Department:
People We Serve:
Programs & Initiatives:
Share
Print
RSSMOPD Pre-Plan Review Project Data Form
The Pre-Permit Review Project Review Data Form must be completed prior to meeting with MOPD's Accessibility Compliance Unit for Pre-Plan Review services.
MOPD's Pre-Permit Review Project Review Data Form
CITY OF CHICAGO
Mayor’s Office for People with Disabilities
Project data to determine compliance with the
Chapter 18-11 of the Chicago Building Code; ANSI A117.1- 2003 and the Illinois Accessibility Code
|
Project Name ____________________________________________________ |
DOB Permit App# _____________________ |
||
|
Project Address ___________________________________________________ |
Owner ________________________________ |
||
|
Architect ______________________________ |
Address _____________________________ |
Phone ____________________ |
|
MOPD SCHEDULE (A)
|
# of Lodging Accessible Units |
|
Multiple Dwelling (4 or More Stories and 10 or More Units)? (Y/N) |
|
|
# of Lodging Units w/Communication Features |
|
Structure w/4 or More Units? (Y/N) |
|
|
# of Accessible Lodging Units w/ Communication Features |
|
SFR (Detached? (Y/N) |
|
|
# of Type A Dwelling Units |
|
Attached Multi-Story SFR w/ Separate Means of Egress? (Y/N) |
|
|
# of Type B Dwelling Units |
|
|
|
|
# of Type A and B Dwelling w/ Conduit Lines |
|
Other:
_______________________________________________
|
|
|
# of Visitable Dwelling Units |
|
||
|
# of Attached Multi-Story SFR Units w/ Separate Means of Egress |
|
||
|
# of Section 504 Dwelling Units Accessible |
|
||
|
# of Section 504 Dwelling Units w/ Communication Features |
|
||
|
# of Zoning Incentive Building Type A Dwelling Units |
|
||
|
Change of Occupancy to Residential (20 Units or More)? (Y/N) |
|
||
|
Planning Development? (Y/N) |
|
||
|
Planning Development # |
|
||
MOPD SCHEDULE (B)
|
Government owned, subsidized or guaranteed? (Y/N) |
|
Construction Type: ______ |
Occupancy Class: ______ |
||||||||||||
|
# of Government Funded Dwelling Units |
|
||||||||||||||
|
# of Dwelling Units |
|
||||||||||||||
|
Approx. Area Per Story |
|
||||||||||||||
|
Type of Funding: Private: ____ City: ____ State: ____ Federal: ____ City/Federal: ____ City/State: ____ State/Federal: ____ |
|||||||||||||||
|
New Homes for Chicago Project? (Y/N) |
|
|
|||||||||||||
|
Planned Development Type: Addition: _____ Alteration/Replacement: _____ New Construction: _____ Repair: ______ |
|||||||||||||||
|
Chicago Public Schools? (Y/N) |
|
|
|||||||||||||
|
Developer Services: ________ |
Self Certification: _______ |
Audited Review: |
Yes: ______ |
No: ______ |
|||||||||||
|
For Alterations/Replacement, provide the following info: |
|||||||||||||||
|
Total Alteration Cost in last 30 months _____________ EAC ____________ ERC _____________ EAC/ERC % ____________ |
|||||||||||||||
|
|
|||||||||||||||
|
Architect Certifying Compliance
|
___________________________ (Printed Name) |
___________________________ (Signature) |
_______________________ Date |
||||||||||||
|
MOPD ACCEPTS PROPOSAL
|
___________________________ (Printed Name) |
___________________________ (Signature) |
_______________________ Date |
||||||||||||
|
To be signed and dated by authorized Mayor’s Office for People with Disabilities staff and returned to applicant. |
|||||||||||||||
|
|
|||||||||||||||
|
1st Review: |
Units ________________ |
Date _______________________ |
Reviewer ____________________________ |
||||||||||||
|
2nd Review: |
Units ________________ |
Date _______________________ |
Reviewer ____________________________ |
||||||||||||
|
3rd Review: |
Units ________________ |
Date _______________________ |
Reviewer ____________________________ |
||||||||||||
|
Permit Fees: $ ____________ |
Fees Waived: |
Yes: _____ |
No: _______ |
||||||||||||
Rev 1/8/2008 – MOPD FORM.doc
