Report (62) A* 1 q 160 54) -72-1-c, isf:
COMBUSTIBLE
RECSIVE STOCK STORAGE
QUESTIONNAIRE
FEB 2 1 2017
OF
(Please print the information clearly.) ' T
Business Name:
3 67, i,‘
1 DIV SIO
Business Address: i �-f /6 (;t S L47 R70C. f `1✓ f ( 1 ej ca`� C; / 7 r)c>2
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The purpose of this questionnaire is to assist the in determining the Fire Code requirements for t storage of
"High Piled Combustible Stock" at your facility. These requirements will be based on the IBC, IFC Chapter
23 and NFPA 13 (07). This form should be completed and signed by a qualified person having the necessary code
knowledge required for Combustible Stock Storage, e.g., architect or engineer of record, code consultant, insurance
underwriter or fire protection engineer. c kvr,t4
•
1. Commodity Class: _ t. _,,,,- C�'h Source: IFC NFPA
Aerosol Level III: ❑Yes L No Class I, II, Ill, IV, High Hazard (V) (lowest to highest):
2. Description of storage (IT additional space is needed,attach additional page):
5O/(. eLA05.- 1'c- ' .;;" lic�bikk�-1e/ (`` � w,lief
C' I c -t,-c4- =66 t'5� l t iter ,�4,+r -/ Fig .5-
i ice
Public/Private areas: a` iio--fe%
3. Maximum height of storage: -() feet (distance from floor to top of commodity)
4. Method of storage (check all that apply):
❑ Encapsulated in plastic CE Non-encapsulated
❑ Wooden pallets ❑ Plastic pallets (type)
❑ On racks with solid shelves ❑ On racks without solid shelves
❑ Bin box made of: (check one) [' Solid pile that is: (check one)
❑ metal ❑wood ❑ plastic ❑ stable ❑ unstable
5. Types o racks: (check all that ply)
single row double row ❑ multiple row
6. Area of storage:
❑ 0—500 sq ft 12,000—20,000 sq ft ❑ 300,001 —500,000 sq ft
❑ 501 —2,500 sq ft ❑ 20,001 — 100,000 sq ft ❑ 500,001 sq ft and over
❑ 2,501 — 12,000 sq ft ❑ 100,001 —300,000 sq ft ❑ 2 hour separation
7. Sprinkler information:
a. Sprinkler density: ( i7 q i -"(; ..�6 'Rack sprinklers? ❑YesNo
c. Temperature rating of sprinkle head in: I! Ceiling Racks
Fire hose stations and hose
d. connections: ❑Ye No Number required: ze:
e. Fire flow worksheet completed: ❑Yes No Design cross-checked: ❑YesNo
Class 1 standpipes �.,
f. required: 0 Yes itiN/o'
6
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8. Building height: ((1 feet 9. Distance from top of storage to fire sprinkler deflector: feet
Smoke/Heat
10. vents: ❑ Yes No Ratio: square feet
Draft
11. curtains: ❑ Yes No sq ft s ttions Depth: ❑4 feet ❑ 6 feet ❑ 8 feet
12. Column/Wall fire protection required: ❑ Yes No Additional fire sprinkler heads: ❑Yes 111-1(c
Protected by listed/testedDescription
assay: ❑Yes No
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13. Aisle width between racks and storage: s6. T feet
Smoke detection
14. system: ❑ Yes ` No
15. Maximo cubic feet per pile: (choose one)
!L 0=50,000z.suh;c foot E 100;001 _ 200r001Lcu#sfc--fect
❑ 50,001 — 100,000 cubic feet ❑ 200,001 —4 0,000 cubic feet
Access roadways within 150-feet of all portions of exterior
16. walls: Yes ❑ No
Access doors provided every 100 lineal feet on exterior walls hich face access
17. roadways: Yes ❑ No
18. Alternate materials/methods requested: ❑Yes o