Please Print All Information
BLOCK__________________
SITE LOCATION_____________________________
Florham Park Borough
OWNER IN FEE________________________________________
111 RIDGEDALE AVENUE ADDRESS_______________________________________________
FLORHAM PARK, NJ 07932 FLORHAM PARK, NEW JERSEY 07932
973-410-5346 (FAX) 973-410-5486
ELECTRICAL
CONTRACTOR:__________________________________________________________
ADDRESS:_______________________________________________________________
CITY:_____________________________________________________________________
PHONE: _________________________________________________________________
LICENSE NO._________________ EXPIRATION DATE____________________
HOME IMPROVEMENT CONTRACTOR REGIS. NO.__________________
OR EXEMPTION REASON (IF APPLICABLE)__________________________
FEDERAL EMPLOYEE OR S.S. NO._____________________________________
TECHNICAL SITE DATA:
QUANTITY SIZE
ITEMS
_______
LIGHTING FIXTURES
_______
RECEPTACLES
_______
SWITCHES
_______
DETECTORS
_______
LIGHT POLES
_______
MOTOR-FRAC HP
_______
EMERGENCY/EXIT LIGHTS
_______
COMMUNICATION POINTS
_______
ALARM DEVICES/F.A.C. PANEL
_______ TOTAL NUMBER
_______ ________ POOL PERMIT W/UW LIGHTS
_______ ________ STORABLE POOL/SPA/HOT TUB
_______ ________ KW ELEC. RANGE/RECEPTACLE
_______ ________ KW OVEN/SURFACE UNIT
_______ ________ KW ELEC. WATER HEATER
_______ ________ KW ELEC. DRYER/RECEPTACLE
_______ ________ KW DISHWASHER
_______ ________ HP GARBAGE DISPOSAL
_______ ________ KW CENTRAL A/C UNIT
_______ ________ HP/KW SPACE HEATER/AIR HANDLER
_______ ________ KW BASEBOARD HEAT
_______ ________ HP MOTORS 1/+ HP
_______ ________ KW TRANSFORMER/GENERATOR
_______ _______
AMP SERVICE
_______ ________ AMP SUBPANEL
_______ ________ AMP MOTOR CONTROL CENTER
_______ ________ KW ELEC. SIGN/OUTLINE LIGHT
OTHER___________________________________________________________________
OTHER___________________________________________________________________
OTHER ___________________________________________________________________
OTHER___________________________________________________________________
ESTIMATED COST OF WORK________________________________________________
SIGNATURE___________________________________________________________________
Owner ( )
Contractor ( )
SUBCODE:
PLANS REQUIRED ( )
APPROVED
( )_________________________________________________
SUBCODE SIGNATURE
APPROVAL DATE_________________________________________________________________
CONTRACTOR AFFIX SEAL
LOT______________________
DATE RECEIVED__________________
DATE ISSUED_____________________________
CONTROL #_______________________________
PERMIT #__________________________________
PLUMBING
CONTRACTOR:_________________________________________________________
ADDRESS:_______________________________________________________________
CITY:_____________________________________________________________________
PHONE: _________________________________________________________________
LICENSE NO. _______________________ EXPIRATION DATE______________
HOME IMPROVEMENT CONTRACTOR REGIS.NO.___________________
OR EXEMPTION REASON (IF APPLICABLE)__________________________
FEDERAL EMPLOYEE OR S.S.NO.______________________________________
DESCRIPTION OF WORK:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
TECHNICAL SITE DATA:
QUANTITY
FIXTURE/EQUIPMENT
_______
WATER CLOSET
_______
URINAL/BIDET
_______
TUB
_______
LAVATORY
_______
SHOWER
_______
FLOOR DRAIN
_______
SINK
_______
DISHWASHER
_______
DRINKING FOUNTAIN
_______
WASHING MACHINE
_______
HOSE BIBB
_______
WATER HEATER
_______
FUEL OIL PIPING
_______
GAS PIPING
_______
STEAM BOILER
_______
HOT WATER BOILER
_______
SEWER PUMP
_______
INTERCEPTOR/SEPARATOR
_______
BACKFLOW PREVENTER
_______
GREASETRAP
_______
SEWER CONNECTION
_______
WATER SERVICE CONNECTION
_______
STACKS
________
LAWN SPRINKLER
________
A/C
OTHER
_____________________________________________________
OTHER
_____________________________________________________
OTHER
_____________________________________________________
TOTAL
_____________________________________________________
ESTIMATED COST OF WORK__________________________________________
SIGNATURE_____________________________________________________________
Owner ( )
Contractor ( )
SUBCODE SIGNATURE__________________________________________________
APPROVAL DATE_______________________________________________________________
CONTRACTOR AFFIX SEAL
Please Print All Information
BLOCK__________________
LOT______________________
SITE LOCATION_____________________________
Florham Park Borough
OWNER IN FEE________________________________________
111 RIDGEDALE AVENUE ADDRESS_______________________________________________
FLORHAM PARK, NJ 07932 FLORHAM PARK, NEW JERSEY 07932
973-410-5346 (FAX) 973-410-5486
BUILDING
FIRE
CONTRACTOR:__________________________________________________________
ADDRESS:_______________________________________________________________
