The URL can be used to link to this page

Home My WebLink AboutCertificate of Occupancy CITY HALL Inspection Services Div 215 Church Avenue ~. PO Box 1130 ~ Oshkosh WI -~ 54903-1130 OJHKOJH ON THE WAm City of Oshkosh Approved: Issued: 9/14/05 9/16/05 Waukau LLC 100 N. Westhaven Drive Oshkosh, Wisconsin 54904 CERTIFICATE OF OCCUPANCY An Occupancy Permit is hereby granted for the 4 unit condo located at 3140 White Tail Lane, Oshkosh, Wisconsin 54904 as described in Building Permit Application number(s) 110530. This building is to be used only as a multi-family residence and is located in the R-3, Multiple Dwelling District. LIMITATIONS: Maximum persons and/or living units: Four dwelling units each containing 2 bedrooms. The "den", which is noted on the approved plans and is located towards the road for the upper two units, can not be used as a bedroom. This is due to the den not meeting egress requirements. CONDITIONS: 1) Final grading must be done in accordance with the approved subdivision drainage plan. This plan is on file in the public works office, 3rd floor of City Hall. 2) Erosion control measures must be maintained until the lawn is established. Note: Final grade must be a minimum of 6" below all siding. NOTE: 1) Copies of inspection results are available upon request in room 205, City Hall. 2) Future permits may be required for additional work to your property. A new Certificate of Occupancy shall be required prior to occupancy, should additional building(s) be erected, or should any buildings mentioned above be altered or moved. The use of land, or buildings, shall not be changed until a Certificate of Occupancy is issued for that occupancy. All conditions noted above must be complied with in order for this certificate to be valid. â~{~ Building Systems Inspector cc: Midwest General Contractors Inc. Job-~ddres; ~IL LN Owner WAUKAU LLC Category 130 - New Multi-F1>mily Building Permit Work Card Permit Number 0110530 Create Date 4/9/04 Contractor MIDWEST GENERAL CONTRACTORS INC Type. Building Zoning 0 Sign 0 Canopy 0 Fence 0 Raze Plan L2-23-0404 Class 01 Canst: 5Bibc Size Irreg Value $340,000.00 Unfinished/Basement ~ ~i' Finished/Living ~ Sq. Ft. Rooms Bedrooms 0 Baths ----.<> Garage ------.J> Sq. Ft. [l Projection I Stories 2 Height ------.J> Ft. 0 Floating Slab 0 Post Canopies ~ Signs 0 Foundation. Poured Concrete 0 Concrete Block 0 Pier 0 Treated Wood 0 Other Occupany Permit Required Flood Plain No Height Permit Not Required Park Dedication Required # Dwelling Units ~ # Structures Use/Nature New 4 Unit Condo / All 2 bedroom units, 2 w/ dens. Each with attached 2 car garage. . NOTE: The dens 01 Work bhall not be used lor sleeping purposes unless compliance with the egress requirements Is provided. HVAC Contr Plumbing Contr Electric Contr Inspections: Date 6/22/05 -'------ Type Final Inspector Nicole Krahn not approved room"" DatelTime requested: Access: þPEN 7-5 6/22/05 08:42 AM Notice Type: Phone Number: JAY 420-5878 Ready DatelTime: 6/22/05 08:42 AM Requested By: MIDWEST GENERAL CONTRACTORS It 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ---- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- Date ~-'------ Type Re Final Inspector Nicole Krahn -&pprovedwr¿6'ñi:!