STATE OF LOUISIANA DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONS OFFICE OF STATE FIRE MARSHAL CODE ENFORCEMENT AND BUILDING SAFETY 8181 INDEPENDENCE BLVD., BATON ROUGE, LA 70806 800-256-5452 225-925-4920 FAX: 225-925-4414 www.dps.state.la.us/sfm

01012007 FIRE MARSHAL USE ONLY: DATE RECEIVED REVIEWER / BADGE: P0:

PLAN REVIEW APPLICATION o CHECK HERE IF STATE UNIFORM CONSTRUCTION CODE REVIEW IS REQUIRED BY THIS OFFICE

PROVIDE INFORMATION ON THE NAME OF THIS SPECIFIC PROJECT, TENANT, LEASE SPACE, SCOPE OF WORK, ETC.

1. Project Information PART 1. REQUIRED FOR ALL SUBMITTALS ATTACH APPLICABLE CHECKLIST & FEE SCHEDULE PLEASE PRINT (BLACK OR BLUE INK ONLY)

Project Name:

Street Address:

Suite/Space No:

City:

State: LA

Zip:

-

Parish:

Within city limits? o Yes o No

PROVIDE INFORMATION ON THE OVERALL STRUCTURE OR BUILDING THAT THIS PROJECT IS WITHIN, IF DIFFERENT THAN ABOVE.

2. Structure Information (Overall Building )

Building Name:

Street Address:

City:

State: LA

Zip:

-

Parish:

Number of building floors: Project on which floor(s):

3. Purpose of Application PART 3. REQUIRED FOR ALL SUBMITTALS

System Type:

o

ARCHITECTURAL REVIEW

ARCHITECTURAL LIFE SAFETY ADA-AG ACCESSIBILITY ENERGY CONSERVATION KITCHEN EXHAUST HOOD CONSTRUCTION

CHECK ONLY ONE:

o

FIRE ALARM SYSTEM REVIEW CHECK ONLY ONE FIRE ALARM SYSTEM TYPE:

o Local o Auxiliary o *Central Station o Proprietary Station o Remote Station

*IF SYSTEM TYPE IS CENTRAL STATION, YOU MUST ATTACH COPY OF CENTRAL STATION UL LISTING TO THIS APPLICATION

o

KITCHEN HOOD WET CHEMICAL SUPPRESSION SYSTEM REVIEW

o

FIRE SUPPRESSION SYSTEM REVIEW CHECK SYSTEM TYPE :

o SPRINKLER o DRY CHEMICAL o CLEAN AGENT o HALON o PAINT SPRAY BOOTH o FOAM WATER

o

STORAGE TANK FOR FLAMMABLE OR COMBUSTIBLE LIQUIDS: NUMBER OF TANKS ABOVE GROUND

Review Type:

o

NEW CONSTRUCTION

IF PROJECT IS A SYSTEM REVIEW, THEN PROVIDE PREVIOUS ARCHITECTURAL REVIEW NUMBER

P0

CHECK ONLY ONE:

o

RENOVATION OR ADDITION

IF CHANGE OF OCCUPANCY, THEN CHECK NEXT LINE. PREVIOUS ARCHITECTURAL REVIEW NUMBER, IF APPLICABLE

P0

o

CHANGE OF OCCUPANCY

WITH OR WITHOUT RENOVATIONS, CHECK HERE. PROVIDE REVIOUS ARCHITECTURAL REVIEW NUMBER, IF APPLICABLE

P0

o

BUILDING FOUNDATION ONLY

o

BUILDING SHELL ONLY

PROVIDE PREVIOUS BUILDING FOUNDATION REVIEW NUMBER

P0

o

RE-SUBMITTAL

PROVIDE PREVIOUS PROJECT REVIEW NUMBER

P0

o

PRELIMINARY

RESERVED FOR LARGE PROJECTS. MUST HAVE STATE FIRE MARSHAL PRE-APPROVAL TO SUBMIT AS PRELIMINARY

PROVIDE COST AND SQUARE FOOTAGE AREAS OF THIS PROJECT OR SYSTEM - FOR SYSTEMS, ENTER ONLY SYSTEM COST

4. Project Details PART 4. REQUIRED FOR ALL SUBMITTALS

New Sq Ft:

