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Hot Work Permit Request
For questions about this form please contact Fire & Life Safety at
919-515-2958
Requester Information
Name
(Required)
Email
(Required)
Phone
(Required)
Hot Work Information
Building Name / Area Name
(Required)
Street Address
(Required)
Room / Specific Area Of Hot Work
(Required)
Type Of Hot Work
(Required)
Short Term Welding (1 day permit) – F/A Disconnect Required
Long Term Welding (required permanent work station for duration of project) – F/A Disconnect Required
Brazing
Soldering
Sweating Pipe
Torch Work
Grinding
Cooking
Other
Type Of Hot Work: Other
(Required)
1-Hour Post Welding Notification is required to 919-515-2568. Ensure work is cool to the touch before leaving the area
(Required)
Permit holder acknowledges this requirement
By checking the box above, the permit holder acknowledges that any damages incurred by the hot work that is not monitored after the work is completed, will be the permit holder’s responsibility. Additionally, the permit holder agrees to report 1-Hour Post Welding Notification.
Responsible Person Information
The Responsible Person Is:
(Required)
NC State Project Manager
Submitter
Other
Responsible Person Name
(Required)
Responsible Person Phone Number
(Required)
Responsible Person Email
(Required)
Notes For Permit Reviewer
Permit Start Date
(Required)
MM slash DD slash YYYY
Start Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Permit Expiration Date
(Required)
MM slash DD slash YYYY
End Time
(Required)
Hours
:
Minutes
AM
PM
AM/PM