~ ay w/ Midwest dropped off the signed and dated correction notice stating that the items were corrected. He also dropped off the compliance statements. No re-inspection was conducted per the office policy. DatelTime requested: Access: 7/1/05 07:50 AM Notice Type: Phone Number: Ready DatelTime: ~ 07:50 AM Requested By: 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid --------------------------------------------------------------------------------------------- Jol>Addresš 3140 WHITE TAIL LN Owner WAUKAU LLC Building Permit Work Card Permit Number 0110530 Create Date 4/9/04 Contractor MIDWEST GENERAL CONTRACTORS INC Category 130 - New Multi-Pamily Type. Building Zoning 0 Sign 0 Canopy 0 Fence 0 Raze I Plan L2-23-0404 Class 01 Const: 5Blbc Size Irreg Value $340,000.00 UnlinishediBasement 0 Sq, Finished/Living -Ft. Rooms ------.J> Bedrooms ------.J> Baths Stories 2 Height ------.J> Ft. 0 Floating Slab 0 Post 0 Sq, Ft, Garage 0 Sq. Ft. 0 n Projection I Canopies 0 Signs Foundation. Poured Concrete 0 Concrete Block 0 Pier 0 Treated Wood 0 Other Occupany Permit Required Flood Plain No Height Penmit Not Required # Structures Park Dedication Required # Dwelling Units "---- Use/Nature New 4 Unit Condo / All 2 bedroom units, 2 w/ dens. Each with attached 2 car garage. . NOTE: The dens 01 Work ~hall not be used for sleeping purposes unless compliance with the egress requirements is provided. HVAC Contr Plumbing Contr Electric Contr Inspections: Date 3/28/05 -'-- Type Rough In Inspector Nicole Krahn not approved Request Line Waiting lor UL Firestopping Submittals. DatelTime requested: Access: þpen Man - Fri 7-5 Ready DatelTime: 3/23/05 11 :47 AM Requested By: MiDWEST GENERAL CONTRACTORS It 3/23/05 11:47 AM Notice Type: Phone Number: 420-5878 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid --------------------------------------------------------------------------------------------- Date 4/12/05 -'--- Type Insulation Inspector Nicole Krahn approved w/cond. Request Line NOTE: Drywall was already Installed in numerous locations. The insulation that could be seen was installed properly. DatelTime requested: 4/11/05 07:58 AM Access: 10pen 7-5 M-F, Jay wants to be present. Ready DatelTime: 4/11/05 07:58 AM Requested By: MIDWEST GENERAL CONTRACTORS II Notice Type: Phone Number: 420-5878 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid --------------------------------------------------------------------------------------------- Jo¡"'Address 3140 WHITE TAIL LN Owner WAUKAU LLC Building Permit Work Card Permit Number 0110530 Create Date 4/9/04 Contractor MIDWEST GENERAL CONTRACTORS INC Category 130 - New Multi-Pamily Type. Building Zoning 0 Sign 0 Canopy 0 Fence 0 Raze Plan L2-23-0404 Class 01 Const: 5Bibc Size Irreg Value $340,000.00 Unfinished/Basement 0 Sq. Finished/Living 0 Sq, Ft, -Ft. Rooms ------.J> Bedrooms ------.J> Baths 0 Garage ------.J> Sq, Ft. n Projection I Stories 2 Height ------.J> Ft. 0 Floating Slab 0 Post Canopies ~ Signs 0 Foundation. Poured Concrete 0 Concrete Block 0 Pier 0 Treated Wood 0 Other Occupany Permit Required Flood Plain No Height Permit Not Required Park Dedication Required # Dwelling Units ~ # Structures Use/Nature New -¡Unit Condoï All :2 bedroom units, 2 w/ dens. Each with attached 2 car garage. . NOTE: The dens 01 Work hall not be used for sleeping purposes unless compliance with the egress requirements is provided. HVAC Contr Plumbing Contr Electric Contr Inspections: Date 9/27/04 Type Footings -- r~ "'-'-~'. ~ " Date/Time requested: 9/24/04 03:55 PM Access: Inspector Nicole Krahn no time Notice Type: Phone