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Ao Sr. Comandante do Corpo de Bombeiros Militar do Rio Grande do Sul

Encaminho a V.S.ª, formulário para:

Consulta Técnica via formulário

Consulta Técnica presencial

PPCI N.º
Solicitação de certidões e 2ª Via de documentos

Requerimento de alteração de ordem cronológica

✘ Outras solicitações

FORMULÁRIO DE ATENDIMENTO E CONSULTA TÉCNICA – FACT

1. IDENTIFICAÇÃO DA EDIFICAÇÃO OU ÁREA DE RISCO DE INCÊNDIO

Razão Social: CONDOMÍNIO SHOPPING DO VALE

Nome Fantasia: CONDOMÍNIO SHOPPING DO VALE

CNPJ: 00.995.983/0001-43

Logradouro: AVENIDA GENERAL FLORES DA CUNHA

Nº: 4001 Complemento: Bairro: VILA BOM PRINCIPIO

Município: CACHOEIRINHA CEP: 94.950-001

2. IDENTIFICAÇÃO DO PROPRIETÁRIO OU RESPONSÁVEL PELO USO DA EDIFICAÇÃO OU ÁREA DE RISCO DE

INCÊNDIO
Nome do Proprietário: MICHELE DA SILVA IVANKIO

CPF: 687.738.200-59 Telefone: 51 98553-7769 E-mail: michele.ivankio@gmail.com

Nome do responsável pelo uso: MICHELE DA SILVA IVANKIO

CPF: 687.738.200-59 Telefone: 51 98553-7769 E-mail: michele.ivankio@gmail.com

3. IDENTIFICAÇÃO DO RESPONSÁVEL TÉCNICO PELO PPCI

Nome: ADRIANO KRUKOSKI FERREIRA

CPF: 475.027.110-15 Telefone: 51 99832-4193 E-mail: adriano@3kfire.com

Formação profissional: ENGENHEIRO CIVIL E DE SEGURANÇA DO TRABALHO Nº CREA/CAU: RS 075.433

4. DOCUMENTOS JUNTADOS ÀO FACT (para preenchimento do CBMRS)

□ Comprovante de pagamento de taxa de serviço não emergencial

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5. OBJETO DO REQUERIMENTO OU CONSULTA TÉCNICA E FUNDAMENTAÇÃO LEGAL

Ilmo. chefe da AAT do 3º PelBM - Corpo de Bombeiros de Cachoeieinha. Encaminho através deste requerimento, o pedido de
ampliação do prazo de adequação, concedido após vistoria ordinária em minha edificação. Solicito a ampliação de prazo por
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igual período do prazo anterior (30 dias úteis)
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Tal pedido se faz necessário devido as lojas âncoras, cito, Americanas, Renner, Marisa dentre outras dependerem de aprovação
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de compra dos itens de adequação junto as suas sedes onde cada empreendimento possui um rito processual para aprovação e
liberação de verbas para o itens de adequação. Algumas mais céleres, outras mais morosas.
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Fundamento meu pedido a luz da RTCBMRS Nº 5 parte 1.1, item 6.5.3.1.1.
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Cachoeirinha RS, ____

______________, 29 Novembro
de ______________ 2022
de ________

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Proprietário e/ou responsável pelo uso da edificação ou área de risco de incêndio Responsável técnico pelo PPCI
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6. DESPACHO (para preenchimento do CBMRS)

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______________, RS, ____ de ______________ de ________

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NOME DO OFICIAL ENCARREGADO – Posto
Função