Burlington Fire DepartmentOffice of the Fire Marshal

132 North AvenueBurlington, Vermont 05401

(802) 864-5577BFDFireMarshal@BurlingtonVT.gov

Fire Pump Permit Application

Section A – Site Information Complete for All Permits

Name of Building/Site: Type Name of Building/SiteDPW – ISD Parent Building Permit Number:

Type Permit Number

Physical Location (911 Address): Type Number and Street NameName of Lessee (If Business) Type Name of LesseeBuilding Owner Name: Type Building Owner NameOwner Mailing Address: Type Number and Street Number Type Zip CodeOwner Contact (Phone and E-Mail): Type Phone Number Type Email

Section B – Fire Pump Project InformationThe fire pump will support - check all that are applicable:

☐ NFPA 14 Class I Standpipe System ☐ Fire Sprinkler System☐ Shared between buildings in a complex ☐ Fire Hydrant System☐ Specialty Suppression System ☐ Other: Please Specify

Section C – Fire Pump Information

Manufacturer: Type Manufacturer Model: Type Model

GPM Type GPM @ Number PSI

Type:

☐ Diesel ☐ Electric

This application must be accompanied by the following:

Electric fire pumps must be accompanied with a letter from BED indicating service reliability as per NFPA 20. Manufacturer’s specifications and information for each type of system component being installed. Fire alarm system connections shall require a separate City permit issued to a qualified fire alarm technician.

NOTE: All submittal documents are required prior to review and permitting.

*F O R O F FICE USE O NLY – DO N O T W RITE IN GREY * Firehouse # Permit # Received Date: Approval Date:

Check # Check From: Amount: Reviewer:

Burlington Fire Department Page 1 of 2 Fire Pump Permit Application

Section D – Contractor Information

Name of Installer: Type Name of Installer VT TQP Certification Number: Type Certification Number

Name of Designer: Type Name of Designer VT TQP / Engineer License: Type Engineer License

Section E – Project Valuation and Permit FeeComplete for all permits.

Make check payable to Burlington Fire Department and include with this application.

I, Type Name of Applicant Here certify that the total valuation of the construction work is as follows:

Fire Pump Permit FeesSystem Design Project Costs Fee Schedule Fee summation

NFPA 20 compliant fire pump and associated components

Enter Amount Cost X $ 0.007($7 minimum fee for work value less

than or equal to $1,000)

Enter Amount

Permit amendment fee ($50 plus 3% of work cost increase)

Enter Amount $50 + (Cost increase X $ 0.03) Enter Amount

Sprinkler/Standpipe/Fire Alarm - requires separate permit application

SEPARATE PERMIT APPLICATION

Expedited permit fee (10 days to process per BCO 13-59(c)(8))(**Only if a stand-alone fire pump permit not associated with joint sprinkler permit)

$150 per hour(total cost determined by FMO based

on project complexity)

Enter Amount

Recording Fee (Required for all permits) $15Total Fee schedule total

(Minimum fee = $22)Enter Total

Applicant’s Company Name: Type Company Name

Contact Person: Type Contact Person Position: Type Position

Address: Type Address

Phone Number: Type Phone Number E-mail: Type E-Mail

Note:

Knox Box(es) and two sets (minimum) of all building master keys is/are required for all buildings equipped with a fire alarm and/or sprinkler system (BCO 13-60). Knox Boxes can be ordered online at www.knoxbox.com (3200 series with hinge or residential series - determined in consultation with FMO)

I hereby certify that the information contained within this application is correct and accurate:

Signature of Applicant: ____________________________ Date: _______________

Burlington Fire Department Page 2 of 2 Fire Pump Permit Application

South Burlington Fire Department575 Dorset Street

South Burlington, VT 05403(802) 846-4110

Fax (802) 846-4125Form updated 11/26/2019 (Increase in recording fee as per 2019 change in 32 VSA § 1671)

Burlington Fire Department Page 3 of 2 Fire Pump Permit Application