Fire Alarm Review Application

FIRE ALARM REVIEW APPLICATION
Name of Person Completing this form:*

First NameLast Name
1. Select One

NEW PLAN REVIEWRESUBMITTAL
ASSOCIATED EXISTING PROJECT
EXISTING PROJECT NAME
2. REVIEW TYPE - FIRE ALARM SYSTEM
3. New Project Name
Street Address
Suite or Space No
City
Within city limits?

YesNo
State
Zip
Parish
STATE OWNEDSTATE LICENSEDSTATE LEASEDMUNICIPAL PROJECTPRIVATE PROJECTFEDERALLY OWNEDFEDERALLY FUNDED
Complete the following --- if the Building has more than one story?
Number of Stories
Project is on which floor(s)?
Is this a high-rise building? A high rise is defined as a building with 7 stories or more or 75 ft high or taller.

YesNo
Estimated Cost of Project
Project Description
4. Is this system required by Code or by an Equivalency to Code?

YesNo
Please select the Fire Alarm System type

Remote StationCentral StationProprietaryLocal System
Is the system a new installation or a modification to an existing system?

ModificationNew
Fire Alarm Firm's License Number
Are the plans being submitted by an OSFM licensed qualifier?

YesNo
Qualifier's License Number
Engineer's License Number
5. Indicate the device types to be included in the system and the number of each:
Strobe

Strobe:
Number of Devices
Speaker/Strobe

Speaker/Strobe:
Number of Devices
Horn

Horn:
Number of Devices
Speaker

Speaker
Number of Devices
Horn/Strobe

Horn/Strobe:
Number of Devices
Panel

Panel:
Number of Devices
Smoke Detector

Smoke Detector:
Number of Devices
Heat Detector

Heat Detector:
Number of Devices
Relay Module

Relay Module
Number of Devices
Carbon Monoxide

Carbon Monoxide
Number of Devices
6. OCCUPANCY CLASSIFICATION(s)
Assembly

ASSEMBLY
Square Feet
50 TO 299 OCCUPANTS300 TO 499 OCCUPANTS500 TO 999 OCCUPANTS1,000 OCCUPANTS OR MORE
Group A-1Group A-2Group A-3Group A-4Group A-5
Instutional

INSTITUTIONAL
Square Feet
Group I-1 (Group Care)

Group I-1 (Group Care)
Group I-2 (Health Care)

HOSPITALLIMITED CARE FACILITYNURSING HOME
Group I-3 (Detention/Correction)

CONDITION 1CONDITION 2CONDITION 3CONDITION 4
Group I-4 (Day-Care)

Group I-4 (Day-Care)
Number of Children over 2 1/2 years of age
Number of Children 2 1/2 years of age or less
Number of Adults (if Adult Day Care)
Business Square Feet
MERCANTILE Square Feet
square feet

Class A >30,000 sq. ftClass B Between 3,000 and 30,000 sq. ftClass C <3,000 sq. ft
Educational or Day-Care Square Feet
School/Classroom & Day Care

School/ClassroomDay Care
Number of Children over 2 1/2 years of age
Number of Children 2 1/2 years of age or less
Number of Adults (if Adult Day Care)
Residential Square Feet
Group (R)

Group R-1 (Hotel/Motel - Primarily Transient)Group R-2 (Apartments- Primarily Permanent)Group R-3 (Small Miscellaneous)Group R-4 (Small Residential Care for <16 Occupants)
Number of Occupants
FACTORY / INDUSTRIAL square feet
Group F-1 (Moderate Hazard)Group F-2 (Low Hazard)High Hazard
Complete ONLY if High Hazard above

GROUP H-1 DETONATION HAZARDGROUP H-2 DEFLAGRATION HAZARDGROUP H-3 COMBUSTIBLE HAZARDGROUP H-4 HEALTH HAZARDGROUP H-5 HAZARDOUS PRODUCTION MATERIALS
Storage Square Feet
Group (S)

GROUP S-1 (Moderate Hazard)GROUP S-2 (Low Hazard)
Identify the materials to be stored:
HIGH HAZARD STORAGE

