Application for Plan Review

Transcription

1 St. Paul, MN Phone: (651) Fax: (651) TTY: (651) Application for Plan Review PROJECTED CONSTRUCTION VALUATION ANTICIPATED START DATE CITY OR TOWNSHIP WHERE LOCATED *** PLEASE VERIFY *** COUNTY STATE PROJECT NO OWNER (OR STATE AGENCY IF APPLICABLE) CONTACT PERSON DESIGN FIRM PROJECT CONTACT Check if you would also like to receive your plan review by PROJECT TYPE Public (state-owned) building paid for by the state or other state agency for: National Guard Historical Society MN Zoo D.O.T. D.N.R. Iron Range R MNSCU (State College or University) State Hospital State Home Capitol Complex Public school district building of $100,000 or more in construction cost State Licensed Facility licensed as a: Hospital Nursing Home Correctional Facility Boarding Care Home Supervised Living Facility Free-standing Outpatient Surgical Center Residential Hospice CLASS OF WORK New Building Construction Addition Remodeling Other, specify IBC OCCUPANCY CLASSIFICATION(S) IBC TYPE OF CONSTRUCTION SPRINKLERED Yes No Partial PROJECT DESCRIPTION NOTE: The following materials must be submitted (as applicable) with this Application for Plan Review: 1. Complete set of Plans and Specifications 4. Code Record 7. Soils Investigation Report 2. Addenda and/or Change Orders 5. Sample Structural Calculations 8. Energy Code Envelope 3. Plan Review Fee 6. Special Inspection Program Compliance Forms Licensed professional: I attest that these plans and/or specifications were prepared by me or under my direct supervision and that reasonable care has been given to compliance with applicable laws, ordinances and building codes and that this application is not a building permit, nor does it authorize the start of construction APPLICANT NAME (PRINT) APPLICANT SIGNATURE DATE Minnesota Registration No. Is this project on the State MAPS accounting system? Yes No State Agency that will be paying fee? Calculated Plan Review Fee (By Applicant) A plan review fee must be submitted. Please see Plan Review Fee Project No. Date Amount of Check the Plan Fee Schedule Worksheet for correct calculation of the required plan review fee This material can be made available in different forms, such as large print, Braille or on a tape. To request, call (DIAL-DLI) Voice or TDD (651) BCS 02 (12/07)

2 St. Paul, MN Phone: (651) Fax: (651) Plan Review Fee Schedule Worksheet PROJECT NO. When the State will be providing plan review services on State Licensed Facilities, Public Buildings, and School District Building Projects the cost of which is $100,000 or more, a Plan Review Application and Plan Review fee are required to be submitted to this office. Plan Review fees are calculated in accordance with the formula contained in Minnesota Rules part , subparts 1, 2, and 4. The basis for the formula used to calculate the Plan Review fee is taken from the schedule contained in the 1985 Uniform Building Code. In order to correctly calculate the amount of the Plan Review fee, it is necessary that you go online to our website and use our fee calculator. This will ensure that your fee will be accurate and that no delay in processing an incorrect fee should occur. Our fee calculator can be found at: At Plan Review, click on fee calculator. Enter your Construction Valuation and calculate your fees. If plan review and inspections are to be provided by this office, the full plan review fee will be charged. If plan review will be provided by this office and building permit/inspections by the municipality, our office will charge 75% of our normal plan review fee and the municipality will charge 25% of their normal plan review fee. Copy those numbers below exactly as they appear in the fee calculator and return this form stapled to your payment. Construction Valuation $ Check one: Full plan review fee to the State 75% of plan review fee to the State Plan Review Fee $ This material can be made available in different forms, such as large print, Braille or on a tape. To request, call (DIAL-DLI) Voice or TDD (651) DATE PAYMENT RECEIVED AMOUNT OF PAYMENT RECEIVED BCS 03 (2/07)

