Plan Application Form - Louisville
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1
2PLAN APPLICATION FORM
ENVIRONMENTAL AND PUBLIC PROTECTION CABINET
DEPARTMENT OF PUBLIC PROTECTION
OFFICE OF HOUSING, BUILDINGS AND CONSTRUCTION
DIVISION OF BUILDING CODE ENFORCEMENT & DIVISION OF PLUMBING
101 SEA HERO ROAD, SUITE 100
FRANKFORT, KENTUCKY 40601-5405
BUILDING CODES: 502-573-0373
PLUMBING: 502-573-0397
NOTE: Complete all applicable spaces
Please type or print
Today's Date: _____________
REV.3/2004
NAME OF PERSON
IS THE BCE PLAN REVIEW FEE
YES
SUBMITTING PLANS
PHONE (
)
-
INCLUDED WITH PLANS?
NO
MAILING ADDRESS: ______________________________________________________________________________________________________________________________________________________
NUMBER / STREET, HWY, ROAD or P. O. BOX
CITY
STATE
ZIP CODE
BUSINESS & PROJECT NAME: _____________________________________________________________________________________________________________________________________________
(Or tenant name if multi-tenant building
PROJECT LOCATION: ____________________________________________________________________________________________________________________________________________________
NO./ STREET, HWY or ROAD ( Please do not indicate P.O. Box or Postal Routes )
CITY
ZIP CODE
COUNTY
OWNER (INDIVIDUAL & COMPANY: ___________________________________________________________________________________________ PHONE (
)__________ - _______________
MAILING ADDRESS: ______________________________________________________________________________________________________________________________________________________
NUMBER / STREET, HWY, ROAD or P. O. BOX
CITY
STATE
ZIP CODE
ARCHITECT (NAME & FIRM)_________________________________________________________________________________________________ PHONE (
)__________ - _______________
AS THE ARCHITECT LISTED ABOVE, I AM RESPONSIBLE FOR CONSTRUCTION CONTRACT ADMINISTRATION.
YES
NO
MAILING ADDRESS: ______________________________________________________________________________________________________________________________________________________
NUMBER / STREET, HWY, ROAD or P. O. BOX
CITY
STATE
ZIP CODE
ENGINEER (NAME &FIRM)____________________________________________________________________________________________________ PHONE (
)__________ - ______________
MAILING ADDRESS: ______________________________________________________________________________________________________________________________________________________
NUMBER / STREET, HWY, ROAD or P. O. BOX
CITY
STATE
ZIP CODE
PROJECT CONTRACTOR:____________________________________________________________________________________________________ PHONE (
)__________ - ______________
MAILING ADDRESS: ______________________________________________________________________________________________________________________________________________________
NUMBER / STREET, HWY, ROAD or P. O. BOX
CITY
STATE
ZIP CODE
BUILDING INFORMATION
∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞
∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞
NUMBER OF BUILDINGS IN THIS SUBMITTAL: ___________
USE OF BUILDING(S) ie...restaurant, office, classroom, storage or other ( please specify )__________________________________________
BUILDING(S) IN THIS PROJECT IS / ARE:
NEW FREESTANDING BUILDING
NEW ADDITION TO EXISTING STRUCTURE
RENOVATION ONLY
RENOVATION & ADDITION
2
FT.
BASEMENT
TOTAL AREA IN NEW BLDG. OR ADDITION: _________________________
NUMBER OF LEVELS (INCLUDING BASEMENT) _____________
YES
NO
2
FT.
TOTAL AREA IN EXISTING BLDG.: _____________________
DATE CONSTRUCTION TO BEGIN: ____________________
ESTIMATED COMPLETION DATE: ______________________
TYPE OF PLAN SUBMITTALS
∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞
∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞
BUILDING
PLAN
SUBMITTALS
SHOP DRAWING PLAN SUBMITTALS
(Check the type of evaluations requested at this time)
(Check the type of evaluations requested at this time)
Suppression System
Range Hood System
BUILDING PLAN REVIEW (BCE)
PLUMBING PLAN REVIEW
(Sprinkler, CO5, Etc.)
Fuel Tank
Full Building Review
Plumbing Review ONLY
Alarm Systems
Elevator
Expedited Site & Foundation Review
Water Supply Review
Boiler System
Swimming Pool
Expedited Tenant Fit-up Review
Waste Water Review
Seating System
Prefabricated Truss
Partial Evaluation (please specify)
Other (please specify)
_____________________________
__________________________________
__________________________________
SUBMIT ONLY ONE SET FOR BCE
SEE BACK OF THIS FORM FOR PLUMBING PLAN
SUBMIT ONLY ONE SET OF PLANS FOR THE ABOVE
SET REQUIREMENTS
∞∞∞ THE INFORMATION IN THIS SECTION IS FOR THE DIVISION OF PLUMBING (TO BE COMPLETED BY PERSON SUBMITTING PLANS) ∞∞∞
YES
NO
DESIGN CAPACITY OF BUILDING:
NO. OF MALES ________
NO. OF FEMALES ________
ARE RESTROOMS ACCESSIBLE TO PUBLIC?
MUNICIPAL
PRIVATE
YES
NO
SEWAGE DISPOSAL:
TYPE:
ARE RESTROOMS ACCESSIBLE TO DISABLED?
PUBLIC
DRILLED WELL
CISTERN
HAULED WATER
ROOF WATER
SPRING
STREAM
WATER SUPPLY:
IF PRIVATE, INDICATE THE TYPE AND THE DESIGN: __________________________________________________________________________________________________
BY WHOM: _____________________________________________________________________________________________________________________________________
NAME
TITLE
REGISTRATION NUMBER
∞THIS SECTION TO BE COMPLETED BY THE LOCAL HEALTH
THIS AREA FOR DEPARTMENT USE ONLY
DEPARTMENT OFFICIAL ( Must be completed prior to sending Plumbing
Plans to Frankfort ) ∞
REVIEWED BY:
______________________________________________________________________
NAME
_______________________________________________
DATE: _______________
TITLE
APPROVED BY:
COUNTY OR DISTRICT
HEALTH DEPARTMENT:
______________________________________________________________________
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