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Application for Building PermitDISTRICT NAMEFACILITY NAMEDate Received by Regional Office of Education_____________Regional Office of Education Assigned Application Number _____________COUNTYFACILITY LOCATIONc Property is owned by the districtc Property not owned by district (Attach Authorization by owner)COST AND FINANCING£ Less Than $20,000£ More than $20,000£ Less than 15% of replacement costPROJECT SCOPE£ More than 15% of replacement cost but less than 50% of replacement cost£ More than 50% of replacement cost£ Fire Prevention and Safety Financing involvedAREA AFFECTED:£ New area more than 7200 square feet£ Less than 50% of existing area£ More than 50% of existing area (sprinkle entire area per 105 ILCS 5/22-23)PROJECT NUMBER:TOTAL ESTIMATED COST:ESTIMATED COMPLETION DATE:SOURCE OF ALL FUNDS:TOTAL SQUARE FOOTAGE:FOR HEALTH/LIFE SAFETYFUNDING (5¢ LEVY OR BONDS)INDICATE:Amendment number:Item(s):CATEGORIES OF WORK INVOLVED£ New building construction £ Energy conservation £ Site work£ School building addition £ Mechanical (HVAC) work £ Sprinkler system installation£ Asbestos abatement £ Paving £ Structural work£ Accessibility (ADA) £ Plumbing work £ Telephone systems (E-911)________________________$_____________________________________________________________________________________________#_______________________#_______________________£ Electrical work £ Security system £ Other:______________________________DrawingsSpecificationsSprinkler PlansPROJECT DOCUMENTS (Attach two copies of all construction documents)CONSTRUCTION DOCUMENTS ATTACHEDDATE SUBMITTEDARCHITECTWe hereby certify that this application accurately describes the work to be performed and that, upon approval, all work will be completed to the best ofour knowledge in compliance with the Health/Life Safety Code and the Sprinkler Code 5/22, 23 in accordance with this application and all applicablelaws and regulations.(Seal)___________________________________________________License NumberExpiration Date___________________________________________________________________________________________________Name and Signature of Architect/Engineer Name of Firm Phone NumberSCHOOL DISTRICTThe Board of Education does hereby approve and adopt said plans and specifications for submission to the Regional Superintendent for review andissuance of a building permit.______________________________________________________________________________________________________Date Signature of President, Board of Education Date Signature of District SuperintendentThe above Application for Building Permit is hereby accepted as submitted. AnApplication of Occupancy Permit and the final inspection are required for theCertificate of Occupancy, and must be scheduled prior to occupancy ofbuilding.Form 36-10 (3/04) (Prescribed by Regional Superintendent for local board use)___________________________________________________Date Signature of Regional Superintendent180.200a)1- -5
Pre-Construction Plans and Specifications CertificationI/We hereby certify that these Plans and Specifications, dated __________, as they relate to thescope of services agreed upon between ___________________________(architect firm) and___________________________ (school district) for the ______________________________(project), were prepared under my supervision and to the best of my knowledge comply with 23Ill. Adm. Code, Part 180, Health/Life Safety Code for Public Schools.____________________________________________________________________________A. The administrative provisions of the Part shall apply instead of the administrative provisionscontained in Sections 101, 103-114, 116 and 118-121 of Chapter 1 of the BOCA NationalBuilding Code.Signature: ___________________________Firm Name: __________________________License Expiration: ____________________(seal)____________________________________________________________________________B. The Illinois Accessibility Code (71 Ill. Adm. Code 400) shall apply instead of the accessibilityprovisions set forth in Chapter 11 of the BOCA National Building Code.Signature: ___________________________Firm Name: __________________________License Expiration: ____________________(seal)____________________________________________________________________________C. The requirements set forth in the Illinois Plumbing Code (77 Ill. Adm. Code 890) shall applyinstead of those expressed in the BOCA National Plumbing Code incorporated in Chapter 35 ofthe BOCA National Plumbing Code.Signature: ___________________________Firm Name: __________________________License Expiration: ____________________(seal)____________________________________________________________________________D. The requirements set forth in the Illinois State Fire Marshal’s rules titled Boiler and PressureVessel Safety (41 Ill. Adm. Code 120) shall apply instead of those expressed in the Boiler andPressure Vessel Safety Code (ASME 89) published by the American Society of MechanicalEngineers and incorporated in Chapter 35 of the BOCA National Building Code.Signature: ___________________________Firm Name: __________________________License Expiration: ____________________(seal)Form 36-11 (3/04) (Prescribed by Regional Superintendent for local board use) 3-14.201- -6