GROUP H-1 DETONATION HAZARDGROUP H-2 DEFLAGRATION HAZARDGROUP H-3 COMBUSTIBLE HAZARDGROUP H-4 HEALTH HAZARDGROUP H-5 HAZARDOUS PRODUCTION MATERIALS
UTILITY / MISCELLANEOUS square feet
Provide a Description of Use
***TOTAL SQUARE FEET OF THE AREA UNDER REVIEW***
7. ADDITIONAL FEATURES
(Select ALL applicable fire protection or occupancy features that are associated with this project)
ADDITIONAL FEATURES

Sprinkler System – 13Sprinkler System – 13 DSprinkler System – 13 RMotor-Vehicle RelatedStage or PlatformAircraft RelatedSpecial AmusementHazardous MaterialsOwned and Operated By a Religious EntityKitchen Hood Fire Suppression SystemFire Alarm SystemUniversity / CollegeBoiler(s)Special Locking System(s)Emergency ShelterPaint BoothClean AgentGenerator (Required)Covered Mall BuildingCasino/Gaming AreaGenerator (Non-Required)AtriumUnderground BuildingAmbulatory Health Care
UTILITY / MISCELLANEOUS

V-B /V(000) (NON-RATED WOOD)V-A/V(111) (FIRE-RATED WOOD)IV-HT / IV(2HH) (HEAVY TIMBER)III-B / III(200) (COMBINATION WOOD/STEEL/CONC)III-A/III(211) (COMBINATION WOOD/STEEL/CONC)II-B / II(000) (NON-RATED STEEL/CONC)II-A/II(111) / (1 HOUR RATED STEEL/CONC)I-B / II(222) (2 HOUR RATED STEEL/CONC)I-A / 332 3 HOUR RATED STEEL/CONCI-A / I(442) (4 HOUR RATED STEEL/CONC)Not Provided / Unknown
9. APPLICANT(S) (P.O.R. / OWNER / TENANT / CONTRACTOR / ADDITIONAL CONTACT) AS APPLICABLE

PROFESSIONAL OF RECORD
Engineer

Engineer:
Louisiana License Number
Architect

Architect
Louisiana License Number
Name

FIRST NAMEMIDDLE NAMELAST NAMESUFFIX
NAME OF FIRM
EMAIL
example@example.com
PHONE

Area CodePhone Number
FAX
STREET ADDRESS
PARISH/COUNTY
CITY
STATE
ZIP Code
OWNER
Name

FIRST NAMEMIDDLE NAMELAST NAMESUFFIX
NAME OF FIRM
EMAIL
example@example.com
PHONE

Area CodePhone Number
FAX
STREET ADDRESS
PARISH/COUNTY
CITY
STATE
ZIP Code
TENANT
TENANT
Name

FIRST NAMEMIDDLE NAMELAST NAMESUFFIX
NAME OF FIRM
EMAIL
example@example.com
PHONE

Area CodePhone Number
FAX
STREET ADDRESS
PARISH/COUNTY
CITY
STATE
ZIP Code
CONTRACTOR
CONTRACTOR
Name

FIRST NAMEMIDDLE NAMELAST NAMESUFFIX
NAME OF FIRM
FAX
EMAIL
example@example.com
PHONE

Area CodePhone Number
STREET ADDRESS
PARISH/COUNTY
CITY
STATE
ZIP Code
ADDITIONAL CONTACT
ADDITIONAL CONTACT
Name

FIRST NAMEMIDDLE NAMELAST NAMESUFFIX
NAME OF FIRM
EMAIL
example@example.com
PHONE

Area CodePhone Number
FAX
STREET ADDRESS
PARISH/COUNTY
CITY
STATE
ZIP Code
10. DOCUMENTS PROVIDED FOR REVIEW

PlansCorrespondenceShop DrawingsSpecificationsPhotographs
This section allows the applicant any owner, professional of record, contractor, developer, or manufacturer to clearly identify all records containing proprietary or trade secret information submitted to the Office of State Fire Marshal, as documents that contain confidential, proprietary, or trade secret information, in accordance with the Public Records Law, specifically R.S. 44:3.2D Any record disclosures will be made in accordance with the Public Records Law.

