Date:	Revised Date:
Campus/Facility:	Client:
(Address)
Building Name(s):	Building Numbers:
Project Title:
Architect/Engineer:
JDE #	Estimated Project Cost:
Code Enforcement Jurisdiction: DASNY	Other:	Variance Requested: Yes No
Occupancy Classification(s): (Group I Condition):	Construction Classification:
NFPA 101 Life Safety Code (for OPWDD & OMH Facilities): (Complete Attachment #3 or #4 as applicable. Use link below)	Life Safety Code Occupancy Chapter (s): Life Safety Code Construction Classification: FSES Utilized: Attach Copy.
Project Type: Check all that apply. Refer to the Existing Building Code for definitions.	New Building Repair Alteration Level 1 Alteration Level 2	Alteration Level 3 Change of Occupancy Addition Historic Building	Demolition Chapter 4. Prescriptive Compliance Method Chapter 14. Performance Compliance Methods.
Work Involved:	General Construction	Structural	Site Work
Check all that apply.	Roofing	Mechanical	Sprinkler
Asbestos Abatement/Environmental	Plumbing	Elevators
Fire Alarm	Electrical	Other
Statement of Special Inspections Required: Yes No
Comments:

LEGEND: NA: Not Applicable, NR: Not Required, NP: Not Permitted FC: Fire Code, PC: Plumbing Code, MC: Mechanical Code, FGC: Fuel Gas Code, ECC: Energy Conservation Code
No	Topic	Building Code Section (unless otherwise noted)	Required/ Allowed	Actual	Comment
1	Fire Apparatus Access Road	FC503.1
2	High Rise Buildings	403
Construction	403.2	Indicate any reduction in Fire Ratings below
Reduction in Fire Rating	403.2.1
Shaft Enclosures	403.2.1.2
Structural Integrity for Exit Stairway and Elevator Hoistway Enclosures	403.2.3	Provide Information for Risk Category III or IV and for all Buildings more than 420 ft. in height.
Sprayed Fire-Resistant Materials	403.2.4	Indicate Bond Strength.
Sprinkler Protection	403.3
Water supply for Fire Pumps	403.3.2	Indicate number of Water Supplies.
Secondary Water Supply	403.3.3
Emergency Systems	403.4
Smoke Detection & Fire Alarm System	403.4.1,2
Standpipe System	403.4.3
Emergency Voice/Alarm Communication System	403.4.4
Fire Department Communication System	403.4.5	Wired Radio Other
Fire Command Center	403.4.6
Smoke Removal	403.4.7
Standby & Emergency Power	403.4.8
Equipment Room Separation	403.4.8.1
Fuel Line Piping Protection	403.4.8.2
Means of Egress: Remoteness of Exit Stairways	403.5.1
Smokeproof Enclosures	403.5.4
Luminous Egress Path Markings	403.5.5
Elevators	403.6	Fire Service Access Occupant Evacuation
3	Atriums	404
Sprinkler Protection	404.3
Fire Alarm System	404.4
Smoke Control	404.5
Enclosures	404.6
Standby Power	404.7
Travel Distance	404.9
4	Hazardous Materials Control Areas	414.2	Provide additional information indicating number, size, materials stored, and quantity of each material.
5	Dwelling and Sleeping unit separation	420.2 & 420.3
Sprinkler System	420.5
Fire Alarm System & Smoke Alarms	420.6
6	Building Area & Height	501	Provide information in Attachment 1. Use link below.
7	Mixed Occupancies:	508	Provide analysis.
Accessory Occupancies	508.2
Nonseparated Uses	508.3
Separated Uses (Ratio < 1)	508.4
8	Incidental Uses:	509
9	Exterior Wall Fire-Resistance Rating	602.1 Table 602
Exterior Fire Separation Distance	602.1 Table 602
10	Fire Resistive Construction	701.1
Exterior Wall: Allowable Area of Openings:	705.8	Provide analysis.
Unprotected	705.8
Protected	705.8
Exterior Wall: Vertical Separation of Openings	705.8.5
Parapets	705.11
Fire Walls	706
Party Walls	706.1.1
Fire Barriers	707
Fire Partitions	708
Smoke Barriers	709
Smoke Partitions	710
Floor & Roof Assemblies	711
Vertical Opening	712
Shaft Enclosures	713
Penetrations	714
Joint Systems	715
Opening Protectives	716
Ducts and Air Transfer Openings	717
Concealed Spaces	718
Prescriptive Fire Resistance	721	Provide Specific item numbers from Tables
Calculated Fire Resistance	722	Provide Specific Components and Calculations from Tables
11	Interior Finishes	801.1
Wall & Ceiling: Exits	803.11 Table 803.11
Wall & Ceiling: Corridors	803.11 Table 803.11
Wall & Ceiling: Rooms/Spaces	803.11 Table 803.11
Floors	804
Combustible Decorative Materials	806.3	Provide Percentage of combustible decorative materials
12	Fire Protection: General	901.1
Sprinkler System	903	Indicate Type of Sprinkler System NFPA 13 NFPA 13R NFPA 13D
