HomeMy WebLinkAboutHVAC Alteration Safety & Buildings Division PLANS APPROVAL APPLICATION E-
201 E. Washington Avenue
P.O. Box 7989 DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS
Madison, WI 53707 BUREAU OF BUILDINGS AND STRUCTURES PLAN NO
INSTRUCTIONS: Fill in all applicable data. Submittal of this Plan Approval Application form is required with each plan submittal, with a minimum of 4
sets of plans. Data required is described in code section ILHR 50.12.
SUBMIT PLUMBING PLANS SEPARATELY, ACCOMPANIED BY PLUMBING PLAN APPLICATION FORM SBD -6154.
Name of Owner Building Occupancy or Use Designer or Design firm ❑ BLDG 4"HVAC
U ! \ 0_■ -� '7:, S. - IV:- tom- .,s.
Company Name Tenant Name (if any ` /I`` Street & No.
■ rte..... rr ta. Sam 1�+ . /"1 - 4‘)A. s . .� 4�
1 � -
Street & No. / 1 Building is located at: .111,- 0 IC . City State & Zip
y / 5 — in the City ❑ Town ❑ Village (j3\ .4
City / , , pp State & Zip of (') SO-K r D 0 Contact Person
1 A.,, . c 4( ` a Coun of: , _ — 1L ii , r ' t II o la - \ i t. — U---
• Previous Owner if any Return Plans to: II Owner 'd Designer Phone
_ ❑ Other: 4 \ — 1 4 Q l -- 090°
PUBLIC RECORDS: This plan, and related documents, may be subject to public inspection and copying. (IND 69.02(6)
1. This application for ❑ New Bldg ❑ Addn to Bldg fkt Alteration ❑ Revision to previously reviewed plan ❑ ILHR 70 Hist Bldg
2. The Department has processed a Petition for Variance for this project? El Yes ❑ No; Preliminary Review? ❑ Yes ❑ No
3. Review of the following building components is requested. PI s and calculations are included for each component.
El Footing & Foundation ❑ Building ❑ Structural HVAC ❑ Other:
4. The following construction classification type is requested and shown on plans. ❑ #1 Fire Resist. ❑ #2 Fire Resist.
❑ #3 Metal Frame Prot D#4 Hvy Tmbr 0#5A Msnry Prot 0#5B Msnry ❑ Metal Frame 0##7 Wood Frame Prot . ❑ #8 Wood Frame
5. If plans do not show compliance with requested construction classification, but are approvable at a lower class, do you wish plan approval at
the lower construction classification? ❑ Yes ❑ No
6. SOIL BEARING CAPACITY: The Soil Bearing used for design is PSF. This value is ❑ presumed ❑ verified .
7. BUILDING SYSTEMS: Please check appropriate boxes ❑ Complete sprinkler ❑ Partial sprinkler ❑ Fire alarm ❑ Emergency Power
❑ Complete detection system ❑ Partial detection system. For partial systems, show area protected on plans or by letter.
8. MECHANICAL INFORMATION: Total output rating of heating units is: \ (may tr \ • BTUH. Air cond. g rgl Full ❑ Partial ❑ None
Primary fuel source is 0 Gas ❑ Oil ❑ Electric ❑ L.P. ❑ Coal ❑ Wood ❑ Solar ❑ Other
9. COMPONENTS INCLUDED WITH THIS SUBMITTAL 10. FEES See current fee summary or IND 69.09; and back of form.
NOTE: Must be submitted by building designer Building:..Volume C.F....$
Designer Name Reg. No g C .F. ..$
METAL
HVAC' Volume Sk tl. 60c . Cr...
BUILDING Supplier Alteration' Area S.F....$
Structural: (Separate submission only) $
Designer Name Reg. No Ftg & Fdn: (Separate submission only) $
TRUSSES Supplier Revision to previously reviewed plan $
Industrial Exhaust $
Designer Name Reg. No
PRECAST Other: $
CONCRETE Supplier Priority Review (Total of above fees) $
Permission to Start $
Designer Name I Reg. No
LAMINATED , Inspection Fee $ ri S • cc.)
WOOD Supplier Total $ \ 3.Sy or.)
OFFICE USE ONLY Date*
Designer Name Reg. No
OTHER
Ell
Fee
(SPECIFY) Supplier Paid ❑ Designer
By: ❑ Other
11, DESIGN AND SUPERVISION (ILHR 50.07- 50.10) It this building. following construction of this project, contains more than 50.000 cubic feet, total volume. all applicable boxes below must be
completed prior to plan review. The project designer is the person who signed and sealed the plans, except for components designed and sealed by other designers. Plans for buildings over
50,000 C.F. will not be reviewed until the signature of the supervising professionals) Is provided. The Department expects. and requires, that the project designer review individual component
submittals for compliance with the general design concept. The project designer. and department, will rely on the seal of the component designers for compliance with the codes as they apply to
their designs.
Name of Building Designer (Type or Print) Reg. No. Name of HVAC Designer (Type or Print) Reg. No.
r � t i . :- c - c !l> - CC - °ac)(a - l�
Name of Professional Supervising Building (Type or Print) Reg. No. Address
Signature of Professional Supervising Building - Date
Name of Professional Supervising HVAC (Type or Print) Reg. No. Addrese _
Signature of Professional Supe ' ' C Dale L j ( 7 `— `Ka- W\ •
�Ir�ir 1 t- 3 —