,

,

Estimated Cost of this Project: $ , ,

Existing Sq Ft:

,

,

Calculated Fee Attached: $ ,

Renovated Sq Ft:

,

,

MONEY ORDERS, CASHIER’S CHECKS, CERTIFIED CHECKS, COMPANY CHECKS, PERSONAL CHECKS ACCEPTED (NO TEMPORARY CHECKS).

FOLLOWING OCCUPANCIES REFER TO OVERALL STRUCTURE OR BUILDING:

SELECT ONE OR MORE OF THE FOLLOWING OCCUPANCIES AND PRINT BELOW: ASSEMBLY EDUCATIONAL DAY CARE HEALTH CARE DETENTION HOTEL DORMITORY APARTMENT LODGING / ROOMING BOARD AND CARE MERCANTILE BUSINESS INDUSTRIAL STORAGE UNUSUAL

Main Occupancy:

Sq Ft F

,

,

Secondary:

Sq Ft F

,

,

Thirdly:

Sq Ft F

,

,

PROVIDE INFORMATION ON THE OWNER FOR THE OVERALL STRUCTURE OR BUILDING FOR THIS PROJECT.	5. Owner Information PART 5. REQUIRED FOR ALL SUBMITTALS
LAST NAME FIRST NAME INITIAL
Owner:			,
Name of Firm:
Mailing Address:
City:			State:		Zip:		-
Contact Person:			E-mail:
Telephone No:		Cell No.			Fax No.
PROVIDE INFORMATION ON THE TENANT FOR THIS SPECIFIC PROJECT, IF DIFFERENT THAN OWNER.	6. Tenant Information
LAST NAME FIRST NAME INITIAL
Tenant:			,
Name of Firm:
Mailing Address:
City:			State:		Zip:		-
Contact Person:			E-mail:
Telephone No:		Cell No.			Fax No.
City:			State:		Zip:		-
E-mail:
Telephone No:		Fax No:
PROVIDE INFORMATION ON THE PREPARER OF THE FIRE ALARM, SPRINKLER, OR FIRE SUPPRESSION SHOP DRAWINGS.	7. Preparer of Shop Drawings Information			o SFM Licensed Contractor o State Licensed Engineer
LAST NAME FIRST NAME INITIAL
Qualifier:			,
Qualifier Lic. No:
Name of Firm:
Firm License No:
Mailing Address:
City:			State:		Zip:		-
Contact Person:			E-mail:
Telephone No:		Cell No.			Fax No.
PROVIDE INFORMATION ON THE PROFESSIONAL OF RECORD FOR THIS PROJECT.	8. Professional of Record Information			o Architect o Civil Engineer o EE / ME / FP Engineer
LAST NAME FIRST NAME INITIAL
Professional:			,
LA License No:
Name of Firm:
Address:
City:			State:		Zip:		-
Contact Person:			E-mail:
Telephone No:		Cell No.			Fax No.
CHECK ONLY ONE: IS THIS PROJECT STATE OWNED, MUNICIPAL (FEDERAL, PARISH, CITY OWNED), OR OTHER (PRIVATE OWNED)?	9. Government and Municipal Projects PART 9. REQUIRED FOR ALL SUBMITTALS			o		State Owned Project
				o		Municipal Project
				o		Other (Private Owned)
IF A REVIEW FOR THE NATIONAL ENERGY CODE IS PART OF THIS PROJECT, THEN CHECK APPLICABLE BOX AT RIGHT:	10. Energy Code Review			o		YES, ENERGY CODE PACKAGE ATTACHED
				o		NO ENERGY CODE PACKAGE ATTACHED