07201628 Permit File
CITY OF DUBLIN
Division of Building Standards • 5800 Shier-Rings Road • Dublin, Ohio 43016
Phone: (614) 410-4670 • Inspection Line: (614) 410-4680
WTFD: (614) 652-3920
Office
FIRE PROTECTION PERMIT APPLICATION
Application Date Bldg. App. # 0 T'ao tto a 3 Fire Protection App. # O _4• ZO \ko?_ b
PROJECT INFORMATION
Project Address SyOo Cco n+E 2d. su,{c /?o Project Name rMPLoYgs µCutrly
Owner/Tenant Contact Name Telephone
APPLICANT INFORMATION
Fire Protection Contractor 9Ys4e-s i~
Address 71/,vr o.-cr Telephone Gw-~~3 ~~ay
State Certificate Number S - ;ZS - 13AC Dublin Registration Number O
Installer Name Loa,-, S4_-wat4- State Certificate Number S'/-F9-o0
SCOPE OF WORK
(Mark One) New Replace Repair Alteration
FIRE DETECTION AND ALARM SYSTEM (Number of Each)
Detectors Strobes Horns Fire Alarm Boxes Other
SUPPRESSION SYSTEM (Number of Each)
Standpipes On Site Water Piping Sprinkler Heads / Limited Area Other
FEES
FIRE DETECTION OR SUPPRESSION PERMIT PROCESSING FEE $60.00
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 any part thereo , nor to make any connection to a water main.
Signature of Licensed Contractor DATE i//rl~~ J
~~EkiART DATE 7
Print Name LONNI 1
FOR OFFICIAL USE ONLY
Review Comments: 7h 'e
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Fire Department: 9is Date:
Plans Examiner: Date: 0
Issued by CBO: Date: D
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 . . . . . 07-00201628 Date 11/29/07
Property Address . . . . . . 5400 FRANTZ RD
Parcel Number: 273-010866
Alternate Address: PRESERVE PH 2
Tenant nbr, name . . . . . . EMPLOYERS HEALTH SUPPRESS
Application type description FIRE PROTECTION
Property owner . . . . . . .
Contractor . . . . . . . . . BRIGADE FIRE PROTECTION
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.