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Estimated Construction Cost Fee Due see following table on page 2 to calculate Owner or Authorized Representative s Name Type or Print PH-4096 Rev 3/12 Signature Date RDA-0495 When calculating fee round the construction cost up to the nearest one-thousand dollars e.g. 125 101. State of Tennessee Department of Health Health Licensure and Regulation Division of Health Care Facilities 710 Hart Lane 1st Floor Nashville Tennessee 37243 Office Phone 6.

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How to fill out the Ph 4096 Form online

Filling out the Ph 4096 Form online is a crucial step in the plans review submittal process for construction projects in Tennessee. This guide will walk you through each section of the form, ensuring that you provide all necessary information accurately.

Follow the steps to successfully complete the Ph 4096 Form online.

  1. Click the ‘Get Form’ button to obtain the Ph 4096 Form and open it for editing.
  2. Begin by entering the description of the project in the designated field. This should clearly articulate the nature of your construction or renovation.
  3. Select the type of project by checking one of the boxes for new construction, renovation, or addition.
  4. Fill in the project name and provide the street address, city, zip code, and county of the project location.
  5. Input the project owner's name and telephone number, ensuring all contact details are correct for future correspondence.
  6. Include the contact person's information along with their fax number and mailing address. This person is responsible for communication regarding the project.
  7. Provide the project architect or engineer's details. Include their name and telephone number and the architectural or engineering firm, including contact information.
  8. Detail the sprinkler contractor's name and contact details, including their fax number and mailing address if applicable.
  9. Indicate the approximate dates for the construction start and completion. Ensure these dates are realistic and reflect actual planning.
  10. Specify the occupancy type and construction type as defined by the relevant codes, marking the correct responses as applicable.
  11. Provide additional details such as the height of the construction, number of stories, and building area for both new and existing constructions.
  12. Mark whether a Certificate of Need is required and provide its expiration date if applicable.
  13. Indicate if a licensing application and fee are required. If yes, prepare to manage this prior to review.
  14. Enter the details of where approved drawings should be shipped, filling in any relevant FedEx or UPS account numbers.
  15. Certify the total construction cost, excluding land cost, and note the fee due for the submission.
  16. Finally, type or print the name of the owner or authorized representative, sign, and date the form.
  17. You can now save your changes, download the form for your records, print it if necessary, or share it with relevant parties.

Complete your Ph 4096 Form online to streamline your project review process.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232