HomeMy WebLinkAbout1984-Building Safety & Buildings Division PLANS APPROVAL APPLICATION E-
201 E. Washington Ave. Department of
P.O. Box 7969 INDUSTRY, LABOR AND HUMAN RELATIONS PLAN NO . _a ��
Madison, WI 53707
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 Or ner Buil ing Occupancy or Use De ' gner or Design firm of � ❑H
$LDG. VAC
n � I. ASI Uii C-141 51 .. sM 2 ter _ �r ...� .
Company Tenant Name, if any Street & No.
l
Street & No. Building locati n, Sort & No. City State & Zip
,� ON\A LI Lv 2 /oUl - �► ar -4t S--r: r' Ya5i4, \•( : 1'
City State & Zip ity .R" ,County Phone
Village. ❑
05 � \V I 1 Q DI Town. ❑ _. f> 5' 1 1 \•J' L lr, - ', ° Z33. er:
Previous Owner, if any Return Plans to ❑Owner .Designer ❑ Other
THIS APPLICATION IS FOR: Type of Construction (Ind 51.03) R Sprinkler System Provided WE '-r FOR OFFICE USE ONLY
, Building Plan Approval ❑ Fire Resistive —Type A #1 ❑ Fire Alarm Provided
❑ HVAC Plan Approval ❑ Fire Resistive —Type B #2 2 Other Detection System ProvidedSMG kttsiat. Recd.
❑ Other ❑ Metal Frame Protected #3 ❑ Emergency Power Provided
PLANS FOR: ❑ Heavy Timber #4 Mechanical Information:
ja New Building ❑ Exterior Masonry #5A Type of Heating ,- )..4 G f -, j Rept. No.
❑ Addition ❑ Exterior Masonry #5B
❑ Alteration ❑ Metal Frame Unprotected #6 DETERMINATION OF FEES
❑ Revision to previously approved plans ❑ Wood Frame Protected #7 (See back of form)
❑ Structural ,®' Wood Frame Unprotected #8 ' Area Height Volume
❑ Footing & Foundation SOIL BEARINGS CAPACITY -
' ❑ Other Method used ❑Verified TiZ1.e X �!J = Lis Sbo cu. ft. .
Check one: Presumptive
X = cu.ft.
Value used: 30 9 :) PSF Total Volume or
Total Area of Alteration =
COMPONENTS INCLUDED WITH THIS SUBMITTAL Total Vol. /1000 (Building) Minimum Fee $75.00
NOTE: Must be submitted by building designer t!' ;,�
X 1.10 =_$ i --
Designer Name Reg. No. Total Vol. /1000 (HVAC) Minimum Fee $70.00
METAL X .81
$
BUILDING Supplier Alt. Area Minimum Fee $70.00
I X .02 = $
Designer Name Reg. No.
❑Structural ❑Exhaust ❑ Illumination
TRUSSES Su tier ❑Ftg & Found DRevision $
pp ❑ 'PRIORITY PLAN REVIEW.
Designer Name Reg. No. FEE IS EQUAL TO THE TOTAL PLAN
PRECAST EXAMINATION FEES ABOVE. $
CONCRETE Supplier
❑ Permit to start $81.00 $
Designer Name IReg. No. PUBLIC RECORDS: Inspection Fee
LAMINATED =
WOOD Supplier This p /an, and related documents, may b
subject to public inspection and copying, $
Designer Name I Reg. No. See Ind. 69.09(8) for addition/ informa- Total
OTHER
(SPEC /FY) Supplier tion regarding public records. I 3 e , a
$
DESIGN AND SUPERVISION (Ind. 50.07- 50.10) Wisconsin Registered Professional required for buildings, containing more than 50,000 cu.ft.,
total volume. This project has been prepared under my supervision. Individual components, submitted herein, may have been designed and sealed
by others. I have reviewed those component documents for conformance with the general design concept. I have relied on the seal of the component
designers for compliance with codes as they apply to their design.
If this submittal includes building, or building components, the designer and supervising professional below must be that of the building. If submittal
is for HVAC, only, blocks below may be completed by HVAC designer and supervi .r. •
Name of :i BLDG 0 HVAC Designer Type or Print Reg. No. ignatue,f ►' -BLDG = -VAC Designer Date
r, I
Plans for buildings over 50,000 cu. ft. will not be approved until the name of the supervising pro - ssional is known and the signature provided below.
Name of Supervising Professional (Type or Print) Reg. No. Address
Signature of Supervising Professional Date
DILHRSB -118 (R. 9/83)