Commercial Exhaust Hood System Permit Application

Name of the Business
Address Line 1
Address Line 2
City, State, Zipcode
Phone
Fax
Type of Business



Facility Contact Information

Primary Contact Name
Address Line 1
Address Line 2
City, State, Zipcode
Phone
Cell
Fax
Email


Secondary Contact Name
Address Line 1
Address Line 2
City, State, Zipcode
Phone
Cell
Fax
Email


Third Contact Name
Address Line 1
Address Line 2
City, State, Zipcode
Phone
Cell
Fax
Email


Building Owner Name
Address Line 1
Address Line 2
City, State, Zipcode
Phone
Cell
Fax
Email



Commercial Exhaust and Suppression Hood Systems Permit Application


Company Performing Installation of EXHAUST HOOD AND DUCT SYSTEM

Name of Company
Company Contact Person
Address Line 1
Address Line 2
City, State, Zipcode
Phone
Fax

Exhaust Hood and Duct System to be Installed

Manufacture of Hood System**
Model Number of Hood System
Serial Number of Hood System
Type of Hood System
Number of Hood Systems to be Installed
Size of Exhaust Hood to be Installed
Date When Work is to Begin
Date When Work is to Be Completed

**CERTIFIED MANUFACTURE SHOP DRAWINGS AND MANUFACTURE INSTALLATION SPECIFICATIONS MUST BE SUBMITTED TO THE ELLSWORTH FIRE DEPARTMENT INSPECTION OFFICE BEFORE INSTALLATION.**


Company Performing Installation/Testing/Maintenance of EXHAUST HOOD SUPPRESSION SYSTEM

Name of Company
Company Contact Person
Address Line 1
Address Line 2
City, State, Zipcode
Phone
Fax

Company Technician(s) Performing: Installation/Testing/Maintenance

Name of Technician
Qualifications
Name of Technician
Qualifications

(Technicians must submit proof of their qualifications to perform work on the Suppression System that is being permitted.)


Exhaust Hood Suppression System to be Installed/Testing/Maintenance

Manufacture of Suppression System**
Model Number of Suppression System
Serial Number of Suppression System
Type of Suppression System
Number of Suppression Systems to be Installed
Size of Suppression System to be Installed
Date When Work is to Begin
Date When Work is to Be Completed
Is the Suppression System Connected to the Building Fire Alarm System? YesNo

**CERTIFIED MANUFACTURE SHOP DRAWINGS AND MANUFACTURE INSTALLATION SPECIFICATIONS MUST BE SUBMITTED TO THE ELLSWORTH FIRE DEPARTMENT INSPECTION OFFICE BEFORE INSTALLATION.**