HomeMy WebLinkAboutOWNER INFORMATION CHECKLIST - 17-00801 - 2300 University Blvd - Madison High School - AdditionOwner's Information Certificate
Name/Address of property to be protected with sprinkler protection:
Madison High School - Classroom and Gymnasium Addition
2300 University Blvd.
Rexburg, ID 83440
Name & Address of Owner: Madison School District #321 60 West Main Street Rexburg,ID 83440
Existing or planned construction is:
X Fire resistive or noncombustible
❑ 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
Aerosol products
❑ Yes X No
Fixed guideway transit system
❑ Yes X No
Pyroxylin plastic
❑ Yes X No
Race track stable
❑ Yes X No
Liquid or solid oxidizers
❑ Yes X No
Marine terminal, pier, or wharf
❑ Yes X No
Airport terminal
0 Yes X No
❑ 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 NEPA 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
0 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 X No
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 0 White 0 Chrome 0 Brass - see specifications -
Escutcheon Finish 0 White 0 Chrome 0 Brass -see specifications -
Head Type 0 Semi -Recessed 0 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:y
Date: i nii r,/i R
Name of owner's representative or agent completing certificate (print): Brent McFarland
Relationship and firm of agent (print)'..Architect