3 St. Paul, MN Phone: (651) Fax: (651) TTY: (651) Application for Building Permit PROJECTED CONSTRUCTION VALUATION ANTICIPATED START DATE CITY OR TOWNSHIP WHERE LOCATED *** PLEASE VERIFY *** COUNTY STATE PROJECT NO OWNER (OR STATE AGENCY IF APPLICABLE) CONTACT PERSON CONSTRUCTION FIRM PROJECT CONTACT DESIGN FIRM PROJECT CONTACT Permit Applicant is: Owner Designer Contractor Other (specify) APPLICANT FAX CITY STATE ZIP CODE Class of Work is: New Addition Alteration Other (specify) PROJECT DESCRIPTION Applicant: I completed the information on this application and acknowledge that this is not a building permit. Work will be performed in accordance with the conditions of the permit, the approved plans and specifications, and the Minnesota State Building Code. Work will not begin until the building permit has been issued by this office. APPLICANT NAME (PRINT) APPLICANT SIGNATURE DATE Is this project on the State MAPS accounting system? Yes No State Agency that will be paying fee? Calculated Permit Fees (By Applicant) A Building Permit fee must be submitted. Please see the Building Permit Fee Schedule Worksheet for correct calculation of fees for the building permit and state surcharge. Permit Fee Surcharge Fee Project No. Date Amount of Check This material can be made available in different forms, such as large print, Braille or on a tape. To request, call (DIAL-DLI) Voice or TDD (651) BCS 06 (2/07)

4 St. Paul, MN Phone: (651) Fax: (651) Building Permit Fee Schedule Worksheet PROJECT NO. When the State will be providing building inspection services on State Licensed Facilities, Public Buildings, and School District Building Projects the cost of which is $100,000 or more, a Building Permit Application, Building Permit fee and Surcharge fee are required to be submitted to this office. Building Permit and Surcharge fees are calculated in accordance with the formulas contained in Minnesota Rules part The formula used to calculate the Building Permit Fee is taken from the schedule contained in the 1985 Uniform Building Code. The formula used to calculate the surcharge is taken from Minnesota Statutes Section 16B.70. In order to correctly calculate the amount of the building permit and surcharge, it is necessary that you go online to our website and use our fee calculator. This will ensure that your fee will be accurate and that no delay in processing an incorrect fee should occur. Our fee calculator can be found at: At Plan Review, click on fee calculator. Enter your Construction Valuation and calculate your fees. Copy those numbers below exactly as they appear in the fee calculator and return this form stapled to your payment. Construction Valucation: $ Building Permit: $ Surcharge: $ Total Fee $ This material can be made available in different forms, such as large print, Braille or on a tape. To request, call (DIAL-DLI) Voice or TDD (651) DATE PAYMENT RECEIVED AMOUNT OF PAYMENT RECEIVED BCS 07 (2/07)

5 The fee calculator can be found at Make checks payable to: DEPARTMENT of LABOR and INDUSTRY. Minnesota Department of Labor and Industry 443 Lafayette Road N., St. Paul, MN Phone: (651) or DIAL-DLI ( ); TTY: (651)

6 St. Paul, MN Phone: (651) Fax: (651) Special Structural Testing and Inspection Program Summary Schedule PROJECT NAME LOCATION RADIO COMMUNICATIONS TOWER PROJECT NO. PERMIT NO. Technical (2) Section Article Description (3) Type of Inspector (4) Specific Report Frequency (5) HIGH STR BOLTS SI-T ONCE AET REINF STEEL PLACEM'T SI-T ONCE BRAUN BOLT INSTALL IN CONC SI-T ONCE BRAUN CONC PLACEMENT SI-T ONCE MN/DOT CONC STRENGTH TA ONCE MN/DOT Assigned Firm (6) Note: This schedule shall be filled out and included in a Special Structural Testing and Inspection Program. (If not otherwise specified, assumed program will be Guidelines for Special Inspection & Testing as contained in the State Building Code and as modified by the state adopted IBC.) *A complete specification-ready program can be downloaded directly by visiting CASE/MN at (1) Permit No. to be provided by the Building Official (2) Referenced to the specific technical scope section in the program. (3) Use descriptions per IBC Chapter 17, as adopted by Minnesota State Building Code. (4) Special Inspector Technical (SIT); Special Inspector Structural (SIS) (5) Weekly, monthly, per test/inspection, per floor, etc. (6) Name of Firm contracted to perform services. ACKNOWLEDGEMENTS (Each appropriate representative shall sign below) Owner: Firm: MN/DOT Contractor: Firm: Architect: Firm: SER: Firm: SI-T Firm: AMERICAN ENGR TESTING SI-T: Firm: BRAUN INTERTEC TA: Firm: MN/DOT SI-T: Firm: MN/DOT If requested by engineer/architect of record or building official, the individual names of all prospective special inspectors and the work they intend to observe shall be identified as an attachment. Legend: SER = Structural Engineer of Record SI-T = Special Inspector - Technical TA = Testing Agency SI-S = Special Inspector - Structural F = Fabricator Accepted for the Building Department By Date This material can be made available in different forms, such as large print, Braille or on a tape. To request, call (DIAL-DLI) Voice or TDD (651) BCS 10 (2/07)