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Home My WebLink AboutCertificate of Occupancy CITY HALL Inspection Services Div 215 Church Avenue PO Box 1130 ~ Oshkosh WI ~ 54903-1130 OiHKOiH ON 'HE WAm City of Oshkosh Approved: Issued: 3/6/06 3/9/06 Midwest Homes Of Wisconsin 100 N. Westhaven Drive Oshkosh, Wisconsin 54904 CERTIFICATE OF OCCUPANCY An Occupancy Permit is hereby granted for the new 6-unit condo located at 3145 White Tail Lane, Oshkosh, Wisconsin 54904 as described in Building Permit Application number(s) 115034. This building is to be used only as six dwelling units and is located in the R-3, Multiple Dwelling District. LIMITATIONS: Maximum persons and/or living units: One family per dwelling unit 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, 3râ 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. DL~~ Building Systems Inspector Building Permit Work Card Job Address .3145 WHITE TAIL LN OWner, MIDWEST GENERAL CONTRACTORS INC Category 130 - New Multi-Family Permit Number 0115034 Create Date 6/10/2005 Contractor MIDWEST HOMES OF WI Type. Building Zoning 0 Sign 0 Canopy 0 Fence 0 Raze Plan 09-38-0605 Class of Const: VB Size Value $510,000.00 Unfinished/Basement 0 Sq. Finished/Living 8508 Sq. Ft. -Ft. Rooms ~ Bedrooms ~ Baths ~ Garage 2880 Sq. Ft. 0 Projection I Stories 1 Height ~ 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 6 Unit Condo - New 6 unit condo as per State Transaction ID # 1134200. of Work HVAC Contr BREWER HEATING Electric Contr CUMINGS ELECTRIC INC Plumbing Contr WATTERS PLUMBING Inspections: Date 2/1/2006 -'---- Type Final Inspector Nicole Krahn approved Request Line Bid Compliance Statement on file. DatelTime requested: 1/27/2006 10:47 AM Access: ~ay wants to be present - call for entry. Ready DatelTime: 1/31/2006 07:00 AM Requested By: MIDWEST GENERAL CONTRACTORS INC-Jay 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Notice Type: Phone Number: 420-5878 Page40f4 Job Address 3145 WHITE TAIL LN Building Permit Work Card Permit Number 0115034 Create Date 6/10/2005 OWner. MIDWEST GENERAL CONTRACTORS INC Contractor MIDWEST HOMES OF WI Category 130 - New Multi-Family Type. Building Zoning 0 Sign 0 Canopy-----'o Fence Class of Const: VB Size 0 Raze I Plan 09-38-0605 Value $510,000.00 Unfinished/Basement 0 Sq. Finished/Living 8508 Sq. Ft. -Ft. Rooms ~ Bedrooms ~ Baths ~ Garage 2880 Sq. Ft. 0 Projection I Stories Height ~ 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 6 Unit Condo - New 6 unit condo as per State Transaction ID # 1134200. of Work HVAC Contr BREWER HEATING Electric Contr CUMINGS ELECTRIC INC Plumbing Contr WATTERS PLUMBING Inspections: Date 10/10/2005 --'----------- Type Rough In Inspector Nicole Krahn approved w/cond. Request Line NOTE: No access to the basements. Basement floor was poured w/o inspections or approval. DatelTime requested: Access: 10pen 10/6/2005 02:15 PM Notice Type: Phone Number: 420-5878 Ready DatelTime: 10/6/2005 02:15 PM Requested By: MIDWEST HOMES OF WI-Jay 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Date ~-'---- ì~m'", DatelTime requested: Access: Type Insulation Inspector Nicole Krahn approved 10/12/2005 09:47 AM Notice Type: Phone Number: JAY 420-5878 ~EN 7-5 Ready DatelTime: 10/12/200509:47 AM Requested By: MIDWEST GENERAL CONTRACTORS INC 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Page30f4 