REQUEST FOR DISPENSATION

Highlighted text in this document indicates an area for completion or samples for guidance only. Any highlighted text is to be completed and / or removed in the submission.

File Number(if applicable)

ASEE(BP26–2–B001)

DEEP(BP26–2–B049)

REQUEST FOR:DISPENSATION

Building / [Add building name]
Defence property / [Property name]
E&IG Region / [Estate Services region]
Address
DEIS ID / [Building/facility no] XXXX/XXXX

1.0Introduction

[INSERT BUILDING CERTIFIER NAME] has been engaged as the project building certifier for the above project. This document has been provided on behalf of the [INSERT PROJECT CONTRACTOR NAME]. This document and its attachments are submitted under the provisions of chapter 3 of the MFPE.

2.0Dispensations

A request is made to the Director of Estate Engineering Policy (DEEP) to support and for the Assistant Secretary Environment and Engineering (ASEE) to approve the Dispensation(s) to the Defence Manual of Fire Protection Engineering (MFPE) Edition 2 policy requirements nominated in section5.0.

3.0Building description

Characteristic / Description
BCA classification(s) / Part of building / Use / Classification (A3.2)
Ground floor / Office / Class 5
First floor / Training / Class 9b
Second floor / Office / training / Class 5 / 9b
Number of floors / Above ground
Below ground
Rise in storeys
Effective height / Choose an item
Type of construction / Type A / B / C / N/A
Large-isolated building / Yes / No

4.0Contribution Factor classification & criticality assessment

The following table indicates the contribution factor and the criticality assessment findings as determined through completion of the form in MFPE annex 2A. The signed form is attached at Appendix X.

Contribution Factor (CF) / Description
CF (entire building) / CF 1, 2, 3, 4 or 5
Building or part identified as having an intolerable loss in a fire event in the form at annex 2A / Building or part
Ground floor server room xx
First floor UPS room xx

Note: If no areas have an intolerable loss in a fire event enter ‘not applicable’.

5.0Summary of issues

The following table identifies the Dispensations to the MFPE being sought.

No. / Issue / Supporting Annex reference / MFPE reference
Deletion of sprinklers in part of a building which have been classified as having an intolerable loss in a fire event and the fire compartment exceeds 72m2. / A / 10.10
Deletion of smoke exhaust in a storage building which have been classified as having an intolerable loss in a fire event. / A / 11.14

6.0Supporting Documentation

The following documentation is provided to address the Dispensations as listed in the previous table.

Annex / Document
A / Fire engineering dispensation report number XXXX, revision number XXXX by (company name) dated XXXX

Note: Reference number and revision number of all reports must be included.

7.0Previous Performancesolutions and / or dispensations

Details of any previously supported performance solutions/dispensationssubmitted and/or approved for the building.

Issue / Reference / Submitted or approved
  1. 1. XXX
/ XXXX / Submitted/approved
2.
3.

8.0Buildingcertifiers concurrence and details

I agree with the dispensationproposed. Defence acceptance of the dispensation will allow me, as the building certifier, to issue the building approval.
Name:
Signature: / Date:
State or Territory accreditation or licence details:
Company:
Postal Address:
Town/City:
State/Territory: / Postcode:
Telephone Number:
Email:

FOR INTERNAL DEFENCE USE

PROJECT: [Add project name]

BASE/ESTABLISHMENT: [Base/establishment

9.0Project Delivery Authority (Department of Defence)

Acknowledged

Name:

Signature:

Date:

Telephone Number:

10.0Director of Estate Engineering Policy (DEEP)

Comments:

Dispensation:Supported Not Supported

Name:

Signature: DEEP

Date:

11.0Assistant Secretary – Environment & Engineering

Comments:

Dispensation:ApprovedNot Approved

Name:

Signature:ASEE

Date: