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CITY OF MIDDLETON FIRE PROTECTION PLAN REVIEW / PERMIT APPLICATION 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: Has installation of the fire protection system started yet? Yes No Penalty for failure to obtain a permit before starting work shall be double the fees. This shall be in addition to any other penalties provided elsewhere in the Middleton General Ordinances. OCCUPANCY TYPE R-2 R-3 R-4 A-2 A-3 A-4 A-5 R-1 A-1 H-1 H-2 H-3 H-4 H-5 E-school F-1 F-2 B I-2 I-3 I-4 E-daycare I-1 S-1 S-2 M U PROJECT’S AREA: AMOUNT OF FEE ENCLOSED: $ (square feet of affected area) (See Fee Schedule on page 2) SCOPE/DESCRIPTION OF WORK: Scope of work shall include type of devices, number of devices, and specific location within building. Attach additional page if necessary. TYPE OF SUBMITTAL: NEW SYSTEM ALTERATION Yes No (Check all that apply) DEMOLITION ONLY Less Than 21 Sprinklers 4 or Less Fire Alarm Devices Yes No TYPE OF SYSTEM: ALTERNATE SUPPRESSION SYSTEM (Check all that apply) FIRE ALARM SYSTEM OUTDOOR FIRE FEATURE ACCESS CONTROL/DELAYED EGRESS SPRINKLER SYSTEM KITCHEN HOOD OTHER: NUMBER OF DEVICES: Complete the following applicant/designer/owner information. Utilize the check box to indicate payer. APPLICANT INFORMATION DESIGNER INFORMATION FIRST NAME LAST NAME FIRST NAME LAST NAME COMPANY NAME COMPANY NAME ADDRESS ADDRESS CITY STATE ZIP+4 (9 DIGITS) CITY STATE ZIP+4 (9 DIGITS) PHONE NUMBER (W/AREA CODE) EMAIL **REQUIRED** PHONE NUMBER (W/AREA CODE) EMAIL OWNER INFORMATION OTHER (please specify) FIRST NAME LAST NAME FIRST NAME LAST NAME COMPANY NAME COMPANY NAME ADDRESS ADDRESS CITY STATE ZIP+4 (9 DIGITS) CITY STATE ZIP+4 (9 DIGITS) PHONE NUMBER (W/AREA CODE) EMAIL PHONE NUMBER (W/AREA CODE) EMAIL Applicant Signature: Application Date: 7426 HUBBARD AVE MIDDELTON, WI 53562 [PHONE REDACTED] [EMAIL REDACTED] PLAN REVIEW DACT ---PAGE BREAK--- Reviews and Permit Fees See Area Table See Area Table See Area Table See Area Table $250 $250 $250 for up to 10 devices $100 for each additional 10 devices $250 $250 $250 $150 $150 $150 $175 Fire Alarm plan review new or alteration over 4 devices Fire Suppression plan review new or alteration over 20 heads Alternate Fire Suppression plan review Standpipe system Commercial kitchen hood review & permit Clean Agent Review Permit Controlled Access Review & Permit Fire Alarm Panel/DACT Existing Replacement Smoke Control Panels Fire Command Centers Outdoor Fire Feature Fire Alarm Alteration 4 devices or less Fire Suppression Alteration 20 heads or less & no hydraulic impact Plan Revision to approved plans (simple revisions) Fire Alarm/Suppression new/alteration over 4&20 permit fee Base Fee $100 + SF fees below Group I Bldg. $.03 per SF Group II Bldg. $.04 per SF Group III Bldg $.02 per SF AREA TABLE SIZE OF PROJECT FEE Less than 2,500 square feet $130.00 2,501 – 5,000 square feet $160.00 5,001 – 10,000 square feet $200.00 10,001 – 20,000 square feet $250.00 20,001 – 30,000 square feet $300.00 30,001 – 40,000 square feet $450.00 40,001 – 50,000 square feet $600.00 50,001 – 75,000 square feet $800.00 75,001 – 100,000 square feet $1,100.00 100,001 – 200,000 square feet $1,300.00 200,001 – 300,000 square feet $3,100.00 300,001 – 400,000 square feet $4,50000 400,001 – 500,000 square feet $5,700.00 Over 500,001 square feet $6,700.00 Note: When making your payment, We accept checks mad out to (City of Middleton) or we can process credit card payments. Check mailed to: City of Middleton Credit card processing please contact: Middleton Building Inspection Department [PHONE REDACTED] ATTN: Building Inspection 7426 Hubbard Ave Middleton, WI 53562 Rev. 4/29/2021 Square Footage Basement Ground Floor 1st Floor 2nd Floor 3rd Floor Add. Floors Total SF Group I All residential buildings, single family, two-family and multifamily dwellings, residential garages and storage sheds. (This group does not include hotels, motels or institutional buildings). Group II General and professional offices, barber shops, beauty parlors, bowling alleys, dry-cleaning establishments, clinics, natatoriums, shelters, hotels and motels, taverns, restaurants, cafeterias, retail establishments, commercial garages, service stations, churches, assembly halls, theaters, exhibition buildings, educational institutions, hospitals, nursing homes, places of detention, gymnasiums, arenas, laboratories, lodge halls, funeral homes, libraries, skating rinks, dance halls, and armories. Group III Warehouses, freight terminals, storage buildings, refrigeration storage, factories, machine shops, electric sub-stations, sewage treatment plants, heating plants, steam & electric generating plants, transformer vaults and other building not classified in Groups I – II. ---PAGE BREAK--- SUBMITTAL PROCESS Submit a stamped PDF of the set of plans- unlocked and scaled - if too large for E-mail please a range a cloud drive transfer please submit all calculations and material specifications Completed application form Completed checklist FEES