Job Address 3145WHITETAILLN Building Permit Work Card Permit Number 0115034 Create Date 6/10/2005 OWner' MIDWEST GENERAL CONTRACTORS INC Contractor MIDWEST HOMES OF WI Category 130 - New Multi-Family Type . Building Zoning 0 Sign 0 Canopy Q Fence 0 Raze Plan 09-38-0605 Class of Const: VB Size Value $510,000.00 Unfinished/Basement 0 Sq. Finished/Living 8508 Sq. Ft. -Ft. Rooms ~ Bedrooms 0 Baths 0 Garage 2880 Sq. Ft. n Projection I Stories 1 Height ~ Ft. 0 Floating Slab 0 Post Canopies 0 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 '6 Unit Condo - New 6 unit condo as per State Transaction ID # 1134200. of Work HVAC Contr BREWER HEATING Electric Contr CUMINGS ELECTRIC INC Plumbing Contr WATTERS PLUMBING Inspections: Date 8/30/2005 -'---- Type Drain Tile - Inspector Nicole Krahn not approved FAXED REQUEST / POST & BEAMS OPEN POUR 8/30 & 8/31 Poured w/o inspection DatelTime requested: Access: 8/29/2005 09:43 AM ~~ Notice Type: Phone Number: JANELL 231-1667 Ready DatelTime: 8/29/2005 02:30 PM Requested By: JOHN SKOTZKE CONCRETE CONST 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Date 9/22/2005 -'---- Type Inspector Nicole Krahn not approved Faxed request - Flashing garage & porch, would like to pour ASAP, please advise. 9/22 No access. Road was fiooded. 9/23 @ 10:00 Already poured. DatelTime requested: Access: 9/21/2005 03:22 PM ~~ Notice Type: Phone Number: 231-1667 Ready DatelTime: 9/21/2005 03:22 PM Requested By: JOHN SKOTZKE CONCRETE CONST-Mike or Tom 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Page20f4 Job Address 3145 WHITE TAIL LN Building Permit Work Card Permit Number 0115034 CreateDate 6/10/2005 OWner' MIDWEST GENERAL CONTRACTORS INC Contractor MIDWEST HOMES OF WI Category 130 - New Multi-Family Type. Building 0 Sign 0 Canopy 0 Fence Class of Const: VB Size 0 Raze Plan 09-38-0605 Zoning Value $510,000.00 Unfinished/Basement 0 Sq. -Ft. Rooms 0 Bedrooms Finished/Living 8508 Baths 0 Sq. Ft. Garage 2880 Sq. Ft. n Projection I Stories Height ~ Ft. 0 Floating Slab 0 Post Canopies 0 Signs 0 Foundation. Poured Concrete 0 Concrete Block 0 Pier 0 Treated Wood 0 Other Occupany Permit Req~ Flood Plain No Height Permit Not Required # Structures Park Dedication Required # Dwelling Units ~ :;;;",;:"" r w, ~."' - -,"" - ~ ~ '"" "_00'" ,,~~ HVAC Contr BREWER HEATING Electric Contr CUMiNGS ELECTRIC INC Plumbing Contr WATTERS PLUMBING Inspections: Date 8/4/2005 -'---- Type Footings Inspector Nicole Krahn not approved FAXED REQUEST / READY 8/4/05.11-12 Footings were poured w/o an inspection Date/Time requested: Access: 8/4/2005 07:14 AM ~~ Notice Type: Phone Number: MIKE OR TOM 231-1667 Ready DatelTime: 8/4/2005 11 :00 AM Requested By: JOHN SKOTZKE CONCRETE CONST 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Date 8/17/2005 10:00AM Type Foundation Backfill Inspector Nicole Krahn not approved 'REQUEST LINE No stone was over the draintile. The inspection was not ready DatelTime requested: Access: 8/16/2005 01:20 PM ~~ Notice Type: Phone Number: JAY 420-5878 Ready DatelTime: 8/16/2005 01:20 PM Requested By: MIDWEST GENERAL CONTRACTORS INC 0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Page 1 of4 Electric Permit Work Card JobAddress'3145WHITETAiLLN Permit Number 116598 CreateDate 07/06/2005 d Owner MIDWEST GENERAL CONTRACTORS INC Contractor CUMINGS ELECTRIC INC Category 630 - Residential-New Multi-Family Service Service '0 New 0 ChangeO Temp 0 N/~ Type 0 Overhead Volts 120/240 Circuits Amps ~ Switches ~ . Underground ON/A Fixtures -..2 Receptacles 0 Value $18,000.00 Fee E?