Please Print Please Print
Date:
Name of the Project/Building:
Name of the Owner:
Print
Signature
Name of Designer/Company:
Type of system to be installed:
13
13R
13D
14
Other:
FMO Lic. #
FMO Cert. #
Number of Risers
Wet
Dry
Pre-Action
Deluge
System Size:
New
SqFt
Add On
SqFt
Existing
SqFt
Proposed Hazard Classification (show each area on the floor plan):
Light
Ordinary Group I
Ordinary Group II
Extra Hazard Group I
Extra Hazard Group II
Rack
Density
Area
Ht
Commodity Class
Storage
Density
Area
Ht
Commodity Class
Number of Heads Calculated
Type of Sprinklers:
QR
Standard
ELO
ESFR
Extend. Cov.
Standpipes:
No
Yes
Concealed Combustible Space (identify on the floor plans):
No
Yes
Areas NOT sprinklered? Why?
Is a Fire Pump required:
No
Yes
Size & Driver
Flow Test:
Date
Static
Residual
Flow
(include site layout with location of test hydrant and flow hydrant)
Underground Size:
inch
Length
feet
Number of fittings: Valves
Tees
Elbows
If required Water Supply Tank size:
gallons
Estimated Demand on the SYSTEM side BOR:
gpm @
psi
Estimated (adjusted) flow and pressure on the SUPPLY side BOR:
gpm @
psi
(adjusted from the flow hydrant to the BOR) (include 1.85 graph with submittal)
Designer’s Signature: Date: _____________
City Lic. #
PRELIMINARY SPRINKLER FORM
Email:
PRELIMINARY SPRINKLER FORM PROCEDURES
This form is required to be completed for all buildings, additions, and renovations that are submitted to this Agency for permit, when an automatic
suppression system is to be installed. A licensed sprinkler contractor, or a DE registered PE shall complete the form in a legible manner. The form
shall accompany a floor plan sheet with the hazard classifications for each proposed area, and all concealed spaces shown. On the same sheet a site
sketch showing the loca
tion of the test hydrants used for flow testing (both flow and pressure hydrant) are to be shown with all underground pipe to
the building.
1. The name of the project or building, and the owner shall be the same as on the application. The owner’s name shall be printed along with a
signature of the owner as to the correctness to the submitted information (i.e. storage features, commodity being stored). The submitter of the
formDesigner/ Companyshall
be provided. The designer shall provide FMO license number and FMO Certificate number or their DE PE
number.
2. Place a check mark next to the appropriate system or systems being installed/proposed. Then indicate the number of risers for each type of
system to be installed/proposed. The system size shall be the square footage the system is to cover. For a new system state the total area the
system will cover. For an add-on, state the number
of square feet that the additional system will cover and the square feet that the existing
system covers. For existing systems that will be upgraded state the number of square feet the system will/does cover.
3. Place a mark next to all proposed hazard classifications as they appear on the floor plan sheet provided. Unless otherwise noted, the Agency
will assume the minimum design area for each hazard classification (light – extra hazard 2), but for rack spr
inklers or storage areas the submitter
shall state the density, area, height of rack or storage, and the commodity class for the storage. For storage, a letter from the owner shall be
required to verify the material being stored, the aisle width, rack configuration, height of storage to the ceiling, and if the product is
encapsulated or not. The Designer will note the sprinkler head temperature of the rack and ceiling sprinklers. If the system design mand
ates the
number of sprinklers to be calculated, state the number of heads.
4. Place a mark by the type of sprinklers that will be used.
5. If standpipes are required or will be provided, place a mark on the appropriate line (yes/no).
6. If concealed spaces are shown on the floor plan, place a mark on the appropriate line (yes/no).
7. Areas that are NOT to be covered shall be explained clearly (use additional paper if necessary).
8. St
ate whether
or not a fire pump will be needed. If a fire pump is required state the size and
driver (i.e. 1000 GPM @ 80 psi Electric Motor).
9. Flow test data shall be current, within the last (1) year, and on the water utilities company letterhead. The flow hydrant and the pressure hydrant
shall be shown on a site sketch with reference to the building and source, showing underground pipe layout and sizes. Note on the form the
size, length and all
fittings that will be in the underground from the test hydrant to the system riser.
10. If a tank is to be used, the size will be needed in gallons.
11. State the estimated demand at the base of riser (BOR) of the most demanding system(s). This should be an approximation of how much water
and pressure will be needed to satisfy the system demand including inside hose streams, outside hose streams, and the 10-psi safety factor.
Finally we will need the adjusted esti
mated flow and pressure on the supply side of the BOR. State the water supply adjusted to the base of riser
inside the building. These two numbers will then be compared to determine if enough water and pressure are available to supply the system. If
the water supply is unable to meet or exceed the demand, a tank and/or pump may be required. Attach a Logarithmic graph (N
1.85
) showing the
adjusted water flow curve with the esti
mated sprinkler demand plotted, including hose streams and the 10-psi safety factor, under the curve.
12. The form shall be signed by the license holder of the Sprinkler Company or the DE Registered PE.
NOTE: A complete submittal will have the form completed, and signed. Along with the form the following attachments shall be submitted:
a N=1.85 graph for the flow test;
documentation of the flow test from the water supplier;
a floor plan showing the following:
hazard classifications of all areas,
areas that are not covered,
combustible concealed areas, and
a site layout showing underground piping from flow test point to the bottom of the riser at the building; and
for storage, the aforementioned items signed by the building owner.
Preliminary sprinkler forms that are incomplete, or non-compliant will cause the building plan to be “NOT APPROVED”, thus no
permit will be issued until corrections are approved.
NO OTHER SUBSTITUTE TO THIS FORM IS ALLOWED