HomeMy WebLinkAbout2005-Certificate of Occupancy
CITY HALL
Inspection Services Div
215 Church Avenue
PO Box 1130
~ Oshkosh WI
~ 54903-1130
OfHKOfH
ON THE W^'"
City of Oshkosh
Approved:
Issued:
10/20/05
10/20/05
Midwest General Contractors Inc.
100 N. Westhaven Drive
Oshkosh, Wisconsin 54904
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby granted for the multi-family residence located at 446
Wyldewood Drive, Oshkosh, Wisconsin 54904 as described in Building Permit
Application number(s) 106710.
This building is to be used only as a 6 unit condo and is located in the R-3PD,
Multiple Dwelling District with a Planned Development Overlay.
LIMITATIONS:
Maximum persons and/or living units: Six living units
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.
~--~"""-
JJvc~ll;IaJ' ~
Building Systems Inspector
Create Date 2/16/04
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Building Permit Work Card
Job Address 446 WYLDEWOOD DR Permit Number 0106710
Owner WYLDEWOOD CONDOMINIUMS LLC
Contractor MIDWEST GENERAL CONTRACTORS INC
Category 13~ - New Multi-Family
, J!,
Type.. Building 0 Sign
o Canopy
o Fence
o Raze
Plan K1-128-1203
Unfinished/Basement 0
Sq.
Ft.
Bedrooms
Finished/Living
o
Sq.Ft.
Garage
$474,000.00
~ Sq. Ft.
o Projection I
Zoning
Class of Const:
VBibc Size
Value
Rooms 0
o
Baths
o
Stories
Height 0 Ft. Canopies 0 Signs 0
-
o Floating Slab o Pier o Other
o Post o Treated Wood
Flood Plain No Height Permit Not Required
# Dwelling Units 6 # Structures
Foundation . Poured Concrete
o Concrete Block
Occupany Permit Required
Park Dedication Required
UselNature 6 Unit Condo /4 Units @1442 sf, 2 Units @ 1321 sf, all with 440 sf garage.
of Work
HV AC Contr
Plumbing Contr
Electric Contr
Inspections:
Date 11/17/04
Type Final
Inspector Nicole Krahn
approved w/cond.
Will be ready Monday wants the inspection by WED AM before they close WED PM. Waiting for fire department approval and completion
statements.
DatelTime requested: 11/11/04
Access:
12:40 PM
Notice Type:
Phone Number:
]
Ready DatelTime: 11/17/04 12:40 PM Requested By: Jay Midwest
o Reinspect Fee 0 Fee Waived
o Reinspect Fee Paid
Page 4 of 4
Building Permit Work Card
Job Address 446 WYLDEWOOD DR Permit Number 0106710 Create Date 2/16/04
.
Owner WYLDEWOOD CONDOMINIUMS LLC Contractor MIDWEST GENERAL CONTRACTORS INC
Category 130 - New Multi-Family .
-.
Type . Building o Sign o Canopy o Fence o Raze I Plan K1-128-1203
Zoning Class of Const: VBibc Size Value $474,000.00
-
Unfinished/Basement 0 Sq. Finished/Living 0 Sq.Ft. Garage 0 Sq.Ft.
- Ft. - -
Rooms 0 Bedrooms 0 Baths 0 o Projection I
-
Stories 1 Height 0 Ft. Canopies 0 Signs 0
- - -
Foundation . Poured Concrete o Floating Slab o Pier o Other
o Concrete Block o Post o Treated Wood
Occupany Permit Required Flood Plain No Height Permit Not Required
-
Park Dedication Required # Dwelling Units 6 # Structures 1
UselNature 6 Unit Condo /4 Units @1442 sf, 2 Units @ 1321 sf, all with 440 sf garage.