~D ~---J Appliances Range, garb. disp., dryer, dishwasher, fan, furnace, & AlC UselNature of Work Unit Condo - New 6 unit condo as per State Transaction ID # 1134200. Inspections: Date 02/01/2006 Type Final I~Q'm '" DatelTime requested: 12/2112005 09:20 AM Access: Inspector Adam Krause approved Notice Type: Phone Number: NANCY 231-5946 CUMINGS ELECTRIC INC Ready DatelTime: 12/21/200509:20 AM Requested by: 0 Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid Electric Permit Work Card Job Address '3145WHITETAILLN Owne." MIDWEST GENERAL CONTRACTORS INC Permit Number 116598 CreateDate 07/06/2005 Contractor CUMINGS ELECTRIC INC Category 630 - Residential-New Multi-Family Service Fee $234.00 0 . Underground 0 N/A Fixtures 0 Receptacles ~ Value $18,000.00 Service 0 New 0 ChangeO Temp 0 N/A I Type 0 Overhead Volts 120/240 Circuits 0 Amps ~ Switches ~ Appliances Range, garb. disp., dryer, dishwasher, fan, furnace, & AlC Use/Nature of Work 6 Unit Condo - New 6 unit condo as per State Transaction ID # 1134200. Inspections: Date 10/05/2005 Type Service Inspector Kevin Benner approved Request Line Faxed to WPS 10/5/5, Mailed 10/10/5 DatelTime requested: 10/04/2005 08:13 AM Access: Notice Type: Phone Number: Ready DatelTime: 10/04/200508:13 AM Requested by: 0 Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid CUMINGS ELECTRIC INC-Jan Date 10/07/2005 Type Rough In Inspector Kevin Benner approved Request Line - ready late this afternoon DatelTime requested: 10/06/2005 08:12 PM Access: Notice Type: - Phone Number: Ready DatelTime: 10/06/200503:00 PM Requested by: -- 0 Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid CUMINGS ELECTRIC INC-Jan Job Address 3145 WHITE TAIL LN HVAC Permit Work Card Permit Number 118449 Create Date 07/06/2005 Owner MIDWEST GENERAL CONTRACTORS IN( Contractor BREWER HEATING Category 510- Ind. & Comm-Heating & Ventilating Fuel ~ i:TIii:=:J I Electric I ~ System ~ew 0 Replace l."':I Forced Air I U Radiant I U Steam U Electric I U HotWater I U Suppl. Plan ~ Value n Other I l."':I AlC I U Vent I U Con. Burner I $27,000.00 I I Chimney Type 0 Chimney A 0 ChimneyB 0 Direct Vent . Not Applicable Heat Loss 0 As Approved 0 Existing . Not Applicable I Value BTU Rate 0 As Per Plan 0 Variable . Other I Value Use/Nature 6 Unit Condo - New 6 unit condo as per State Transaction ID # 1134200. of Work Inspections: Date 2/1/06 Type Final Inspector Nicole Krahn not approved Waiting for the Hvac Compliance Statement DatelTime requested: 02l01/200611:20AM Notice Type: Phone Number: Access: Ready DatelTime: 02/01/2006 11 :20 AM Requested By: 0 Reinspect Fee 0 Fee Waived D Reinspect Fee Paid -------- - -------------- ------- -- ------- -- - ---------- -- ----------------------------------- u- Date 3/6/06 Type Final Inspector Nicole Krahn appròved . Hvac compliance statement received. DatelTime requested: 03/06/2006 08:13 AM Notice Type: Phone Number: Access: Ready DatelTime: 03/06/2006 08:13 AM Requested By: 0 Reinspect Fee 0 Fee Waived D Reinspect Fee Paid ------------------------------------------------------------------_u_---------------------- Plumbing