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1330
Form 4
COLCHESTER PUBLIC SCHOOLS
FIRE MARSHAL APPROVAL FORM
This completed form shall be approved by the local Fire Marshal and accompany any application
proposing that any building space will be utilized DIFFERENTLY from the use for which the space
is normally utilized. (Activities may include craft fairs, indoor graduation, outdoor events, theater
productions, private concerts, etc.)
Applicant:_______________________________________________________________________
Date of Activity: _________________________________________________________________
Time of Activity: _________________________________________________________________
Describe any floor or wall covering which will be needed for the activity. Describe the material of
which the covering is made or the method used to make it flame retardant:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Provide a dimensional sketch of the space being applied for including exit openings and layout:
(Utilize this space for the sketch or attach a sketch to this form)
*If you have questions regarding specific use of a space, please contact the Colchester Fire Marshal
directly at 860-207-6870.
Other requirements as deemed necessary by the local Fire Marshal:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Signature, Fire Marshal Approval Date
The undersigned agrees to provide the layout/physical set up as approved and agrees, to any other
requirements deemed necessary by the Fire Marshal. Any deviation from the permit without the Fire
Marshal's written consent shall make the entire permit null and void.
_______________________________________________________________________________
Signature of Applicant Date