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BILLINGS FIRE DEPARTMENT 2305 8th Avenue North Paul A. Dextras Billings, Montana 59101 FIRE CHIEF (406) 657-8423 Fax (406) 657-8456 CITY OF BILLINGS DELAYED PLAN SUBMITTAL VERIFICATION FORM Permit # Building/Business Name: Building Address: Type of System: Automatic Sprinkler System (Complete Attached Owner’s Information Certificate) Alternative Automatic Extinguishing System Fire Alarm Other: Architect: Address: Phone # Requirements: 1. This form shall be completed and returned to the Fire Marshal’s Office prior to approval of building plans. 2. Delayed plans shall be submitted within 60 days of the approval of the building plans. 3. Plans shall be complete and contain all required information in accordance with the currently adopted fire code. 4. Submit Automatic Sprinkler System, Alternative Automatic Extinguishing System, and Fire Alarm Plans to: Fire Safety Consultants, Inc. 2420 Alft Lane Suite B100 Elgin, IL 60124 Office Phone: (847) 697-1300 Email: 5. Submit High Piled Storage Plans to: Billings Fire Department Attention: Fire Marshal 2305 8th Avenue North Billings, MT 59101 Signature of Architect or Building Owner Date Printed Name Updated: 04/27/2015 To protect life and property while recognizing our people as the key to our success ---PAGE BREAK--- Owner’s Information Certificate (Complete if building contains a sprinkler system) Name/Address of property to be protected with sprinkler protection: Name of Owner: Existing or planned construction is: Fire resistive or noncombustible Wood frame or ordinary (masonry walls with wood beams) Unknown Is the system installation intended for one of the following special occupancies: Aircraft hangar Yes No Fixed guideway transit system Yes No Race track stable Yes No Marine terminal, pier, or wharf Yes No Airport terminal Yes No Aircraft engine test facility Yes No Power plant Yes No Water-cooling tower Yes 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 Nitrate film Yes No Pyroxylin plastic Yes No Compressed or liquefied gas cylinders Yes No Liquid or solid oxidizers Yes No Organic peroxide formulations Yes No Idle pallets Yes No If the answer to any of the above is “yes,” describe type, location, arrangement, and intended maximum quantities. Page 2 of 3 ---PAGE BREAK--- Indicate whether the protection is intended for one of the following specialized occupancies or areas: Spray area or mixing room Yes No Solvent extraction Yes No Laboratory using chemicals Yes No Oxygen-fuel gas system for welding/cutting Yes No Acetylene cylinder charging Yes No Production or use of compressed or liquefied gases Yes No Commercial cooking operation Yes No Class A hyperbaric chamber Yes No Cleanroom Yes No Incinerator or waste handling system Yes No Linen handling system Yes No Industrial furnace Yes No Water-cooling tower Yes No If the answer to any of the above is “yes,” describe type, location, arrangement, and intended maximum quantities: Will there be any storage of products over 12 ft (3.6 m) in height? Yes No If the answer is “yes,” describe product, intended storage arrangement, and height: Will there be any storage of plastic, rubber, or similar products over 5 ft (1.5 m) high except as described above? Yes No If the answer is “yes,” describe product, intended storage arrangement, and height: I certify that I have knowledge of the intended use of the property and that the above information is correct. Signature of owner’s representative or agent: Date: Name of owner’s representative or agent completing certificate (print): Relationship and firm of agent (print): Page 3 of 3