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DISTRICT NAME AND NUMBERCOUNTYFACIL ITY NAMEFACILITY LOCATIONAPPLICATION FOR OCCUPANCY PERMIT¨ Permanent¨ Temporary¨ Partial¨ Property is owned by the district.¨ Property not owned by district (Attach Authorizationby Owner)Project # __________________________________¨ New Construction¨ Addition¨ Renovation/RemodelingARCHITECT/ENGINEER’S STATEMENT OF BUILDING COMPLIANCE/PROJECT COMPLETIONI, _____________________________________, hereby certify that, based upon my survey of the abovenamed facility on __________________________, and to the best of my knowledge and belief, the abovementioned project number ______________________ has been completed in full compliance with “The HealthLife/Safety Code for Public Schools,” 23 Illinois Administrative Code 180.This Statement of £ Building Compliance or £ Project Completion is valid as of the day of the survey indicatedabove. Changes to the facility or conditions affecting it after that date may render this statement invalid.Signed this __________ day of _______________________, ______(Seal)Typed Name of Architect/EngineerSignature of Architect/EngineerName of Firm License Number Expiration DateApplication is hereby made for issuance of an Occupancy Permit to occupy the above named facility for theprimary purpose of:_________________________________________________________________________________.The facility was surveyed by ___________________________________on ______________ and wasRegional Superintendent DesigneeDatefound to comply with the requirements specified in the Health/Life Safety Code for Public Schools for such afacility.Date President of the Board of Education Date District SuperintendentForm 36-15 (3/04) (Prescribed by Regional Superintendent for local board use) 180.225 and 180.230 a)1-11
______________________________ COUNTYREGIONAL OFFICE OF EDUCATION____________________________________________, ILLINOIS ___________( )TelephoneSCHOOL BUILDING CERTIFICATE OF OCCUPANCY_______________________________________________________________________________Name and Number of School District_______________________________________________________________________________Name of School Building_______________________________________________________________________________Address of School BuildingThe above named facility has been inspected by this office pursuant to the provisions of Sections 3-14.21 and 2-3.12of the School Code and has been determined to comply with the requirements of the Health/Life Safety Code for PublicSchools (23 IL Adm Code 180). Occupancy of the said facility is hereby approved.Issued this ________ day of _________________________Approved___________________________________Regional SuperintendentForm 36-16 (3/04) (Prescribed by Regional Superintendents for Regional Superintendents use) 180.230 a)1-12
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 and 12: CHAPTER 1FORMS• Application for B
Page 13 and 14: Pre-Construction Plans and Specific
Page 15 and 16: Regional Superintendent’s Verific
Page 17: SCHOOL BUILDING PERMITREGIONAL OFFI
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
Page 77 and 78:
NOTICE OF INCOMPLETE SAFETY SURVEY
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CHAPTER 4HEALTH/LIFE SAFETY AMENDME
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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 and 116:
Application for Approval for Use of
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
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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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