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HomeMy WebLinkAboutOWNERS CERTIFICATE - 23-00006 - Hibbard Elemenatry - Fire SprinklerOwner's Information Certificate Annex A Name/Addres of property to be protected with sprinkler protection: Name & Address of Owner:- �," 6a�+ b �17 I ►�J� C �� ��2 f Existing or planned construction is: Fire resistive or noncombustible 6 Wood frame or ordinary (masonry walls with wood beams) ❑ Unknown Describe the intended use of the buildin9: 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 ZNo ❑ Yes ®No Fixed guideway transit system Z Race track stable ❑ Yes No Marine terminal, pier, or wharf F ❑ Yes El No ❑ Yes d No Airport terminal Aircraft engine test facility ❑ Yes Ed No Power Plant ❑ Yes 0 No Water-cooling tower ❑ Yes -I] 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 ®No Aerosol products ❑ Yes �No © 2015 National Fire Protection Association NFPA 13 (p. 1 of 3) 2016 Edition Nitrate Film ❑ Yes .® o Pyroxylin plastic El Yes ®No Compressed or liquefied gas cylinders ❑ Yes VNo o Liquid or solid oxidizers ElYes Organic peroxide formulations ❑ Yes 5 No Idle Pallets ❑ Yes S�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: ❑ Yes ICJ No Spray area or mixing room Solvent extraction ❑ Yes l/ No Laboratory using chemicals ❑ Yes © No Oxygen -fuel gas system for welding or cutting ❑ Yes No Acetylene cylinder charging ❑ Yes 0 No Production or use of compressed or liquefied gasses El Yes © No Commercial cooking operation 2/Yes ❑/No Class A Hyperbaric chamber ❑ Yes In No Cleanroom ❑ Yes Ld No Incinerator or waste handling system ❑ Yes MNo Linen handling system ❑ Yes ENo Industrial furnace ❑ Yes E� No Water-cooling tower ❑ Yes 21 No If the answer to any of the above is "yes," describe type, location, arrangement, and intended maximum Will there be any storage of products over 12ft (3.7 m) in height? ❑ Yes ❑ 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? ❑ 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 E�d White 0 Chrome 0 Brass Escutcheon Finish In_ White Chrome Brass Head Type Ez 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 � resentative or agent: l Date:--A4I�L� Z 2 r Name of owner's representative or agent completing certificate (print): Relationship and firm of agent (print): FIGURE A.23.1 (b) Owner's Information Certificate © 2015 National Fire Protection Association NFPA 13 (p. 3 of 3) 2016 Edition