Number: 231-1667 Ready Date/Time: 9/27/04 04:00 PM Requested By: JOHN SKOTZKE CONCRETE CONST 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid --------------------------------------------------------------------------------------------- Date 10/4/04 -- Type Foundation Backfill Inspector Nicole Krahn no time r~m"" Date/Time requested: Access: 10/1/04 02:01 PM -- Notice Type: Phone Number: JERRY 420-2245 :CONTACT JERRY, HE WOULD LIKE TO BE PRESENT Ready Date/Time: 10/1/04 02:01 PM Requested By: MIDWEST GENERAL CONTRACTORS II 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid --- - ----- ------ ----------- - -------- - ------------ --------------- -- ----- ----------------------- Job-Addres; 3140 WHITE TAIL LN Owner WAUKAU LLC Building Permit Work Card Permit Number 0110530 Create Date 4/9/04 Contractor MIDWEST GENERAL CONTRACTORS INC Category 130 - New Multi-f'amlly Type . Building ,0 Sign 0 Canopy 0 Fence 0 Raze I Plan L2-23-0404 Zoning Class 01 Const: 5Bibc Size Irreg Value $340,000.00 Unfinished/Basement 0 Sq. Finished/Living 0 Sq. Ft. -Ft. Rooms 0 Bedrooms 0 Baths 0 Garage ~ Sq. Ft. 0 Projection I Stories 2 Height ------.J> Ft. 0 Floating Slab 0 Post Canopies ~ Signs 0 Foundation. Poured Concrete 0 Concrete Block 0 Pier 0 Treated Wood 0 Other Occupany Permit Required Flood Plain No Height Permit Not Required # Structures Park Dedication Required # Dwelling Units ~ Use/Nature New 4 -Unit ëOñdo / All 2 bedroom units, 2 w/ dens. Each with attached 2 car garage. . NOTE: The dens of Work hall not be used for sleeping purposes unless compliance with the egress requirements is provided. Note: Occupancy permits will not be issued until all of the improvements have been installed and approved, Includingr storm water drainage systems and grading. HVAC Contr Plumbing Contr Electric Contr Inspections: Date 9/20/04 --'------- Type Footings Inspector Nicole Krahn cancelled r~"ffi"= Dateffime requested: Access: 9/18/04 03:06 AM -- Notice Type: Phone Number: MIKE OR TOM 231-1667 Ready Dateffime: 9/20/04 04:00 PM Requested By: JOHN SKOTZKE CONCRETE CONST 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid --------------------------------------------------------------------------------------------- Date 9/21/04 Type Footings -- I'-O"W="'^"~" m. Dateffime requested: 9/20/04 03:45 PM Access: Inspector Nicole Krahn no time Notice Type: Phone Number: MIKE OR TOM 231-1667 Ready Dateffime: 9/21/04 02:00 PM Requested By: JOHN SKOTZKE CONCRETE CONST 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid --------------------------------------------------------------------------------------------- , - Electric Permit Work Card Job Address 3140 WHITE TAIL LN Owner WAUKAU LLC Permit Number 112403 Create Date 01/25/2005 Contractor CUMINGS ELECTRIC INC Category 631 - Residential-New Multi-Family Wiring Service b New 0 Change 0 Temp 0 N/A I Type 0 Overhead Volts 120/240 Circuits 0 Amps 400 Switches 0 . Underground 0 N/A Fixtures 0 Receptacles 0 Fee $204.00 0 Value $12.000.00 Appliances Use/Nature of Work New 4 Unit Multi-Family / CEI job #8421 Inspections: Type Re Final Inspector Adam Krause approved Date 09/14/2005 r'~e ~W," DatelTime requested: 09/09/2005 Access: 01:37 PM Notice Type: Phone Number: 420-5878 Ready DatelTime: 09/09/2005 01:37 PM Requested by: 0 Reinspect Fee. Fee Wavied 0 Reinspect Fee Paid MIDWEST JAY -----------------------------------------------------------------------------------. Electric