HomeMy WebLinkAboutCertificate of Occupancy
CITY HALL
Inspection Services Dlv
215 Church Avenue
~POBOX1130
~ Oshkosh WI
~ 54903-1130
OJHKOJH
ON THE WATER
City of Oshkosh
Approved:
May 10, 2006
LLC Pacur
3555 Moser Street
Oshkosh, Wisconsin 54901-1270
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby issued for the office and basement addition,
located at 3555 Moser Street, Oshkosh, Wisconsin 54901-1270 as described in
Building Permit Application number(s) 114218.
This building is to be used only as industrial space and is located in the M-3,
General Industrial District.
LIMITATIONS:
Maximum number of persons:
Per State Approved Plans
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.
cc: Ganther Construction
Job Address 3555 MOSER ST
OWner F<HJ JKJ LLC
Building Permit Work Card
Permit Number 0114218
Create Date 5/18/2005
Contractor GANTHER CONSTRUCTION
Category 210 - Addition industriai
Type. Building
0 Sign
0 Canopy
0 Fence
0 Raze
Plan 08-31-0505
Zoning
Class of Const: 2Blbc
Size 78x68
--
Value
$405,663.00
Unfinished/Basement 0 Sq. Finished/Living
-Ft.
Rooms ~ Bedrooms ~ Baths
Height ~ Fto
0 Floating Siab
0 Post
5239 Sqo Ft. Garage 1168 Sq.Ft.
~ n Projection I
Canopies 0 Signs
Stories 1
Foundation. Poured Concrete
0 Concrete Biock
0 Pier
0 Treated Wood
0 Other
Occupany Permit Required
Flood Plain No
Height Permit Not Required
Not Required
# Dwelling Units ~
# Structures
Park Dedication
Use/Nature Industriai/5239 sf office addition w/1168 sf basement. . Note: Compliance with Engineer Division Storm
of Work Drainage Review letter conditions of approval must be provided.
HVAC Contr
Plumbing Contr
Electric Contr
Inspections:
Date 6/212005 --'--------
Type Footings
Inspector Allyn Dannhoff
no time
I
r'- C~ . - ",-
DatelTime requested: 6/1/2005
Access:
02:00 PM
Notice Type:
Phone Number:
Ready DatelTime: 6/2/2005 07:00 AM Requested By: GANTHER CONSTRUCTION-AJ
0 Reinspect Fee 0 Fee Waived
0 Reinspect Fee Paid
muuuuuuuuu.u...ummuuummO....m..uumuuumm"mOmmOumu",'mmmuummmmmmmmmummmmmmuu
Date ~ --'-------- Type Foundation Backfill
i"¡"~"' ""
DatelTime requested: 6/23/2005 07:56 AM
Access:
¡SOMEONE WILL BE ON SITE
Ready DatelTime: 6/23/2005 07:56 AM Requested By: GANTHER CONSTRUCTiON
Inspector Allyn Dannhoff
no time
Notice Type:
Phone Number: AJ 376-0216
-.J
0 Reinspect Fee 0 Fee Waived
0 Reinspect Fee Paid
mmmmmUu'uuumOmUmm'muummummuuuummmmmuumuuumuu'u'uu.u.uuUU'U'Ummmomommmmommum..oo
Page 1 of3
Job Address 3555 MOSER ST
OWner RHJ JKJ LLC
Category 2100 Addition Industrial
Building Permit Work Card
Permit Number 0114218
Create Date 5/18/2005
Contractor GANTHER CONSTRUCTiON
Type. Building
Zoning
0 Sign
0 Canopy
0 Fence
0 Raze
Plan 0803100505
$405,663.00
Class of Const: 2Bibc
Size 78x68
Value
Unfinished/Basement 0 Sq. Finished/Living 5239 Sq. Ft.
-Ft.
Rooms ~ Bedrooms ~ Baths 0
Garage ~ Sq. Ft.
n Projection I
Height ~ Ft.