of Work
HV AC Contr Plumbing Contr
Electric Contr
Inspections:
Date 8/30/04
Type Insulation
Inspector Nicole Krahn
approved
r~-Ll",
DatelTime requested: 8/30/04
Access:
ppen M-F 7-5
04:16 PM
Notice Type:
Phone Number: 420-5878
]
Ready DatelTime: 8/30/04 04:16 PM Requested By: MIDWEST GENERAL CONTRACTORS INC-Jay H
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
----------------------------------------------------------------_._------------------------~-
Date 9/1/04
Type Drain Tile
Inspector Nicole Krahn
no time
FAXED REQUEST / ALL 6 UNITS ARE READY, ALSO INSPECT FLASHING. CALL JANELL WITH QUESTIONS
DatelTime requested: 8/31/04
Access:
02:52 PM
Notice Type:
Phone Number: JANELL 231-1667
]
Ready DatelTime: 9/1/04
03:00 PM Requested By: JOHN SKOTZKE CONCRETE CONST
o Reinspect Fee 0 Fee Waived
o Reinspect Fee Paid
Page 3 of 4
Building Permit Work Card
Job Address 446 WYLDEWOOD DR Permit Number 0106710
Create Date 2/16/04
Owner WYLDEWOOD CONDOMINIUMS LLC
Contractor MIDWEST GENERAL CONTRACTORS INC
Category 130 - New Multi-Family
-,s
Type . Building 0 Sign
o Canopy
o Fence
o Raze
Plan K1-128-1203
Zoning
Class of Const:
VBibc
$474,000.00
Size
Value
Unfinished/Basement 0 Sq.
-
Ft.
Rooms 0 Bedrooms
Stories
Finished/Living 0 Sq.Ft. Garage 0 Sq.Ft.
-
0 Baths 0 o Projection I
-
Height 0 Ft. Canopies 0 Signs 0
-
o Floating Slab o Pier o Other
o Post o Treated Wood
Foundation . Poured Concrete
o Concrete Block
Occupany Permit Required
Flood Plain No
Height Permit Not Required
Park Dedication Required
# Dwelling Units 6
# Structures
Use/Nature 6 Unit Condo /4 Units @1442 sf, 2 Units @ 1321 sf, all with 440 sf garage.
of Work
HV AC Contr
Plumbing Contr
Electric Contr
Inspections:
Date 7/12/04
Type Foundation Backfill
Inspector Nicole Krahn
not approved
REQUEST LINE Foundation jumps exist due to the sewer.
OatelTime requested: 7/8/04
Access:
Notice Type:
Phone Number: JAY 420-5878
03:26 PM
Ready OatelTime: 7/8/04
03:26 PM Requested By: MIDWEST GENERAL CONTRACTORS INC
o Reinspect Fee 0 Fee Waived
o Reinspect Fee Paid
-------------------------------------------------------------------------------------------~-
Date 7/26/04
Type Foundation Backfill
Inspector Nicole Krahn
approved w/cond.
REQUEST LINE The foundation was backfilled. I could not verify the repair. Jay w/ Midwest stated that a wall was poured under the
umps.
DatelTime requested: 7/22/04
Access:
Notice Type:
Phone Number: JAY 420-5878
01 :44 PM
Ready DateJTime: 7/22/04
01:44 PM Requested By: MIDWEST GENERAL CONTRACTORS INC
o Reinspect Fee 0 Fee Waived
o Reinspect Fee Paid
Page 2 of 4
Building Permit Work Card
Job Address 446 WYLDEWOOD DR Permit Number 0106710 Create Date 2/16/04
.
Owner WYLDEWOOD CONDOMINIUMS LLC Contractor MIDWEST GENERAL CONTRACTORS INC
,
Category 130.- New Multi-Family
Ii
Type . Building o Sign o Canopy o Fence o Raze I Plan K1-128-1203
Zoning Class of Const: VBibc Size Value $474,000.00
-
Unfinished/Basement 0 Sq. Finished/Living 0 Sq.Ft. Garage 0 Sq.Ft.
