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CITY OF VERONA BUILDING/HVAC/FIRE AND COMPONENTS APPLICATION FOR (City of Verona)

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BROWSE CITY OF VERONA (WI) FORMS

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CITY OF VERONA
VERONA FIRE DEPARTMENT
BUILDING/HVAC/FIRE AND COMPONENTS
APPLICATION FOR REVIEW
INSTRUCTIONS: Please type or print clearly.
To avoid delays in the plan review process, ensure this form is filled out completely and accurately.
PROJECT ADDRESS: _____________________________________________________________________________
PROJECT NAME: _________________________________________________________________________________
Other Potential Plan Submittals Required For A Project?
Petition for Variance – Submit form SBD-9890
Erosion control & stormwater management under SPS 306
Plumbing and private sewage systems under chapters SPS 381-385
Boiler & pressure vessels under SPS 341
Elevators or Escalators under chapter SPS 318
Mechanical Refrigeration under SPS 345
Swimming Pools or other Aquatic Centers within a Commercial/Public
Facility under chapter SPS 390
There is no state electrical review under chapter SPS 316
Tank storage of 5,000 gallons or more of flammable or combustible liquids
under chapter SPS 310
Contact the Building Department for individual submittal requirements for all of the above.
Department of Health enforces Building Code Requirements, including Plan Review, for Hospitals and Nursing Homes. Daycare facilities must meet building codes
prior to their licensing.
For licensing of Hotels, Motels, Restaurants, Pools, Campgrounds and Bed & Breakfast establishments contact the WI Environmental Sanitation Section at (608) 266-2835.
The Wisconsin Permit Center at 1-800-435- 7287 may be able to help you with other state permit requirements.
Type of Submittal Requested (check all that
apply)
New
Alteration – Level: 1 2 3
Addition/Alteration–Level: 1 2 3
Approval Extension
Revision
Footing & Foundation Plans Only
Permission to Start
Follow Up of a Denial Within 8 Months
Preliminary Consultation (contact reviewer before
scheduling or submitting)
Structural Framework – Shell Only
Multiple Identical Buildings (see box 5)
Number of Buildings ___________
Occupancy Type Additional Non-Accessory
Major Use – Check Use with Occupancies – Check All
the Greatest Floor Area that Apply )
A Assembly A1 A2 A3 A4 A5
B Business/Office B
E Educational E
F Factory/Industrial F1 F2
H Hazardous H1 H2 H3 H4 H5
I Institutional/Daycare/CBRF I1 I2 I3 I4
M Mercantile/Retail M
R Residential R1 R2 R3 R4
S Storage S1 S2
U Utility/Misc U
Atrium located in any type of occupancy
Construction Information
Construction Class – Check One
IA IB IIA IIB IIIA IIIB IV VA VB
Area (project area, include all levels):_______________ sq ft
Number of Floor Levels ____________
Total Building Volume is less than 50,000 Cu. Ft.
Yes No
Seismic Review Threshold (circle one)
B-F and greater than 1 story A or 1 story
Non-Structural Alteration
Objects Submitted for Review as Current Review
(check all that apply)
Building
HVAC
Lighting & Emergency Egress
Fire Suppression (see box 7)
Fire Detection/Alarm (see box 7)
Other Projects (Stand Alone from above)
Bleacher
Canopy
Kitchen Exhaust Hood
Membrane Construction
Rack Supported Storage Building
Elevated Pedestrian Access
Structural Component Plan(s) which accompany
this current plan submittal (check all that apply):
Roof Truss Metal Bldg
Floor Truss Fire Escape
Steel Girder Precast Plank
Laminated Wood Precast Wall
Fire suppression and alarm plans are required for certain occupancies. See building approval letter or contact us for requirements. When required, the plans
for fire sprinkler, fire detection, and fire alarm must be submitted to the Building Department. The Building Department will then foreword to the Fire
Department agent for review.
FIRE ALARM
Installation Has Begun
Complete Partial None
Type: Automatic Detection Manual Alarm
Monitoring Type:
Central Station Proprietary Supervision
Remote Supervision Protected Premises
FIRE SUPPRESSION
Installation Has Begun
Less Than 21 sprinklers
Complete Partial None
Type: Wet Dry Pre-action/Deluge
Anti-Freeze Manual Wet
NFPA Fire Suppression Standards used
11 11A 12 13 13R
14 15 16 17 17R
17A 20 24 750
2001 Other _______________
Statements of Owners and Designer
Required Signatures
Applicant Signature: ______________________________ Application Date: _______________________________
1. Designer #1 Information 2. Designer #2 Information
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3. Owner 4. Applicant Same as (Check one) 1 2 3
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SUPERVISING PROFESSIONALS If building will be 50,000 cu ft or greater (SPS 361.40) I have been retained by the owner as the supervising professional per SPS
361.40 for the performance of the supervision of reasonable on-the-site observations to determine if the construction is in substantial compliance with the approved
plans and specifications. Upon completion of construction, I will file a written statement with the Department and municipality certifying that, to the best of my
knowledge and belief, construction has or has not been performed in substantial compliance with the approved plans and specifications. In the event that I am no
longer associated with this project I will file a compliance statement (SBD-9720) notifying the Department as such and indicating the current status of compliance.
Signature Print
____________________________________ ________________________________________
Building HVAC Date_______________
____________________________________ ________________________________________ Building HVAC Date_______________
NOTE: Building Supervising Professional is also responsible for supervision of the Lighting & Fire Suppression / Alarm Installation (If Applicable)