0 Fioating Slab
0 Post
Canopies ----.2 Signs 0
Stories 1
Foundation. Poured Concrete
0 Concrete Block
0 Pier
0 Treated Wood
0 Other
Occupany Permit Required
Flood Plain No
Height Permit Not Required
Not Required
# Dwelling Units ~
# Structures
Park Dedication
Use/Nature Industrial/5239 sf office addition w/1168 sf basement. . Note: Compliance with Engineer Division Storm
of Work Drainage Review letter conditions of approval must be provided.
HVAC Contr
Plumbing Contr
Electric Contr
Inspections:
Date 8/5/2005 --'--------
Type Rough in
Inspector Allyn Dannhoff
no time
r"'= '"
DatelTime requested:
Access:
8/1/2005 11:13AM
---
Notice Type:
Phone Number: AJ
37600216
þN SiTE TUESDAY & WEDNESDAY
Ready DatelTime: 8/1/2005 11 :13 AM Requested By: GANTHER CONSTRUCTION
0 Reinspect Fee 0 Fee Waived
0 Reinspect Fee Paid
muummummmmmmmumommmuummmmmmo..uumuouummomummumummmmmmumummmmuomUOuumuuu
Date ~ ~ Type Final Inspector Allyn Dannhoff approved w/cond.
REQUEST LINE / WOULD LIKE INSPECTION MONDAY PM IF POSSIBLE 10/5/05 OCCUPANCY APPROVED SUBJECT TO FCN
B/H/P
DatelTime requested:
Access:
~ILL BE ON SITE
9/30/2005
11:05AM
Notice Type:
Phone Number: AJ 376-0216
--
Ready DatelTime: --'----- Requested By: GANTHER CONSTRUCTION
0 Reinspect Fee 0 Fee Waived
0 Reinspect Fee Paid
mmuum"mmommmmmmm"hhhhhu'hhuOuhhhmmmmmmmommmmm"u""hhmhummmmummmummUhhuumo
Page20f3
Job Address 3555 MOSER ST
Owner I'<HJ JKJ LLC
Building Permit Work Card
Permit Number 0114218
Create Date 5/18/2005
Contractor GANTHER CONSTRUCTION
Category 2100 Addition industrial
Type. Building
0 Sign
0 Canopy
0 Fence
0 Raze
Plan 08-31-0505
$405,663.00
Zoning
Class of Const:
2Bibc
Size 78x68
Value
Unfinished/Basement 0 Sq. Finished/Living 5239 Sq. Ft.
-Ft.
Rooms 0 Bedrooms ~ Baths ~
Garage ~ Sq. Ft.
n Projection I
Height ~ Ft.
0 Floating Slab
0 Post
Canopies ----.2 Signs 0
Stories 1
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
Not Required
# Dwelling Units ~
~:~~~~ure ~~~~~~~/ ~;~;:~~:~ec~~~:::~~Sw~f1;:~~~~a~~~e~~. p;o~~~~comPlIance with Engineer Division Storm
HVAC Contr
Plumbing Contr
Electric Contr
Inspections:
Date 5/10/2006 --'--------
Type Final
Inspector Allyn Dannhoff
approved
NO APPARENT CONCERNSoPER RECENT ZONING/SCREENING DIRECTIONS, SCREENING IS NOT REQUIRED FOR ROOF TOP
EQUIPMENT iyVAS NOT ADDRESSED AT INITIAL ZONING REVIEW OF 5/5/)
Notice Type:
Phone Number:
DatelTime requested:
Access:
Ready DatelTime: - -'----- Requested By:
0 Reinspect Fee 0 Fee Waived
0 Reinspect Fee Paid
mmommmmmmmmmmumu'mmmmmmmmmmmmmmmummm""""OU"'U"om"Ommommmmmmmmm'uumuuu
Page30f3
Job Address 3555 MOSER ST
Electric Permit Work Card
Permit Number 115653 Create Date 08/08/2005
OWner RHJ JKJ LLC
Contractor BRAUN ELECTRICAL SOLUTIONS INC
Category 643 - Commercial-Addition/Remodels
Service p New 0 ChangeO Temp . N/A I Type 0 Overhead
" Circuits
Volts 120/240 60
Amps 100 Switches 70
0 Underground . N/A
Fixtures 80
Receptacles 200
Value $32,382.00
Fee
$283000 0
Appliances
Us"lNature
of Work
omm / Addition of office to existing building
Inspections:
Date
Type Rough in
Inspector Kevin Benner
RECEIVED INSPECTION REQUEST ON REQUEST LINE 8/1/05, 8:29 AM-NO PERMIT, SPOKE TO LEO HE
SAID HE SENT PERMIT APP ON THURS & HE WOULD GET BACK TO US, HE WOULD LIKE TO BE
PRESENT FOR INSP FOR TUES 8/2/05, LATE AM OR EARLY PM PERMIT ISSUED 8/8/05
DatelTime requested: 08/01/2005 08:29 AM
Access:
Notice Type:
Phone Number: LEO 216-0517
Ready DatelTime: 08/02/2005:
0 Reinspect Fee 0 Fee Wavied
Requested by:
0 Reinspect Fee Paid
BRAUN ELECTRICAL SOLUTIONS INC
---------------_u_------_u_u_---_u_-----------_u_-----------------------------.
