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

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    Cell

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    Building Owner Name

    Address Line 1

    Address Line 2

    City, State, Zipcode

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    Cell

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    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.**