DOCUMENT CONTAINS CONFIDENTIAL PROPRIETARY OR TRADE SECRET INFORMATIONDOCUMENT DOES NOT CONTAIN CONFIDENTIAL PROPRIETARY OR TRADE SECRET INFORMATION
11. REVIEW FEE & PAYMENT (See the FEE SCHEDULE below to determine the required fee)

Money orders, cashier's checks, certified checks, and company checks are accepted. Personal checks accepted - must include LA driver's license number on check. State Projects are projects contracted through LA Facility Planning and Control. LSUCC REVIEWS ARE NOT PERFORMED BY THIS OFFICE FOR STATE PROJECTS. State Projects, both full reviews and exemption requests, are fee exempt except for Project Re-submittals. Fee exemptions are NOT allowed for Project Re-submittals.

Municipal Projects include all city, parish, and federal projects. Except for Project Re-submittals, Municipal Projects are charged a flat review fee of $20 for the Base Review Fee. In addition to the Base Review Fees, full LSUCC Review Fees apply for Municipal Projects where requests for LSUCC review service are accepted. Fee exemptions are NOT allowed for Project Re-submittals. "Devices" are identified as visual notification devices, system smoke detectors, and system heat detectors only.

In accordance with R.S.40:1574.1 and R.S.40:1730.41, the owner of the project who submits the plans and specifications shall pay to the Office of State Fire Marshal, Code Enforcement and Building Safety a plan review or document fee based on the following schedule.

ITEM		REVIEW FEE
Number of devices = 1 - 25		$ 75
Number of devices = 26 - 50		$ 105
Number of devices = 51 - 75		$ 135
Number of devices = 76 - 100		$ 165
Number of devices = 101 - above		$ 165 + $ 30 for each additional group of 1 -25 devices over 100

Calculated fee attached
Fire Alarm System - Minor Scope Of Work (MSW) Projects with minimal scopes of work (MSW) are considered for exemption from the full review fee (MSW fee is $20) under the following conditions;

1. Minor alterations/additions/modifications to EXISTING fire alarm systems, that do not jeopardize required system performance and involve up to a maximum of ten (10) devices, are permitted as "Minor Scopes of Work" (MSW 2. Installations of, and modifications to, NON-REQUIRED fire alarm systems must be submitted for review, but are considered minor scopes of work (MSW 3. A plan review submittal is not required for corrective work ordered by the Fire Marshal Inspector and identified in the inspection report, subject to the following stipulations: a. Limited to manual pull stations, smoke detectors, heat detectors and audible/visual notifications appliances. b.This policy shall not apply to other fire alarm systems components such as additional fire alarm control panels, digital alarm communication equipment or similar devices cited by inspection. If these devices are required to be added to the fire alarm system, then the inspector shall require the shop drawings to be re-submitted to the plan reviewer with an application, appropriate review fee and a copy of the inspection report identifying the deficiencies. C.Limited to a maximum of ten (10) devices. d. Contractor shall provide revised battery calculations to the inspector. e.Contractor shall provide all information concerning the devices listing and compatibility (i.e. 2-wire smoke detectors and certain heat detectors 4. Complete all information on the FIRE ALARM REVIEW APPLICATION. a.Provide the State Fire Marshal Architect Review number, copy of inspection report, or reason for modification. If there is no architectural State Fire Marshal Architectural review number, indicate inspection report or reason for fire alarm system modification in the PROJECT DESCRIPTION (Item no 3 above Provide copy of inspection report with submittal. Owner to provide reason for the submittal indicated in the description of work, if the reason is not as stated above. b. PROJECT DESCRIPTION of work shall include the number of fire alarm devices and the cost of

C. When the FIRE ALARM REVIEW APPLICATION is complete, it may be delivered to the S.F.M. Plan Review Section, with sufficient supplemental information and payment for review. (Money orders, cashier's checks, certified checks, and company checks are accepted. Personal checks accepted - must include LA driver's license number on check
Should be Empty:

FIRE ALARM REVIEW APPLICATION

OWNER

TENANT

CONTRACTOR

ADDITIONAL CONTACT