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HomeMy WebLinkAboutFS OWNERS INFO CERTIFICATE - 20-00489 - Rockwell House - 4 plex.pdfOwner's Information Certificate Annex A Name/A�1�jress of property to be rotectedwith sprinkler protection: 43i 5 2�_,L w Q, x- xt„T:_D r)- 3 �-r Lt a Name & Address of Owner: / o,- 1—,L C_ Existing or planned construction is: ❑ Fire resistive or noncombustible Wood frame or ordinary (masonry walls with wood beams) Gam^ ❑ Unknown p Describe the intended use of the building: Note regarding speculative buildings: The design and installation of the fire sprinkler system is dependent on an accurate description of the likely use of the building. Without specific information, assumptions will need to be made that will limit the actual use of the building. Make sure that you communicate any and all use considerations to the fire sprinkler contractor in this form and that you abide by all limitations regarding the use of the building based on the limitations of the fire sprinkler system that is eventually designed and installed. Is the system installation intended for one of the following special occupancies: Aircraft Hanger ❑ Yes Z No Fixed guideway transit system ❑ Yes 2'�No Race track stable ❑ Yes ZNo Marine terminal, pier, or wharf ❑ Yes 1Z No Airport terminal ❑ Yes 2 No Aircraft engine test facility ❑ Yes �Z No Power Plant ❑ Yes 0 No Water-cooling tower ❑ Yes Z 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 Z No Aerosol products ❑ Yes eNo © 2015 National Fire Protection Association NFPA 13 (p. 1 of 3) 2016 Edition Nitrate Film ❑ Yes t' No Pyroxylin plastic ❑ Yes Z No Compressed or liquefied gas cylinders ❑ Yes VrNo Liquid or solid oxidizers ❑ Yes Z( No Organic peroxide formulations ❑ Yes ,Z No Idle Pallets El Yes ya 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 VNo Solvent extraction ❑ Yes 17/No Laboratory using chemicals ❑ Yes P�' No Oxygen -fuel gas system for welding or cutting ❑ Yes Z'No Acetylene cylinder charging ❑ Yes ;2(No Production or use of compressed or liquefied gasses ❑ Yes la' No Commercial cooking operation ❑ Yes ZNo Class A Hyperbaric chamber ❑ Yes 12�No Cleanroom ❑ Yes Z' No Incinerator or waste handling system ❑ Yes Vf No Linen handling system ❑ Yes 0 No Industrial furnace ❑ Yes 17 No Water-cooling tower ❑ Yes 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 (3.7 m) in height? ❑ Yes Z No If the answer is "yes," describe product, intended storage arrangement, and height. © 2015 National Fire Protection Association NFPA 13 (p. 2 of 3) 2016 Edition Will there be any storage of plastic, rubber, or similar products over 5ft (1.5 m) high except as described above? El Yes �, No If the answer is "yes," describe product, intended storage arrangement, and height. Is there any special information concerning the water supply? ❑ Yes�No If the answer is "yes," provide the information, including known environmental conditions that might be responsible for corrosion, including microbiologically influenced corrosion (MIC). 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 El White 0 Chrome E] Brass Escutcheon Finish 0 White 0 Chrome 0 Brass Head Type p Semi -Recessed p Concealed (Additional cost if not in specifications) I certify that I have knowledge of the intended use of is pr yy d�that the above information is correct. Signature of owner's representative or agent: v Date: A-(0 0.1 t Name of owner's representative or agent completingcerti Cate (print): ( iii%6i/(Gt? t Relationship and firm of agent (print): 0Vj FIGURE A.23.1 (b) Owner's Information Certificate © 2015 National Fire Protection Association NFPA 13 (p. 3 of 3) 2016 Edition