Permit Work Card Job Address 3145 WHiTE TAIL LN Permit Number 115392 Create Date 07/06/2005 Owner MIDWEST GENERAL CONTRACTORS INC Contractor WATTERS PLUMBiNG Category 440 - I;dustriai-interior Plan Value $32,010.00 Bathtub ,- ~ Shower 12 Water Softner ----2 Wail.SI. ~ Shamp Sink ~ Coffee Maker ~ Whirlpool ~ Floor Drain 6 Local Waste ~ Ice Chest ~ FlrlWstSink ~ Int Grease Trap ~ Lavatory ~ Lndry Tray 0 Clothes Wshr ~ Exam Sink ~ Catch Basin ~ Ext Grease Trap ~ Toilet ~ Disposal 6 Bidet ~ Sculry Sink ~ Wash Ftn ~ RPZValve ~ Res. Sink ~ Dishwasher 6 BeerTap 0 Hand Sink ~ Urinal ~ Eye Wash Statn ~ Bar Sink ~ Sump Pump ~ Lab Sink 0 Plaster Sink ~ Standp Rec ~ Wtr Sewer Mtrs ~ Water Heater ~ Classrm Sink 0 Sterilizer ----2 Surgeons Sink ~ Ice Maker ~ Deduct Meters ~ Site Drain ~ Breakrm Sink ~ DipWell 0 F Prep Sink ~ Gar Drain ~ Wtr Usage Mtrs ~ Roof Drain ~ Ejector/Grind 0 Drink Ftn 0 Serv Sink ~ Soda Disp ~ Misc. ~ Fixtures Use/Nature ¡Interior plumbing for new 6 unit apartment (ck#60107) I of Work Size Material Type # Conn,Type Sanitary Sewer 0 0 0 0 0 Storm Sewer 0 0 0 0 0 Water Service 0 0 0 0 0 Date 12119/2005 Type Final Inspector Paul Wolf approved r-~- DatelTime requested: Access: ~ay 420-5878 121161200!1 0:00 AM Notice Type: Telephone Number: 733-8125 Ready DatefTime: 12116/200~ 10:00 AM Requested By: WATTERS PLUMBING-Jamie 0 Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Job Address 3145 WHITE TAIL LN Owner MIDWEST GENERAL CONTRACTORS INC Plumbing Permit Work Card Permit Number 115392 - Category 440 - industrial-Interior Bathtub ~ Shower Whirlpool ~ Floor Drain Lavatory ~ Lndry Tray Toilet ~ Disposal Res. Sink ~ Dishwasher Bar Sink ~ Sump Pump Water Heater ~ Classrm Sink Site Drain ~ Breakrm Sink Roof Drain ~ Ejector/Grind Misc. ~ Fixtures Use/Nature of Work 12 6 0 6 6 6 0 ~ 0 WaterSoftner 0 Local Waste 0 Clothes Wshr 6 Bidet 0 Beer Tap 0 Lab Sink 0 Sterilizer 0 Dip Well ----2 Drink Ftn 0 Interior piumbing for new 6 unit apartment (ck#60107) Size Sanitary Sewer Storm Sewer Water Service Date 9/2812005 Type Rough In Inspector Allyn Dannhoff Material Type Contractor Plan WATTERS PLUMBING Create Date 07/06/2005 - WaitSt Ice Chest Exam Sink Sculry Sink Hand Sink Plaster Sink Surgeons Sink F Prep Sink Serv Sink 0 ----2 ----2 ~ ~ ~ ~ ~ ~ Value $32.010.00 Shamp Sink ~ Coffee Maker ~ FlrlWst Sink ~ Int Grease Trap ~ Catch Basin 0 Ext Grease Trap ~ Wash Ftn ~ RPZValve ~ Urinal ~ EyeWashStatn ~ Standp Rec ~ Wtr Sewer Mtrs ~ Ice Maker ~ Deduct Meters ~ Gar Drain ~ Wtr Usage Mtrs ~ Soda Disp ~ I no time FAXED REQUESTNO STAFF AVAILABLE TO PERFORM INSPECTION # 0 0 0 0 0 0 0 0 0 0 Conn.Type DatefTime requested: Access: 9/27/200506:19 PM Notice Type: 0 0 0 0 0 Telephone Number: JAMIE 733-8125 Ready DatelTime: 9/27/2005 08:00 AM Requested By: WATTERS PLUMBING 0 Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Plumbing Permit Work Card Permit Number 115392 Job Address 3145 WHITE TAIL LN Owner MIDWEST GENERAL CONTRACTORS INC Category 440 - Industrial-Interior , Bathtub 6 Shower Whirlpool ~ Floor Drain Lavatory 24 LndryTray Toilet ~ Disposal Res. Sink ~ Dishwasher Bar Sink ~ Sump Pump Water Heater ~ Classrm Sink Site Drain ~ Breakrm Sink Roof Drain 0 Ejector/Grind Misc. ~ Fixtures Use/Nature of Work ~ ~ ~ ~ ~ ~ ~ ~ ~ Water Softner 0 Local Waste 0 Clothes Wshr 6 Bidet 0 