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Report (28) 7311 4 get, 7ry RECEIVPr COMBUSTIBLE SEP 1 8 2011 STOCK STORAGE CITY OF f it r-„i.t QUESTIONNAIRE BUILDING Di\fl"T I' (Please print the Information clearly.) Business Name: lc. . rC Business Address: '?3i : } a l 4%44, 5.,, 7. 7.4V 74Aaer f, 7,Q The purpose of this questionnaire is to assist the In determining the Fire Code requirements for the 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, 1. Commodity Class: t1 Source;IFC NFPA Aerosol Level III: 0 Yes Oda Class III,Ill,IV, High Hazard(V)(lowest to highest): I I 2. Description of storage (if additional space is needed, attach additional pmt era ts4,k#, Public/Private areas: 3. Maximum height of storage: Lit feet(distance from floor to top of commodity) 4. Method of storage(check all that apply): CI Encapsulated in plastic on-encapsulated @'Vooden pallets 0 Plastic pallets(type) On racks with solid shelves Q5n racks without solid shelves ❑Bin box made of:(check one) 0 Solid pile that is: (check one) 0 metal 0 wood D plastic 0 stable d unstable 5. Types of racks:(check all that apply) Q single row [ 1ouble row 0 multiple row 6. Area of storage: ©0—500 sq ft j'12.000_20,000 sq ft 0 300,001 —500,000 sq ft ❑501 —2,600 sq ft 0 20,001 —100,000 sq ft 0 500,001 sq ft and over ©2,501 —12,000 sq ft 0 100,001—300,000 sq ft 0 2 hour separation 7. Sprinkler information: a. Sprinkler density: q3/ACCV b.Rack sprinklers? 0 Yes adHo c. Temperature rating of sprinkle head in: 0 Ceiling 0 Racks Fire hose stations and hose d. connections: 0 Yes 0 No Number required: Size: e. Fire flow worksheet completed: [ fes 0 No Design cross-checked: ErYes 0 No Class 1 standpipes f. required. Q Yes 040 • 8. Building height: 0241 feet 9. Distance from top of storage to fire sprinkler deflector: feet Smoke/Heat 10. vents: 0 Yes alcio Ratio: square feet Draft 11. curtains: 0 Yes EXO sq ft sections Depth: 04 feet 0 6 feet 0 8 feet 12- Column/Wall fire protection required: 0 Yes ErNo Additional fire sprinkler heads. Yes Ef*No Protected by listed/tested Description assay: 0 Yes 0 No : 13. Aisle width between racks and storage: feet Smoke detection 14. system: Gies 0 No 15. Maximum cubic feet per pile:(choose one) 1.31c--50,000 cubic feet 0 100,001-200,000 cubic feet 0 50,001-100,000 cubic feet 0 200,001-400,000 cubic feet Access roadways within 150-feet of all portions of exterior 18, walls: "s 0 No Access doors provided every 100 lineal feet on exterior walls which face access 17. roadways: laCes D No 18. Alternate materials/methods requested: 0 Yes Er‘o owner/Tenant V1/4..-761,5 Sett:,c /4I > Pdc t/ Signature: Title: -Re51-04 r4,14-444-ic,v5 t4to tit Phone: (563) - 5 ?) Fax: (TO)Ce 93 itt