ARCHITECTURAL PLAN
REVIEW SUBMITTAL
FORM
OFFICIAL USE ONLY
DEC 2012
IOWA STATE FIRE MARSHAL OFFICE
STATE BUILDING CODE BUREAU
215 EAST 7TH STREET
DES MOINES, IA 50319
Business Hours: 8am - 4:30pm M-F
Phone: 515-725-6145
Building Code Bureau: www.iowabuildingcode.org
Fax: 515-725-6172
Email: bcinfo@dps.state.ia.us
State Fire Marshal: www.dps.state.ia.us/fm/index.shtml
Please send this completed form with plans and fees to the SFM’s address listed above.
PROVIDE ALL INFORMATION REQUESTED OR MARK AS NOT APPLICABLE.
Part 1- GENERAL INFORMATION
Project Name:
Brief description of work:
Project Street Address:
City:
Owner:
Owner Email:
Iowa, Zip:
County Name:
Contact:
Phone:
Architect/Engineer Firm Name:
Phone:
A/E Responsible Designer’s Name:
A/E Firm’s Street Address:
City:
IA License #:
State:
Zip:
A/E Contact Email:
Firm Submitting plans:
(If not the designer)
Firm Contact: Person’s Name:
Phone:
Email Address:
A prelim review is required prior to bid letting for building projects that are required to comply with
the State Building Code per 661-300.4 (1). Has a prelim been performed?:
Yes
No
N/A
Prelim was performed by- State Official’s name:
Date performed:
Is this project owned by the State of Iowa?
Yes
No
Is this project built with any funds appropriated by the State of Iowa?
If YES, describe type of state funds used:
Yes
No
Is this project located in a jurisdiction that has adopted and enforces building codes through plans
review and inspections?
Yes
No
If yes, Building Department or Official’s name:
Phone:
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Part 2 - BUILDING INFORMATION
BUILDING USE:
(State all uses in mixed use buildings)
NUMBER OF FLOORS:
(Split levels, full stories or basements)
MEZZANINE(s) Shown on plans?
Yes
If yes, describe use of mezzanine(s):
OCCUPANCY GROUP:
(Per IBC Chapter 3)
HEIGHT OF BUILDING (FT):
N/A
Total Area:
FIRE ALARM, SPRINKLER AND SUPPRESSION SUBMITTALS
Fire Protection plans & fees shall be submitted separately by the responsible contractor, using the
Fire Alarm; Sprinkler; or Suppression submittal forms available on our website: BCB FORMS
Part 3 – PLAN REVIEW CODE INFORMATION
Please indicate below type of construction used as defined by the International Building Code
NEW:
I-A
I-B
II-A
II-B
III-A
III-B
IV
V-A
V-B
EXISTING:
I-A
I-B
II-A
II-B
III-A
III-B
IV
V-A
V-B
Will the new building or addition have a fire sprinkler?
Yes
No
Does the existing building have a fire sprinkler?
Yes
No
What type of NFPA fire sprinkler does the building have?
13
13R
13D
Will the new building be provided with a complete NFPA 72 fire alarm system?
Yes
No
Does the existing building have a NFPA 72 fire alarm?
Yes
No
SIZE OF AREAS (SF) AND OCCUPANT LOADS FOR APPLICABLE WORK
Please indicate scope of work, area and calculated occupant loads below.
New Building
(New stand alone structure)
Square Feet:
Occupant Load:
Remodeled Space
(Renovated area that was previously occupied)
Square Feet:
Occupant Load:
New Addition to Building
(New structure attached to existing building)
Square Feet:
Occupant Load:
Finish Existing Shell Space
(Existing space not previously finished or occupied)
Square Feet:
Occupant Load:
Part 4 – PLAN REVIEW FEES
BUILDING VALUATION: Total building construction valuation includes materials & labor for all trades used (except fire
protection) supervision, project management, profit and overhead. (Does not include value of land civil & site
improvements). Valuation for Fire Alarm/Sprinkler-Suppression systems shall be considered separately for purposes of
establishing plan review fees on a separate submittal form.
TOTAL PROJECT VALUATION
Value: $
In accordance with Administrative Rule 661-300.4(2), I hereby certify that to the best of my
knowledge that the total estimated cost for this project is:
BUILDING VALUATION
Up to and Including:
$344,836
Greater than $344,836 up to
$1,000,000
FEE CALCULATION
REVIEW FEE
$200 minimum fee
$
$ 0.58 per thousand or fraction thereof
$
$ 580 for first million, plus $0.32 for each additional
$
thousand or fraction thereof
An additional $25 fee is charged for Energy code review for new buildings or
additions to buildings that have 100,000 cubic feet or more of conditioned space.
