FSSD-0-WVFSR02

APPLICATION FOR MODIFICATION/WAIVER OF FIRE SAFETY

REQUIREMENTS
[Section 27 of the Fire Safety Act (CHAPTER 109A)]
Date*: 14/08/2015
To*: Fire Safety and Shelter Department
The Commissioner
Singapore Civil Defence Force
Fire Safety & Shelter Department
91 Ubi Avenue 4
Singapore 408827

Instructions
1. When submission of plan is done by a Qualified Person, it is advisable to have
this application form completed, digitally signed and submitted by the Qualified
Person as the applicant.

2. For particulars of the waiver items, the applicant should state with regard to
the modification/waiver sought, why he considers the endorsement of the
provisions of the requirements unreasonable relative to the circumstances
of the case.

3. The applicant may, if aggrieved by the decision of the Commissioner appeal

in the prescribed form and manner together with payment of the prescribed
fees to the Minister within 28 days of the date of notification of the decision.

4. $100/- shall be payable per specific requirement per proposal.

5. Repeated waiver applications under the same proposal submitted at

different period shall be charged separately.

6. It may take you 4 minutes to complete this form.

Particulars Of Project
Project Reference Number* A1631-00096-2015

Project Title* PROPOSED ADDITIONS AND ALTERATIONS TO

EXISTING UNITS AT LEVEL 2, 3, 4, 5, 6, 7, 12, 13,
14, 17 AND 18 INNOVIS BUILDING ON LOT 04506N
MK03, AT NO 2 FUSIONOPOLIS WAY SINGAPORE
138634

Mukim 03 Lot04506N, 2, FUSIONOPOLIS WAY,

#2-01 TO 05, Singapore 138634, 2, FUSIONOPOLIS
WAY, #3-01 TO 05, Singapore 138634, 2,
FUSIONOPOLIS WAY, #4-01 TO 08, Singapore
138634, 2, FUSIONOPOLIS WAY, #5-01 TO 08,
Singapore 138634, 2, FUSIONOPOLIS WAY, #6-01
Location Description
TO 08, Singapore 138634, 2, FUSIONOPOLIS WAY,
[Include Lot/Plot, MK/TS,
#7-04 TO 08, Singapore 138634, 2, FUSIONOPOLIS
House No, Building
WAY, #12-01 TO 06, Singapore 138634, 2,
Address and Road
FUSIONOPOLIS WAY, #13-01 TO 06, Singapore
information]*
138634, 2, FUSIONOPOLIS WAY, #14-01 TO 06,
Singapore 138634, 2, FUSIONOPOLIS WAY, #17-01
TO 07, Singapore 138634, 2, FUSIONOPOLIS WAY,
#18-01 TO 07, Singapore 138634

Particulars Of Application
Full Proposal Title*
Note: This ‘ Full Proposal Title’ will
be reflected as ‘Proposal’ title in
the Waiver Decision Letter issued
by SCDF subsequently.
PROPOSED ADDITIONS AND ALTERATIONS TO
EXISTING UNITS AT LEVEL 2, 3, 4, 5, 6, 7, 12, 13,
14, 17, AND 18 INNOVIS BUILDING ON LOT
04506N MK03, AT NO 2 FUSIONOPOLIS WAY
SINGAPORE 138634.

Building Category* INDUSTRIAL

FSSD BP or
ME Plan Ref No (if Any)
State whether
Pre-submission
Consultation Ref No: Yes No
PREVIOUS-WAIVER CASE
REF NO (IF ANY) Yes No

QRA Ref No(s) (If any)

Capacity Of The Applicant For The Waiver

Capacity of the applicant Applicant For The Proposal
 Particulars Of Waiver Items
S/N Description of waiver Provisions made on Reasons in support of
application and relevant plan* the applications*
clause number*

1 Clause 2.2.12 (b) 1. Building is 1. The whole floor

protected with belong to one
Every occupant or automatic sprinkler tenancy.
tenant within a system.
building or storey 2. STAFF
of a building shall 2. Adequate exit LOUNGE/LOBBY
have direct access signs will be area are mainly
to the required exit provided. used by APPLE
or exits without the staffs to received
need to pass 3. also provided to visitors.
through the open the marked
spaces or rooms door at time. 3. The separations
occupied by other are required for
occupant or security reasons
tenants. as APPLE is
dealing with high
level confidential
To allow user at materials that
Staff lounge "A" require this
(Blue) to go arrangement.
through the
proposed "door A" 4.in time of
to access emergency, the
staircase 1 and "door A" will be
access staircase release
2. to open and free
from obstruction

5. The "door A"

complies to the
clause 2.3.9(k) as
follows:

a) connected to
the fire alarm
system

b) fail safe system

c) provided with
break glass

5. Visitors who
arrives to the
STAFF
LOUNGE/LOBBY
are through
appointments only
and accompanied
by APPLE staff at
all time.

7. In time of
emergency , the
visitors will guided
by APPLE staffs to
the EXIT protected
staircases.

8. In addition
Client has agreed
to installed
INTERCOM
system within the
STAFF
LOUNGE/LOBBY
AREA similar
clause 2.3.9(k)(3).
This is in the
cases when the
secured doors
does not open.

Add Delete

Waiver Fee Computation

Number of requirements 1

Waiver Fee ($160.00 / req) $ 160.00

Payment Mode
Total Plan Fee Payable $ 160.00
Indicate payment mode:-

JAV (For Government Projects Only)

GIRO QP GIRO Code Bank Branch

For Giro, please ensure that there are sufficient funds in your bank account. We will
deduct the application fees from your bank account through GIRO within 7 working days.
When payment is successful, a receipt will be given. Please do not make another
payment through the SCDF e-services.

Please note that payment is to be made at the customer service centre at HQSCDF
Cash Card/Credit
Card/NETS/EZ-Link

Internet Banking Credit card payment can be made either:

(Credit Card/Debit 1) at the customer service centre at HQSCDF
2) by logging on to http://www.scdf.gov.sg (go to 'eServices' and click 'payment')
Card)

NOTE: Kindly make payment within 4 weeks from the date of the acknowledgement letter otherwise your
application shall be rejected by the system.
Applications will be processed only after full payment has been made.

Section I Particulars Of Applicant

Name* APPLE SOUTH ASIA PTE LTD

NRIC No / Passport No NA

Designation

Firm Name APPLE SOUTH ASIA PTE LTD

UEN

Address 7 ANG MO KIO STREET 64

SINGAPORE 569086

Telephone No.

Extension No.

Fax No.

Email Address SPACEDESIGN@SINGNET.COM.SG

Section II Particulars Of Qualified Person
Name* SELVANAYAGAM N

Role In Project Architect

Registration No 1631

NRIC No / Passport No S2168882G

Firm Name SPACE DESIGN ARCHITECTS

UEN

Address 338B KING GEORGES AVENUE

KING GEORGE'S BUILDING
SINGAPORE 208573

Telephone No. 64388772

Extension No

Fax No. 64388773

Email Address SPACEDESIGN@SINGNET.COM.SG

Declaration By Qualified Person

I hereby apply for modification / waiver of fire safety requirements under
Section 27 of the Fire Safety Act (Chapter 109A) for the proposal
described in this form

I being a Qualified Person, hereby declare that I have obtained consent

from the owner of this project to submit plan to Fire Safety & Shelter
Department for approval