- Ft. - -
Rooms 0 Bedrooms 0 Baths 0 o Projection I
- -
Stories 1 Height 0 Ft. Canopies 0 Signs 0
- - -
Foundation . Poured Concrete o Floating Slab o Pier o Other
o Concrete Block o Post o Treated Wood
Occupany Permit Required Flood Plain No Height Permit Not Required
-
Park Dedication Required # Dwelling Units 6 # Structures 1
Use/Nature 6 Unit Condo /4 Units @1442 sf, 2 Units @ 1321 sf, all with 440 sf garage.
of Work
HV AC Contr Plumbing Contr
Electric Contr
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Inspections:
Date 6/22/04
Type Footings
Inspector Nicole Krahn
no time
Faxed request (rec'd Sat 6/19/04) - ready 6/21/049:30-10:30
DatelTime requested: 6/21/04
Access:
07:00 AM
Notice Type:
Phone Number: 231-1667
Ready DatelTime: 6/21/04 09:30 AM Requested By: JOHN SKOTZKE CONCRETE CONST-Mike or Tom
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
------------------------------------------------------------------'-------------------------~-
Date 711/04
Type Foundation Backfill
Inspector Nicole Krahn
no time
Faxed request (rec'd 6/29/04 4:40 AM) - ready 6/29/04 1 :00-2:00
DatelTime requested: 6/29/04
Access:
07:00 AM
Notice Type:
Phone Number: 231-1667
Ready DatelTime: 6/29/04 01:00 PM Requested By: JOHN SKOTZKE CONCRETE CONST-Mike or Tom
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
-----------------------------------------------------------------_._------------------------~-
Page 1 of 4
Electric Permit Work Card
Job Address 446 WYLDEWOOD DR Permit Number 110095 Create Date 08/20/2004
.
Ow,ner WYLDEWOOD CONDOMINIUMS LLC Contractor CUMINGS ELECTRIC INC
Category 631 - Residential-New Multi-Family Wiring
Service tJ Ne~ .. 0 ChangeO Temp . N/A I Type o Overhead . Underground ON/A I
Volts 120/240 Circuits 0 Fixtures 0
Amps 400 Switches 0 Receptacles 0
Fee $234.00 0 Value $18,000.00
Appliances
UselNature ~iring for new 6 unit
of Work
Inspections:
Date 11/09/2004
Type Final
Inspector Kevin Benner
approved w/cond.
REQUEST LINE
The post lights and AC condensing units are not installed, and the micro-wave cords are not installed per the
manufactures installation requirements ( the cord is not visible its entire length) FAXED TO THE E.C. 11/9/04
DatelTime requested: 11/08/2004 02:42 PM
Access:
Notice Type:
Phone Number: NOT GIVEN
Ready DatelTime: 11/08/2004 02:42 PM Requested by: CUMINGS ELECTRIC INC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Date
Type Re Final
Inspector Nicole Krahn
approved
Request Une
I
DatelTime requested: 11/16/2004 01 :13 PM
Access:
Notice Type:
Phone Number: 420-5878
Ready DatelTime: 11/17/200407:00 AM Requested by: Midwest-Jay
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Electric Permit Work Card
Job Address 446 WYLDEWOOD DR Permit Number 110095 Create Date 08/20/2004
.
Owper WYLDEWOOD CONDOMINIUMS LLC Contractor CUMINGS ELECTRIC INC
Category 631 - Residential-New Multi-Family Wiring
~New .J-. I Type
Service \0 Change 0 Temp . N/A o Overhead . Underground ON/A I
Volts 120/240 Circuits 0 Fixtures 0
Amps 400 Switches 0 Receptacles 0
Fee $234.00 0 Value $18,000.00
Appliances
I
Use/Nature Wiring for new 6 unit
of Work
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Inspections:
Date
Type Rough In
Inspector Kevin Benner
no time
Incorrect address originally given
DatelTime requested: 08/20/2004 01 :39 PM
Access:
Notice Type:
Phone Number:
Ready DatelTime: 08/20/2004 01:39 PM Requested by: CUMINGS ELECTRIC INC-Jan
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Date 08/31/2004
Type Service
Inspector Kevin Benner
approved
Faxed to WPS 9/01/04, Mailed 9/7/04
Refaxed to WPS and to the E.C.11/4/04
DatelTime requested: 08/31/2004 08:24 AM
Access:
Notice Type:
Phone Number:
Ready DatelTime: 08/31/2004 08:24 AM Requested by:
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
HVAC Permit Work Card
Job Address 446 WYLDEWOOD DR Permit Number 110798 Create Date 09/28/2004
.