Optional Service-Permission to start requested – (Be sure to check box under Building Submittal Type on front page)
As the owner, I request to begin footing and foundation work PRIOR to plan review approval. I agree to make any changes required after plans have been
reviewed, and to remove or replace any non-code complying construction. I will not permit construction above the foundation until approved plans are at
the site.
(Additional $240.00 Fee per building) Request is for the following buildings:_______________________________________________________________
Owner's Signature ___________________________________________________________________________________Date _____________________________
COMPONENT SUBMITTAL The Department 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.
_______________________________________________________________________________________________________________________________
Original Signature of Building Designer Date Signed Name of Component Fabricator
a) OWNERS Statement. The owner indicated this application requests that plans be reviewed for compliance with the code requirements set forth in Chapters
SPS 361 to 365 of the department. The owner recognizes responsibility for compliance with all the code requirements and any conditions of approval. If a
building is 50,000 cubic feet in total volume or greater, plans are required to be prepared, signed, sealed and dated by a Wisconsin registered engineer or
architect [SPS 361.31]. Signatures and seals affixed to the plans shall be original.
b) DESIGNERS Statement. (SPS 361.20, 361.31 (1), and 361.50) The designer indicated on this application is responsible for preparing or supervising the
preparation of the plans to the best of his/her knowledge to comply with the applicable codes of the Division of Safety & Buildings for this submittal. If a building,
following construction of this project, contains more than 50,000 cubic feet in volume, plans are required to be prepared, signed, sealed and dated by a
Wisconsin re
g
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architect
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{
SPS 361.31
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Plan Review Submittal Process
The City of Verona has been authorized by the Wisconsin Department of Commerce to perform plan review duties for the following:
- A new building or structure of unlimited total volume.
- An addition to a building or structure of unlimited total volume.
- An alteration of a space of unlimited total volume.
- Plumbing Systems for any building or structure, of unlimited total volume (different application form).
- Fire Suppression, Detection and Alarm Systems for any building or structure, of unlimited total volume.
Project waiver. The City of Verona may waive its jurisdiction for the plan review of a specific project or types of projects, or components thereof, in
which case plans and specifications shall be submitted to the Wisconsin Department of Commerce for review and approval.
Items Required for Review
Completed Plan Review Application
Required plans
Required worksheets
Required calculations
Contact the appropriate department for more information on required plans, worksheets and calculations.
All plan review requests shall be submitted to the Building Inspection Department.
Please do not submit to the Fire Department.
Plan Review Fees
Building, heating and ventilation, fire alarm and suppression plans. Fees relating to the submittal of all building and heating and ventilation plans
(new, addition, alteration) and fire alarm and fire suppression plans shall be computed on the basis of the total gross floor area of each building, area of
addition or area of alteration and shall be determined in accordance with the table below.
**Please note the Fire Alarm and Fire Suppression fees include all associated inspections.
Building and HVAC fees below are for plan review only.
All fees will be collected with the issuance of the Uniform Building and Trades Permit.
Area (Square Feet) Building Plans HVAC Plans Fire Alarm System
Plans
Fire Suppression System
Plans
Less than 2,500 $260 $160 $130 $130
2,501 - 5,000 330 220 160 160
5,001 - 10,000 550 260 315 315
10,001 - 20,000 750 400 620 620
20,001 - 30,000 1,100 540 925 925
30,001 - 40,000 1,500 830 1,240 1,240
40,001 - 50,000 2,000 1,100 1,555 1,555
50,001 - 75,000 2,700 1,500 1,880 1,880
75,001 - 100,000 3,400 2,100 2,210 2,210
100,001 - 200,000 5,600 2,700 2,580 2,580
200,001 - 300,000 9,900 6,300 3,030 3,030
300,001 - 400,000 15,000 9,200 3,480 3,480
400,001 - 500,000 18,500 12,000 3,930 3,930
Over 500,000 20,000 13,500 4,310 4,310
Note: A fee reduction may be taken for plans involving multiple identical buildings located on the same site and submitted at the same
time. The fees for the submittal of building, heating and ventilation plans for the first building shall be determined in accordance with the table on
the basis of the total gross area of one building. The fee for each of the remaining identical buildings shall be computed on the basis of an area of
less than 2,500 square feet.
Verona Building Inspection Department
111 Lincoln Street
Verona, WI 53593-1520
Phone: (608) 848-9940
Fax: (608) 845-8613
Email: buildinginspector@ci.verona.wi.us
Verona Fire Department
101 Lincoln Street
Verona, WI 53593
Phone: (608) 845-9401
Fax: (608) 845-9455
Email: veronafire@hotmail.com
*****Administrative Section*****
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CITY OF VERONA BUILDINGHVACFIRE AND COMPONENTS APPLICATION FOR (City of Verona)

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Completed 17 July 2020

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