Application for Fire Protection Permit
Applicant’s signature Print name Date
Section 1 – General Information
PLEASE PRINT OR TYPE
Contractor is required to schedule a rough-in inspection before any concealment.
By signing the application, the applicant certifies that the installation will comply with the regulations of the Newburgh Heights
Building Code and State Codes.
TO THE BUILDING COMMISSIONER: This application is submitted for a permit to erect, add to, alter or repair a structure as described
in this application and any drawings which accompany it. The acceptance of the permit shall be considered an agreement on the part of the
applicant or his agents to comply with the Building and Zoning codes of the City of Newburgh Heights, or other orders, requirements or
specifications slated in the permit.
In signing this application, the contractor or owner’s agent certifies that the work is authorized by the owner or record.
Applicant is Owner Contractor Owner’s agent
Permit No. Date Received
Estimated cost of Project $
Date
Section 2 – Description of Construction and Use Classification of Building
A. Nature of Job
Addition
Alteration
New
Demolition
Moving (relocation)
Foundation only
Use
Change of use - indicate
former use classification
B. Construction
Classification per OBBC
I A B
II A B C
III A B
IV
V A B
C. Proposed Use: For “wrecking”
most recent use. For mixed-
use bldgs. indicate all
applicable uses.
A-1A Assembly, theaters (with
stage)
A-1B Assembly, motion picture
theaters (without stage)
A-2 Night clubs, dance halls, etc.
A-3 Assembly, lecture halls,
recreation centers, terminals,
restaurants other than night
clubs
A-4 Assembly, churches
A-5 Outdoor Assembly structure
B Business
E Educational (School, day care)
C. (Continued)
F-1 Factory and industrial
moderate hazard
F-2 Factory and industrial low
hazard
H High Hazard
I-1 Institituional, residential care
I-2 Institutional, incapacitated
day nursery, hospital
I-3 Restrained, jails, prisons, etc.
M Mercantile
R-1 Residential
R-2 Residential
R-3 Residential
S-1 Storage, moderate hazard
S-2 Storage, low hazard
U Utility, miscellaneous
D. Installation
Sprinkler head
Detection unit
Pull station
Alarm panel
Hood (list number
of nozzles)
Other:
# of units
Village of Newburgh Heights Housing and Building Department
3801 Harvard Ave., Newburgh Heights OH 44105 Phone: 216-641-4654
Address of construction ____________________________________________________________________________
Owner’s name ___________________________________________________ Phone ___________________________
Owner’s address __________________________________________________________________________________
Contractor ______________________________________________ Business phone ___________________________
E-mail address ________________________________________________________
Contractor’s address _______________________________________________________________________________
Street City State Zip
