Water Availability/fire Flow Form

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City of Perris
Building and Fire Marshal
Water Availability/Fire Flow Form
SECTION A: To be completed by customer
Project Name:
____________________________________
Project Address/Parcel Number: _______________________________________________________
Applicant Phone #: (______)__________________________Fax #: (______)
___________________
2
Area of largest building ___________ ft
; (measured without area separations wall unless they are 4-hrs)
Construction type?
(check one):
IA IB
IIA
IIB
IIIA
IIIB IV VA
VB
Is this building sprinklered throughout?
(check one)
N
Y
SECTION B: To be completed by Perris Building/Fire Marshal Division
Fire Flow Requirement: __________ GPM ___________Hour Duration
By: _____________________________________
Date: _______________________
SECTION C: To be completed by local water department/district or attach the
local water department/district form that contains the same information
Water Department/District: ______________________________________________________________
Test location
: __________________________________
(indicate address or cross-streets & provide reference map)
Hydrant number(s)
: ___________________________________________________________
(if applicable)
Date of Test: _____________________________
Time of test: ____________________
am
pm
FLOW TEST RESULTS
TEST INFORMATION IS VALID FOR 6 MONTHS FROM DATE TEST IS PERFORMED
Static pressure:
psi
Residual pressure:
psi
Observed flow:
gpm
Flow calc’d at 20 psi:
gpm
Check the box if the test information above was obtained in a manner other than an actual flow test (i.e. by computer modeling).
I have witnessed and/or reviewed this water flow information and by personal knowledge and/or on-site
observation certify that the above information is correct.
Name: _____________________________________
Title: ______________________________________
Signature: ______________________________
Company/Agency: ___________________________
Date: __________________

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