SPECIAL LOCKING REVIEW APPLICATION

SPECIAL LOCKING REVIEW APPLICATION

NOTE: THIS APPLICATION IS NOT FOR THE INSTALLATION OF MECHANICAL NON-ELECTRONIC HARDWARE.
1.

NEW PLAN REVIEWRESUBMITTAL
ASSOCIATED EXISTING PROJECT PO
EXISTING PROJECT NAME
2. REVIEW TYPE: SPECIAL LOCKING
Project Name
Street Address
Suite or Space No
City
Within city limits?

YesNo
State
Zip
Parish
State: LA Zip

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. Number of Locations to be installed
YesNo
Please select of special locking to be installed

Access-Controlled EgressDelayed-Egress LockingSpecial Locking in Healthcare OccupanciesElectric Strikes or Electrified HardwareMagnetic Lock Releasing DevicesOther
If OTHER, please specify
Fire Alarm Firm's License Number
Are the plans being submitted by an OSFM licensed qualifier?

YesNo
Qualifier's License Number
Statewide Electrical Contractors License Number
(attach a copy of the Electrical Contractor's license)
Does the building have an automatic sprinkler system installed?

YesNo
Does the building have a fire alarm installed?

YesNo
5. OCCUPANCY CLASSIFICATION
ASSEMBLY Square Feet
Occupants

50 TO 299 OCCUPANTS300 TO 499 OCCUPANTS500 TO 999 OCCUPANTS1,000 OCCUPANTS OR MORE
Group

Group A-1Group A-2Group A-3Group A-4Group A-5
Institutional Square Feet
Group I-1 (Group Care)
Group I-2 (Health Care)

HOSPITALLIMITED CARE FACILITYNURSING HOME
*(SPECIAL LOCKING IS NOT PERMITTED IN DETECTION AND CORRECTIONAL (GROUP I-3) OCCUPANCIES)
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
Class

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/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-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
High Hazard (Factory)

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-1 (Moderate Hazard)GROUP S-2 (Low Hazard)High Hazard Storage
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 (WORK AREA)
(Select ALL applicable fire protection or occupancy features that are associated with this project)
ADDITIONAL FEATURES

Sprinkler System 13Stage or PlatformSprinkler System - 13 DMotor Vehicle RelatedSprinkler System - 13 RHazardous MaterialsOwned and Operated By a Religious EntityAircraft RelatedKitchen Hood Fire Suppression SystemFire Alarm SystemUniversity / CollegeBoiler(s)Special Locking System(s)Emergency ShelterClean AgentPaint BoothGenerator (Required)Covered Mall BuildingCasino/Gaming AreaGenerator (Non-Required)AtriumUnderground BuildingAmbulatory Health CareSpecial Amusement
CONSTRUCTION TYPE

V-A/V(111) (FIRE-RATED WOOD)IV-HT / IV(2HH) (HEAVY TIMBER)III-B / III(200) (COMBINATION WOOD/STEEL/CONC)II-B / 11(000)II-A/II(111) (NON-RATED STEEL/CONC)(1 HOUR RATED STEEL/CONC)lll-A / lll(211) (COMBINATION WOOD/STEEL/CONC)V-B / V(000) NON-RATED WOODLL-B / LL(000) NON-RATED (STEEL/CONC)Not Provided / UnknownI-A / I(332) (3 HOUR RATED STEEL/CONC)I-A / I(442) (4 HOUR RATED STEEL/CONC)L-B / ll(222) (2 HOUR RATED STEEL/CONC)
8. APPLICANT(S) (P.O.R. / OWNER / TENANT / CONTRACTOR / ADDITIONAL CONTACT) AS APPLICABLE
PROFESSIONAL OF RECORD
P.O.R is a Louisiana Licensed

Engineer: Louisiana License Number:
P.O.R is a Louisiana Licensed

Architect: Louisiana License Number:
Engineer: Louisiana License Number:
Louisiana License Number
Architect: Louisiana License Number:
Louisiana License Number
Name

FIRST NAMEMIDDLE NAMELAST NAMESUFFIX
NAME OF FIRM
FAX
EMAIL
example@example.com
PHONE
STREET ADDRESS
ZIP Code
PARISH/COUNTY
CITY
STATE
ZIP Code

