Fire Protection Shut Down Permit Rev102408

							                                               UNIVERSITY OF HOUSTON
                                               DEPARTMENT OF PUBLIC SAFETY
                                               FIRE MARSHAL’S OFFICE
                                               3869 Wheeler Rm 107
                                               Houston, TX 77204-6191
                                               Main (713)743-1635 Fax (713)743-5169



                                                  FIRE PROTECTION SYSTEM SHUT DOWN PERMIT

    I. Contractor/Shop Doing Work Completes A or B:
          A) Outside Contractor: Project Number _______________ UH Project Coordinator ______________________________
          Contractor Co. _______________________________________________ Telephone/Cell _________________________
          Sub-Contactor Co. ____________________________________________ Telephone/Cell _________________________
          B) UH Employee/Shop: Department ______________________________ Shop _________________________________
          Supervisor ______________________________________ Telephone/Radio ____________________________________
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    II. Obtain from Work Control:
          Work Request # _______________ Date Issued _______________ Issued By ___________________________________
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    III. Worksite Information:
          Start-up Date ______________________ Start-up Time ____________ Building ________________________________
          Floor(s) ______________________________________ Room(s) _____________________________________________
          System that will be Impaired: Sprinkler _______ Fire Pump _______ Water Supply _______ Fixed Ext. System _______
          Fire Alarm _______ Other _______ Description __________________________________________________________
          ________________________________________________________________________________________________________________________

          After Hours/Weekend Work: Date(s) ___________________________ Time(s) _________________________________
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          Minimum Requirements: 1. Requestor must obtain a work request number from Work Control before permit is valid, and work
          may begin. 2. There must be a minimum of one 3A:40BC multi-purpose fire extinguisher on-site. 3. All impairments to fire
          protection systems must be restored by 3:00 PM daily, unless otherwise arranged. 4. All fire system work to be performed before
          7:00 AM, or after 3:00 PM daily, or on weekends, must be stated and pre-arranged with Plant and Operations Building Maintenance.
          5. The Fire Alarm Shop extension is 3-5762, and the Fire Marshal’s Office extension is 3-1635, must be notified if work is re-
          scheduled, canceled, or completed before 3:00 PM. 6. A Fire Watch must be provided at all locations due to the potential for a
          catastrophic fire. A Fire Watch requires that a person, who is trained in the use of fire extinguishers, is familiar with the facility, and
          the procedures for sounding the fire alarm: A) Watch for fires B) Notify the building occupants in case of fire by sounding the
          alarm C) Notify the fire department by calling 911 D) Attempt to extinguish the fire if within the capacity of the equipment
          available E) Inspect work area and all adjacent areas to which sparks and heat might have spread, including floors above and below,
          and on opposite sides of walls for at least 30 minutes after the work was completed 7. Permit must be posted at jobsite.
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          I have read and understand the above information and agree to abide by the requirements of this document, and the Fire Marshal’s
          Office Shut Down Procedure. I further understand that all production operations are subject to inspection, and possible corrective
          action.
          _________________________________________________                                                     ___________________________________________________________
                                        Print Name                                                                                                         Sign Name
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    IV. Completed by Fire Marshal’s Office:
          Issued By: _________________________________________________ Date: __________________________________
          Permit Expires ____________________________ Extension _____ Extension Expires ____________________________
                                                     (Date/Time)                                                                                                              (Date/Time)
Rev. 08/28/08