Form Sbd 118 – Fill Out and Use This PDF

Wisconsin Department of Safety and Professional Services

Application for Review - Buildings, HVAC, Lighting,

Fire and Components – SBD-118

Use this form in conjunction with the City of Sparta Commercial Building Permit application

for projects not requiring State approved plans.

	Designer Information (Customer 1)		First Time Submitter _____Yes ____No			Designer Information (Customer 2)		First Time Submitter ___Yes ___No
	First Name		Last Name	Customer Number		First Name		Last Name	Customer Number
	__________________________________________________________________					____________________________________________________________
	Company Name					Company Name
						____________________________________________________________________
	__________________________________________________________________
	Address					Address
	__________________________________________________________________					____________________________________________________________________
	City		State	Zip+4 (9 digits)		City		State	Zip+4 (9 digits)
	__________________________________________________________________					____________________________________________________________________
	Phone Number (area code)		Fax	E-Mail		Phone Number (area code)		Fax	E-Mail
	__________________________________________________________________					____________________________________________________________________
	Check all applicable					Check all applicable
	(	) Designer of ___Bldg ___HVAC,___ Lighting _____Fire Alarm _____Fire Suppression				(	) Designer of ___Bldg ___HVAC,___ Lighting _____Fire Alarm _____Fire Suppression
	(	) Supervising Professional of ____Bldg _____HVAC				(	) Supervising Professional of ____Bldg _____HVAC
	WI Designer Registration #______________________ Exp Date ________________					WI Designer Registration #______________________ Exp Date ________________
	Property Owner (not lessee) Information (Customer 3)					Other (Customer 4) ____Add’l Owner ______ Designer ______Mail to ______Payer
	First Name		Last Name	Customer Number		First Name		Last Name	Customer Number
	__________________________________________________________________					____________________________________________________________________
	Company Name					Company Name
	__________________________________________________________________
						____________________________________________________________________
	Address					Address
	__________________________________________________________________
						____________________________________________________________________
	City		State	Zip+4 (9 digits)		City		State	Zip+4 (9 digits)
	__________________________________________________________________					____________________________________________________________________
	Phone Number (area code)		Fax	E-Mail		Phone Number (area code)		Fax	E-Mail

SBD-118 (R 05/12)

7. Fire Protection														Submitter Comments or Requests (Optional)
Provide the following information on any fire alarm or fire suppression system. If not part of this
submittal, they will generally need to be submitted for review to the office that reviewed any building
plans for the project, except that our Holmen office does not review fire protection plans. Submit plans
for multi-purpose piping (MPP) systems as part of your plumbing plan submittal using the plumbing
plan application, SBD-6154.
Check system type as applicable. Building plans must also include this information to
determine allowable building area / heights						FIRE SUPPRESSION
		FIRE ALARM
(	) Complete ( ) Partial (		) None
Type: (		) Automatic Detection	(	) Complete			(	) Partial		(	) None
	(	) Manual Alarm	Type: (		) Wet		(	) Dry ( ) Pre-action/Deluge
Monitoring Type:				( ) Anti-Freeze ( ) Manual Wet
(	) Central Station		NFPA Fire Suppression Standards used
(	) Remote Supervision		(	) 11	(	) 11A		(	) 12	(	) 13	(	) 13R
(	) Proprietary Supervision		(	) 13D	( ) 13D - MPP					(	) 14	(	) 15
(	) Protected Premises		(	) 16	(	) 17		(	) 17R	( ) 17A ( ) 20
			(	) 22	(	) 24		(	) 750	(	) 2001 (		) Other _____

8. Other Potential Plan Submittals Required For A Project?

Contact S&BD for individual submittal requirements for all of the following:

 Petition for Variance – Submit form SBD-9890		- Erosion control and stormwater management under SPS 360
 Plumbing and private sewage systems under SPS 381-385		- Boiler andpressure vessels under SPS 341
	Elevators or Escalators under SPS 318	-	Mechanical Refrigeration under SPS 345
	Swimming Pools or other Aquatic Centers within a Commercial/Public Facility under SPS 390	-	There is no state electrical review under SPS 316

Tank storage of 5,000 gallons or more of flammable or combustible liquids under SPS 10

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 and breakfast establishments contact the Environmental Sanitation Section, 608-266-2835.

The Wisconsin Permit Center, 1-800-435- 7287, may be able to help you with other state permit requirements.

Note: Be aware that state plan review and approval is separate from local permits. Check with the local municipality and county for their requirements.

9.Required Signatures

a)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.

SignaturePrint

________________________________________ _____________________________________________________________________________( ) Building ( ) HVAC Date_______________

________________________________________ _____________________________________________________________________________( ) Building ( ) HVAC Date_______________

NOTE: Building supervising professional is also responsible for supervision of fire suppression / alarm installation (if applicable)

b)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

c)Optional Service-of 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 $75.00 fee per building) Request is for the following buildings:________________________________________________________________________

Owner's Signature __________________________________________________________________________________________Date _____________________________

d)( ) Invoice designer, who will be personally responsible for payment.

Designer Signature ___________________________________________________________________

10.Statements of Owners and Designer

a)Owners Statement: The owner indicated on page one requests that plans be reviewed for compliance with the code requirements set forth in Comm 60 to 66 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 361.40): The designer indicated on page one of this form 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 Safety and Buildings Division 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-registered engineer, architect, or designer [SPS 361.31(1)]. Signatures and seals affixed to the plans shall be original.

SBD-118 (R 05/12)