Internet version
Fuel-Fired Appliances
[ ] Oil
[ ] Gas
[ ] Solid
B. FIRE PROTECTION CHARACTERISTICS
ProposedPresent
Use Group:
Proposed
PresentConstr. Class:
Fuel Storage Tank:
Fuel Type: [ ] Flammable OR [ ] Combustible
Capacity
New OR ExistingFire Alarm System:
[ ]
[ ]
Location of Panel:
Total Cost of Fire Protection Work $
Initial
ApprovalFailure FailureType:
Dates (Month/Day)INSPECTIONS
Other
Fireplace Venting
Flam/Combust Tanks
Final
TCO
Smoke Control
Mechanical
Pre-Eng. System
Fire Pump
Standpipe
Suppression Sys.
Alarm System
JOB SUMMARY (Office Use Only)
PLAN REVIEW
No Plans Required
[ ]
Approved by:
Date:
SUBCODE APPROVAL for CERTIFICATE
CA
[ ]
CO
[ ] [ ]
CCO
Joint Plan Review Required:
[ ] Bldg. [ ] Elec. [ ] Plumb. [ ] Elev.
SUBCODE APPROVAL for PERMIT
Date:
Approved by:
Approved by:
Date:
Fire Protection Plans Approved[ ]
Partial -Underslab Utilities Approved[ ]
Approved by:
Date:
Fuel Type:
Other
Location:
[ ]
Solar
[ ]
Electric
[ ]
Oil
[ ]
Gas
[ ]
New OR
Location of Main Control Valve:
Existing
Fire Suppression/Standpipe System:
[ ] [ ]
Heating System: Modification to Existing
OR
[ ]
New
[ ]
[ ] Replacement
OR
[ ]Conversion
OR
C. CERTIFICATION IN LIEU OF OATH
I hereby certify that I am the (agent of) owner of record and am authorized to make this
application.
Water Supply Source
Method of Alarm/Suppression System Supervision _____________________
[ ] Certified Contractor [ ] Exempt Applicant
D. TECHNICAL SITE DATA
Applicant/Contractor
sign here:
DESCRIPTION OF WORK:
$
Print name here:
0
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