Menlo Park Fire Protection District Fire Prevention Bureau 170

Revised 1-06-20

Menlo Park Fire Protection District

Fire Prevention Bureau

170 Middlefield Rd, Menlo Park, CA 94025 PH: (650) 688-8425

PLAN CHECK APPLICATION

A. Project Address: _______________________________________Suite(s):_________Bldg:_____Floor(s):__________

Project City/Town: _________________ Is this project in Unincorporated San Mateo Co? Please Circle one: YES NO

Project Name: ____________________________ Please check one: Commercial ________ Residential ________

City of Menlo Park Residential Projects Only: Remodel Valuation $__________________

Description of work: __________________________________________________________________________________________

____________________________________________________________________________________________________________

B. If the plans you are submitting today are not for a sprinkler/underground or alarm/monitoring system, please mark the

appropriate area below:

Residential Site/Plan Review (Planning or Bldg.) ______ Access Gate _____ Commercial Site Review (Planning or Bldg.) _____

Commercial Projects Only (please circle one): New Construction or Tenant Improvement

Commercial Project (New Const/TI) Square Footage: _______________________________

Total Building Square Footage: _________________________________________________

Other: Use Permit_____ Hood & Duct _____ Clean Agent_____ Generator_____ Emergency Repair Permit_____

UST Removal/Installation_____ High Pile Storage_____ Solar_____ Hazardous Materials_____ Other__________________

C. If you are submitting plans for a sprinkler/underground or alarm/monitoring system, please fill out below:

Fire Sprinkler: Fire Alarm:

New____ TI_____ New_____ TI_____

# of heads (per floor) _____ # of risers_____ # of devices (per floor) _____

System Cost (City of Menlo Park Residential projects only): _____________

Underground Fire Service Installation: Fire Monitoring System:

# of feet_____ # of devices_____

Applicant/Company: ______________________________ CA Contractor License #

Contact Name: _______________________________ Phone: _________________________ Ext: _________

Signature: _________________________________________________

Email:____________________________________________________

SUBMITTING AS OWNER/BUILDER (Complete only if you OWN the property AND are the INSTALLING CONTRACTOR)

Owner/Builder:_____________________________________________ Agent for Owner:_____________________________

Owner/Agent Signature:_____________________________________ Phone:_________________________Ext:_________

Email:_____________________________________________________

Note: (1) Owner must sign plans and/or provide a letter stating the agent has permission to act on owner’s behalf

(2) San Mateo County Assessor or third-party verification of existing square footage may be required.

OFFICE USE ONLY

Record Number/Permit#:__________ Comments:

Date: ____________ Approved: ____________ Denied: ___________ PR Time: ___________ Reviewer Initials: ___________