Owner WYLDEWOOD CONDOMINIUMS LLC Contractor BREWER HEATING
Category 512 -Ind. & Comm-Both Plan K1-128-1203
Fuel ~ Gas I UOil I I I Electric I I I Solar I I I Solid I Value $27,000.00
>, System ~ New I o Replace I D Other I
l!'J Forced Air I U Radiant I U Steam I l!'J A1C I U Vent I
U Electric I U Hot Water I U Suppl. I U Con. Burner I
Chimney Type o Chimney A o Chimney B . Direct Vent o Not Applicable I
Heat Loss . As Approved o Existing o Not Applicable I Value 0
BTU Rate . As Per Plan o Variable o other I Value
Use/Nature HVAC system for 6 unit as per State Transaction ID No. 976043.
of Work
Inspections:
Date 10/20/05
Type Final
Inspector Nicole Krahn
approved
DatelTime requested: 10/20/2005 07:23 AM
Notice Type:
Phone Number:
Access:
]
Ready DatelTime: 10/20/2005 07:23 AM
Requested By:
o Reinspect Fee 0 Fee Waived
o Reinspect Fee Paid
Job Address 446 WYLDEWOOD DR
Owner WYLDEWOOD CONDOMINIUMS LLC
Plumbing Permit Work Card
Permit Number 109010
Contractor WATTERS PLUMBING
Plan C6-95-0404-P
.
Category 440 - Industrial-Interior
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature
of Work
Sanitary Sewer
Storm Sewer
Water Service
Date 11/17/04
6 Shower 12 Water Softner 0 Wait. St. 0 Shamp Sink 0
-
0 Floor Drain 6 Local Waste 0 Ice Chest 0 FlrlWst Sink 0
-
24 Lndry Tray 0 Clothes Wshr 0 Exam Sink 0 Catch Basin 0
-
18 Disposal 6 Bidet 0 Sculry Sink 0 Wash Ftn 0
-
6 Dishwasher 6 Beer Tap 0 Hand Sink 0 Urinal 0
-
0 Sump Pump 6 Lab Sink 0 Plaster Sink 0 Standp Rec 0
-
6 Classrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 6
-
0 Breakrm Sink 0 Dip Well 0 F Prep Sink 0 Gar Drain 0
-
0 Ejector/Grind 0 Drink Ftn 0 Serv Sink 0 Soda Disp 0
0
[NEW 6 UNIT CONDO INTERIOR ONLY
Size Material Type
Type Final
# Conn.Type
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Inspector WJ (Chip) Callies
approved
Create Date
Value
$32,010.00
o
o
o
o
o
o
o
o
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
-=J
Faxed request
DatelTime requested: 11/16/04 03:09 PM
Notice Type:
Telephone Number: 733-8125
Access:
~all Jay 420-5878
Ready DatelTime: 11/16/04 03:09 PM Requested By: WATTERS PLUMBING-Jamie
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
------------------------------------------------------------------~-------------------------~------------
Job Address 446 WYLDEWOOD DR
Owner WYLDEWOOD CONDOMINIUMS LLC
Category 440 - I~dustrial-Interior
Bathtub A 6 Shower
Whirlpool 0 Floor Drain
Lavatory 24 Lndry Tray
Toilet 18 Disposal
Res. Sink 6 Dishwasher
Bar Sink 0 Sump Pump
Water Heater 6 Classrm Sink
Site Drain 0 Breakrm Sink
Roof Drain 0 Ejector/Grind
Misc. 0
Fixtures
Use/Nature
