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fU gD gD gD c< 4 * l $ $ _T gD c< _T gD gD 1L 6 P , -Q $ .( \ 2 < P ;Q $ |U 0 U Q Y @ Y -Q gD * * * * Fire Suppression SystemPlan Review Information Nebraska State Fire Marshal
246 South 14th Street Lincoln, NE 68508
Phone: (402) 471-2027 Fax: (402) 471-3118
This form is to be completed in addition to the Plan Submittal Application
Name of facility: FORMTEXT F a c i l i t y a d d r e s s : F O R M T E X T C i t y : F O R M T E X T C o u n t y : F O R M T E X T P h o n e n u m b e r a n d / o r c o n t a c t a t j o b s i t e : F O R M T E X T S p r i n k l e r C o n t r a c t o r : F O R M T E X T C o n t r a c t o r p h o n e : F O R M T E X T C o n t r a c t o r l i c e n s e n u m b e r : F O R M T E X T C o n t r a c t o r f a x : F O R M T E X T N a m e o f p e r s o n r e s p o n s i b l e f o r d e s i g n : F O R M T E X T
P r o v i d e a d e s c r i p t i o n o f t h e w o r k t o b e c o m p l e t e d : F O R M T E X T P r o v i d e a d e s c r i p t i o n o f t h e f a c i l i t y ( i . e . n o n - c o m b u s t i b l e 3 - s t o r y o f f i c e w i t h r e t a i l s t o r e s o n g r o u n d f l o o r ) : F O R M T E X T D o e s t h e d e s i g n i n v o l v e a p a r t i a l s y s t e m o r a v a r i a n c e / d e v i a t i o n f r o m T i t l e 1 5 3 C h a p t e r O n e N e b r a s k a S t a t e F i r e C o d e R e g u l a t i o n s ( i n c l u d e w r i t t e n d o c u m e n t a t i o n o r c o p y o f o r d e r s ) ? I f s o , e x p l a i n : F O R M T E X T
M u n i c i p a l w a t e r s u p p l y ? Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X W a t e r s u p p l y d a t a : S t a t i c F O R M T E X T p s i R e s i d u a l F O R M T E X T p s i F l o w F O R M T E X T g p m D a t e o f t e s t : F O R M T E X T L o c a t i o n : F O R M T E X T M u n i c i p a l u n d e r g r o u n d m a i n s i z e : F O R M T E X T C i r c u l a t i n g o r d e a d e n d : F O R M T E X T S i z e o f s u p p l y l i n e i n t o b u i l d i n g : F O R M T E X T F i r e p u m p ? Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X P u m p c a p a c i t y : F O R M T E X T T y p e o f d r i v e r : E l e c t r i c F O R M C H E C K B O X D i e s e l F O R M C H E C K B O X O t h e r F O R M T E X T R e s e r v o i r o r t a n k ? Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X D e s c r i b e : F O R M T E X T D o e s t h e w a t e r s u p p l y i n c l u d e a p o n d , p o o l , o r w e l l ? Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X I f y e s , e x p l a i n : F O R M T E X T
S t a n d a r d s u s e d f o r t h e d e s i g n ( c h e c k a l l t h a t a p p l y )
N F P A 1 3 F O R M C H E C K B O X N F P A 1 3 R F O R M C H E C K B O X N F P A 1 3 D F O R M C H E C K B O X N F P A 2 3 0 F O R M C H E C K B O X
O t h e r : F O R M T E X T
D o e s t h e d e s i g n i n c l u d e t h e p r o t e c t i o n o f h i g h - p i l e d c o m b u s t i b l e s t o r a g e ? Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X
I f y e s , c o m p l e t e t h e b a c k o f t h i s i n f o r m a t i o n s h e e t covering high-piled combustible storage.