Permit Work Card Job Address 3140 WHITE TAIL LN Owner WAUKAU LLC Permit Number 112403 Create Date 01/25/2005 Contractor CUMINGS ELECTRIC INC Category 631 - Residential:New Multi-Family Wiring Service b New Volts 120/240 '0 ChangeO Temp 0 N/A I Type 0 Overhead . Underground ON/A Fixtures 0 Receptacles 0 Value $12,000.00 Circuits Amps 400 Switches Fee $204.00 0 Appliances Use/Nature of Work New 4 Unit Multi-Family / CEI job #8421 Inspections: Date 03/23/2005 Type Rough In Inspector Kevin Benner approved I~"W"~ DatelTime requested: 03/23/2005 07:58 AM Access: Notice Type: Phone Number: Ready DatelTime: 03/23/2005 07:58 AM Requested by: -- 0 Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid CUMINGS ELECTRIC ING-Jan -----------------------------------------------------------------------------------. Date Type Final Inspector Allyn Dannhoff no time Request Line KEVIN B ON VACATION DatelTime requested: 06/20/2005 08:37 AM Access: Notice Type: Phone Number: Ready DatelTime: 06/20/2005 08:37 AM Requested by: -- 0 Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid CUMINGS ELECTRIC INC-Jan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - -. Electric Permit Work Card Job Address 3140 WHITE TAIL LN Permit Number 112403 Create Date 01/25/2005 Owner WAUKAU LLC Category 631 - Residential-New Multi-Family Wiring Contractor CUMINGS ELECTRIC INC Circuits I Type 0 Overhead 0 . Underground 0 N/A Fixtures Receptacles 0 Value $12,000.00 Service b New Volts 120/240 0 ChangeO Temp 0 N/A Amps 400 Switches 0 Fee $204.00 0 Appliances Use/Nature ofWork New 4 Unit Multi-Family / CEI job #8421 Inspections: Type Service Inspector Kevin Benner approved Date 03/21/2005 REQUEST LINE Faxed & Mailed to WPS 3/21/05 Date/Time requested: 03/17/2005 01:13 PM Access: Notice Type: Phone Number: NOT GIVEN Ready DatelTime: 03/17/200501:13 PM Requested by: -- 0 Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid CUMINGS ELECTRIC INC - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -. Date 03/18/2005 Type Service I"~'.M' Date/Time requested: 03/22/2005 Access: Inspector Jon Fischer approved 07:34 AM Notice Type: Phone Number: Ready DatelTime: 03/22/2005 07:34 AM Requested by: -- 0 Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid -----------------------------------------------------------------------------------. HVAC Permit Work Card I Job Address 3140 WHITE TAIL LN Permit Number 111305 Create Date 10/26/2004 yr " ` °, Owner 'WAUKAU LLC Contractor BREWER HEATING I SEP2 ;ii; I Category 512 - Ind. & Comm -Both Plan L2 -23 -0404 i D rF Fuel ✓ Gas U Oil 11 Electric 1 1 Solar Solid Value $ System 0 New El Replace 111 Other 1 J u Forced Air u Radiant A Steam J NC A Vent j U Electric J Hot Water u Suppl. U Con. Burner Chimney Type 10 Chimney A 0 Chimney B • Direct Vent 0 Not Applicable Heat Loss 0 As Approved 0 Existing 0 Not Applicable Value 01 BTU Rate 0 As Per Plan 0 Variable 0 Other Value I Use /Nature 4 Unit / Install HVAC systems as per State Transaction ID # 1065802 i of Work Inspections: Date 7/1/05 Type Final Inspector Nicole Krahn approved Date/Time requested: 07/01/2005 07:52 AM Notice Type: Phone Number: Access: Ready Date/Time: 07/01/2005 07:52 AM Requested By: 0 Reinspect Fee 0 Fee Waived 1 ❑ Reinspect Fee Paid Category 440 - industrial-interior Bathtub 4 Shower --.i Whirlpool ~ Floor D1ain ~ Lavatory 12 tridry Tray ~ Toilet 8 Disposal 4 