HomeMy WebLinkAboutHVAC 123-1096H
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City of Oshkosh
P.o. BOX 1130
OSHKOSH, wr 54902-1130
ON THE WATER
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COMPANY NAME 'C<~::> ,,'\'- G.:. S' 'S".z- I--- ~ '~VAc.J k:.J)ATE
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APPROVAL REQUIRMENTS FOR REPLACEMENT OF COMMERCJALAND INDUSTRIAL HEATING
AND COOLING EQUIPMENT FOR BUILDINGS UNDER 100,000 'CUBIC FEET
IN AREA.
1) OWNER OF BUILDING
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2) ADDRESS OF BUILDING ~ . \ c
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3) WHAT THE BUILDING IS USED FOR
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4) EQUIPMENT BEING REPLACED (MODEL,SIZE)
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5) NEW EQUIPMENT (MODEL,SIZE)
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6) WAS THERE ADEQUATE HEATING&lOR COOUNG?
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7) HOW WAS THE NEW UNIT SIZED?
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8) IS THERE A BOILERlFURNACE ROOM?
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9) PLEASE INCLUDE STATE FORM 580118 WITH A $80.00 FEE.
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FOR COMPLl~NC[ ''1iT~ REQlJi REHF:TS c)F,'.: _ _. .'
DEPT. OF INDUSTF:'l. L.;8GR ,\iJD '1UI"\;; .'::':": :u,;~
SEE CCRt;ESPO:'~J~:\~CE
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BUILDING/STRUCTURE/HVAC PLANS .APPROVAL APPLICATION
-Complete Both Sides- ' '
E-File
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Wisconsin Department of Industry,
Labor & Human Relations
Safety & Buildings Division
Scheduling information - complete
when calling to schedule review:
, Plan No. J.J 1-fll 'ft, II
INSTRUCTIONS: Fill in all applicable data. Caution: Failure to complete the form entirely may cause additional delay. Submittal of this Plans Approval
Application is required for ~ building, Submit this form with at least 4 sets of plans which include details and data as required by ILHR 50,12. Plans may be
submitted to any of the plan review offices listed on the reverse side. Projects are scheduled for review. Please call the selected office prior to submittal.
Any components submitted independently from the building plans must be submitted to the offices which did the project's initial review. Personal information
you provide may be used for secondary purposes. [Privacy Law s. 15.04 (1)(m)].
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Fax Number
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4. Building History
Previous Owner (If any)
Previous Plan or File No.
Variance No,
Preliminary No.
Other information (previous use, last submission)
7. Building Information
D Complete Sprinkler - NFPA
D Partial Sprinkler - NFPA
D Unlimited Area D Smoke Detection
D Fire Alarm D Emergency Power
Total cubic foot volume of tbe !Juilding upon
completion of this project: 0 Less than 50,000
o 50,000 or Greater
Total Number of Stories
Entire Building Footprint Area
Soil Bearing Capacity
D Presumed 0 Verified
Erosion Controllnforrnation:
o Less than 5 acres disturbed
o 5 or more acres disturbed
D Energy Tradeoffs Used
Building, lighting, and HVAC must be
submitted together.
o Energy Tradeoffs Not Used
Building and lighting must be submitted
together. HVAC may be submitted separately.
2. Pro'ec::t Irifonnalf6i1'"''''
BUUdiri-Q'CdparrcyiChapfer(s) And Use
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"Teh~nrl'!~m~l(lf Any)
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BuJraiCocaliO ',("I" moeY8tSr eI
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ity D Village D Township of
OS~'cc;'S
Coullty of
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Property ID No, (tax parcel no. - contact county)
Government Owned
Government Leased or Operated
5. Submittal Request
Proiect
DNew
D Alteration
D Addition
D Revisions
D Use Change
D ILHR 70 Hist Code
DYes
DYes
3. Buildin
Designer
Design Firm
Number & Street
City, State, Zip Code
Contact Person
Fax Number
)
o Designer
D For Building
D Same as Building Designer
;'1 For HVAC
D .Same as HVAC Designer
Supervising Prof (if different from designer)
Registration #
sq ft
sq ft
Number & Street
o Variance
D Preliminary
D Canopy
D Bleacher
D Tower
D Other: (specify)
sq. ft,
psf
Review Reauested: D Permission to Start
o Footing/Foundation D HVAC
D Building D Structural Component
8. Construction Class Requested
D 1. Fire Resistive Type A
D 2. Fire Resistive Type B
o 3 Metal Frame Protected
D 4. Heavy Timber
D 5A. Exterior Masonry - Protected
D 5B, Exterior Masonry - Unprotected
D 6, Metal Frame - Unprotected
D 7. Wood Frame - Protected
D 8. Wood Frame - Unprotected
If plans do not show compliance with requested Construction class
but are approvable at a lower class, do you wish approvl" at the
lower class? Yes No
9. Multifamil Dwellin Data Onl
Type of Fire Protection:
D Automatic Sprinkler D 2 Hour Rating
City, State, Zip Code
Telephone Number
D Type 8 Modified 66.33 (2)(15) ()
11. Related Business Systems - Please call the respective Program for clarification and plan submittal requirements.
D Fire Service Provided D Flammable/Combustible Liquid (608) 266-5824 D Boiler/Pressure Vessel (608) 266-1904
D Limited Use/Access Will any portion of this building be used for D Mechanical Refrigeration (608) 266-1904
D Passenger elevator meeting ILHR 18 req. storage or dispensing of flammable/combustible D Plumbing (608) 266-3815
D Freight elevator meeting ILHR 18 req, liquids as covered by ILHR 10? Sewer:
D Part 5 lift (residential type) DYes 0 No 0 Municipal 0 Private Sewage System
D Part 20 lift (wheelchair lift)
Total Area of Dwelling Units =
Nondwelling Units Portion =
Number of Dwelling Units: (BR = Bedroom)
1~ 2~ 3~ 4~
SBD-118 (R.12195)
. CONTINUED ON REVERSE SIDE -