Professional Documents
Culture Documents
must be complete!)
FACILITY REPORT
FACILITY NAME ADDRESS PHONE CITY
PLEASE UPDATE ALL CHANGES AS REQUIRED LOG NO. (Assigned by OPC) Team (Assigned by OPC) ______________ COUNTY TITLE FAX To be determined PLEASE UPDATE ALL CHANGES AS REQUIRED E-MAIL: Team (Assigned by OPC) ZIP
PROJECT REPORT
______________ PROJECT NAME Facility) CITY _______________
ADDESS OR DESCRIPTIVE LOCATION Same as COUNTY _____________ ZIP ____________ TITLE _________________________________ FAX
(Must be filled in)
PROJECT CONTACT PERSON* Same as above *(For Construction Survey Scheduling) PHONE PROJECT COST ESTIMATE
SPRINKLER REPORT
REQUIRED IS FACILITY COMPLETELY FIRE SPRINKLERED? Yes ( ) Date___________ No (
IS FACILITY ON INTERIM FULLY SPRINKLERED CONTRACT? Yes ( ) No (X ) Not Known ( ) If Yes, Exp. IS FACILITY IN FIRE SAFETY EVALUATION SYSTEM (FSES) COMPLIANCE? Yes ( ) No ( ) Not Known/NA (X )
OWNER
OWNER (COMPANY NAME) OWNER CONTACT PERSON ADDRESS (If different than facility) CITY COUNTY Not known PHONE FAX ZIP 33021 E-MAIL: PLEASE UPDATE ALL CHANGES AS TITLE STATE Florida
(To initiate project review, all items must be complete!) ***PROVIDE A COPY OF THE C.O.N. LETTER OF EXEMPTION OR NON REVIEWABLE AS REQUIRED*** (EXCEPTION: NOT REQUIRED FOR AMBULATORY SURGICAL CENTER) C.O.N. # EXP. DATE_________ SQ. FT (CON)_________EXEMPT #_________NON-REVIEWABLE # _________
ANY CHANGES IN THE DESIGNATED PROJECT PLAYERS MUST BE UPDATED ON THIS FORM AS REQUIRED. NEW FIRMS MUST PROVIDE A REVISED APPLICATION FOR REVIEW AND A LETTER FROM THE OWNER STATING THIS ACCEPTANCE. ALL OTHER STATUTORY REQUIREMENTS FOR ASSUMING ARCHITECTURAL/ENGINEERING REPRESENTATION MUST BE COMPLETED.
THE FOLLOWING FIRMS WILL BE COPIED WITH ALL CORRESPONDENCE PROJECT PLAYER REPORT
ARCH. FIRM Bhide & Hall Architects P.A. PROJECT MGR. Wendell Hall ARCHITECT FOR SIGNING & SEALING Wendell Hall MAILING ADDRESS 1329-C Kingsley Ave. CITY Orange Park STATE FL MECH. ENG. FIRM N/A Engineer MAILING ADDRESS CITY FIRM CERTIFICATION AAC-000569 FLA. REGISTRATION AR -00004951 TELEPHONE NO. 904-264-1919 ZIP CODE 32073 FAX: 904-264-3100 E-MAIL whall@bhide-hall.com FIRM CERTIFICATION PROJECT MGR. FLA. REGISTRATION TELEPHONE NO. ZIP CODE FAX: E-MAIL Not known FIRM CERTIFICATION FLA. REGISTRATION TELEPHONE NO. FAX: FIRM CERTIFICATION FLA. REGISTRATION TELEPHONE NO. ZIP CODE FAX: E-MAIL Not known
STATE
SPRK. ENG. FIRM PROJECT MGR. ENGINEER FOR SIGNING & SEALING MAILING ADDRESS CITY STATE FL ELEC. ENG. FIRM N/A PROJECT MGR. ENGINEER FOR SIGNING & SEALING MAILING ADDRESS Rd CITY STATE
ELEC. ENG. FIRM______________________________________________ FIRM CERTIFICATION CA-____________ PROJECT MGR. ______________________________________________ FLA. REGISTRATION PE-_____________ ENGINEER FOR SIGNING & SEALING____________________________ TELEPHONE NO.____________________ MAILING ADDRESS____________________________________________ FAX NO.____________________________ CITY______________________ STATE_______________ ZIP CODE________________ FAX: _________________ E-MAIL __________________________________________ STRUCT. ENG. FIRM FIRM CERTIFICATION PROJECT MGR. ______________________________________________ FLA. REGISTRATION ENGINEER FOR SIGNING & SEALING TELEPHONE NO. MAILING ADDRESS FAX NO. CITY Jacksonville STATE FL ZIP CODE E-MAIL Not known 2 of 2