of Work
Plumbing Permit Work Card
Permit Number 109010
Contractor WATTERS PLUMBING
Plan C6-95-0404-P
Wait. St. 0 Shamp Sink
Ice Chest 0 FlrfWst Sink
Exam Sink 0 Catch Basin
Sculry Sink 0 Wash Ftn
Hand Sink 0 Urinal
/i,:"r;
( tt;~/
Create Date 06/29~P04
0,
)
f.-',
~. .If""/f:::
Value
$32,010.00
o
o
o
o
o
o
o
o
12 Water Softner 0
-
6 Local Waste 0
-
0 Clothes Wshr 0
-
6 Bidet 0
-
6 Beer Tap 0
-
6 Lab Sink 0
-
0 Sterilizer 0
-
0 Dip Well 0
-
0 Drink Ftn 0
o
o
o
o
o
o
6
o
o
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
o Standp Rec
o Ice Maker
o Gar Drain
o Soda Disp
Plaster Sink
Surgeons Sink
F Prep Sink
Serv Sink
Deduct M,::ters
Wtr UsagE~ Mtrs
NEW 6 UNIT CONDO INTERIOR ONLY
~
Size
Material
Type # Conn. Type
0
0
0
0
0
0
0
0
0
0
Sanitary Sewer
Storm Sewer
Water Service
Date
Type Rough In
o
o
o
o
o
Inspector WJ (Chip) Callies
no time
FAXED REQUEST
DatelTime requested: 8/23/04 02:45 PM
Access:
Notice Type:
Telephone Number: 920-732-8125
Ready DatelTime: 8/23/04 03:30 PM Requested By: WATTERS PLUMBING
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Job Address 446WYLDEWOOD DR
Owner WYLDEWOOD CONDOMINIUMS LLC
. .
Category 440 -Industrial-Interior
Bathtub ," ~ Shower
Whirlpool 0 Floor Drain
Lavatory 24 Lndry Tray
Toilet 18 Disposal
Res. Sink 6 Dishwasher
Bar Sink 0 Sump Pump
Water Heater 6 Classrm Sink
Site Drain 0 Breakrm Sink
Roof Drain 0 Ejector/Grind
Misc. 0
Fixtures
Use/Nature
of Work
12 Water Softner
6 Local Waste
o
6
6
6
o
o
o
Clothes Wshr
Bidet
Beer Tap
Lab Sink
Sterilizer
Dip Well
Drink Ftn
Plumbing Permit Work Card
Permit Number 109010
Contractor WATTERS PLUMBING
Plan C6-95-0404-P
o Wait. St. 0 Shamp Sink
o Ice Chest 0 Flr/Wst Sink
o Exam Sink 0 Catch Basin
o Sculry Sink 0 Wash Ftn
o Hand Sink 0 Urinal
o Plaster Sink 0 Standp Rec
o Surgeons Sink 0 Ice Maker
o F Prep Sink 0 Gar Drain
o Serv Sink 0 Soda Disp
NEW 6 UNIT CONDO INTERIOR ONLY
Size
Sanitary Sewer
Storm Sewer
Water Service
Date
Type Underground
Material
Type # Conn.Type
0
0
0
0
0
0
0
0
0
0
o
o
o
o
o
Inspector WJ (Chip) Callies
no time
{
-"
Create Date 06/29/2004
Value
o
o
o
o
o
o
6
o
o
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct ME!ters
Wtr Usage Mtrs
$32,010.00
o
o
o
o
o
o
o
o
FAXED REQUEST
~
Daterrime requested: 7/8/04
Access:
01:16 PM
Notice Type:
Telephone Number: 733-8125
Ready DatelTime: 7/8/04 01:00 PM Requested By: WATTERS PLUMBING
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Degner, Mary Lou
From:
Sent:
To:
Subject:
Krahn, Nicole R.
Tuesday, September 20, 2005 7:41 AM
Degner, Mary Lou
RE: 446 WYLDEWOOD DR
No. I called Jay to see if he could get me the compliance statements.
