HomeMy WebLinkAboutFS OWNER INFO - 16-00683-684 - Sugar Mill ApartmentsOwner's Information Certificate
Name/Address of property to be protected with sprinkler protection:
SugarMill Apartments, 267 W 4th S, Rexburg, Idaho 83440
Name & Address of Owner: Ryan & Greg Nelson, P.O. Box 142, Menan, Idaho 83434
Existing or planned construction is:
❑ Fire resistive or noncombustible
X Wood frame or ordinary (masonry walls with wood beams)
❑ Unknown
Is the system installation intended for one of the following special occupancies:
Aircraft Hanger
❑ Yes X No
Fixed guideway transit system
❑ Yes X No
Race track stable
❑ Yes X No
Marine terminal, pier, or wharf
❑ Yes X No
Airport terminal
❑ Yes X No
Aircraft engine test facility
❑ Yes X No
Power Plant
❑ Yes X No
Water-cooling tower
❑ Yes X No
If the answer to any of the above is "YES," the appropriate NFPA standard should be referenced for sprinkler
density/area criteria.
Indicate whether any of the following special materials are intended to be present:
Flammable or combustible liquids
❑ Yes X No
Aerosol products
❑ Yes X No
Nitrate Film
❑ Yes X No
Pyroxylin plastic
❑ Yes X No
Compressed or liquefied gas cylinders
❑ Yes X No
Liquid or solid oxidizers
❑ Yes X No
Organic peroxide formulations
❑ Yes X No
Idle Pallets
❑ Yes X No
If the answer to any of the above is "Yes," describe type, location, arrangement, and intended maximum
quantities.
Indicate Whether the protection is intended for one of the following specialized occupancies or areas:
Spray area or mixing room
❑ Yes X No
Solvent extraction
❑ Yes X No
Laboratory using chemicals
❑ Yes X No
Oxygen -fuel gas system for welding or cutting
❑ Yes X No
Acetylene cylinder charging
❑ Yes X No
Production or use of compressed or liquefied gasses
❑ Yes X No
Commercial cooking operation
❑ Yes X No
Class A Hyperbaric chamber
❑ Yes X No
Cleanroom
❑ Yes X No
Incinerator or waste handling system
❑ Yes X No
Linen handling system
❑ Yes X No
Industrial furnace
❑ Yes X No
Water-cooling tower
❑ Yes X No
If the answer to any of the above is "yes," describe type, location, arrangement, and intended maximum
quantities.
Will there be any storage of products over 12ft (3.6 m) in height? ❑ Yes X No
If the answer is "yes," describe product, intended storage arrangement, and height.
Will there be any storage of plastic, rubber, or similar products over 5ft (1.5 m) high except as described above?
❑ Yes XNo
If the answer is "yes," describe product, intended storage arrangement, and height.
The following is a part of the fire service design. Please sign at the bottom to confirm the parameters. If the
choices below are not acceptable, please indicate "other". Please note that any changes in the below may result
in additional charges.
Head Finish It White ❑ Chrome ❑ Brass
Escutcheon Finish OC White ❑ Chrome ❑ Brass
Head Type M Semi -Recessed ❑ Concealed (Additional cost if not in specifications)
I certify that I have knowledge of the intended use of this property and that the above information is correct.
Signature of owner's representative or agent: --------
Date: 3/9/2017
Name of owner's representative or agent completing certificate (print): Bryan Heasted
Relationship and firm of agent (print): Project Engineer Headwaters Construction
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Water Flow Test
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Project Name: Ro x 12-P ex
Project Address: 486Bexburg;iD 8W0,-
Our Bow test conducted on October S, 2016 resulted in the following water pressure and volume taken
at the above location:
Static: 80 Residual: 76
Test Conducted By: Clint Charles
Witnessed By: Dale Pickering
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Pitot: 49
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4170 Airpon Road Sufi S 45 5
Nampa, ID 83687 Idatn NRa ID 83403
PH: (208) 468905 Ph: (208) 3137153
FAX: (208) 461-907 208709 6247