Page 1 and 2: Health/LifeEffectiveMarch 20042 nd
Page 3 and 4: FOREWORDThe information in this pub
Page 5 and 6: TABLE OF CONTENTSForeword----------
Page 7 and 8: • Application for Extension of Ti
Page 9 and 10: School Building Construction/Recons
Page 11: CHAPTER 1FORMS• Application for B
Page 15 and 16: Regional Superintendent’s Verific
Page 17 and 18: SCHOOL BUILDING PERMITREGIONAL OFFI
Page 19 and 20: ______________________________ COUN
Page 21 and 22: PARTIAL FACILITY OCCUPANCY RESTRICT
Page 23 and 24: Annual Building InspectionOverviewT
Page 25 and 26: CHAPTER 2FORMS• Notice of Annual
Page 27 and 28: HEALTH/LIFE SAFETY ANNUAL INSPECTIO
Page 29 and 30: Y N NA Boiler Room(s) 175 185 180 R
Page 31 and 32: Y N NA Music Practice Room 175 185
Page 33 and 34: HEALTH/LIFE SAFETY CHECKLIST/GLOSSA
Page 35 and 36: 23. Hold-Open Devices (185.370b11A;
Page 37 and 38: 52. Door Closers (185.390e2E; 185.3
Page 39 and 40: 72. Door Closers (185.380c10E; 185.
Page 41 and 42: GREENHOUSE121. Fire Detectors (185.
Page 43 and 44: 153. Hold-Open Devices (185.370b11A
Page 45 and 46: 185. Illuminated Exit Signs (185.37
Page 47 and 48: 228. Flammable Storage (185.370b4H;
Page 49 and 50: 263. Hold-Open Devices (185.370b11A
Page 51 and 52: 312. Door Closers (185.380c10E; 185
Page 53 and 54: GLOSSARYNUMBERLOCATION(i.e. Fire Ar
Page 55 and 56: Posted Occupancy NoticeNOTICEFOR YO
Page 57 and 58: REGIONAL SUPERINTENDENT’S ANNUAL
Page 59 and 60: OVERVIEW OF TEN-YEAR SURVEY PROCESS
Page 61 and 62: 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
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X. LEAD-BASED PAINT Peeling paint w
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NOTICE OF INCOMPLETE SAFETY SURVEY
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CHAPTER 4HEALTH/LIFE SAFETY AMENDME
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State Superintendent on the Approva
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Step #4The state superintendent che
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Procedures for Health/Life SafetyEm
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HEALTH/LIFE SAFETYCERTIFICATE OF AU
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Fire Prevention and Safety Funds--E
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CHAPTER 4FORMS AND DOCUMENTS• Eme
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CERTIFICATION OF NEED FOR FIRE PREV
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Instructions for CompletingSchedule
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Instructions for CompletingRecommen
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REGIONAL SUPERINTENDENT’S CERTIFI
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ORDER TO EFFECT COMPLIANCE WITH THE
Page 103 and 104:
This application is to befilled out
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STATEMENT OF COMPLETION FORHEALTH/L
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REGIONAL OFFICE OF EDUCATIONAPPLICA
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Sample wording for notices of publi
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CHAPTER 5TEMPORARY FACILITIES• Te
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Temporary vs Permanent Facility Pro
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Application for Approval for Use of
Page 117 and 118:
c c c 29. Is the insulation materia
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CHAPTER 6CONDEMNATION/DEMOLITION PR
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ORDER OF CONDEMNATIONDISTRICT NAME
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DISTRICT NAMEFACILITY NAMEAPPLICATI
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cccccc9. Removal of debris:Verify t
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Code InformationWhen are Part 180,
Page 129 and 130:
Reference List of Codes for Public
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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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