Fillable Master Fire Permit (City of Golden Valley)

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Master Fire Permit (City of Golden Valley)

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File type: PDF

U.S.A. forms for City of Golden Valley

BROWSE CITY OF GOLDEN VALLEY (MN) FORMS

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Fire Permit Application Page 1 of 2
Job Site Address Unit #
Total Project Valuation $
(must include material and labor costs)
Applicant Is ❒ Owner ❒ Contractor
Business Name
Name
Street Address City State ZIP
Email Phone
Contractor
Name License # Contact Person
Street Address City State ZIP
Email Phone Cell Phone
Property Use Type Of Permit Type Of System
r Residential
r Industrial
r Public
r Commercial
r Industrial
r Sprinkler System
r Standpipes
r Special Extinguishing
System
r Underground Tank (UST)
r Above Ground Tank
(AST)
r Piping/Dispensers
r Hood & Duct
r Fireworks
r Christmas
Trees Lot
r Fire Pump
r Fire Alarm
r Tent/
Canopy
r NFPA 13
r NFPA 13D
r NFPA 231C
r NFPA 17A
r NFPA 13R
r NFPA 231
r NFPA 72
r NFPA 2001
r Other _____________________________
Type Of Work
r Others ___________________________
r New System
r Repair/Replace
r Abandonment
r Existing System
r Removal
r Recall
r Others ___________________________
r Other ___________________________
Specic Description Of Work To Be Completed Fire Permit Fees
Permit Fee $
Plan Check Fee $
Total Fees Due $
Fire Department | 7800 Golden Valley Road, Golden Valley, MN 55427
763-593-8065 | FAX: 763-593-8098 | TTY: 763-593-3968 | www.goldenvalleymn.gov
4/05/12
continued
This document is available in alternate formats upon a 72-hour request. Please call 763-593-8006 (TTY: 763-593-3968) to
make a request. Examples of alternate formats may include large print, electronic, Braille, audiocassette, etc.
Signature
Permit becomes void if work does not begin within 180 days or if suspended at any time for over 180 days. Permits issued and inspections made by the
City are a public service and do not constitute any representation, guarantee or warranty, either implied or expressed, to any person as to the condition of
the building or conformance to applicable construction codes. The Undersigned acknowledges that this application has been read and that the above
is correct and agrees to comply with all the ordinances and laws of the City of Golden Valley. The Undersigned has also read and agrees to the data
practices advisory statement at the bottom of this page.
Applicant’s Signature
X
Date
Notes
Fire Permit Application Page 2 of 2
Sta Use Only
Permit Approved By Date Approved
Required Inspections
r Plan Review
r Tank Removal
r Hydrostatic
r Audible/Visible
r Flow Test
r Site Inspection
r Tank Installation
r Fire Pump
r Heat Detection
r Final
r Tank Cleaning/Purging
r Piping: Installation/
Coverage
r Alarm/Dialer
r Pull Station
r Head Locations
r Central Station
r Smoke Detector
r Anunciator
r Other ______________________________________
DATA PRACTICES ADVISORY: The data you supply in this application will be used to assess your qualications for a permit and will
become public data under the Minnesota Government Data Practices Act when received by the City of Golden Valley. This data
is not legally required, but the City will not be able to grant the permit without it. The data is needed to distinguish this applica-
tion from others, to identify this application in City permit les, to verify the identity of the applicant, to contact the applicant if
additional information is required, and to determine if the applicant meets all ordinance requirements. Under Minnesota law (M.S.
270.72), the City may be required to provide the business tax identication number and social security number of each applicant
to the Minnesota Commissioner of Revenue.
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Master Fire Permit (City of Golden Valley)

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Completed 16 July 2020

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