--Original Message----
From: Degner, Mary Lou
Sent: Monday, September 19, 2005 1 :42 PM
To: Krahn, Nicole R.
Subject: 446 WYLDEWOOD DR
Has final HV AC for 446 Wyldewood Dr been approved?
1
Degn&r, Mary Lou
From:
Sent:
To:
Subject:
Degner, Mary Lou
Wednesday, October 19, 20052:09 PM
Krahn, Nicole R.
446 Wyldewood Dr.
I found an HVAC compliance statement in my basket for 446 Wyldewood Dr. (I am assuming this came from you?) Does
this mean thatan Occupancy Permit can be issued, and if this is the case do you want any special notes or conditions
listed?
1
Se~ 20 05 08:44a
DON HAANEN
(-
920-497-5007
p. 1
~ Buildings, HVAC Compliance Statement 580-9720 ('SCA/b~;
., This form is required to be submitted by the supervising professional (architect, engineer, HVAC designer or electrical Or;;>. ':of.,
designer) obs~rving construction of projects within buildings with total areas exceeding 50.000 cubic feet or greater and \ ') 1<::1!;}'"
bleachers (Cornm 50.1 O/Comm 61.50). Failure to submit this fonm may result in penalties as specified in Comm {' dJ'rr;: .
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)J.
1. PROJECT INFORMATION: Please fill in the following with information from your plan approval letter.
Transaction 10 Number 937355
Site Number 667578
Site location (number & street) 446 WYLDEWOOD
o City 0 Village 0 Town Of OSHKOSH County of W1NNEBAGO
2. PURPOSE OF THIS STATEMENT: (Check Box A, B, C, or 0 to indicate purpose and complete any other
applicable boxes and information. Attach additional pages if necessary).
Check those which apply: 0 Building Object 10# 928333 D HVAC Object 10# _
o Lighting Object 10#
o Partial Completion
Description of Portion Completed
A) 0 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.
o 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 appropriate.ly registered professionals.
3. Shaft and stairway enclosure
4. Exits including exit and directional lights
5. Fire-resistive construction, enclosure of hazards. fire walls, labeled
doors, class 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
12. All conditions of lighting plan approval
and applicable variances
o HVAC ITEMS
1. HVAC system including final test
2. All conditions of HVAC plan approval
and applicable variances
B) 0 Statement of Noncompliance
Due to the following listed violations, this project is not ready for occupancy:
C) 0 Supervising Professional Withdrawn From Project (Use A or B above to indicate project status ,is of this date.)
D) 0 Project Abandoned
3. SUPERVISING PROFESSIONAL SIGNATURE FOR:
o Building D HVAC 'b Lighting D ~ ~ 9/20/2005
Name (please print or type)
Phone # 920-497-5007 Customer 10# 649536 Signature
SBD-9720 (R.O t/2003)
4,
p
Buildings, HV ACt Compliance Statement
This form is requ.ireG to be submitted by the supervising professional (atehitect. engineer, HVAC designer or elec:trleal
c:e:.igner) observing construction of projec;.tS within buadings with lotal areas 50.000 cuaic feet .r greatet' and bleache~ ()-
.. (Comm 50. 1oIComm 61.50). l=ailure to submit this form may result in penalties :illa specffied in ~m SO.261Comm 0' .23:.1 h:;,
and/or local ordinances. ",
General Instructions: priOr to the initial occupancy of new buildings or additions and the final occupancy of
altered exlsting buildings. submit trlis complttted and signed form to:
. The municipal building inspection office an~
. safety and Buildings. 10541N Ranch Road Haywari_ Wi. 54143
Pel'5Onal informatIon you provide may be us~ for secondary purpo~" IPrivacy l..0w, ~- 15.1)4 (1)(m)]. .
