HomeMy WebLinkAboutFPD-F-62 Special Hazard Permit ApplicationFPD-F-62 SPECIAL HAZARD PERMIT APPLICATION (010124djs)
SPECIAL HAZARD PERMIT APPLICATION
Date: _________ _____ Inspector: ____ ___________ Occupancy No._____ _________
Business Name: Telephone No.:
Address (site location) Permit Billing Address:
City, Zip: City, Zip:
EMERGENCY CONTACTS
PRIMARY SECONDARY
Name: Name:
Title: Title:
Business Phone: Business Phone:
24-hour Phone: 24-hour Phone:
Level 1 Level 2 Level 3
SPECIAL HAZARD PERMIT $129.00 $145.00 $202.00
AEROSOL LEVEL 2 OR 3 PRODUCTS
FLAMMABLE AND COMBUSTIBLE LIQUIDS
HAZARDOUS MATERIAL- Not otherwise specified (SEE WORKSHEET)
HIGH-PILED COMBUSTIBLE STORAGE >500 sq. ft.
COMPRESSED GASES
Conditions:
Permit holders shall comply with all applicable state and local regulations regarding: storage and handling of regulated chemicals, including, but not
limited to: maintaining appropriate safeguards to contain, separate and monitor said chemicals; assuring that adequate security measures have been
taken regarding said chemicals; providing proper training to employees regarding safe handling of said chemicals; providing appropriate emergency
training; and ensuring that required emergency labeling and warning signs (in accordance with NFPA 704) are posted and maintained.
Declaration:
I hereby certify that the information presented on this form is true and correct to the best of my knowledge, and thereby request a Special Hazard Permit
to be issued for this business as soon as payment is rendered. THE FEE FOR SAID PERMIT IS NON-REFUNDABLE.
Print Name: Signature of Owner/Agent: Date:
FPD-F-62 SPECIAL HAZARD PERMIT APPLICATION (010124djs)
(See CFC Table 105.6.20 for permit amounts)
Level 1
• 10-100 gal. flammable/combustible liquid
• 20-100 lbs flammable solid
• 201-3,000 cubic ft. – any compressed gas (excluding
CO2 of LPG)
• 50-999 lbs Aerosols (Level 2 or 3)
• 501-2,500 sq. ft. High Piled Storage (any commodity
class)
• Any Hazardous Materials not otherwise specified (per
CFC Appendix, Chapter 1, Table 105.6.20)
• 6,000-12,000 cubic ft. of Carbon Dioxide
• 250-1,149 gal. LPG (aggregate container water capacity)
• Storage of tires indoors – any amount
• Storage of any scrap tires or tire byproducts in excess of
2,500 cubic feet (regardless of location)
• Operation of any combustible dust-producing equipment
• Cryogenics as per CFC Table 105.6.10
Level 2
• 101-1,000 gal. flammable/combustible liquid
• 101-1,000 lbs flammable solid
• 3,001-6,000 cubic ft. – any compressed gas (Excluding
CO2 or LPG)
• 1,000-2,500 lbs Aerosols (Level 2 or 3)
• 2,501-12,000 sq. ft. High Piled Storage (any commodity
class)
• Any Hazardous Materials not otherwise specified (per
CFC Appendix, Chapter 1, Table 105.6.20)
• 12,001-18,000 cubic feet Carbon Dioxide
• 1,150-2,299 gal. LPG (aggregate container water
capacity)
Level 3
• >1,000 gallons flammable/combustible liquid
• >1,000 lbs flammable solid
• >6,000 cubic feet of any compressed gas (Excluding CO2
or LPG)
• >2,500 lbs of Aerosols (Level 2 or 3)
• >12,000 sq. ft. High Piled Storage (any commodity class)
• Any Hazardous Materials not otherwise specified (per
CFC Appendix, Chapter 1, Table 105.6.20)
• >18,000 cubic ft. of Carbon Dioxide Gas
• >2,300 gal. LPG (aggregate container water capacity)
Office only: Customer I.D.__________________