CITY:_____________________________________________________________________
PHONE: __________________________________________________________________
LICENSE NO._____________________ EXPIRATION DATE_________________
HOME IMPROVEMENT CONTRACTOR REGIS. NO.___________________
OR EXEMPTION REASON (IF APPLICABLE)__________________________
FEDERAL EMPLOYEE OR S.S. NO._____________________________________
CONTRACTOR:________________________________________________________________
ADDRESS:______________________________________________________________________
CITY:____________________________________________________________________________
PHONE: ________________________________________________________________________
LICENSE NO. __________________________EXPIRATION DATE__________________
HOME IMPROVEMENT CONTRACTOR REGIS.NO.__________________________
OR EXEMPTION REASON (IF APPLICABLE)_________________________________
FEDERAL EMPLOYEE OR S.S.NO.____________________________________________
DESCRIPTION OF WORK:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
TYPE OF WORK
PLEASE CHECK:
COST
NEW BUILDING_______________________
________________________ _______________
ADDITION______________________________ ________________________ _______________
ROOFING_______________________________
____________________________________ ____
SIDIONG_______________________________ ____________________________________
OTHER__________________________________ ____________________________________ ___
FENCE (6' HEIGHT)____________________ _______________________________________
POOL_____________________________________ ____________________________________ ___
DEMOLITION_________________________ ________________________________________
ASBESTOS ABATEMENT_____________ _____________________________________
RADON EQUIPMENT__________________ ______________________________________
DECK SQUARE FOOTAGE_____________ ____________________________________ ____
Retaining Wall _________________sq. feet _____________________________________
BUILDING CHARACTERISTICS:
NO. OF STORIES_________________________BLDG. HEIGHT_____________________
AREA: LARGEST FLOOR
______
TOTAL BLDG. AREA
____________________________
VOLUME OF BLDG.
______
TOTAL LAND AREA DISTURBED_________________________________________________
ESTIMATED COST OF BUILDING WORK:
NEW BUILDING COST_____________________________________________________________
ALTERATION COST___________________________________________________________
TOTAL _________________________________________________________________________________
SIGNATURE__________________________________________________________________________
Owner ( )
DATE RECEIVED___________________
DATE ISSUED______________________________
CONTROL #________________________________
PERMIT #__________________________________
Contractor ( )
TECHNICAL SITE DATA:
WATER SUPPLY SOURCE___________________________________________________
METHOD OF ALARM/SUPPRESSION SYSTEM____________________________
STORAGE TANK TYPE:
( ) FLAMMABLE LIQUID _____________________
( ) COMBUSTABLE LIQUID _____________________
( ) LPD ( ) LNG CAPACITY_____________________ FUEL__________________
ALARM SYSTEM:
( ) 110 V INTERCONNECTED ( ) SYSTEM ____________________________
ALARM DEVICES:
NUMBER
(SMOKE, HEAT, PULLS,
WATER/FLOW)
_______________________________________
_______________________________________
SUPVERVISORY DEVICES:
(TAMPERS, LOW/HIGHAIR)
___________________________________
SIGNAL DEVICES:
(HORNS, STROBES, BELLS)
____________________________________
OTHER DEVICES:
TOTAL
__________________________________
SUPPRESSION SYSTEMS:
FIRE PUMP______ GPM_______TYPE____ ________________________________
DRY PIPE/ALARM VALVES
____________________________________
SPRINKLER HEADS (WET/DRY)
____________________________________ _
STANDPIPES
___________________________________
PRE-ENGINEERED SYSTESM
WET CHEMICAL ( ) DRY CHEMICAL ( )_______________________________________
SUPPRESSION ( ) CO² ( ) FOAM ( ) HALON________________________
KITCHEN HOOD EXHAUST SYSTEM ____________________________________ ___
SMOKE CONTROL EXHAUST SYSTEM _______________________________________
GAS ( ) OIL ( ) FIRED APPLICANCE______________________________________
CHIMNEY LINER
________________________________________
SUBCODE:
PLANS REQUIRED ( )______________________________________________________________
APPROVED
( )_________________________________________________________
SUBCODE SIGNATURE
APPROVAL DATE ____________________________________________________________
ESTIMATED COST OF WORK_______________________________________________________
SIGNATURE_________________________________________________________________
Owner ( )
Contractor ( )
SUBCODE SIGNATURE_______________________________________________________________
APPROVAL DATE_____________________________________________________________________