1. PROJECT INFORMATJON: Please fill in the following with information from your plan approval letter.
Transaction 10 Number c(7 ,; 4 3 "
Site Number t'c t. 7<;; 7 tj'
Sitelocation(numbcr&."""t} /1~~~ = ~
~ity Cl Village 0 Town of +-.' County of
2. PURPOSE OF THIS STATEMENT: (CheCI( Box A, 8. C. or 0 to indicate purpose and complete any otner
applicable boxes ane information. Attach additiQn211 pages if necessary.) / .JIA
Check those which aoply: Cl Building Object 10 " I!f'HVAC Object 10 #. &. err 772-__
Cl Lighting Object 10 #
;J~
Condn #.5"- #& (-(.,A...J, Idfl.('~ tY-J'
J
o Partial Completion
A) CJ
DescriptiOn of Portion completed
Statement of Sub:otant.tal Compliance
To the best of my kr'lowledge. belief. and Dased on on site obseNilticn. constNdlOn Of ~"'e fOllowing bl.lildlng arid/or I"!VAC
Items a~plic::llbte to this project have b9Qn completed in substantia! compliance witrl tr'le aporove~ plans 3M!
speclficlIltion$.
C! BUILDING/LIGHTING ITEMS
" SlrU~urlll ,ystern inclu<!irl!;lllUDmitt:l1IlnCl .,fec;;on of 01111 :luiICil'\; comPOfJo.,t,
(trusses. prec.l5t. moral Il\lilding. 01C:.)
2. Fife orOlec:lion systemS (s~rinll;lers. alanT'ls. smoke eeteelol1i) ~l!lM9"ee.
installec!. and lest.6 (i/lcll.di", folWQrdi flow on ~ac:k lIow ~e"il;eli) ~
aoproprlately rogiatel1ld prOl'e,siol"ll:llS
3. Shaft and ST.llirway c:ncl03UnI
4. ExiUi indudinSl e~l o"CS Clireetionalligl'llS
5. Fi....resll:i..e ccnlt.tr\ldiOl'l. endOSUl'iI of J\azllrds, fi" wallS. IaC&I~ door.>. ,iaSs
of COl'I&Il\ICI!on. f1rclllltoPOOd ponetr3uon:
6. Sanltl!ltlCII $ySl8m (toilets, lIinQ. orinkifl!) fac:ilitioll)
7. Gamer.free inc:ll.lding Com", 18 elevator'! at'ld lif-oS
S. Energy Rl'I-.eIOCle requi~cl'ltS
iii. All COI'I"iliOl\l of DuilCi.,g pia" .C1oroyal anCl :l~pl;Cilt:lllf VlIf1:al'lCMi
10. E;l;tel'iC' 'i\;P\ti:1~ & CQl'ltrol tgC"Iremllnts
, 1. Inle:tQr 1'C;1'I1itl~ & contrOl rC:u,f'2mtnts
'2. All conc:;tions 01 !~I'lllt'lg ~lan :Ii)orovat
and acplcble vari<!l"ces
U ~vAC ITE.MS
,. ~iVAC sys10m I~CluClil1g final tet:
2. A.ll cOIlCliliOI'lB or !-1VAC !)llln apJrlrovilIl line:
~pplicaole variances
The following itvrns ani not in compliance and must b~ addressed: D D
7Z err (Z.-C- '
B) 0 Statement of Nonccmpliance
Due to the tcl1owir19 listed violations. 1Ptis project is Mot ready fer occupancy:
J!Fr- .SE.~
~4.A/Z'~
C) C Supervising Professional Withdrawn From Project (Use A or '6 abOve to indicate project statl.lS as of U\ls date.)
D) tJ Project Abandoned
3. SUPERVISING PROFESSIONAL SIG~Re._FO...R:
c Building ~VAC 0 Lighting ~ 6~4.
, Name (gleass orint or type)
P"ong l'Iumb.r y ~ - ~ "- Cuslomer 10 fI. ~ i:2'1 ,~
~rt
U' 9(23/4r
I ~1A~
.,
Signaturo
S:ll.l)~9!!O (R.O\l%OO2)
23
TOTAL P.01
2"d
02~9-8vL-028
ssaH a]:'.1.s]:...I:)
e2E:Ol ~O 92 das