Form Bcc 534 – Fill Out and Use This PDF

Application for Approval and Renewal of Inspection and Evaluation Agencies

139

Michigan Department of Licensing and Regulatory Affairs

Bureau of Construction Codes / Plan Review Division

P.O. Box 30255, Lansing, MI 48909

517-241-9328

www.michigan.gov/bcc

Agency Use Only

Authority:

1972 PA 230

LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available

Part 11 Premanufactured Unit Rules, Rule 1172

upon request to individuals with disabilities.

Approval:

Mandatory Annual Renewal

□ INITIAL APPLICATION

FILING FEE:

$750.00

□ ANNUAL RENEWAL

FILING FEE:

$150.00

Rule 1171.

□

(1)

An inspection or evaluation agency seeking approval shall submit an application to the commission which includes the items listed in this rule.

□

(2)

The original articles of incorporation of the agency and all subsequent amendments thereto, as filed in the state of incorporation.

□

(3)

The bylaws of the organization.

□

(4)

The names, addresses, and business affiliations of all members of the board of directors and of top management personnel.

□

(5)

Stock owned in amounts over $5,000.00 reflecting the financial interests of the agency’s board of directors and top management personnel if

□ (6)

requested by the commission.

Certification by the agency that:

□

(a)

Its board of directors, as a body, and its technical personnel, as individuals can exercise independence of judgment.

□

(b)

Its activities pursuant hereto will result in no financial benefit to the agency via stock ownership or other financial interests in any producer, supplier,

□ (7)

or vendor of products involved, other than through standard published fees for services rendered.

Names, years of experience, state in which professionally registered, and other qualifications of the directors of inspection or evaluation

□ (8)

programs.

Names and years of experience of employees practicing in the following disciplines: architecture, structural engineering, mechanical engineering,

□ (9)

electrical engineering, fire protection and other branches of engineering; the states in which each is registered and the services each performs.

An organization chart showing management and supervisory persons, including the number of graduate engineers and architects, and the names

□ (10)

of all consulting engineers or architects, designating which are full time and which are part time engineers.

Number and location of factory inspectors, supervisors and other technicians, including evaluators of factory inspectors and the qualifications of

each specialized group, including records of work experience, licenses held and other pertinent qualifications; descriptions of the type of work

□ (11)

each group and each technician is expected to perform, and the qualifications of each group and each technician to perform the work assigned.

An outline of the training program, if any, of the agency to assure that all inspectors, evaluators, and other technicians are properly trained to do

□ (12)

each job assigned to them.

An outline of the general procedures for supervision of inspectors and evaluators, including checking and evaluation of their work.

□

(13)

All engineers, technicians, and other personnel who will perform services for the organization but who are not employees of the organization, and

□ (14)

the supervisory and other relationships which each will have to the agency.

Type of products, components, equipment, structures, and other items which the organization has evaluated, tested or inspected, and the number

of years of experience the organization has had with each, and the type of codes, standards, specifications and requirements with respect to which

□ (15)

organization has had experience in providing evaluation, inspection or testing services, and the number of years of experience with each.

Description of the record keeping system the agency proposes to use with particular regard to availability of records to the commission and the

□ (16)

capacity to render reports to the commission.

Description of the frequency with which the agency is capable of performing inspections or evaluations.

□

(17)

List of the states in which the agency is now approved to inspect or evaluate premanufactured units or building components, and a further listing

□ (18)

of those states in which the agency intends to seek such approval within the next 2 years.

Certification that the agency is able to evaluate building systems for compliance with the codes, standards, specifications and requirements

adopted in this state, or premanufactured units or building components for compliance with approved building systems.

APPLICANT (Note: All correspondence will be sent to this address)

NAME OF COMPANY

APPLICANT NAME

FEIN OR SS NO.* (Required)

ADDRESS

CITY

STATE

ZIP CODE

TELEPHONE NUMBER (Include Area Code)

APPLICANT’S SIGNATURE (Must be an original signature)

DATE

E-MAIL ADDRESS

FAX NUMBER (Include Area Code)