Res. Sink 4 Dishwasher --.i Bar Sink 0 Sump Pump 0 Water Heater 4 Classrm Sink ~ Site Drain ~ Breakrm Sink ~ Roof Drain 0 Ejector/Grind ~ Mise, 0 Fixtures Plumbing Permit Work Card Permit Number 110993 Create Date 10/08/2004 Contractor WATTERS PLUMBING Plan C6-123-0904-P Value $17,980.00 Water Softner 0 Wait.St. ~ Shamp Sink ~ Coffee Maker ~ Local Waste 0 Ice Chest ~ Flr/WstSink ~ Int Grease Trap ~ Clothes Wshr 0 Exam Sink ~ Catch Basin 0 Ext Grease Trap ~ Bidet 0 Sculry Sink ~ Wash Ftn 0 RPZ Valve 0 Beer Tap 0 Hand Sink ~ Urinal ~ Eye Wash Statn ~ Lab Sink 0 PlasterSink 0 Standp Rec ~ Wtr Sewer Mtrs 0 Sterilizer 0 Surgeons Sink ~ Ice Maker 4 Deduct Meters ~ Dip Well 0 F Prep Sink ~ Gar Drain ~ Wtr Usage Mtrs ~ Drink Ftn 0 Serv Sink ~ Soda Disp ~ Job Address 3140 WHITE TAIL LN OWner WAUKAU LLC . Use/Nature of Work 4 UNIT Size Material Type # 0 0 0 0 0 Conn, Type Sanitary Sewer Storm Sewer Water Service Date 6/22105 Type Final r- ~~ ""- "00 ", DatelTime requested: 6/21/05 Inspector Rich Wood approved 07:00AM Notice Type: Telephone Number: 733-8125 Access: Ready DatelTime: 6/21/05 08:00 AM Requested By: WATTERS PLUMBING-Jamie 0 Reinspect Fee 0 Fee Waived D Reinspect Fee Paid - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - -- - - - - - - - ---- - - - - - - - - - - - - - - - - - - - - -- -- - - - - - - - - - - - --- - - - - - - -- - --- --- -- - - - --- Job Address 3140 WHiTE TAiL LN Owner WAUKAU LLC . Plumbing Permit Work Card Permit Number 110993 Create Date 10/08/2004 Contractor WATTERS PLUMBING Plan C6-123-0904-P Value $17,980.00 Water Softner 0 Wait.St. ~ Shamp Sink ~ Coffee Maker 0 Local Waste 0 Ice Chest ~ Flr/Wst Sink ~ Int Grease Trap 0 Clothes Wshr 0 Exam Sink 0 Catch Basin ~ Ext Grease Trap ~ Bidet 0 Sculry Sink 0 Wash Ftn ~ RPZ Valve 0 Beer Tap 0 Hand Sink ~ Urinal ~ Eye Wash Statn ~ Lab Sink 0 Plaster Sink ~ Standp Rec 0 Wtr Sewer Mtrs 0 Sterilizer 0 Surgeons Sink ~ Ice Maker --.i Deduct Meters ~ Dip Well 0 F Prep Sink 0 Gar Drain 0 Wtr Usage Mtrs ~ Drink Ftn 0 Serv Sink 0 Soda Disp ~ Category 440 - Industriai-interior Bathtub 4 Shower. --.i Whirlpool 0 Floor Drain ~ Lavatory 12 Ëñdry Tray ~ Toilet ~ Disposal --.i Res. Sink 4 Dishwasher --.i Bar Sink 0 Sump Pump ~ Water Heater 4 Classrm Sink ~ Site Drain 0 Breakrm Sink ~ Roof Drain 0 Ejector/Grind ~ Misc. ~ Fixtures 4 UNiT Use/Nature of Work Size Material Conn.Type Sanitary Sewer Storm Sewer Water Service Type # 0 0 0 0 0 0 0 0 0 0 Date 3/17/05 Type Rough in Inspector WJ (Chip) Callies approved r~""' DatelTime requested: 3/16/05 03:24 PM Access: Notice Type: Telephone Number: 733-8125 Ready DatelTime: 3/16/05 03:00 PM Requested By: WATTERS PLUMBiNG 0 Reinspect Fee 0 Fee Waived D Reinspect Fee Paid --------------------------------------------------------------------------------------------------------- Category 440 - Industrial-Interior Bathtub 4 Shower. --.i Whirlpool 0 Floor Drain ~ Lavatory ~ ['¡dry Tray ~ Toilet 8 Disposal --.i Res. Sink 4 Dishwasher --.i Bar Sink ~ Sump Pump ~ Water Heater 4 Classrm Sink ~ Site Drain ~ Breakrm Sink ~ Roof Drain ~ Ejector/Grind ~ Misc. 0 Fixtures Plumbing Permit Work Card Permit Number 110993 Create Date 10108/2004 Contractor WATTERS PLUMBiNG Plan C6-123-0904-P Value $17,980.00 WaterSoftner 0 Wait.St. ~ Shamp Sink 0 Coffee Maker 0 Local Waste 0 Ice Chest ~ Flr/Wst Sink ~ Int Grease Trap ~ Clothes Wshr 0 Exam Sink ~ Catch Basin ~ Ext Grease Trap ~ Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZValve 0 Beer Tap 0 Hand Sink 0 Urinal 0 Eye Wash Statn ~ Lab Sink 0 Plaster Sink ~ Standp Rec ~ Wtr Sewer Mtrs ~ Sterilizer 0 Surgeons Sink ~ Ice Maker 4 Deduct Meters ~ Dip Well 0 F Prep Sink ~ Gar Drain ~ Wtr Usage Mtrs ~ Drink Ftn 0 Serv Sink ~ Soda Disp ~ Job Address 3140 WHiTE TAIL LN Owner WAUKAU LLC . Use/Nature of Work 4UNIT Type # 0 0 0 0 0 Size Material Conn.Type Sanitary Sewer Storm Sewer 0 0 0 0 0 Water Service Type Underground Inspector WJ (Chip) Callies no time Date I~" ",oom DatelTime requested: 10/15/04 09:13AM Notice Type: Telephone Number: JAMIE 733-8125 Access: Ready DatelTime: 10/15/04 12:00 PM Requested By: WATTERS PLUMBING 0 Reinspect Fee 0 Fee Waived D Reinspect Fee Paid - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - -- ----- - - - - - - - -- - - - ---- - - - - - - - - - - - - - - - - - - - - ------- -- - - - - - - ----- - - - -- -- Buildings, HVAC 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 exceeding 50,000 cubic feet or greater and bleachers (Comm 50.10 /Comm 61.50). Failure to submit this form may result in penalties as specified in Comm 50.26 /Comm 61.23 and/or local ordinances. General Instructions: Prior to the initial occupancy of new buildings or additions and the final occupancy of altered existing buildings, submit this completed and signed form to: • The municipal building inspection office and • Safety and Buildings, 10541N Ranch Road, Hayward, WI 54843 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 980845 Site Number 669115 Site location (number & street) 3140 WHITETALE El City ❑ Village ❑ Town Of OSHKOSH County of WINNEBAGO 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: El Building Object ID# 934239 0 HVAC Object ID# ❑ Lighting Object ID# ❑ Partial Completion Description of Portion Completed A) 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. El BUILDING/LIGHTING ITEMS 1. Structural system including submittal and erection of all building 10. Exterior lighting & control requirements components (trusses, precast, metal building, etc.) 11. Interior lighting & control requirements 2. Fire protection systems (sprinklers, alarms, smoke detectors) 12. All conditions of lighting plan approval designed, installed, and tested (including forward flow on back flow and applicable variances devices) by appropriately registered professionals. 3. Shaft and stairway enclosure ❑ HVAC ITEMS 4. Exits including exit and directional lights 1. HVAC system including final test 5. Fire - resistive construction, enclosure of hazards, fire walls, labeled 2. All conditions of HVAC plan approval doors, class of construction, fire stopped penetrations and applicable variances 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 followingltems are not In compliance and must be addressed: B) ❑ Statement of Noncompliance Due to the following isted violations, this project p led is not ready for occupancy: C) ❑ Supervising Professional Withdrawn From Project (Use A or B above to indicate project status as of this date.) D) ❑ Project Abandoned 3. SUPERVISING PROFESSIONAL SIGNATURE FOR: El Building ❑ HVAC ❑ Lighting DON HAANEN ± Date: 5/30/2005 Name (please print or type) Phone # 920 -497 -5007 Customer ID# 649536 Signature 4 SBD - 9720 (R.O1/2003) 3 • . ' -:. ''.. • -.',.:.• ;:" , Biiildings '..': i''..'' -• ... , - ..-,; . , . . .. . . • ..'• z. • .....:,..,'-.. - •; HVAC, Statement -- .. .