Alt. Fire Extinguishing System	904
Standpipe System	905
Portable Fire Extinguishers	906
Fire Alarm System	907	Indicate Type of Fire Alarm System Addressable Conventional (zoned)
Smoke Detection System	907
Emergency Voice	907.5.2.2
Occupant Notification	907.5 & Appendix E Table E104.2.1	Indicate the number accessible and hearing-impaired rooms to be provided with visual appliances
Smoke Control	909
Smokeproof Enclosure/ Stair Pressurization	909.20
Fire Command Center	911
Fire Department Connections	912	Location shall be approved by Local Fire Chief
Fire Pumps	913
Equipment room Identification	914
Carbon Monoxide Detection	915/FC915	Indicate the Type of CO Detection Independent CO System CO Alarms CO Detection connected to FACP
Emergency Responder Radio Coverage	916/FC510
13	Means of Egress	1001.1	Provide information in Attachment 1. Use link below.
Common Path of Egress	1006.2.1, Table 1006.2.1
Single Exits	1006.3.2
Emergency Lighting	1008.3
Accessible Means of Egress	1009.1
Elevator Required	1009.2.1
Elevator accessed from “area of refuge”	1009.4
Area of Refuge	1009.6
Controlled Egress Doors (I-1 & I-2 only)	1010.1.9.6
Delayed Egress Locks	1010.1.9.7
Panic Hardware	1010.1.10
Stairways	1011.1
Ramps	1012.1
Exit Signs	1013.1
Handrails	1014.1
Guards	1015.1
Mechanical Equipment Guards	1015.6
Window Opening Control Devices	1015.8
Exit Access	1016.1
Exit Access Stairways	1019.1
Corridor Fire Rating	1020.1
Corridor Width	1020.2
Dead End Corridor	1020.4
Exit Fire Rating	1023.2
Smokeproof Enclosure	1023.11
Exit Passageways	1024.1
Luminous Egress Path Markings	1025.1
Horizontal Exit	1026.1
Exterior Stairs	1027.1
Exit Discharge	1028.1
Assembly	1029.1
Emergency Escape & Rescue	1030.1
14	Accessibility	1101.1 ICC/A117.1(09)
Accessible Route	1104.1
Accessible Entrance	1105.1
Parking	1106.1
Dwelling & Sleeping Units	1107.1
Toilet Rooms	1109.2
Platform Lifts	1109.8
Signage	1111.1
15	Interior Environment	1201
Ventilation	1203
Unvented Attic & Enclosed Rafter assemblies	1203.3
Light: Natural/Artificial	1205
Sound Transmission	1207
Ceiling Heights	1208.2
Toilet & Bathroom Requirements	1210.1
16	Energy Conservation	1301/ECC	Provide information in Attachment 2. Use link below.
17	Roof Assembly Fire Classification	1505.1
Roof Covering	1507.1
Reroofing	1511
Photovoltaic Panels	1512
18	Structural Requirements	1601.1	Provide information in Attachment 1. Use link below.
Truss Type, Pre-Engineered Wood or Timber Construction	19-NYCRR Part 1264/1265	Provide information in Attachment 1. Use link below.
19	Foundation	1801.1	Provide information in Attachment 1. Use link below.
20	Safety Glazing	2406.1
21	Foam Plastic Insulation	2603
Thermal Barrier	2603.4
22	Electrical	2701.1
Emergency & Standby Power	2702.1
Elevator & Platform Lifts	2702.2.2
Exit Signs	2702.2.5
High Rise Building	2702.2.9
Means of Egress	2702.2.11
Smoke Control Systems	2702.2.15
23	Mechanical Systems	2801.1
Fire & Smoke Dampers	717.5	Refer to 717.5 for specific requirements.
Fan Shutdown	MC606.4
Combustion Air	MC701.1 & FGC304.1
Chimneys, Flues & Gas vents	MC801.1 & FGC501.1	Provide diameter of chimney/gas vents.
23	Plumbing	2901.1
Fixture Count	2902.1	Provide information in Attachment 1. Use link below.
Maximum Consumption	PC604.4
Available Street Water Pressure
Fixture Units	PC709.1
House Traps	PC1002.6
Water Supply Materials	PC 605
24	Elevator & Conveying systems	3001.1
Elevator Car sized to accommodate a Stretcher	3002.4
Elevator Emergency Operation	3003.2
Machine Rooms Fire Rating	3005.4
Elevator Lobbies	3006.1
Fire Service Access Elevators	3007.1
Occupant Evacuation Elevators	3008.1
Escalators	3004.2
25	Special Construction	3101.1
Pedestrian Walkways/Tunnels	3104
Awning and Canopies	3105
Swimming Pool Enclosures	3109.1, NYS Supplement
Swimming Pool Entrapment protection	3109.6, NYS Supplement
Swimming Pool Alarms	3109.7, NYS Supplement

Additional information provided.

Open Attachment 1 and enter information

Commercial Energy Conservation information provided.

Open Attachment 2 and enter information
LSC Health Care Facility, Chapters 18/19 for OPWDD & OMH Facilities Open Attachment 3 and enter information:
LSC Board & Care

Chapters 32/33 for OPWDD facilities

Open Attachment 4 and enter information: