MECKLENBURG COUNTY
Land Use and Environmental Services Agency
Code Enforcement
ENGINEERING JUDGMENT SUBMITTAL FORM
(SEE REQUIREMENTS ON PAGE THREE)
9/19/07
Date:
PROJECT INFORMATION
Project Name:
Building Permit #:
Street Address:
City/State:
General Contractor:
Design Professional In Responsible Charge (DPIRC):
ENGINEERING JUDGMENT ENGINEER OF RECORD
Name:
Street Address:
City/State:
Phone #:
SPECIAL INSPECTIONS
(Special Inspections By NC Registered Design Professional Are Required For All Engineering Judgments And Shall Be Contracted By The Owner.)
Special Inspector
Street Address:
City/State:
Phone #:
ENGINEERING JUDGMENT DESIGN INFORMATION
Date of EJ Drawing:
EJ Drawing #
Fire Resistance Rating:
Maximum Joint Width
Movement Class (If Applicable)
Joint System Type (Check As Applicable)
Floor to Floor
Floor to Wall
Head of Wall
Wall to Wall
Page 1 of 3
Edge of Slab
Through Penetration System Type (Check As Applicable)
Metallic
Non Metallic
Cable
HVAC
Cable Tray
Structural
Blank
Insulated Pipe/Tubing
Busway
Other Application/System Type (Describe)
Tested System(s) Engineering Judgment Is Based Upon: (Tested designs shall be identified in the space provided and copies of tested systems
shall be attached to this document for review)
This Engineering Judgment represents a firestop system design that would in my professional opinion be expected to pass the
stated fire resistance ratings, meet ASTM E1399, ASTM E2307-04, and the applicable North Carolina State Building Code
referenced test standards. Additionally, the Engineering Judgment meets the intent of the referenced project design.
Registration #:
Name:
Phone #:
Engineer’s Seal
Date
E J Engineer of Record Signature:
COMPLETED FORM TO BE SUBMITTED BY THE DPIRC
Based on our review of the referenced documents, we believe the Engineering Judgment design as submitted meets the
intent of the project design on the above referenced project.
Registration #:
Name:
Phone #:
Date
DPIRC Signature:
MECKLENBURG COUNTY OFFICIAL USE ONLY
Name:
Title:
Date
Code Official Approval Signature:
Page 2 of 3
PEOPLE 
 PROGRESS  PARTNERSHIPS
700 North Tryon Street  Charlotte, North Carolina  (704) 336-2831  Fax (704) 336-3839
www.meckpermit.com
SUBMITTIAL REQUIREMENTS FOR ENGINEERING
JUDGMENTS OF RATED FIRESTOP ASSEMBLIES.
9/19/07
Engineering Judgments (EJ) shall be submitted and approved by Mecklenburg County Code
Enforcement prior to the installation and must meet the following conditions:
1.
A tested system does not currently exist. (If a tested system exists by another
manufacturer, the EJ will not be allowed.)
2.
The EJ shall be prepared and issued:
a. By a firestop manufacturer's qualified technical personnel and include a signed
review report (opinion letter) by the independent testing agency recognized by the
North Carolina State Building Code, which was responsible for the testing/listing
of the system that was used as the basis for the EJ; or
b. By a NC registered design professional.
3.
Be based upon interpolations of previously tested firestop systems that are either
sufficiently similar in nature or clearly bracket the conditions upon which the EJ is to be given.
Such system(s) serving as the basis shall be identified on the EJ. Additional knowledge and
technical interpretations based upon accepted engineering principles, fire science and fire testing
guidelines (e. g. ASTM E 2032 – Standard Guide for Extension of Data from Fire Endurance
Tests) may also be used as further support data.
4.
Be based upon full knowledge of the elements of the construction to be protected and
understanding of the probable behavior of that construction and the recommended fire stop
system protecting it were they to be subjected to the appropriate Firestop Standard Fire Test
Method for the required fire rating duration.
5
Be limited only to the specific conditions and configurations upon which the EJ was
rendered and should be based upon reasonable performance expectations for the recommended
firestop system under those conditions.
6.
Be accepted only for a single specific job and location and should not be transferred to
any other job or location without thorough and appropriate review of all aspects of the next job or
location's circumstances.
Page 3 of 3
PEOPLE 
 PROGRESS  PARTNERSHIPS
700 North Tryon Street  Charlotte, North Carolina  (704) 336-2831  Fax (704) 336-3839
www.meckpermit.com