HomeMy WebLinkAbout1982-Plan Approval Application Safety & Buildings Division PLANS APPROVAL APPLICATION ¢'�' 4 V� vs- L
201 E. Washington Ave. E
P.O. Box 7969 Department of riLE
Madison, WI 53707 INDUSTRY, LABOR AND HUMAN RELATIONS .RcfQ'IQOt' — I'1,.. (O
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 sets 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 Ave., Madison, 53702
Na of Ow 2. jNN er Building Occupancy or Use Designer or Design Firm
� r } M PEN 't4 d - f'lC .JA-04 E.1. AFS6 t4 4 ckl►'twsr
Company Tenant Name, if any Street & No.
ill WI4- 9-4(N6TaN AVM
Street & No 1
C, Building Location, Street & No. �,. City State & Zip
Cite¢ i i ' v,Sat∎I (3� S►�W t1
161t 1441( �( s 4o(
y State & Zip City /r� Y 'A, County Phone
l t}K6UIa. VV ' . S Of Town 6114 YU {b b
� IN ag 414 -233 - b 441.-
Previous Owner if any Return Plans to ❑Owner [Designer
—�`
1. THIS APPLICATION IS FOR: ❑Building Plan Approval Heating Plan Approval ❑Other 4t.t.v't'r...i C
2. PLANS FOR: New Building ['Addition ❑Alteration ❑Structural ❑Footing & Foundation
Revision to previously approved plans ❑Other
SOIL BEARINGS CAPACITY (See Ind. 53.21) Yes No
Method used to determine capacity: N r ❑ Sprinkler System Provided?
Check one: Check Value use t ❑ q Fire Alarm Provided?
❑ Verified ❑ PSF 2000 ❑ 3000 ❑ 4000 ❑ Other Detection System Provided? SMOKE
❑ Presumptive ❑ 6000 ❑ 12000 ❑ Other (' Emergency Power Provided?
Type of Construction OA
/
❑Fire Resistive —Type A ❑Metal Frame Protected ❑ Exterior Masonry ❑B ❑Wood Frame Protected
[Wire Resistive —Type B ❑ Heavy Timber ❑ etal Frame Unprotected ood Frame Unprotected 1
Mechanical Information: Type of Heating f � / 1NC . Net Rating of Heating Units ' rIy W phO "1-41.1 1 H{PV 4
DETERMINATION OF FEES Total Vol. /1000 (Building) Minimum Fee $50.00
(See back of form) X .75 = $
Area Height Volume Total Vol. /1000 (HVAC) Minimum Fee $50.00
X q, 7 ;6 X .50 = $ S • - f9C�
cu. f t. Alf {. Area Minimum Fee $50.00
X = cu. ft. X .01 = $
❑ Structural ❑ Exhaust Illumination
X = cu. ft. ❑ Ftg & Found ❑ Revision $ lO i C C)
Total Volume or
Total Area of Alteration - 4 738 Oci rl ❑ Permit to start $60.00 $
PUBLIC RECORDS: Inspection Fee
This plan, and related documents, may be subject $ 5 0, oe?
to public inspection and copying, See Ind. 69.09(8) C%
for additional information regarding public Sub Total
records. $ l /0 ,
Per Ind. 69.01(2) fees will be increased 8% Add 8% of Sub Total CJ 3 /�
C./
effective Oct. 1, 1981. �—
FOR OFFICE USE ONLY Total
Amt. Recd, __� Rept. No — $
DESIGN AND SUPERVISION (IND 50.07 - 50.10) �{
The design, plans, computations and specifications for this project have been prepared under my supervision. I am registered as an .tSJ Architect ❑ Engineer
❑ Designer in Wisconsin as provided in Section 443.01 of the Wisconsin Statutes. ❑ I am not registered. If this building, existing and additions, contains
over 50,000 cu. ft. total volume, it must be designed by a registered person.
Na a of Designer (Type or print/ )Reg. No. _ Signature esigner Date
I .__ft A r Ar-44 L¢ �_�_ f D 5 -2 Z-$z
Plans for buildings over 50,000 cu.ft. will not be approved until the name of the supervising professional is (mown an signature provided.
INa - of Supervising Professional (Type or Print) yi
Reg. No. Address
_ —.raw 'i ti Ili A S J 4Y�
i gnat, r of Supervising Professional Date
DILHR -SBA- 18 '. 1182)