Attachment A "Request for Final Inspection/Re-inspection and Certificate of Occupancy Form"

What Is Attachment A?

This is a legal form that was released by the U.S. Department of the Interior - Bureau of Indian Affairs on May 1, 2020 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2020;
  • The latest available edition released by the U.S. Department of the Interior - Bureau of Indian Affairs;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Attachment A by clicking the link below or browse more documents and templates provided by the U.S. Department of the Interior - Bureau of Indian Affairs.

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U.S. Department of the Interior
(Attachment A)
Deputy Assistant Secretary – Indian Affairs (Management)
Office of Facilities, Property and Safety Management
Division of Safety and Risk Management
Request for Final Inspection/Re-Inspection and Certificate of Occupancy Form
Submit this Form and ALL Required Documentation to Division of Safety and Risk Management (DSRM)
Site Name: ____________________________________________________________ IA-FMS Site ID: __________________________
Project Description: _____________________________________________________ Project No: ______________________________
IA POC, IA, BIA or BIE Project Manager: ____________________________________ Telephone No.: ___________________________
eMail Address: ______________________________________________ Proposed Date for Inspection: __________________________
Required documentation as listed in the Final Inspection and Certificate of Occupancy Guidelines, Appendix 1. If work
has not been completed by the requested inspection date, the inspection will not be scheduled.
The following required documentation, as applicable, is hereby submitted to the Division of Safety and Risk Management,
as the Authority Having Jurisdiction.
Automatic Sprinkler Protection System
Stationary Fire Pump
(NFPA 13 - Standard for the Installation of Sprinkler Systems)
(NFPA 20 - Installation of Stationary Pumps)
Clean Agent Fire Extinguishing System
Hydrants
(NFPA 2001 - Clean Agent Fire Extinguishing Systems)
(NFPA 291 - Fire Flow Testing and Marking of Hydrants)
Wet Chemical System Acceptance Report
Asbestos
(NFPA 17A - Standard for Wet Chemical Extinguishing Systems)
(40 CFR - Protection of the Environment, Part 763)
Fire Detection Alarm System
Emergency and Standby Power Systems
(NFPA 72 - National Fire Alarm and Signaling Code)
(NFPA 110 - Emergency and Standby Power Systems)
Emergency Systems
Folding and Telescopic Seating
(NFPA - 70 National Electrical Code)
(NFPA 102 - Grandstands, Folding and Telescopic Seating,
Tents, and Membrane Structures)
Hydraulic/Electric Elevator System
(ASME A17.1/CSA B44 Handbook)
In addition to the above, Operation and Maintenance Manuals for all equipment are on site and there is an approved copy of design plans
and specifications available at the job site. I hereby certify that all construction work for this project is complete and that the
above required documentation, as applicable, is submitted with this request form to the Division of Safety and Risk
Management.
_______________________________________________________
________________________________
Signature of IA POC, BIA or BIE Project Manager
Date
This section for Division of Safety and Risk Management Use Only
___________________________________
_____________________________________________
Scheduled Date
Assigned Inspector
___________________________________
Final Inspection
Scheduled Time
st
Re-Inspection: 1
___ 2nd ___ 3rd ___
Issued: 5/2020 Replaces: 7/2015
Previous Version Obsolete
U.S. Department of the Interior
(Attachment A)
Deputy Assistant Secretary – Indian Affairs (Management)
Office of Facilities, Property and Safety Management
Division of Safety and Risk Management
Request for Final Inspection/Re-Inspection and Certificate of Occupancy Form
Submit this Form and ALL Required Documentation to Division of Safety and Risk Management (DSRM)
Site Name: ____________________________________________________________ IA-FMS Site ID: __________________________
Project Description: _____________________________________________________ Project No: ______________________________
IA POC, IA, BIA or BIE Project Manager: ____________________________________ Telephone No.: ___________________________
eMail Address: ______________________________________________ Proposed Date for Inspection: __________________________
Required documentation as listed in the Final Inspection and Certificate of Occupancy Guidelines, Appendix 1. If work
has not been completed by the requested inspection date, the inspection will not be scheduled.
The following required documentation, as applicable, is hereby submitted to the Division of Safety and Risk Management,
as the Authority Having Jurisdiction.
Automatic Sprinkler Protection System
Stationary Fire Pump
(NFPA 13 - Standard for the Installation of Sprinkler Systems)
(NFPA 20 - Installation of Stationary Pumps)
Clean Agent Fire Extinguishing System
Hydrants
(NFPA 2001 - Clean Agent Fire Extinguishing Systems)
(NFPA 291 - Fire Flow Testing and Marking of Hydrants)
Wet Chemical System Acceptance Report
Asbestos
(NFPA 17A - Standard for Wet Chemical Extinguishing Systems)
(40 CFR - Protection of the Environment, Part 763)
Fire Detection Alarm System
Emergency and Standby Power Systems
(NFPA 72 - National Fire Alarm and Signaling Code)
(NFPA 110 - Emergency and Standby Power Systems)
Emergency Systems
Folding and Telescopic Seating
(NFPA - 70 National Electrical Code)
(NFPA 102 - Grandstands, Folding and Telescopic Seating,
Tents, and Membrane Structures)
Hydraulic/Electric Elevator System
(ASME A17.1/CSA B44 Handbook)
In addition to the above, Operation and Maintenance Manuals for all equipment are on site and there is an approved copy of design plans
and specifications available at the job site. I hereby certify that all construction work for this project is complete and that the
above required documentation, as applicable, is submitted with this request form to the Division of Safety and Risk
Management.
_______________________________________________________
________________________________
Signature of IA POC, BIA or BIE Project Manager
Date
This section for Division of Safety and Risk Management Use Only
___________________________________
_____________________________________________
Scheduled Date
Assigned Inspector
___________________________________
Final Inspection
Scheduled Time
st
Re-Inspection: 1
___ 2nd ___ 3rd ___
Issued: 5/2020 Replaces: 7/2015
Previous Version Obsolete