OWNER
Name

FIRST NAMEMIDDLE NAMELAST NAMESUFFIX
NAME OF FIRM
FAX
EMAIL
example@example.com
PHONE
STREET ADDRESS
ZIP Code
PARISH/COUNTY
CITY
STATE
SPECIAL LOCKING
TENANT
Name

FIRST NAMEMIDDLE NAMELAST NAMESUFFIX
NAME OF FIRM
FAX
EMAIL
example@example.com
PHONE
STREET ADDRESS
ZIP Code
PARISH/COUNTY
CITY
STATE
ZIP Code

CONTRACTOR
Name

FIRST NAMEMIDDLE NAMELAST NAMESUFFIX
NAME OF FIRM
FAX
EMAIL
example@example.com
PHONE
STREET ADDRESS
ZIP Code
PARISH/COUNTY
CITY
STATE
ZIP Code

ADDITIONAL CONTACT
Name

FIRST NAMEMIDDLE NAMELAST NAMESUFFIX
NAME OF FIRM
FAX
EMAIL
example@example.com
PHONE
STREET ADDRESS
ZIP Code
PARISH/COUNTY
CITY
STATE
Correspondence

Plans9. DOCUMENTS PROVIDED FOR REVIEWShop 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
10. 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.

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.

Project Re-submittals: No fee exemptions are allowed.

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.
SPECIAL LOCKING
A-1, A-2, A-3, A-4, A-5
0 2500 2,501 - 4,500 4,501 10,000 10,001 - 50,000 50,001 - 100,000

LSUCC Review Fee + $280.00 + $420.00 + $1,015.00 + $1,501.00 + $1,960.00

= $1,220.00 = $1,806.00 = $2,365.00

+ $1,960.00 + .010/sqft over 100,000sqft

= $2,515.00 + .010/sqft over 100,000sqft
+ $1,595.00 + .010/sqft over 150,000sqft
= $1,920.00 = $2,020.00 + .010/sqft over 150,000sqft
HEALTH CARE, INSTITUTIONAL,
(Includes Limited Care/Assisted Living facilities)

+ $2,485.00 + .020/sqft over 100,000sqft + $2,485.00 + .020/sqft over 100,000sqft

= $3,190.00 + .020/sqft over 100,000sqft + $3,340.00 + .020/sqft over 100,000sqft
HOTELS, DORMITORIES, APARTMENTS,
ROOMING HOUSES,
RESIDENTIAL BOARD AND CARE FACILITIES

$55.00 $85.00 $205.00 $305.00 $405.00
R-4, I-1
+ $1,505.00 + $1,995.00 + $1,995.00 + .010/sqft over 150,000sqft + $1,995.00 + .010/sqft over 150,000sqft

= $2,500.00 + .010/sqft over 150,000sqft = $2,700.00 + .010/sqft over 150,000sqft
SPECIAL LOCKING
+ $1,105.00 + $1,105. 00 + .010/sqft over 150,000sqft + $1,105. 00 + .010/sqft over 150,000sqft

= $1,630.00 + .010/sqft over 150,000sqft
F-1, F-2, S-1, S-2, U
720.00 + .020/sqft over 100,000sqft

= $945.00 + .020/sqft over 100,000sqft
H-1, H-2, H-3, H-4, H-5
To be classified as indicated above

+ $440.00 + .030/sqft over 2,000sqft

Base Review Fee + LSUCC Review Fee

Notes: 1.Fee applies to the primary occupancy class of the building, but includes square footage for the total building, even where composed of separate occupancy classes, incidental uses or accessory uses. 2.Only one complete set of plans and specifications shall be submitted to this office for review. 3.Projects with minimal scopes of work (MSW) may be considered for exemption from the full review fee (MSW fee is $20
ITEM
REVIEW FEE
Number of locking locations = 1 - 10
SPECIAL LOCKING
Should be Empty:

SPECIAL LOCKING REVIEW APPLICATION

2. REVIEW TYPE: SPECIAL LOCKING

PROFESSIONAL OF RECORD

SPECIAL LOCKING

TENANT

SPECIAL LOCKING

A-1, A-2, A-3, A-4, A-5

HEALTH CARE, INSTITUTIONAL,

HOTELS, DORMITORIES, APARTMENTS,

ROOMING HOUSES,

R-4, I-1

SPECIAL LOCKING

F-1, F-2, S-1, S-2, U

H-1, H-2, H-3, H-4, H-5

ITEM

REVIEW FEE

SPECIAL LOCKING