Restaurant / Concept Entity Name
Primary Facility Use (e.g., Full-Service Restaurant, Fast-Casual, Bar/Lounge, Bakery)
Building / Center Name & Address
Suite / Space Number(s)
Total Square Footage
Primary Hospitality Operator Contact
Title
Office Phone
Mobile Phone
24/7 On-Site Emergency Contact
Phone
Proposed Construction Start Date
Target Health Department Inspection Date
Target Grand Opening / Reopening Date
Categories of Work (Check all that apply
Kitchen Exhaust & Ventilation (Type I / Type II hoods, pollution control units, roof curbs, ductwork)
Grease Trap & Interceptor Plumbing (Underground grease traps, floor sinks, trench drains, backflow assemblies)
High-Capacity Gas & Utility Line Runs (Commercial gas manifold upgrades, heavy-duty electrical connections)
Refrigeration & Cold Storage (Walk-in cooler/freezer slab penetrations, exterior compressor rack placements)
Architectural & Seating Layout (Bar counter construction, dining room partitions, host stand buildouts)
Outdoor Dining & Patio Buildouts (Permanent perimeter fencing, gas patio heaters, retractable awnings)
Fire Suppression & ANSUL Systems (Wet chemical hood fire systems, sprinkler head relocations)
Water Heating & Beverage Systems (High-capacity water heaters, soda system conduits, beer trunk lines)
Detailed Description of Improvements:
Provide a complete narrative of all kitchen equipment, plumbing modifications, and dining room alterations (attach extra sheets if necessary)
Company Name
Lead Designer
Phone
Company Name
Lead Engineer
License #
Phone
Company Name
On-Site Project Superintendent
Mobile
Office Phone
Commercial Construction License Number
Trade | Company Name | Contact Person | Phone Number | ||
|---|---|---|---|---|---|
A | B | C | D | ||
1 | Commercial Kitchen Plumbing | ||||
2 | Kitchen Exhaust & HVAC | ||||
3 | Kitchen Fire Suppression (ANSUL) | ||||
4 | Refrigeration & Walk-In Units | ||||
5 | Commercial Electrical |
Attach two (2) physical drawing sets and one (1) digital PDF set of the following:
Stamped Architectural & Kitchen Equipment Layout: Fully dimensioned floor plans showing equipment schedules, cookline spacing, egress paths, and ADA compliance.
MEP & Mechanical Hood Calculation Sheets: Stamped engineering drawings detailing CFM air balance, Type I hood exhaust rates, make-up air (MUA) calculations, and gas line sizing.
Grease Interceptor Capacity Calculations: Plumbing sizing calculations for exterior or sub-floor grease traps, verified against municipal sewer standards.
Rooftop & Structural Weight Evaluations: Structural engineering clearance for rooftop exhaust fans, pollution control units (PCUs), and refrigeration compressors.
Health Department Plan Review Application: Submitted copies of state/local environmental health agency plans and food handling permit applications.
Certificate of Insurance (COI): COI for GC and sub-contractors naming Landlord and Property Management as Additional Insureds (Minimum limits: $5,000,000 Commercial General Liability, $1,000,000 Auto, Workers’ Comp per statutory limits).
Plan Review Deposit Fee.
Deposit fee per lease agreement stipulations
Physical Drawing
Physical Drawing
Digital PDF
Check each box to confirm agreement. All items are mandatory for request approval.
Rooftop Integrity & Grease Exhaust Ducts
All Type I kitchen hood ducts penetrating the roof slab must be welded water-tight (black iron or stainless steel) and fire-wrapped to meet local mechanical codes. Roof curbs for exhaust fans must be installed by a landlord-approved roofing contractor to preserve roof warranty. Approved grease containment boxes must be installed on all exhaust fans.
Slab Cutting & Trench Drain Scanning
Core drilling or slab trenching for floor sinks, grease waste lines, or trench drains requires floor-penetration scanning (GPR) to identify post-tension cables or under-slab main utility feeds prior to cutting. Slurry waste must be captured immediately and never flushed into building sewer lines.
Odors, Heavy Cooking Exhaust & Air Balance
Kitchen ventilation systems must maintain negative pressure within the kitchen area relative to the dining room and public concourses/building common areas. Pollution control units (PCUs) or carbon filtration scrubbers are required for heavy smoke or aromatic cooking (e.g., charbroiling, wood-fired ovens) to prevent odor migration into adjacent suites.
Utility Cut-Overs & Grease Interceptor Tie-Ins
Tying into central building water mains, gas risers, or main sewer lines requires a minimum of 72 hours' prior written notice to Building Management. All connection work must take place outside of operating hours of neighboring tenants.
Health Department Approvals & As-Built Submissions
Tenant and Contractor commit to delivering one complete set of final CAD and PDF "As-Built" drawings, an executed municipal Certificate of Occupancy, and official Health Department Operational Permit sign-offs within thirty (30) calendar days of opening.
By checking the operational boxes above and signing below, the Tenant and General Contractor confirm that all restaurant construction and kitchen installation protocols have been reviewed and agreed upon. Work cannot commence until written authorization is issued by Building Management.
Authorized Signature
Authorized Signature
Date Received
Reviewed By
Kitchen Exhaust & MEP Status
Approved
Re-submission Required
Health Dept & Grease Trap Review
Approved
N/A
COI & Roof Contractor Sign-Off
Yes
Pending
Management Notes & Special Approvals
Landlord / Asset Operations Director Signature
Form Template Insights
Important Note:
This analysis provides strategic insights to help you get the most from your form's submission data for powerful follow-up actions and better outcomes.
AI-Generated Content: This template and its accompanying guidance are AI-generated to provide a practical starting point for your form-building needs. Please review and customise the content to ensure it is accurate, appropriate and suitable for your intended use.
This guide is provided for general informational and planning purposes only. It does not constitute professional, legal, financial, medical, employment, privacy, regulatory, or advice of any other kind, nor does it certify that this template is suitable or compliant for any particular jurisdiction or purpose.
Laws, regulations, industry practices and business requirements vary. You are responsible for reviewing and customising the template to suit your intended use and obtaining advice from appropriately qualified professionals where necessary.
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Here is a detailed breakdown of the structural mechanisms, key operational risks, and design principles behind each section of the form:
Mandatory Questions Recommendation
Important Note:
This section explains why certain fields in this form are marked as required and provides general guidance on how these requirements may support the collection of complete, accurate and relevant information.
Required fields and information-collection obligations may vary depending on your industry, jurisdiction, business operations and intended use of the form. A field marked as required in this template does not necessarily mean that collecting the information is legally mandatory.
Please review each required field to determine whether it is necessary, appropriate and lawful for your particular purpose. Consider applicable privacy, data protection, consent and industry-specific requirements, and consult an appropriately qualified legal, privacy or compliance professional where necessary.
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While every section of a restaurant alteration request form plays a supporting role, six non-negotiable core inputs act as absolute failure points if left blank. Missing any of these renders the form unusable for building operations teams, asset managers, and mechanical reviewers.
1. Primary Culinary Use & 24/7 On-Site Emergency Contacts
2. Detailed Description of Work & Kitchen Equipment Layouts
3. Mechanical Hood Exhaust Specifications & Air Balance Calculations (CFM)
4. Grease Interceptor Capacity Calculations & Slab Trenching Plans
5. Rooftop Weight Evaluation & Dedicated Roofing Contractor Verification
6. Dual Acknowledgment & Mandatory Signatures (Tenant Operator & Contractor)
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