PROJECT / APPLICANT INFORMATION
BUSINESS / PROJECT NAME
LAKEWAY / BEE CAVE PERMIT #
ADDRESS WHERE SERVICES ARE REQUESTED
APPLICANT’S BUSINESS NAME & MAILING ADDRESS
TELEPHONE
SEND CORRESPONDENCE TO: (EMAIL ADDRESS / FAX #)
NOTES OR ADDITIONAL INFORMATION FOR INSPECTOR
APPLICANT’S PRINTED NAME
DATE
APPLICANT’S SIGNATURE
TRAVIS COUNTY ESD NO. 6 USE ONLY
RECEIVED BY
(Revised 08-10-2012)
AMOUNT PAID
CHECK #
COMMENTS
RESIDENTIAL FIRE SPRINKLERS SAVE LIVES! http://www.homefiresprinkler.org/
Travis County Emergency Services District No. 6
Lake Travis Fire Rescue
15304 Pheasant Lane, Austin, Texas 78734
(512) 266-2533 FAX (512) 266-7065
Request for Services
Services are not provided without payment of applicable fee. / Public Agencies and Non-profit Organizations are fee exempt.
SERVICE TYPE
SERVICE FEE
ADMINISTRATIVE FEES
[ ] Reports for Fire, EMS, or any Incident Response………………………………………………………………………………………………………. $5.00 each
[ ] Copies of Records made by the District…………………………………………………………………………………………………………………….. $0.10 per page*
*(or as specified per the open Records Act, Admin. Code, Title 1, Part 3, Ch. 70, Rule 70.10)
INSPECTIONS / TESTS
Aboveground Fire Sprinkler System Acceptance Testing:
[ ] Visual <20 Heads………………………………………………………………………………………………………………………………………………… $40.00 per system
[ ] Visual 20 Heads and Greater………………………………………………………………………………………………………………………………. $40.00 + $2.00 per head >20
[ ] Hydrostatic Test, Including Main Drain Test……………………………………………………………………………………………………….. $60.00 per system
[ ] Underground Fire Line Visual including Hydrostatic Testing……………………………………………………………………………………… $260.00
Fire Alarm System Acceptance Testing:
[ ] 01 – 10 Devices…………………………………………………………………………………………………………………………………………………… $100.00
[ ] 11 – 25 Devices…………………………………………………………………………………………………………………………………………………… $155.00
[ ] 26 – 200 Devices…………………………………………………………………………………………………………………………………………………. $210.00
[ ] >200 Devices………………………………………………………………………………………………………………………………………………………. $210.00 + .50 per device >200
[ ] Alternative Fire Suppression System Acceptance Testing (i.e., Spray Booths, Dry/Wet Chemical, etc.)……………………. $150.00 (includes Plan Review &
Acceptance Test)
[ ] Kitchen Vent Hood Fire Suppression System Acceptance Testing……………………………………………………………………………. $200.00 per system (includes Plan Review &
Acceptance Test)
[ ] Fire Pump Acceptance Test……………………………………………………………………………………………………………………………………… $260.00 per pump
[ ] Commercial Propane Installations…………………………………………………………………………………………………………………………… $250.00
[ ] Fireworks Stand Annual Inspection (includes July 4th & New Years)………………………………………………………………………… $100.00 per year
[ ] Home Inspection (Foster & Adoption)……………………………………………………………………………………………………………………… $30.00
[ ] Daycare Annual Licensing Inspection………………………………………………………………………………………………………………………. $50.00 <25 Children
[ ] Daycare Annual Licensing Inspection………………………………………………………………………………………………………………………. $100.00 >25 Children
[ ] Private School Inspection………………………………………………………………………………………………………………………………………… $50.00
[ ] TABC Licensed Business Inspection…………………………………………………………………………………………………………………………. $160.00
Health Care Facility Annual Licensing Inspections:
[ ] Assisted Living……………………………………………………………………………………………………………………………………………………. $100.00 + $1.00 per bed
[ ] Hospital……………………………………………………………………………………………………………………………………………………………… $100.00 + $1.00 per bed
[ ] Clinic………………………………………………………………………………………………………………………………………………………………….. $100.00 + $1.00 per bed
Fire Final Inspections:
[ ] Buildings <10,000 sq ft………………………………………………………………………………………………………………………………………. $70.00
[ ] Buildings 10,000 sq ft. or greater………………………………………………………………………………………………………………………. $90.00
Re-inspections for Fire Finals, Fire Protection System Acceptance Testing & Fire Hydrant Flows:
[ ] 2nd Inspection…………………………………………………………………………………………………………………………………………………….. $100.00
[ ] 3rd Inspection…………………………………………………………………………………………………………………………………………………….. $200.00
[ ] 4th and any additional Inspections……………………………………………………………………………………………………………………… $300.00 each inspection
[ ] Request to Reschedule with less than 4 Hours Notice…………………………………………………………………………………………. $50.00
Permits
[ ] Hazardous Materials (IFC Sect. 105.6.21)…………………………………………………………………………………………………………… $260.00
[ ] Fireworks Displays (IFC Sect. 3301.2) Class B, 1.3G Fireworks……………………………………………………………………………. $150.00
[ ] Fireworks Displays (IFC Sect. 3301.2) Class C, 1.4G Fireworks……………………………………………………………………………. $50.00
[ ] Open Burning (IFC Sect. 307.2)…………………………………………………………………………………………………………………………… $50.00 per year
[ ] Temporary Membrane Structures, Tents and Canopies (IFC Sect. 105.6.44)………………………………………………………. $160.00 per tent
“Mass Gathering” (4,000 persons or more):
[ ] Permit…………………………………………………………………………………………………………………………………………………………… $200.00
[ ] LTFR Staff requested on site during event……………………………………………………………………………………………………. $80.00 per hour/per staff member
[ ] LTFR Fire Apparatus requested on site during event…………………………………………………………………………………….. $200.00 per hour/per apparatus**
Other Services:
[ ] LTFR Fire Apparatus “Standby”………………………………………………………………………………………………………………………….. $200.00 per hour/per apparatus
[ ] LTFR Fire Inspector “Standby”…………………………………………………………………………………………………………………………… $80.00 per hour/per Inspector
“Fire Watch”
[ ] LTFR Personnel…………………………………………………………………………………………………………………………………………… $80.00 per hour/per person
[ ] LTFR Fire Apparatus…………………………………………………………………………………………………………………………………….. $200.00 per hour/per apparatus
(Revised 08-10-2012)
RESIDENTIAL FIRE SPRINKLERS SAVE LIVES! http://www.homefiresprinkler.org/