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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    Email


    Building Owner Name
    Address Line 1
    Address Line 2
    City, State, Zipcode
    Phone
    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.**