CITY OF CHICAGO
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
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