Permit Request • CampusOptics

Submission of form does not guarantee permit will be granted. Please submit request minimally 2 business days prior to the anticipated start date of your work. Prior to commencing work, please ensure that you have received confirmation that the requested devices have been de-activated.

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Name* Required

Additional Location Details

Requester Information (To Be Filled Out by Requestor)

Company* Required

RIT Contact* Required

Permit Request Information (To Be Filled Out by Requestor)

RIT Job Number* Required

Reason For Impairment* Required

Valve(s) to be closed include location(s) and valve number(s):* Required

What portions of the system will be shut down:* Required

Contractor preforming work* Required

Contractor Contact* Required

Contact name* Required

Precautions Taken (To be Filled Out by Approver)

Public Safety Notified

Fire Department Notified

Town Fire Marshal Notified

Hot Work Prohibited

Hazardous Operations Stopped

Continuous Work Authorized

Ongoing Patrol of Area

Hydrant Connected to Sprinkler Riser

Pipe Plugs on Hand

Fire Hose Laid Out

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files