HomeMy WebLinkAbout2004-Building Compliance Statement -. g r
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Date Sent: 02/13/04 t � �� p
Customer ld: 271821 Transaction Id: 793867
Phone: (920)426-4470 j%I��� � � Z�U�
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THOMAS KARRELS
THOMAS R KARRELS P E S C
7934 ALGOMA BLVD
OSHKOSH WI 54901-2104
Our records indicate that you are the supervising professional for the Regulated Object(s)
(Bui[ding,HVAC, Lighting and/or Poo! ) listed below. Please circle the status (A,B,C,D,E)
corresponding to the statements on the reverse side.
Complete comment lines as appropriate for each object. Return a copy to Safety & Buildings
and the local municipality.
Site Id: 168175 WINNEBAGO Caunty City of OSHKOSH
� H� COMPETITION PRODUCTS WC
280 W 35TH AVE . � �
OSHKOSH WI 54901
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For.
Regulated Object Id: 873396 Object Type: Building ICC
Description:
scac�s �a s c D E Comment: gj�JLDIN� ONL�/ ,
(Circle)
Supervising Professional Signature: `j'/G' �vi�/GiJ�/�'�7��C�7/C�d Date: �l �7-
A. Compliance ,B. Non-Compliance C. Withdrawn D.Abandon E. Not Done Page 1 of 1
See reverse side for instructions on completing this form
Building, HVAC, Lighting, and Public Swimming Pool Compliance Statement
This form is required to be submitted by the supervising professional (architect, engineer, HVAC designer or electrical
designer) observing construction of projects within buildings with total areas 50,000 cubic feet or greater and bleachers
(ILHR 50.10/61.50) and construction of Swimming pools(Comm 90.04 (5). Failure to submit this form prior to occupancy
may result in penalties as specified in Comm 50.26/Comm 61.23, Comm 90.04 (5) and/or local ordinances, and other
state agency rules. This form must be submitted prior to the plan approval expiration or another submittal may be
required.
G e n e ra I I n s t ru ct i o n s:
1. Our records indicate that you are the supervising professional for the regulated objects(s) listed on the other side of
this form. To indicate the status of construction of these objects, please circle the A, B, C, D, or E corresponding to
the statements listed below, complete comment lines as appropriate for that object.
2. Prior to the occupancy of new buildings, additions and the final occupancy of altered existing buildings, or pools,
submit this completed and signed form to:
• The municipal building inspection office or for pools, DHFS, Environmental Sanitation Section, PO Box 309,
Madison, WI 53701-0309, and
• Safety and Buildings, 10541N Ranch Rd., Hayward, WI 54843
If you have any questions, please contact Jeannie Dixon at 715-634-4870.
STATEMENTS OF PROJECT STATUS
A) Statement of Substantial Compiiance
To tne best of my �cnov✓12dge, belief, and based on onsite observation, construction of the Folluwing 6uilding,
HVAC, and/or public swimming pool items applicable to this project have been completed in substantial
com liance with the a roved lans and s ecifications.
BUILDING ITEMS PUBLIC SWIMMING POOL ITEMS
1. Structural system including submittai and erection of all Structural
building components(trusses, precast, metal building, etc.) 1. Stair Uniformity
2. Fire protection systems (sprinklers, alarms, smoke detectors) 2. Unobstructed Deck& Pool Area
designed, installed, and tested (including forward flow on 3. Fencing or Enclosure
back flow devices) by appropriately registered professionals 4. Basin Design
3. Shaft and stairway enclosure Mechanicai �
4. Exits including exit and directional lights
5. Fire-resistive construction, enclosure of hazards, fire walis, 1. Pool Heaters
labeled doors, class of construction, fire stopped penetrations 2• Recirculation System (pumps, filters, turnover rate,
6. Sanitation system (toilets, sinks, drinking facilities) pipe sizes)
7. Barrier-free including elevators andlor lifts 3. Disinfecting equipment
8. Energy envelope requirements 4. Inlets &Skimmers (spacing and required numbers)
5. Back-flow Protection for Pool Water Supply
9. All conditions of building plan approval and applicable Sanitary Facilities Safety
variances �1: Water Closet(s) 1. Hand Rails
HVAC ITEMS 2. Lavatories 2. Guardreils
1. HVAC system including final test 3. Showers 3. Safety Ropes
2. All conditions of HVAC pian approval and applicable 4. Drains 4. Lifeguard Chairs
variances 5. DTinking Facilities 5. Main Drain Size
I�IGHTING ITEMS 6. Hose Bibb(s) 6. Depih Markers
1. Exterior lighting &control requirements
2. Interior lighting &controi requirements
3. All conditions of lighting plan approval and applicable
variances
In the comment line on the other side of this form indicate items that are not in compliance and must be
addressed.
B) Statement of Noncompliance
Due to the violations listed in the comment line, this project is not ready for occupancy.
C) Supervising Professional Withdrewn From Project (Use A or B above to indicate project status as of this
date.)
Use this category to notify the department so that the owner can be requested to provide the name and
registration number of the new supervising professional prior to continuing with the project.
D) Project Abandoned
E) Partial Completion
Use the comment line for description of portion completed.
Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)].
SBD-10601(R.022004) . ,