Form EHP-17 "Project Cost Estimate Worksheet" - Arkansas

What Is Form EHP-17?

This is a legal form that was released by the Arkansas Department of Health - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2016;
  • The latest edition provided by the Arkansas Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form EHP-17 by clicking the link below or browse more documents and templates provided by the Arkansas Department of Health.

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Download Form EHP-17 "Project Cost Estimate Worksheet" - Arkansas

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ARKANSAS DEPARTMENT OF HEALTH
PROJECT COST ESTIMATE WORKSHEET
As required by A.C.A. § 20-7-123, this worksheet must be completed and submitted with appropriate fee(s)
PROJECT ID#
(ADH Use Only)
PROJECT NAME
COUNTY
PROJECT LOCATION (911 if available)
CITY, STATE, ZIP
OWNER/SUBMITTER NAME
TELEPHONE
MAILING ADDRESS____________________________________________________________________
CITY, STATE, ZIP CODE
EMAIL______________________________________________________________________________
------------------------------------------------------------------------------------------------------------------------------------------------
COST ESTIMATE:
ESTIMATED COST SHALL BE BASED ONLY ON THOSE IMPROVEMENTS THAT
REQUIRE A DEPARTMENT OF HEALTH REVIEW .
1. WATER SYSTEM IMPROVEMENTS..............................................
$
For questions regarding water system improvements ENG (501) 661-2623
2. SEWER SYSTEM IMPROVEMENTS…………………...................
$
For questions regarding sewer system improvements ENG (501) 661-2623
3. PLUMBING…………………………………………………................
$
For questions regarding plumbing plans
(501) 661-2650
4. SWIMMING POOL………………………………………...................
$
(501) 661-2171
For questions regarding swimming pool plans
5. FOOD ESTABLISHMENT IMPROVEMENTS…..…………............
$
(501) 661-2163
For questions regarding food establishment plans
6. HEALTH CARE FACILITY IMPROVEMENTS……………..............
$
For questions regarding health care facility improvements (501) 661-2201
7. OTHER............................................................................................
$
TOTAL ESTIMATED COST………………………………..............
$
-------------------------------------------------------------------------------------------------------------------------------------------
A. PLAN REVIEW FEE................................................................... $
1% of total est. cost, not less than $50.00 and not to exceed $500.00.
(see #1 on page 2)
B. PLAN REVIEW FEE………………………………………………. $
______________
(see #2 on page 2)
For plans utilizing onsite wastewater systems including subdivisions
containing lots < 3 acres, mobile home and RV parks.
TOTAL FEES SUBMITTED …………………………………………. $
(Add A & B) Recommend (A) & (B) be separate checks made payable to ADH.
PREPARED BY:
DATE
PRINT NAME: ___________________________________________________________
EHP-17 (8 /16)
Page 1 of 2
ARKANSAS DEPARTMENT OF HEALTH
PROJECT COST ESTIMATE WORKSHEET
As required by A.C.A. § 20-7-123, this worksheet must be completed and submitted with appropriate fee(s)
PROJECT ID#
(ADH Use Only)
PROJECT NAME
COUNTY
PROJECT LOCATION (911 if available)
CITY, STATE, ZIP
OWNER/SUBMITTER NAME
TELEPHONE
MAILING ADDRESS____________________________________________________________________
CITY, STATE, ZIP CODE
EMAIL______________________________________________________________________________
------------------------------------------------------------------------------------------------------------------------------------------------
COST ESTIMATE:
ESTIMATED COST SHALL BE BASED ONLY ON THOSE IMPROVEMENTS THAT
REQUIRE A DEPARTMENT OF HEALTH REVIEW .
1. WATER SYSTEM IMPROVEMENTS..............................................
$
For questions regarding water system improvements ENG (501) 661-2623
2. SEWER SYSTEM IMPROVEMENTS…………………...................
$
For questions regarding sewer system improvements ENG (501) 661-2623
3. PLUMBING…………………………………………………................
$
For questions regarding plumbing plans
(501) 661-2650
4. SWIMMING POOL………………………………………...................
$
(501) 661-2171
For questions regarding swimming pool plans
5. FOOD ESTABLISHMENT IMPROVEMENTS…..…………............
$
(501) 661-2163
For questions regarding food establishment plans
6. HEALTH CARE FACILITY IMPROVEMENTS……………..............
$
For questions regarding health care facility improvements (501) 661-2201
7. OTHER............................................................................................
$
TOTAL ESTIMATED COST………………………………..............
$
-------------------------------------------------------------------------------------------------------------------------------------------
A. PLAN REVIEW FEE................................................................... $
1% of total est. cost, not less than $50.00 and not to exceed $500.00.
(see #1 on page 2)
B. PLAN REVIEW FEE………………………………………………. $
______________
(see #2 on page 2)
For plans utilizing onsite wastewater systems including subdivisions
containing lots < 3 acres, mobile home and RV parks.
TOTAL FEES SUBMITTED …………………………………………. $
(Add A & B) Recommend (A) & (B) be separate checks made payable to ADH.
PREPARED BY:
DATE
PRINT NAME: ___________________________________________________________
EHP-17 (8 /16)
Page 1 of 2
EXPLANATION OF PLAN REVIEW FEES
#1)
A.C.A. § 20-7-123 establishing a fee for the review of plans and specifications which
are required by law or regulation to be reviewed by the Department (Line items #
1,2,3,4,5,6,7 on page 1). The fee is 1% of the estimated cost of improvements, with a
minimum fee of $50.00 and a maximum fee of $500.00. An Engineering estimate must
accompany the plans unless the maximum fee of $500.00 is paid.
IF TOTAL ESTIMATED COST IS $5,000.00 OR LESS, REVIEW FEE IS $50.00.
IF TOTAL ESTIMATED COST IS $50,000.00 OR MORE, REVIEW FEE IS $500.00.
IF TOTAL ESTIMATED COST IS BETW EEN $5,000.00 AND $50,000.00, CALCULATE AS FOLLOWS:
PLAN REVIEW FEE = (0.01) x (TOTAL ESTIMATED COST) = $____________
#2)
A.C.A. § 14-236-116 establishing a fee for the review of plans for subdivisions containing lots
<3 acres utilizing individual onsite wastewater systems.
SUBDIVISIONS on INDIVIDUAL ONSITE WASTEWATER SYSTEMS:
FIRST LOT @ $100.00…..........................$
100
_
ADDITIONAL LOTS @ $25.00/each..........$
TOTAL…................................................=$
(MAXIMUM FEE = $1500.00)
#3)
A.C.A. § 20-27-1201 established a review fee for Mobile Home Parks and Recreational Vehicle
Parks utilizing onsite wastewater systems and is based on the number of spaces.
MOBILE HOME & RECREATIONAL VEHICLE PARKS UTILIZING ONSITE WASTEWATER SYSTEMS:
2-25 SPACES………………….
$25.00
26-50 SPACES………………..
$50.00
51-75 SPACES………………..
$75.00
76 OR MORE…………………. $100.00
EHP-17 (8 /16)
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