must be paid prior to review. Supervising Professional's Statement: I have been retained by the owner as the supervising professional for the performance or 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 City of Middleton Building Inspection Division 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. Supervising Professional Signature Registration # Print Name Rev. 4/29/2021 Fire Alarm Permit - 4 or less devices will need a detailed scope of work statement with a simple floor plan showing the location of the altered, removed or added devices or specific room number or location descriptions. Plan review and permit - More than 4 devices require a full plan, battery calculations, device and equipment manufacture specifications submittal. Fire Suppression Permit – less than 20 heads with no hydraulic impacts, require a detailed scope of work statement with a simple floor plan showing the location of the altered, removed or added heads, or list a specific room number or location descriptions. Plan review and permit – 20 heads or less and has hydraulic impact= full plans and specs. More than 20 heads= full plans and specs Access Control Plan Submittal Requirements Provide PDF drawings with the following information: 1. Detailed scope of work statement identifying the operation of the Access Control/ Egress Control System in normal, loss of power, and the activation of a fire protection system 2. A scaled floor plan that shows: a. Plan should only include access control details b. Onclude room names c. The complete path(s) of egress d. Identifies which doors are to be provided with access control devices e. Detail the installation location and layout, including all hookups/integration into building systems 3. A door schedule showing fire rating and hardware to be provided 4. Manufacturer’s specification sheets for hardware (cut sheets) 5. Sequence of operation 6. Manufacturer’s specification sheets for the types of detectors used (cut sheets) ---PAGE BREAK--- Project Name: Checklist for Fire Suppression and Fire Alarm Plan Review Summary Sheet Paper plan submittals are no longer accepted by the Department. This form is to be included as a summary sheet for fire suppression and fire alarm plan submittals Date of Application: _ Check all that are Applicable Plan Type: _New _Addition _Alteration _Revision to already approved plan Requesting plan review for: (Please check the requested building reviews below) D Fire Suppression Review D Fire Alarm I Detection Review D Underground Private Fire Service Main Review Section 2. PLAN SUBMITTAL REQUIREMENTS. PLAN SUBMITALL SHALL INCLUDE THE FOLLOWING IN ACCORDANCE WITH CODE SECTION SPS 361.31: A complete set of fire suppression or fire alarm plans and supporting documents. Incomplete submittals will be rejected. Please check the boxes below to ensure your plan submittal is complete. Plans shall be legible and to scale. Plans are required to be submitted in accordance with the submitter instructions requirements. For more information, refer to the Fire Suppression or the Fire Alarm plan submittal guidelines. FIRE SUPPRESSION PLANS N/A 1. D D Copy of signed application form. Sign for Supervising Professional if Stand-Alone Plan Submittal 2. D D Properly signed/sealed Title Sheet including plan Index. 3. D D Complete fire suppression plans. 4. D D Hydraulic calculations. Include if applicable. 5. D D Material product data sheets. 6. D D High-piled combustible storage [SPS 362.0202(1)] or High-hazard Group H occupancies (IBC 307], detailed information shall be provided to clearly depict the parameters used for establishing the design criteria. FIRE ALARM/ DETECTION PLANS N/A 1. D D Copy of signed application form. Sign for Supervising Professional if Stand-Alone Plan Submittal 2. D D Properly signed/sealed Title Sheet including plan Index. 3. D D Complete fire alarm plans. 4. D D Battery calculations. 5. D D Voltage-drop calculations for each notification appliance circuit. 6. D D Material product data sheets. 7. D DA detailed, project-specific 'Sequence of Operation' Narrative or Matrix which clearly identifies all functions of the fire alarm system, including the transmission of alarm, supervisory and trouble signals to an approved supervising station. Include the communication method of signals sent from the fire alarm system to the supervising station. UNDERGROUND PRIVATE FIRE SERVICE MAIN PLANS N/A 1. 2. 3. 4. 5. D D Copy of signed application form. Sign for Supervising Professional if Stand-Alone Plan Submittal - no related transaction ID. D D Properly signed/sealed Title Sheet including plan Index. D D Complete underground fire service main plans. D D Thrust block calculations. Include if applicable. D D Material product data sheets. D Submitter acknowledges that the submittal Is complete. D Submitter acknowledges that any additional information requested to complete review will be received by the Department within fifteen (15) business days or the plan is subject to denial. Submitter's Signature Date Rev. 4/29/2021