Fire Flow Test Application 10-09

PORTSMOUTH WATER AND FIRE DISTRICT
1944 East Main Road  P. O. Box 99  Portsmouth, RI  02871  (401) 683-2090

APPLICATION FOR FIRE FLOW TEST
$425.00 Charge Per Test

Date:
Company Name:
Address:
Contact Person:					Phone:
Project Name:
Project Location:
Property Owner's Name:
Assessor's Plat:
Assessor's Lot:
Preferred Residual Hydrant For Test:
Does Test Need To Be Witnessed?				Yes		No
					(Circle One)
Applicant's Signature					Date
PWFD OFFICE USE
Fee Paid:
						Date