Greater than: $1,000,000
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$ 25.00
N/A
Part 5 - ASSISTED LIVING AND ADULT DAY SERVICES REVIEW FEES
Plan Review Fee required for Assisted Living and Adult Day Care projects:
Make checks payable to: INSPECTIONS AND APPEALS
$ 900.00
N/A
Part 6 – BUILDING INSPECTIONS AND FEES
Building projects subject to compliance with the State Building Code are required to have building inspections
performed for new buildings and additions, except for projects that will be reviewed & inspected by local
jurisdictions that have adopted a building code and have building code enforcement. State owned projects for
new construction require state inspections. Inspections fees are not required for projects that only involve
renovations/remodeling. You may check our approved list of jurisdictions with building code enforcement,
please note that this list may change without notice. Please call our office if you have questions regarding
whether inspections fees are applicable to your project.
Inspection fees are assessed based on project valuation below.
REQUIRED INSPECTION FEE
CONSTRUCTION VALUATION
Up to $100,000
$100,001 to $1,000.000
$1,000,001 to $10,000,000
$10,000,001 and above
$ 598.00
$ 645.00
$ 722.00
$ 783.00
Inspection Fees for state owned (IOWA BOARD OF REGENTS) projects.
All required fees for Assisted Living and Adult Day Services are shown in
$ 900.00
Part 5
Part 7 – SUSTAINABLE DESIGN REVIEW FEES
This part only applies if plans are submitted for Sustainable Design Review
Plan review fees for sustainable design projects subject to State Building Code per
administrative rule 661- 310.6(1)
Plan review fees for sustainable design projects subject to Local Building Code
review per administrative rule 661- 310.6(2) Provide evidence of review in Part 8
Plan review fees for sustainable design projects not subject to Local or State
Building Code review per administrative rule 661- 310.6(3)
N/A
$ 100.00
$ 250.00
$ 100.00
Part 8 - TOTAL FEES SUBMITTED
Total Fees submitted for Plan Review and Applicable Inspection Fees.
Parts 4, 6, & 7 Make checks payable to: STATE OF IOWA TREASURER $
Part 5, Make checks payable to: INSPECTIONS AND APPEALS
$
Part 9 - REQUIRED DOCUMENT SUBMITTALS
Indicate below which submittals are applicable for this submittal.
SUSTAINABLE DESIGN
The following are applicable if construction documents are being submitted for Sustainable Design review.
Evidence that the building code review has been approved for construction is required per 661-310.3 (4)
Attached is documentation from the local building department:
Yes
No
N/A
Building Plans are submitted for concurrent review for building code and sustainability:
Yes
No
N/A
Indicate below the standard used for sustainable design as per Green Building Rating System v3 or Higher or
other recognized standard for sustainable design per . 661-310.5 (103A)
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RESIDENTIAL PROJECTS sustainable design criteria as per 661—310.4(103A)
Iowa Green Streets
LEED
ICC 700
Other Standard:
N/A
COMMERICAL PROJECTS sustainable design criteria as per 661—310.5(103A)
N/A
LEED Gold
LEED Silver
Iowa Green Streets (Small Projects only)
Other:
ENERGY CODE COMPLIANCE
Do the construction documents (including all trades) comply with the requirements of the State Energy Code ?
Yes
No
N/A
If yes, Indicate below the compliance method used to determine that this project complies with the energy code,
and provide documentation to show this project is compliant.
COMcheck
ASHRAE/IESNA Std. 90.1
IECC PRESCRIPTIVE & MANDATORY PROVISIONS
Other:
In addition to the documentation requested above, a completed energy review form signed by responsible
architect or engineer is required for buildings that have 100,000 Cubic Feet or more of conditioned space.
Is the Energy Code Review Form attached?:
Yes
No
N/A
LIFE CYCLE COST ANALYSIS
A Life Cycle Cost Analysis is required per 661-303.4(470) and LCCA GUIDELINES.
Is a Life Cycle Cost Analysis required for this project?
Yes
No
N/A
If yes, have you received final approval for Life Cycle Cost Analysis by the Building Commissioner pursuant to
Iowa Code Section 470.1?
Yes
No
ELECTRONIC PLAN SUBMITTAL
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All construction Documents shall be submitted in electronic format on a disc with paper submittal form.
Digital drawings are required in DWF format with addendum, specifications, etc. in PDF format.
One set of paper drawings shall also be submitted along with the electronic documents.
All drawings designed by an Architect/Engineer shall bear the seal and signature along with a certification
indicating which drawings the designer is responsible for.
PART 10 - REQUIRED SIGNATURE
A signature is required by Architect/Engineer responsible for this plan design submittal or an authorized
representative knowledgeable of the construction documents who can answer building code questions.
I hereby certify to the best of my knowledge that all information submitted on this submittal form is accurate and
true and, I acknowledge that missing or incomplete information on construction documents or required fees,
may delay the plan review process until such time all information or fees are received.
Name(print):
Signature:
Date:
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