Date 09/30/2005
Type Final
Inspector Kevin Benner
not approved
Cable and pipe support, AFWL's, D.W. breaker lock, Bond building steel and XFMR, panel scheduies, branch
circuit color identification, flexible cord above ceilin9 for water heater
DatelTime requested: 09/30/2005 08:09 AM
Access:
Meet Leo on site
Notice Type: ~ Phone Number:
Ready DatelTime: 09/30/2005 09:30 AM Requested by:
--
0 Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
BRAUN ELECTRICAL SOLUTIONS INC
-----------------_u_-------------------_u_--------------------------------u_u_-.
Job Address 3555 MOSER ST
OWner RHJ JKJ LLC
Electric Permit Work Card
Permit Number 115653 Create Date 08/08/2005
Contractor BRAUN ELECTRICAL SOLUTIONS INC
Category 543 - Commercial-Addition/Remodels
Service p New 0 ChangeO Temp . N/A I Type 0 Overhead
Volts 120/240 Circuits 60
Amps 100 Swìtches ~
0 Underground. N/A
Fixtures
80
Receptacles 200
Fee
$283.00 0
Value
$32,382.00
Appliances
Use/Nature
of Work
omm / Addition of office to existing building
Inspections:
Date 10/04/2005
Type Re Final
Inspector Kevin Benner
approved w/cond.
Panelboard labeling was not installed.
DatelTime requested: 10/04/2005 08:28 AM
Access:
Notice Type:
Phone Number: 216-0517
Ready DatelTime: 10/04/2005 08:28 AM Requested by:
0 Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
BRAUN ELECTRICAL SOLUTIONS INC Le
-----------------------------------------------------------------------------------.
Job Address 3555 MOSER ST
HVAC Permit Work Card
Permit Number
115292 Create Date 07/19/2005
OWner
RHJ JKJ LLC
Contractor CONDON TOTAL COMFORT
Category 512 -Ind. & Comm-Both
Plan 08-31-0505
Fuel ~ ~ 1"'1 Electric I ~ ~ Value
System ~ New n Replace n Other
~ Forced Air
U Electric
$56,900.00
1
I~I'JC IUVent 1
IW::~
() DlrectVent . Not Applicable
1 U Radiant
I U HotWater
1 U Steam
1 U Suppl.
Chimney Type D Chimney A 0 Chimney B
Heat Loss D As Approved 0 Existing
BTU Rate 0 As Per Plan () Variable
. Not Applicable I
. Other ¡
Value
Value
Use/Nature Install HVAC System for Office Addition.
of Work
Inspections:
Date 10/5/2005
Type Final
Inspector Allyn Dannhoff
approved w/cond.
