HomeMy WebLinkAbout0114352 B
e
OSHKOSH
ON THE WATER
Job Address 926 DEMPSEY TRL
CITY OF OSHKOSH
No
114352
BUILDING PERMIT - APPLICATION AND RECORD
Owner
CITY OF OSHKOSH SEWAGE PLANT
Create Date
06/01/2005
Designer
Contractor
CAPELLE BROS & DIEDRICH
Category
262 - City of Oshkosh-Alteration
Plan 08-34-0605
Type
18 Building
0 Sign
0 Canopy 0 Fence 0 Raze
Class of Const:
Rooms 0 Height 0 Ft.
Bedrooms 0 Stories
Baths 0
Size
Zoning
Unfinished/Basement
0 Sq.Ft.
~ Sq. Ft.
U Projection 1
Finished/Living
Canopies
0
Garage
~ Sq. Ft.
Signs
0
Foundation
8 Poured Concrete 0 Floating Slab
0 Concrete Block 0 Post
0 Pier
0 Treated Wood
0 Other
Occupancy Permit
Not Required
Flood Plain No
Height Permit Not Required
Park Dedication
Not Required
# Dwelling Units
0
# Structures
0
City/ Interior alterations office area of transit garage as per plans.
Use/Nature
of Work
HVAC Contractor
Plumbing Contractor
AHERN-GROSS INC.
Electric Contractor
Fees: Valuation
$61,040.00
Plan Approval
$0.00 Permit Fee Paid
$0.00 Park Dedication
$0.00
Issued By:
Date 06/01/2005
Final/O.P. 00/00/0000
U Permit Voided 1
Parcelld # 0609680000
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any necessary approvals before starting such activity.
Signature
Date
Address
253 N HICKORY ST
Agent/Owner
FOND DU LAC
WI 54936 - 1274 Telephone Number
920-921-7830
To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
BUILDINGS, HV AC, COMPLIANCE STATEMENT SBD-9720
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
(Comm 50.10/Comm 6.1.50). Failure to submit this form may result in penalties as specified in Coml)J.j'jO.:1§!Çomm 61.2.3.
and/or local ordinances. This form must be submitted prior to the plan approval expiration date or afÍotner-s-uDlllittãCmaV"',,';,
be required. \\., ii, . ¡i "\'7 r.~ ~....J
General Instructions: Prior to the initial occupancy of new buildings or additions and thejfOinal9, c~upal"!.cy of
altered existing buildings, submit this completed and signed form to: L 2 ( ;:005
. The municipal building inspection office and . .
. Safety and Buildings, 10541N Ranch Road Hayward,\('{i,,54843"""'T OF
~ote: If the review. was done by the municipality, the compliance statement goes "drily tôtt1e'i'ìf¡j1JjpiP21j>,u}!?~~~r
Inspector. A copy IS not needed by Safety & Buildings.
Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)].
1. PROJECT INFORMATION: Please fill in the following with information from your plan approval letter.
Transaction ID Number
Site Number
Site location (number & street) rJ5¡'¡'~~ ,;3US óA!l.M::£ ~~~~-~
II( City 0 Village 0 Town of mt.\~1.\ County of (¡,j11J .J¡;-~MO
2. PURPOSE OF THIS STATEMENT: (Check Box A, B, C, or D to indicate purpose and complete any other
applicable boxes and information. Attach additional pages if necessary.)
Check those which apply: 0 Building Object ID # 0 HVAC Object ID #
0 Lighting Object ID #
0 Partial Completion
Description of Portion Completed
AI IJt'Statement of Substantial Compliance
To the best of my knowledge, belief, and based on onsite observation, construction of the following building and/or HVAC
items applicable to this project have been completed in substantial compliance with the approved plans and
specifications.
0 BUilDING/liGHTING ITEMS .
1. Structural system including submittal and erection of all building components
(trusses, precast, metal building, etc.)
2. Fire protection systems (sprinklers, alarms, smoke detectors) designed,
installed, and tested (including forward flow on back flow devices) by
appropriately registered professionals
3. Shaft and stairway enclosure
4. Exits including exit and directional lights
5. Fire-resistive construction, enclosure of hazards, fire walls, iabeled doors, class 0 HVAC ITEMS
of construction, fire stopped penetrations
6. Sanitation system (toilets, sinks, drinking facilities)
7. Barrier-free including Comm 18 elevators and lifts
8. Energy envelope requirements
9. All conditions of building plan approval and applicable variances
The following items are not in compliance and must be addressed:
10. Exterior lighting & control requirements
11. interior lighting & control requirements
, 2. All conditions of iighting plan approvai
and applicable variances
,. HVAC system including final test
2. All conditions of HVAC plan approval and
appilcable variances
BI 0 Statement of Noncompliance
Due to the following listed violations, this project is not ready for occupancy:
CI 0 Supervising Professional Withdrawn From Project (Use A or B above to ,indicate project status as of this date.)
OJ 0 Pr~ectAbandoned
3. SUPERVISING PROFESSIONAL SIGNATURE FOR:
)( Building 0 HVAC 0 Lighting ~1I-I'-IeS FVïMAtJ t>lA Date VV()( no 'Zoot;"
q 2.3$ 33. Name (Pleaq ~nt or~) u&W ~ ~
-""-, ",. - io~", -' 76 "-u - .
8111)09720 (IUMOM)