HomeMy WebLinkAboutPlan Approval Application - 5/8/1981
Safety & Building Division
Box 7969
201 E. Washington Avenue
Madison, Wisconsin 53707
PLANS APPROVAL APPLICATION
DepartIT.~tnt of
INDUSTRY,LABOR AND HUMAN RELATIONS
~ i
INSTRUCTIONS: Fill in all applicable data. Submittal of Plan Approval Application form is required with each plan submittal. Examination and
inspection fees, as indicated on back of form. are required to be submitted with a minimum of four SlitS of plans. Data required on plans is
described in code section Ind 50.12.
Codes can be purchased from the Department of Administration, Document Sales, 202 S. Thornton Ava.. Madison, 53702
Name of Owner Building (kcupancy or Use Designer or Design Firm
St. Peters Church Change of use-Chapt. 57 to 54 Reinke, Hansche, Last, Inc.
Company Tenant Name. if any Winnebago County Street & No.
Mental Health Clinic 805 N. Main Street
Street & No. Building.Location. Street & No. CitY State & Zip
435 Hiah Avenue 471 Hiqh Avenue oshkosh, Wis. 54901
City State & Zip City :e~ County Phone
Oshkosh, Wis. 54901 Village Oshkosh winnebago (414) 231-6950
Town
Previous Owner if any Return Plans to DOwner g)Designer
1. THIS APPLICATION IS FOR:
o Building Plan Approval
o Heating Plan Approval
o Othar
2. PLANS FOR:
ONew Building OAddition OAI:eration
ORevi.sion to previously approved plans
DStructural CJFooting & Foundation
IilOther Cnange of Occupancy
- SOIL BEARINGS CAPACITY (See Ind. 53.21)
Method used to determine capacity:
Check one: : Check Value used:
o Verified : 0 PSF 2000
o Presumptive I 0 6000
I
Yes
o 3000
o 12000
04000
o Other
o
o
g]
o
No
lifI Sprinkler System Provided?
KJ Fire. Alarm Provided?
o Other Detection System Provided?
~ Emergency Power Provided?
Type of Construction
OFire Resistive-Type A
OFire Resistive-Type B
Mechanical Information:
OMetal Frame Protected
o Heavy Timber
Type of Heating
o Exterior Masonry OWood Frame Protected
O'l1etal Frame Unprotected OWood Frame Unprotected
Net Rating of Heating Units
s
DETERMINATION OF FEES Total V~1. /1000 (Building) Minimum Fee $50.00
(See back of form) .. X .75 = $
,
Area . Height Volume Total Vol./lOoo (HV AC) Minimum Fee $50.00
X .50 = $
- - DOE~ NOT APP ~y- - - - 'cu. ft. Alt. Cost /1000 Minimum Fee $35.00
X - cu. ft. X 2.00 = $
, o Structural o Exhaust o Illumination
. "~~
X = cu. ft. G Ftg & Found o Revision $
..
TQ.til.1 VQlurne w. o Permit to start $60.00
= $
Total Cost of Alteration
Inspection Fee
$
PUBLIC RECORDS: Total
$
This plan, and related documents, may be subject
to public inspection and copying, See Ind. 69.09(81 FOR OFFICE USE ONLY
for additional information regarding public
records. Amount Rec'd
Date Rec'd
.Receipt No..
DESIGN AND SUPERVISION UNO 50.07.. 50.10)
The design, plans. co.mputations and specifications for this project have been prepared tinder my supervision. I am registered as an g) Architect 0 Engineer
C esigner in Wisconsin as provided in Section 443.01 of the Wisconsin Statutes. 0 I am n e stered. If this building, existing and additiol.s, contains
ov r 50,000 cu. ft. total volume, it must be designed by a registered person.
e of Designer (Type or print) Reg. No. Sig '!P"e of Des~er
RONALD D. HANSCHE 02457 ~ ,
t is buildin~, existing and additions, contains over 50.000 cu. ft. total volume. the construction of this project shall be under the supervision of a
Wisconsin registered architect, engineer or in the case of heating and ventilating. designer.
Plans for buildings over 50,000 cu. ft. will not be approved Jntil the name of the supervising professional is known.
e of Supervising Professional (Type or Print) Reg. No. Address 805 N. Main St.
RONALD D. HANSCHE A02457 Oshkosh, Wisconsin 54901
. SBD. 118 (R. 9/80)