Report (60) ' ��-a SCJ � (UY.�►�
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COMBUSTIBLE
AUG 1 2019 STOCK STORAGE
fJl I , QUESTIONNAIRE
(Please print the information clearly.)
Business Name: PacStar
Business Address: 7245 S.W. DURHAM ROAD, BUILDING K, SUITE 190, PORTLAND, OR 97224
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: II Source: IFC NFPA X
Aerosol Level III: ❑Yes C4 No Class I, II, Ill, IV, High Hazard(V)(lowest to highest):
2. Description of storage(if additional space is needed,attach additional page):
Machined Aluminum.Cold Rolled Steel fabricated parts,Printed circuit boards,electrical wiring harnesses.
Storage is in cardboard boxes and plastic tote bins on Wire mesh pallet decks.
Public/Private areas: Private
3. Maximum height of storage: 22 feet feet(distance from floor to top of commodity)
4. Method of storage (check all that apply):
❑ Encapsulated in plastic ❑ 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
0 stable ❑unstable
5. Types of racks: (check all that apply)
® single row 0 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 0 100,001 —300,000 sq ft ❑2 hour separation
7. Sprinkler information:
a. Sprinkler density: 0.495 Minimum b. Rack sprinklers? ❑Yes ® No
c. Temperature rating of sprinkle head in: ®Ceiling ❑Racks
Fire hose stations and hose
d. connections: ❑ Yes ►4 No Number required: Size:
e. Fire flow worksheet completed: ❑Yes ❑ No Design cross-checked: ❑Yes ❑No
Class 1 standpipes
f. required: 0 Yes 0 No
8. Building height:
10. feet❑ No 9. Distance from top of storage to fire sprinkler deflector: 2 feet
Smoke/Heat
vents: ❑Yes
Draft
11. curtains: ❑Yes ® No sq ftsections Depth: 0 4 feet
ID Yes ®No :
❑6 feet 0 8 feet
12. Column/Wall fire protection required: yes
® No Additional fire sprinkler heads: ❑Yes ®No
Protected by listed/tested Description
assay:
13. Aisle width between racks and storage: 10
Smoke detection Ratio: square feet
14. system: ❑Yes ❑ No
15. Maximum cubic feet per pile: (choose one)
®0—50,000 cubic feet feet
❑ 100,001 —200,000 cubic feet
❑50,001 —100,000 cubic feet ❑200,001 —400,000 cubic feet
Phone:
Access roadways within 150-feet of all portions of exterior
16. walls: ®Yes ❑No
Access doors provided every 100 lineal feet on exterior walls which face access
17. roadways:
18. Alternate materials/methods requested: El Yes ® No
Owner/Tenant Name:
P
St rCommunications
Signature: r -/ '
Title: Director of Production 503.213.2365 Fax:®Yes 0 No