Commercial Exhaust Hood System Permit Application

Commercial Exhaust Hood System Permit Application

Name of the Business

Address Line 1

Address Line 2

City, State, Zipcode

Type of Business

Facility Contact Information

Primary Contact Name

Address Line 1

Address Line 2

City, State, Zipcode

Secondary Contact Name

Address Line 1

Address Line 2

City, State, Zipcode

Third Contact Name

Address Line 1

Address Line 2

City, State, Zipcode

Building Owner Name

Address Line 1

Address Line 2

City, State, Zipcode

Commercial Exhaust and Suppression Hood Systems Permit Application

Name of Company

Company Contact Person

Address Line 1

Address Line 2

City, State, Zipcode

Manufacture of Hood System**

Type of Hood System

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

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**

Type of Suppression System

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.**