Beer Tap 0 Lab Sink 0 Sterilizer 0 Dip Well 0 Drink Ftn 0 - Interior plumbing for new 6 unit apartment (ck#601 07) Size Sanitary Sewer Storm Sewer Water Service Date 8/23/2005 Type Underground approved r~ ,m"= DatefTime requested: 8/23/2005 09:40 AM Notice Type: Access: Material Type Inspector Rich Wood Contractor WATTERS PLUMBING Create Date 07/06/2005 Plan WaitSt. Ice Chest Exam Sink Sculry Sink Hand Sink Plaster Sink Surgeons Sink F Prep Sink Serv Sink # 0 0 0 0 0 0 0 0 0 0 Conn.Type 0 0 ~ 0 0 ~ 0 ~ 0 0 0 0 0 0 Value $32,010.00 Shamp Sink ----2 Coffee Maker 0 FlrlWst Sink ----2 Int Grease Trap ----2 Catch Basin ----2 Ext Grease Trap 0 Wash Ftn 0 RPZ Valve 0 Urinal ----2 Eye Wash Statn ~ Standp Rec ----2 Wtr Sewer Mtrs 0 Ice Maker ----2 Deduct Meters ----2 Gar Drain ----2 Wtr Usage Mtrs 0 Soda Disp ----2 I Telephone Number: JAMIE 733-8125 Ready DatefTime: 8/23/2005 09:40 AM Requested By: WATTERS PLUMBING 0 Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Dee ¿b u~ u',~up !JUN HHANEN 920-497-5007 p- 1 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 fomn 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 infomnation from your plan approval letter. Transaction ID Number 1134200 Site Number 669115 Site location (number & street) 3145 WHITETALE 6UNIT #3 [2] City 0 VIllage 0 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 infomnation. Attach additional pages if necessary). Check those which apply: [2] Building Object 10# 1016965 0 Lighting Object 10# 0 HVAC Object 10# 0 Partial Completion Description of Portion Completed A) [2] Statement of Substantial Compliance To the best of my knowledge. belief, and based on onsite observation, construction of the folfowlng bulldin9 and/or HVAC Items applicable to this project have been completed in substantial compliance with the approved plans and specifications. [2] BUILDING/LIGHTING ITEMS 1. Structural system including submittal and erection of all building components (trusses, precas~ metal building, etc.) 2. Fire protection systems (sprinklers, alanms, smoke detectors) designed, installed, and tested (including forward fiow on back flow devices) by appropriately registered professionais. 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 stoppad penetrations 6. Sanitation system (toilets. sinks, drinking facirrties) 7. Barrier-free including Comm 16 elevators and lifts 8. Energy envelope requirements 9. All conditions of building plan approval and appiicable variances 10. Exterior lighting & control requirements 11. Interior lighting & control requirements 12. All condlfions of lightin9 plan approval and applicabie variances 0 HVACITEMS 1. HVAC system including final test 2. All conditions of HVAC plan approval and applicable variances The following items are not in compliance and must be addressed: 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 as of this date.) OJ 0 Project Abandoned 3. SUPERVISING PROFESSIONAL SIGNATURE FOR: [2] Building 0 HVAC 0 Lighting DON HAANEN . Name (please print or type) Customer I[)# 649536 Signature 920-497-5007 12/2312005 Phone # SBD-'I720(R.O"2003) MAR-03-06 FRI 04: 59 PM BREWER HEATING FAX: 19207486520 PAGE 1 ~-~~ 13:37 \ DESIGN AIR. ß;-/ldJ'^¡ 1',O1/01 r\Ð:Y:) Buildings, HVAC, Compliance Statement 3l'-f< W!-lI(,:.fc,.j 0 be submitted by the supervjs~ professional (architect. engineer. HVAC designer or electrical j}.