07201602 Permit File
CITY OF DUBLIN E ElV®
Division of Building Standards • 5800 Shier-Rings Road • Dublin, Ohio 361
Phone: (614) 410-4670 • Inspection Line: (614) 410-4680 NOV 13 2007
WTFD: (614) 652-3920 BUILDING DIVISION
t Mice CITY OF DUBLIN
FIRE PROTECTION PERMIT APPLICATION
Application Date Bldg. App. # 0 1 ,~O`q" -3 Fire Protection App. # 0- as kk003-
PROJECT INFORMATION „-$T,?i;L
Project Address /g zlyrAlc_ Project Name,~,~/T~~.ti r1~%w•u~
Owner/Tenant Contact Namep.zr/% Ao&/Xzwro, 16 Telephone
APPLICANT INFORMATION
Fire Protection Contractor e gyp e , l~_s
Address~ Telephone -.Z7.Z -sssy
State Certificate Number Dublin Registration Number a -.-I/
Installer Name AV a- State Certificate Number. '"'--013
ti,
SCOPE OF WORK
(Mark One) New Replace Repair Alteration
FIRE DETECTION AND ALARM SYSTEM (Number of Each)
Detectors Strobes Horns Fire Alarm Boxes Other
SUPPRESSIONS STEM (Number of Each)
Standpipes On Site Water Piping Sprinkler Heads Limited Area Other
FEES 11OQ ' Xx
FIRE DETECTION OR SUPPRESSION PERMIT PROCESSING FEE
LOW VOLTAGE PERMIT (DETECTION ONLY) $30.00 Minimum fee
plus $20.00 each 1,000 sq ft or fraction thereof over 1,000 sq ft
OUTSIDE PLAN REVIEW SERVICES (EXAMINER'S FEE AS CHARGED)
STATE SURCHARGE (3%)
TOTAL FEE DUE
This permit is granted on the express condition that said work shall in all respects, conform to the ordinances of
the City of Dublin and all laws of the State of Ohio regulating construction, installation, repair and alteration,
and may be revoked at any time upon violation of any provisions of said laws. This permit conveys no right to
open any street, alley or sidewalk or an art thereof, nor to make any connection to a water main.
Signature of Licensed Contracto,U DATE
Print Name DATE
FOR OFFICIAL USE ONLY
Review Comments: # The so&;71r r 1alle- g1-ion dr4u ir7 q /ofs' h4k.5,41r~97~ T w2s/i.
e~9rfr~cn7'`' laDDrola/ X ~~~i
Fire Department: iii' Date:
Plans Examiner: ac Date: i "1 &'7
Issued by CBO: Date: 42-3- 8
CITY OF DUBLIN
Division of Building Standards • 5800 Shier-Rings Road • Dublin, Ohio 43016
Phone: (614) 410-4670 • Inspection Line: (614) 410-4680
Application Number . . . . . 07-00201602 Date 11/19/07
Property Address . . . . . . 3900 STONERIDGE LN
Parcel Number: 273-009146
Alternate Address: STONERIDGE INTERNAL MED.
Tenant nbr, name . . . . . . STONERIDGE INTERNAL MED
Application type description FIRE PROTECTION
Property owner . . . . . . . DEPT OF MEDICINE FOUNDATION IN
Contractor . . . . . . . . . ROGERS FIRE PROTECTION COMPANY
Permit . . . . . . FIRE SUPPRESSION PERMIT
Additional desc . .
Permit Fee . . . . 60.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 60.00
Special Notes and Comments
CONTACT WASHINGTON TOWNSHIP FIRE
PREVENTION FOR INSPECTIONS AT 766-0857
Other Fees . . . . . . . . . SURCHARGE FEE - FIRE 1.80
Fee summary Charged Paid Credited Due
Permit Fee Total 60.00 .00 .00 60.00
Plan Check Total .00 .00 .00 .00
Other Fee Total 1.80 .00 .00 1.80
Grand Total 61.80 .00 .00 61.80
This permit is granted on the express condition that said work shall in all respects,
conform to the ordinances of the City of Dublin and all laws of the State of Ohio
regulating construction, installation, repair and alteration and may be revoked at
any time upon violation of any provisions of law.