HomeMy WebLinkAbout1981-Plan Approval Application N or tf' : ►I, S t TrM Tor--,
Safety ti Building Division PLANS APPROVAL APPLICATION C L 904 _ C�
201 E. Washington Ave. Department of � �
P.O. Box 7969 INDUSTRY, LABOR AND HUMAN RELATIONS 1 '' , 4 '
Madison, Wi. 53707 S,,/IU���� F^/��
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INSTRUCTIONS: Fill in all applicable data. Submittal of Plan Approval Application form is required with each an submittal. min tion and 1
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
Name of Owner Building Occupancy or Use esigner or Desi n Firm Arecti-rrou-
Company Tenant Name, iT any Street & No.
ZI al ) I IA y
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Street & No. Buildingocation, Street & No. y /State & Zip
> - � rsQ.4.) i' X30 ' 4wEta - j1 ( Pi .90 1
City State & Zip City ►, County one
""' Villa. • Q �J W1� �� l o) Tow . O tOs ) ate D 41 4 -iT � U Previous Owner if any Return Plans to ❑ Owner Designer
1. THIS APPLICATION IS FOR: Building Plan Approval ❑Heating Plan Approval ❑ Other
2. PLANS FOR: 4New Building ❑Addition ❑Alteration ❑Structural ❑Footing & Foundation
Revision to previously approved plans ❑Other
Yes No
SOIL BEARINGS CAPACITY (See Ind. 53.21)
Method used to determine capacity: ❑ Sprinkler System Provided?
Check one: Check Value used: ❑ Fire Alarm Provided?
❑ Verified ❑ PSF 2000 Xf 3000 ❑ 4000 4,11,40- El Other Detection System Provided?
Presumptive ❑ 6000 ❑ 12000 0 Other ❑ V Emergency Power Provided?
• Type of Construction
❑Fire Resistive -Type A ❑Metal Frame Protected ❑ Exterior Masonry ❑Wood Frame Protected G •
❑Fire Resistive -Type B 1,3 Heavy Timber pp EMetal Frame Unprotected ' Iood Frame Unprotected + 0 ,�,,//� '�
Mechanical Information: Type of Heating NCR- Net Rating of Heating Units W 4 - �/4.,(JV
DETERMINATION OF FEES Total Vol. /1000 (Building) Minimum Fee
(See back of form) 49 872>P3 X .75 31 30 = $ s oo
Area Height Volume Total Vol. /1000 (HVAC) Minimum Fee $50.00
X .50
P ' 1 7 4. X 0 g i _ ' - 410 cu . ft Alt. Cost /1000 $ Minimum Fee $35.00
•
/ 44 146 v X / 7' cAy. = cu. ft. X 2.00 = $
❑ Structural ❑ Exhaust ❑ Illumination
X = 7 f / �' 0 cu. ft. ❑ Ftg & Found ❑ Revision $
Total Volume or /j /} /
Total Cost of Alteration i/ t 7' 3 g r 1 Permit to start $ §Oc9� �U $ /L, 60
I / Inspection ction Fee `�
7� x.d�d = $ I. 0
PUBLIC RECORDS: Total rfF , 3S' --
This plan, and related documents, may be subject
$ > 9 7, 8o
to public inspection and copying, See Ind. 69.0918) S ` FOR OFFICE USE ONLY
for additional information regarding public € a � 4 - taw - 13
records. Amount Rec'd
Date Rec'd
Receipt 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 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. °'
Nne of Designer Type or print) 1R-g. No. z , ignatur• of Designer Date
this building, existing and additions, contains over 50,000 cu. ft. total volume, the co struction of this project shall be under the supervision of a
Wisconsin registered architect, engineer or in the case of heating and ventilating, designer.
Pl ns for buildings over 50,000 cu. ft. will not be approved until the name of the supervising professional is known.
Name of Supervising Profe sional (Type or Print) - . g. No. Address
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DILHR -SBD -118 (r. 4/81)