-I~ designer) observing construction of proj~ within buildings wfth lotal areas 50.000 cubic feet or greater and bleachers (Comm 5O.10/Corom 61.50). Failure to submit this form may result 'In penalties as spl¡cified in Corõ1m 50.26/Cornm 61.23 and/or local ordin&nc@s. General Instructions: Prior to the initial occupancy of new buildings or additions and the final occupåricy of altered existing buildings, submit this completed and signed form to: " e The municipal buílding inspection office. and . Safety and Buildings; 10541 N Ranch Road riaY'Nard, Wi. 54843 F>ersona! information you provide may be uSed for secondary purposes [Privacy Law. s. 15.04 (1 Jim)). 1. PROJECT INFORMATION: Please fill in the following with information from your plan approval letter, Transactíon ID Number 12~ZQ~ l . Site Number C. ¿ '7/! s:- Site location (number So street) --4.4-, I ¡'it,J )!lý "... .. li!'éity 0 Village 0 TownOf~5h~.6_countyof -v,~&~ 2. PURPOSE OF THIS STATEMENT: (Check Box A. B, C. or D to indicate purpose ¡me complete anyoIi1er applicable boxes and information, AttaCh additional p"ges if necessary,) Check those which apply: 0 BUilding Object 10 # -"'.... ~AC Object 10 If. ---L4<: C 747 !J Lighting Object 10 # -~ .-- C! Partial Completion ---oèscription of Portion CompÎê"¡;¡--'" A) rY'Statement of Substantial Compliance To the best of my ~nowledge. belief. and ÞaMd on ons~e èbs."'a~on, const'1Jction of 1M following building and/or HVAC item$ applicable !o this project have been completed in substa,,:,a' compliance ~'jtn the aoprcved ;>Ians and , s;¡ec1fi';ations. 0 BUILDINGIUGIffiNG ITEMS 1 StruCtural system jncludi"~ suemltt.1 aod eraClion of oil o"iloing coO1pcnen:s ("""'es. ørecast. rr.etal building. ete,) <, F¡", protocfon sYSIer:\s (sørinkrars. alarms. s:r>o~e Cet.c:or$) aesiçr...o, installed, ""d testea (includinG fol'W1lrd flow on ""oJ< fiow d.vi"",) Oy ae",oonately r~terS<! p<ofessiénals 3. SOOft and SlairwdY enclesura 4, E>:iLs iflclud;"g e:òt and di<octionallighl£ 5. Fi~-tes1sti>e cons,,"coon, enc"losure of nazarà$. "'" wajl£, Jab.I.,ç doers, ",ass 0 IWAC 172MS of consWction. fire stopped penetraoo"" 5 Sani..tion system «giels. sinks. atlnkino facl!iliesl 7. 8anier"free in""ding Co1M'! 16 elevators and lift" 8. Ëna'9Y envelopo requirem."... 9. All condiUons ef ~ullaing plan approval and .oolicob'. vo.;O'cos The following items are not ¡,n compliance and must be addressed: ß~ f?p-~r- þ~,~ .. . / 10" ¡:x,"ccr li.htioG & COntrcl reQuirementS 1,. 'ol.,iO' lisntlng ! control requi",men:s , 2. ~"con::cons 0: "Qn~n9 plan appro,,! a^o õ;;;;!iœ=lo ,,"'iaocc$ :. ~'"..c 5Y"'rr. iocl:Ja'ng flno! test Z. All opndi,ioos of HVAC Ofo" approval a~" oopiicaole variances "--.-..- B) !J Statelnent of Noncompliance Due 10 the followiog listed vioJ:;fions. !hi, project is Mt ready fo' o~c"pqo::y: --.."..- ,..-- "'---- """"--..""..,.. C) !J Supervising Professional Withdrawn Froll! Project (Use A or B ateve .0 !ncic~(e proiec! status as of this cote.) 0) 0 Project Abandoned . 3. SUPERVISING PROFESSIONAL SIG~I"',, TURE F°f3¡ ~ 0 Bu~ding !:ŸF!I7AC a lighting -1..JA,,~~"'""-. "<1"'A2... '- --- 'D¡>te 3. - N<1me (pleas. OO"t or ""'OJ ..--1- ' Phoncncmber..5'...Ÿ- 7~ CustomerID#~i<..£lL--..Signature "'}.. --7h ~ '-/'-"- ~ ],/,5""/ SBD-Q;2C (R OI/ZOOl) "- '0 TOTAl 1".01