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Minnesota Department of Labor and Industry /0•07gi Construction Codes and Licensing Division li Building Plan Review/Inspections MINNESOTA DEPARTMENT OF Lafayette Road North LABOR $t~ INDUSTRY St.Paul, MN 55155-4341 Phone: (651)284-5068 Fax: (651)284-5749 www.doli.state.mn.us/buildingcodes Application for Plan eview , TTY: (651)297-4198 it.5 e_�l l{S //'j r/a,f at) PRI IN INK or TYPE your responses. PROJECT TITLE 0 Y-01/1 p1 5 i SC h10 o I PROJECTED CONSTRUCTION VALUATION 0,a se, 22 -sh-I-e,r`i or- GinA f - — mein o•ioc)r'+`vn s a 1 ?) /021 DDD ADDRESS '79 S" o Id Geys-�-m,1 &y )20( 1,1 ANTICIPATED DATE eg ' c() CITY OR TOWNSHIP WHERE LOCATED*"PLEASE VERIFY*** COUNTY ////STATE PROJECT NO hilho�-? 1-006 LAIC A•Galb ;r CGS 0T— ro h p OWNER(OR STATE AGENCY IF APPLICABLE) # CONTACT PERSON DY-eV)D yyL (0I!G Sc,,ools - r—SY2—I Vo lin OS-Huh ADDRESS PHONE 6'SS" 0I G,v-ys- t) gay )Q.J. N. ''/c.a. yqci -83)1- CITY STATE ZIP CODE FAX —oro Lc MN 5"535-6. 9S€2... Lic1 - P3R41 DESIGN FIRM PROJECT CONTACT WO)6 1A --c- ADDRESS PHONE 0 S e $ b )4A-e- C4k—aV-\— 6s-) 22 - -7-7 73 CITY STATE ZIP CODE FAX 5-i-- eA tAl m iJ 5S-70.2... CSS') 2 2 3- S7G y'CI E-MAIL Check if you would also like to receive your plan review by e-mail [ h VVIArz✓UGG i ► wp)d a)'e• cowl 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 •t Public school district building of$100,000 or more in construction cost , ❑ State Licensed Facility licensed as a: ❑ Hospital ❑ Nursing Home ❑ Correctional Facility ❑ Supervised Living Facility ❑ Free-standing Outpatient Surgical Center CLASS OF WORK ❑ New Building Construction ❑ Addition .J,Remodeling ❑ Other,specify _ IBC OCCUPANCY CLASSIFICATION(S) IBC TYPE OF CONSTRUCTION SPRINKLERED I /.�3� I A 1+ �� Yes EJ No ❑ Partial PROJECT DESCRIPTION 1 pkNS_e_ j., yylec,k4,p7 l 61,,,,te,leal-,..�„�1 uP9r1to.Ct W;,}.� G15So& 4-J C-ei'l rEP1Acew,en+-s p1Q rreG1 w1a:n+enahce 71-CHu , Nrr,-0,<. 176196P45, . 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 Minnesota Registration No. supervision and that reasonable care has been given to compliance with ap 4cable laws, ordinances and building '�� codes and that this application is not a building permit nor does it auth rize the start of construction APPLICANT NAME(PRINT) APPLICANT SIG 4TURE DATE Nil-' - Marc•ttce. La lb Da Is this project on the State"MAPS"accounting system? ❑Yes ❑ N to Agency that will be paying fee? Calculated Plan Review Fee(By Applicant) FOR OFFICE USE ONLY A plan review fee must be submitted.Please see Plan Review Fee roj t No. Date Amount of Check the Plan Fee Schedule Worksheet for correct 9lQ calculation of the required plan review fee 1 °I D- ) . �� g'Sedi (V a I C033.2 This material can be made available in different forms, such as large print, Br Ille or on a tape. To request, ca I 800-342-5354( IAL-DLI)Voice or TDD(651)297-4198. BCS 02(2/07)