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Annual Inspection Checklist for Temporary FacilityDistrict Name/NumberBuilding NameNumber of UnitsYear OriginallyConstructedArea Square Feet Enrollment Grade Level Number of years inuseCOMPLIANCECHECK FOR THE FOLLOWING CONDITIONSYES NO NAc c c 1. Was the unit constructed according to 77 IL Adm Code Part 880 and the seal of approval from IDPH posted as required?c c c 2. Does the district have on file the compliance certificate from IDPH (pink copy)?c c c 3. Architect/Engineer has verified with the IL Dept of Natural Resources/IDOT that the unit(s) is/are not located in adesignated floodplain area.c c c 4. Is the building securely anchored to the foundation to withstand the wind load as described in ASCE 7-95?c c c 5. Are there 2 exits on opposite sides of building?c c c 6. Is there an interconnecting door between classrooms?c c c 7. Is the building located in accordance with Section 175.120 of 23 IL Administrative Code, Part 175? (30 feet from adjacentbuilding or separated by two-hour fire wall; or BOCA 705.2 20’-0” or fire wall)c c c 8. Are the foundation walls maintained plumb and free from open cracks and breaks and kept in such condition as toprevent entry of weather, animals and insects?c c c 9. Is the enclosure between the floor and ground in good condition? (Tight to prevent entrance of weather, animals andinsects)c c c 10. Are the steel floor support members in good rust-free condition?c c c 11. Is the general exterior appearance of the building in an acceptable, well-maintained condition free of loose strips orbattens?c c c 12. Is the roof and flashing in good condition?c c c 14. Are stair tread and ramps maintained with non-slip finish and platforms in good condition?c c c 15. Are the restrooms clean, adequate and in operable condition and properly ventilated?c c c 16. Are the plumbing fixtures properly installed and maintained in working order, free from leaks and defects?c c c 17. Are the lighting fixtures properly maintained, complete with lenses and louvers?c c c 18. Do the doors lock securely without additional locks, bolts or chains?c c c 19. Are doors equipped with panic hardware (If occupancy is over 100 occupants)c c c 20. When building is occupied, are all the doors free from devices or wedges to prevent normal operation?c c c 21. Are screened or barred windows easily opened from inside without keys or tools?c c c 22. Is the exit lighting system used and all exit lights operable when the building is occupied? (rooms/corridors with morethan 2 doors)c c c 23. Is the building equipped with an approved operable alarm and detector system?c c c 24. Are utility shut-offs properly and clearly marked?c c c 25. Is all fuel-burning and heating equipment (flues, ducts, pumps, etc.) maintained and in serviceable condition?c c c 26. Is automatic fuel-burning and heating equipment serviced annually by a qualified person?c c c 27. Have all heat exchanges of forced warm air furnaces and unit heater been examined to determine that they areairtight to prevent carbon monoxide and other combustion gases from getting into occupied space?c c c 28. Are all combustible waste materials disposed of daily from classroom and building?5-6
c c c 29. Is the insulation material non-combustible and interior finishing flamespread 75 or less?c c c 30. Are non-flammable cleaning materials used?c c c 31. Are storerooms and closets free from waste accumulations and unnecessary materials?c c c 32. Are enough fire extinguishers of approved type for intended use installed in the building? (75 feet max. from any point inthe facility to a fire extinguisher.)c c c 33. Have fire extinguishers been inspected and so tagged within the past year?c c c 34. Is the temperature control of the heating and/or cooling system adequate?c c c 35. Is the supply of fresh air adequate (classroom, assemblies and toilets) as required?List all areas of noncompliance: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ARCHITECTThe State of Illinois licensed architect and/or engineer, employed by this district, has certified to this Board of Education that to the best of his/herknowledge and belief, the above mentioned structure will not present a health/life safety hazard to the students housed therein for the schoolyear 20___ - 20___. Further, such architect and/or engineer has listed the area of noncompliance with the Health/Life Safety Code.(Seal)___________________________________________________License NumberExpiration Date________________________________________________ ___________________________________________________Name and Signature of Architect/Engineer Name of Firm Date of InspectionSCHOOL DISTRICTWe hereby certify that this application accurately describes the work to be performed, and that, upon approval all work will be completed inaccordance with this application and all applicable laws and regulations.___________________________________________________ ___________________________________________________Date Signature of President, Board of Education Date Signature of District SuperintendentREGIONAL SUPERINTENDENTThe Above Application for Building Permit is hereby accepted as submitted.___________________________________________________Date Signature Regional SuperintendentForm 36-28 (3/04) (Prescribed by the Regional Superintendent for local board use) 180.230 c) 4)Page 2 of 25-7
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Health/LifeEffectiveMarch 20042 nd
Page 3 and 4:
FOREWORDThe information in this pub
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TABLE OF CONTENTSForeword----------
Page 7 and 8:
• Application for Extension of Ti
Page 9 and 10:
School Building Construction/Recons
Page 11 and 12:
CHAPTER 1FORMS• Application for B
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Pre-Construction Plans and Specific
Page 15 and 16:
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
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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 and 114: Temporary vs Permanent Facility Pro
Page 115: Application for Approval for Use of
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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