ENGINEERING SERVICES SECTION
Instructions for “Construction Plan
Submittal Form”
There are three sections on the Construction Plan Submittal Form that must be filled out:
General Information, Building and Plan Code Information and Estimated Project Cost. Each
section is explained in detail below. NOTE: For the best results use Microsoft Office 2013 to
complete the form.
To populate a field, navigate the white arrow pointer or the “I” bar over the red text on the
form and click. The field will turn gray indicating you can begin entering text. If there is a drop
down arrow on the right hand side of the gray field, click on it to display either a list of choices
or a calendar.
If you have any questions about how to fill out this form, email
[email protected] or call 651-201-4229.
General Information Section
Project Name:
Enter the project name as it is shown on the submitted plans.
Date:
Click on the drop down arrow to expose the calendar.
INSTRUCTIONS FOR “CONSTRUCTION PLAN SUBMITTAL FORM”
Click on the current date.
Project Narrative:
Give a brief description (no more than three lines of text) to describe the project.
Facility Administrator and Administrator’s Email:
Enter the name and email of the administrator of the facility where the work is taking place.
Phone:
Please enter the phone number separated by a hyphen. For example, enter 651-201-5000
instead of 6512015000.
Facility Name and Address:
Enter the name and address of the facility that is on the facility license.
Project Address (including City, State, Zip, and County):
The physical address of the project, which is where the project is taking place. This may be
different than the address on the facility license.
Submitter Information:
Contact information for the individual submitting the project to the Engineering Services
Section.
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INSTRUCTIONS FOR “CONSTRUCTION PLAN SUBMITTAL FORM”
Building and Plan Code Information Section
Number of Floors and Square Feet:
Enter the number of floors and square footage for the entire project.
Type of Project:
Click on the drop down arrow to expose a list of choices, and then select whether this is a new
facility, a remodel, an addition or a remodel and addition.
Type of Construction:
For a complete description of the codes listed in the drop down list refer to NFPA 220 Standard
on Types of Building Construction 1999 Edition.
Click on the drop down arrow to expose a list of choices, and then select the correct code.
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INSTRUCTIONS FOR “CONSTRUCTION PLAN SUBMITTAL FORM”
State License Type:
Check mark the appropriate box to indicate your license type.
▪
FOSC – Freestanding Outpatient Surgical Center
▪
HSP – Hospital
▪
NH – Nursing Home
▪
RES HOSPICE – Residential Hospice
▪
SLF A – Supervised Living Facility Class A (Ambulatory)
▪
SLF B – Supervised Living Facility Class B (Non-Ambulatory)
▪
SLF A & B – Supervised Living Facility Class A and B (Ambulatory and Non-Ambulatory)
Federal Certification Type:
Check mark the appropriate box to indicate your Federal Certification Type, if applicable.
▪
ASC – Ambulatory Surgical Center
▪
CAH – Critical Access Hospital
▪
ESRD – End Stage Renal Disease
▪
HOSPICE – Certified Hospice
▪
HSP – Hospital
▪
ICF/IID – Intermediate care facilities for individuals with intellectual disabilities
▪
SNFNF – Supervised Nursing Facility/Nursing Facility
Estimated Project Cost Section
Estimated Project Cost:
Click on the drop down arrow to expose a list of choices.
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INSTRUCTIONS FOR “CONSTRUCTION PLAN SUBMITTAL FORM”
If your computer does not display the entire width of the text on the list be sure to use the
“screen tip” for your selection. The screen tip is circled in red.
Screenshot of completed Estimated project cost dollar amount range and fee, including the
Estimated project cost:
Submitting Completed Form
Print and mail or hand deliver your completed form to:
MAIL COMPLETED FORM TO:
COURIER/STREET ADDRESS:
MDH – Health Regulation Division
Engineering Services Section
P.O. Box 64900
St. Paul, MN 55164-0900
MDH – Health Regulation Division
Engineering Services Section
85 7th Place East, Suite 220
St. Paul, MN 55101
Or attach your completed form in an email to: [email protected].
Please note that nothing will be processed until all four components of the submittal package
have been received. The four components are: completed submittal form, correct fee amount,
paper and digital copy of the signed/certified final plans.
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