Nebraska State Fire Marshal Plan Review Information Page Two
Use multiple copies of this page if needed
Is solid pile storage being used? Yes FORMCHECKBOX No FORMCHECKBOX Ceiling / Roof height: FORMTEXT S t o r a g e h e i g h t : F O R M T E X T
C e i l i n g / R o o f c o n s t r u c t i o n : F O R M T E X T I s r a c k s t o r a g e b e i n g u s e d ? Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X
C e i l i n g / R o o f h e i g h t : F O R M T E X T S t o r a g e h e i g h t : F O R M T E X T
C e i l i n g / R o o f c o n s t r u c t i o n : F O R M T E X T S i n g l e , d o u b l e o r m u l t i p l e r o w r a c k ? F O R M T E X T H o r i z o n t a l f l u e w i d t h : F O R M T E X T L o n g i t u d i n a l f l u e w i d t h : F O R M T E X T A i s l e w i d t h : F O R M T E X T A r e s o l i d s h e l v e s , g r a t e s o r s l a t s u s e d i n t h e r a c k ( i f y e s , e x p l a i n ) ? Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X
F O R M T E X T A r e o t h e r s t o r a g e m e t h o d s s u c h a s b i n - b o x , h a n g i n g g a r m e n t s , a u t o m a t e d , o r c a r o u s e l u s e d ?
Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X I s b a n d i n g o r e n c a p s u l a t i o n o f t h e c o m m o d i t y u s e d ( i f y e s , e x p l a i n ) ? Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X
F O R M T E X T
D e s c r i b e i n d e t a i l w h a t i s b e i n g s t o r e d : F O R M T E X T D o e s t h e s t o r a g e i n v o l v e l i m i t e d q u a n t i t i e s o f G r o u p A p l a s t i c s i n m i x e d c o m m o d i t i e s ?
Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X I f y e s , w h a t i s t h e f i n a l c o m m o d i t y c l a s s i f i c a t i o n b a s e d o n : F O R M T E X T F o r h i g h - p i l e d s t o r a g e w i t h a m i x o f c o m m o d i t i e s , p r o v i d e i n f o r m a t i o n o n t h e t h r e e m o s t h a z a r d o u s c o m m o d i t i e s t h a t a r e s t o r e d i n q u a n t i t i e s g r e a t e r t h a n t w o p a l l e t l o a d s i n t h e b u i l d i n g : F O R M T E X T Q u a n t i t y : F O R M T E X T F O R M T E X T Q u a n t i t y : F O R M T E X T F O R M T E X T Q u a n t i t y : F O R M T E X T D e s c r i b e i n d e t a i l t h e c o m m o d i t y c l a s s i f i c a t i o n u s e d f o r d e s i g n : F O R M T E X T I f t h e s y s t e m d e s i g n i s n o t b a s e d o n t h e m o s t h a z a r d o u s c o m m o d i t y l i s t e d a b o v e , e x p l a i n w h y :
F O R M T E X T
D e s c r i b e i n d e t a i l t h e s p r i n k l e r p r o t e c t i o n f o r t h e h i g h - p i l e d c o m b u s t i b l e s t o r a g e . I n c l u d e i n f o r m a t i o n o n t h e d e s i g n s t a n d a r d , S e c t i o n o r T a b l e n u m b e r s , c e i l i n g s p r i n k l e r d e n s i t y , t y p e o f s p r i n k l e r h e a d e t c : F O R M T E X T I s s m o k e a n d h e a t r e m o v a l ( v e n t i n g ) p r o v i d e d ? Y e s F O R M C H E C K B O X N o F O R M C H E C K B O X F O R M T E X T
H i g h - p i l e d c o m b u s t i b l e s t o r a g e i s s t o r a g e o f c o m b u s t i b l e m a t e r i a l s i n c l o s e l y p a c k e d p i l e s o r c o m b u s t i b l e m a t e r i a l s o n p a l l e t s , i n r a c k s o r o n s h e l v e s w h e r e t h e t o p o f s t o r a g e i s g r e a t e r t h a n 1 2 feet in height. It also includes certain high-hazard commodities, such as rubber tires, Group A plastics, flammable liquids, idle pallets and similar commodities, where the top of storage is greater than 6 feet in height.
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