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HA WAIL FIRE DEPARTMENT Dltz <br /> FIRE PREVENTION B UREA U PaSaneN Amount$2(XW <br /> HILO:25Aiipimi St.Suite 2501,Hilo,FII9h'20 (80S 932-2912 Re¢ai,,ABS <br /> DUS.4: - -50 Ane Keohokalole HZ�1,Bldg E.Kaihia-Kona,HI 9h' 0(808)323- -60 Permit Nmnbei <br /> TANK INSTALLATION PERMIT APPLIC'ATIO <br /> Completed application shall be submitted with payment to the Hilo or Kona fire prevention office. Payment may be <br /> cash or check. Checks shall be made out to `County Director of Finance'. <br /> (To be completed bh applicant) <br /> Permit Type: ❑LPG(>125 gal) Flammable or Combustible Liquid Storage Tank(>60 gal) <br /> ❑ Aboveground Storage Tank(AST) <br /> ❑Underground Storage Tank(UST) <br /> Tank Capacity: Tank Construction: <br /> Fuel Type: Front Back Sides <br /> Distance from nearest building: Distance from property line: <br /> Tank Owner: <br /> Tank Location/Address: TMK: <br /> Citv/State: Zip Code: <br /> Installer/Contractor: License# <br /> Applicant: Phone: <br /> Fax: E-Mail Address: <br /> Mailing Address for Permit: <br /> *A Site Map shall be attached and submitted with this application. Site map shall depict all structures and tanks,and its <br /> distances to buildings, other tanks, and property lines if applicable. Site map shall also show the location of vehicular <br /> protection,and location of all fire extinguishers. <br /> (To be completed by HFD) <br /> INSPECTION <br /> Detailed site map submitted ❑Yes ❑No Vehicle protection satisfactory ❑Yes ❑No ❑N/A <br /> Distance between tanks satisfactory(table 66.2.3.2.2.1 or table 69.3.3A (2006 NFPA 1)) ❑Yes ❑No ❑N/A <br /> Distance to property line satisfactory(table 66.2.3.2.1,* or table 69.3.3.1 (2006 NFPA 1)) ❑ Yes ❑ No <br /> Distance from building openings/exposures satisfactory(table 69.3.3.9 and table 69.3.5.3) ❑Yes ❑No <br /> Fire protection systems(check all that apply): ❑Sprinkler ❑Foam ❑Fire Alarm ❑ Other [_]N/A <br /> All fire systems satisfactory [-]Yes ❑No ❑N/A <br /> Portable fire extinguishers satisfactory [-]Yes ❑No ❑N/A <br /> Date portable fire extinguishers inspected: Inspected by: <br /> Comments: <br /> APPLICANT SIGNATURE: DATE: <br /> INSPECTOR SIGNATURE: DATE: <br /> Revised 4/13/2012 <br />