--- ..., . .......... ... , . Compliance Stateme , This forrniareqUired,to be sUbmitted by the supervIsing'profesilanaf (irehltect. engineer. HvAC designe cr e'er':•ir...•JI deSighel) Obsenting"ConstrUCtiOn Of phOcts Within buildings with total areas 50.000 cubic feet or greater arts his form may result in penal6os as sPecifiad in Comm 50.26.): 7 l ' :..;: ..-•.:. arid/or local ordinanasi. . . :' • 11 i . ,. ,1 • . . General Instructions: Prior to the initial occupancy of new buildings or additions and the final occupancy cg altered existing buildings, 'Submit this completed and signed form to: - . • ' . . ..The municipal bolding inspection office . , 1 • Safety and Buildings:10541N Ran d+ Road Hayward, Wi. 54843 I Persona( information you provide may be used for secondary purposes [Privacy Law. 8 15.04 (1 1. PROJECT INFORMATION: Please fill in the following with information from your plan approva; ':. , 1 Transaction ID Number /O‘ S . 1 1 4 , , • • Site Number 9 ,.,1 Site location (number & street) 3 /4 43 144ARA:it-s- 1244.6 1 5 4 0 City 0 Village D Town of (rsmierecro. C,ounty of 1 itteini/5 2. PURPOSE OF THIS STATEMENT: (Check Box A.. B. C. or D to indicate pUrpOSe and complete eny ()the' applicable boxes and information. Attach additional pages If necessary.) 1 I 1 i 1 I Check those which apply: ClBuhding Object JD # 0 HVAC Object ID # 4 1 1 7 S7 . i 0 Lighting Object ID c 0 Partial Completion , 1 • „ i Description or Portion Completed . i A) /Statement of Substantial Compliance To the best of my knowledge. belief. and based on onsite observation, construction of the following building itir.d items applicable to this projec t nave been completed in substantial onmoliance with ho approved plans and specitiCatiOnS. . i 0 BUILDING/LIGHTING ITEMS 1. structure: system including submit:al and erection of oh tplcins comoottems j 10. :.-vITIcr ;IgnDi.; & con::::. :!! 'c"•.4:' (trusses. praosat, metal Puking, oz.) 11. !meet '.1v.i.!ng & =fit:: reTJ.r.. "•■: 2. Fir* OrOtection systems (sprinklers. alarms. smoke detectors) cesigned, 12. Ail .-;?rzli:r.s of ',Gntrg insailled. JI e Cr ariances aparapriatety registered prolossienais 1 i 3. Shaft and stairway enClOsure a. Exit; inducing et a0 directional light 5. Fee-resistive cenetructon, enclosure ot hazards. Are walls, lassie° coors. clads! CI HvAC ITEMS Of conscuction, fire stooped pen.Vationa 6. Sanitation systsrn (toasts. sinks. drinking facilities) 1. HvAC syzern including Anti : 7. Barrier-free including Comm 18 elevators and lifts A 1 2. AR conditions of . gx.r. ceprziis: sr.-, 8. Energy envsloos fequiremorlus 1 apglint variances 9. All consmons of building plan approval and applicant. I/anent:ea ..--. 1 '' ; g The following items are not in compliance and must be addressed: r 1' 1 ..-:.. 8) 0 Statement of NoncomPliance i 11 • Due to the following listed violations. this project is not ready for occupancy: 1 , ' __... , 1 1 ..••■•■■•••••••■•■••••■•■,........ ,.... - . • i C) 0 Supervising Professional Withdrawn From Project (Use A or El above to indicate project status gli o* trir.. b) 0 Project Abandoned 3, SUPERVISING PROFESSIONAL SIGignItE 5 0R: , , i . 72, Bulioing te 0 Lighting pate ‘6. -i il Name (pleas & e pnnt type) _ Phone number "le - 7 ' C ustomer ID c' Signature i - --L ' ! SBO-tr2.9 (R.01/2002) • 23 TOTAL P.03 ' I ! , j 1 , l 1 i 1 1 1 , 1 ; E • d 02S9-13fPL-026 1 1 ssaH aTo.st...10 egg:ot go di,2 unr