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CHAPTER 5FORMS• Application for Approval for Use of New Temporary Facility- Form 36-26 (3/04)---------------------------------------------------------------------------(Page 5-5)• Annual Inspection Checklist for Temporary Facility - Form 36-28 (3/04)--------(Page 5-6)• Temporary Facility Certificate of Occupancy (Sample) - Form 36-30 (3/04)----(Page 5-8)5-4
Application for Approval for Use of New Temporary FacilityThe Board of Education forinDistrict Name and NumberCounty, IL, upon resolution adopted at a duly convened meeting, herebyrequests an approval for usage of temporary facility to be used in connection with the__________________________________________ located atName of School Buildinguntil June 30, _____________ .Address of School BuildingThis temporary facility will be used for:c Classroomsc Storagec Libraryc Gymnasiumc Auditoriumc Other .This temporary facility will be:c Relocatablesc Temporary rooms in: _________________________________________________ .Name of Location (rental of churches, etc)Number of units, rooms or buildings to be used: _____________________________ .Number of pupils to be housed in temporary housing: _________________________ .The Board of Education has diligently attempted to eliminate the need for this temporary facility by:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is the plan for elimination of the code deficiencies to bring this facility into compliance with 23 Ill. Adm.Code, Part 180 or to eliminate the need to use this facility?_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________This plan will be accomplished by _____________.Date________________________________________ ________________________________________Date Signature of Board President Date Signature of Board SecretaryI have reviewed the request of School District No. _____________, and approve the request fortemporary housing as submitted by the Board of Education and certified by their architect/engineer.________________________________________DateSignature of Regional SuperintendentForm 36-26 (3/04) (Prescribed by the Regional Superintendent for local board use) 180.230 c)5-5
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Health/LifeEffectiveMarch 20042 nd
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FOREWORDThe information in this pub
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TABLE OF CONTENTSForeword----------
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• Application for Extension of Ti
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School Building Construction/Recons
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CHAPTER 1FORMS• Application for B
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Pre-Construction Plans and Specific
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Regional Superintendent’s Verific
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SCHOOL BUILDING PERMITREGIONAL OFFI
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______________________________ COUN
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PARTIAL FACILITY OCCUPANCY RESTRICT
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Annual Building InspectionOverviewT
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CHAPTER 2FORMS• Notice of Annual
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HEALTH/LIFE SAFETY ANNUAL INSPECTIO
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Y N NA Boiler Room(s) 175 185 180 R
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Y N NA Music Practice Room 175 185
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HEALTH/LIFE SAFETY CHECKLIST/GLOSSA
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23. Hold-Open Devices (185.370b11A;
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52. Door Closers (185.390e2E; 185.3
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72. Door Closers (185.380c10E; 185.
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GREENHOUSE121. Fire Detectors (185.
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153. Hold-Open Devices (185.370b11A
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185. Illuminated Exit Signs (185.37
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228. Flammable Storage (185.370b4H;
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263. Hold-Open Devices (185.370b11A
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312. Door Closers (185.380c10E; 185
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GLOSSARYNUMBERLOCATION(i.e. Fire Ar
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Posted Occupancy NoticeNOTICEFOR YO
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REGIONAL SUPERINTENDENT’S ANNUAL
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OVERVIEW OF TEN-YEAR SURVEY PROCESS
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CHAPTER 3FORMS AND DOCUMENTS• App
Page 63 and 64: CERTIFICATE OF BUILDING COMPLIANCE(
Page 65 and 66: Form 35-84 (3/04)INSTRUCTIONS FOR C
Page 67 and 68: 5) Utility supply services (water,
Page 69 and 70: SAMPLE 10-YEAR SURVEY REPORT(To be
Page 71 and 72: paneling on stud walls with either
Page 73 and 74: water converter to heat these secti
Page 75 and 76: X. LEAD-BASED PAINT Peeling paint w
Page 77 and 78: NOTICE OF INCOMPLETE SAFETY SURVEY
Page 79 and 80: CHAPTER 4HEALTH/LIFE SAFETY AMENDME
Page 81 and 82: State Superintendent on the Approva
Page 83 and 84: Step #4The state superintendent che
Page 85 and 86: Procedures for Health/Life SafetyEm
Page 87 and 88: HEALTH/LIFE SAFETYCERTIFICATE OF AU
Page 89 and 90: Fire Prevention and Safety Funds--E
Page 91 and 92: CHAPTER 4FORMS AND DOCUMENTS• Eme
Page 93 and 94: CERTIFICATION OF NEED FOR FIRE PREV
Page 95 and 96: Instructions for CompletingSchedule
Page 97 and 98: Instructions for CompletingRecommen
Page 99 and 100: REGIONAL SUPERINTENDENT’S CERTIFI
Page 101 and 102: ORDER TO EFFECT COMPLIANCE WITH THE
Page 103 and 104: This application is to befilled out
Page 105 and 106: STATEMENT OF COMPLETION FORHEALTH/L
Page 107 and 108: REGIONAL OFFICE OF EDUCATIONAPPLICA
Page 109 and 110: Sample wording for notices of publi
Page 111 and 112: CHAPTER 5TEMPORARY FACILITIES• Te
Page 113: Temporary vs Permanent Facility Pro
Page 117 and 118: c c c 29. Is the insulation materia
Page 119 and 120: CHAPTER 6CONDEMNATION/DEMOLITION PR
Page 121 and 122: ORDER OF CONDEMNATIONDISTRICT NAME
Page 123 and 124: DISTRICT NAMEFACILITY NAMEAPPLICATI
Page 125 and 126: cccccc9. Removal of debris:Verify t
Page 127 and 128: Code InformationWhen are Part 180,
Page 129 and 130: Reference List of Codes for Public
Page 131 and 132: Asbestos Abatement for Public and P
Page 133 and 134: The Illinois Water Well and Pump In
Page 135 and 136: ARTICLE 14. CHILDREN WITH DISABILIT
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