PCCUPANCY APPROVED SUBJECT TO CORRECTION NOTICE B/H/P
DatelTime requested:
Notice Type: - Phone Number:
Access:
Ready DatefTime:
Requested By:
0 Reinspect Fee 0 Fee Waived
0 Reinspect Fee Paid
-- -.. __Omh_- --. ----. --... -.. h h - m m_"'-- - h m mmm m m mm m m m m m m m mom m- m... m - m - ---... -- - -- -- - -- -- -- m m m --mmmmm -- -- 0
Date 5/10/2006
Type Final
Inspector Allyn Dannhoff
approved
NO APPARENT CONCERNS-PER RECENT ZDNING/SCREENING DIRECTION SCREENING NOT REQUIRED FOR
ROOF TOP MECHANICAL EQUIPMENT 9 WAS NOT ADDRESSED AT INITIAL ZONING REVIEW OF 5/05)
DatefTime requested:
Notice Type: - Phone Number:
Access:
Ready DatelTime:
Requested By:
0 Reinspect Fee 0 Fee Waived
0 Reinspect Fee Paid
--- -- m --m--m h hm m mm m m m m m m m m m ------ --.. 0 m """mm m m- mm..._m mm m- m m ...----m--m_"'--"'--_--h... ----
Plumbing Permit Work Card
Job Address 3555 MOSER ST Permit Number 114310 Create Date OS/27/2005
OWner RHJ JKJ LLC Contractor O'NEILL ENTERPRISE INC
Category 440 - Industrial-Interior Plan Value $8,300.00
Bathtub .......IJ Shower 0 Water Softner 0 Wait.St. 0 Shamp Sink 0 Coffee Maker .......IJ
Whirlpool .......IJ Floor Drain 2 Local Waste 0 Ice Chest 0 FlrlWstSink .......IJ Int Grease Trap .......IJ
Lavatory 4 Lndry Tray 0 Clothes Wshr 0 Exam Sink 0 Catch Basin .......IJ Ext Grease Trap .......IJ
Toilet ------..i DIsposal 0 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve 0
Res. Sink .......IJ Dishwasher 0 Beer Tap 0 Hand Sink 0 Urinal .......IJ Eye Wash Statn .......IJ
Bar Sink 1 Sump Pump 0 Lab Sink 0 Plaster Sink 0 Standp Rec.......IJ Wtr Sewer Mtrs .......IJ
Water Heater ..........'! Classrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0 Deduct Meters .......IJ
Site Drain 0 Breakrm Sink 1 Dip Well 0 F Prep Sink 0 Gar Drain 0 Wtr Usage Mtrs 0
Roof Drain .......IJ Ejector/Grind 0 Drink Ftn 0 Serv Sink 0 Soda Disp .......IJ
Misc. .......IJ
Fixtures
Use/Nature I
of Work Factory addition interior plumbing (Debit Account)
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 7/11/2005
Type Underground
Inspector Rich Wood
approved
r'oo~n'"
DatelTime requested:
71712005 12:28 PM
Notice Type:
Telephone Number:
PAT 428-4700
Access:
þN SITE UNTIL NOON OR 1
Ready DatefTime: 71712005 12:28 PM Requested By: O'NEILL ENTERPRISE INC
0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
..__..__mmmm.._mmmm---_mmmmm..mmmm..mmmm_mmmmmmmmmmmmmmmmmmmm..Omhmmmm..mm...m---"_--m_---..m
Job Address 3555 MDSER ST
Owner RHJ JKJ LLC
Category 440 - Industrial-Interior
Bathtub ---.!1
Whirlpool 0
Lavatory ~
Toilet 4
Res. Sink ---.!1
Bar Sink 1
Water Heater 2
Site Drain ---.!1
Roof Drain 0
Misc. ---.!1
Fixtures
Use/Nature
of Work
Shower
Floor Drain
Lndry Tray
Disposal
Dishwasher
Sump Pump
Classrm Sink
Breakrm Sink
Ejector/Grind
-
Plumbing Permit Work Card
Permit Number 114310
Contractor O'NEILL ENTERPRISE INC
Plan
0
2
0
0
0
0
0
1
0
Water Softner 0
Local Waste 0
Clothes Wshr 0
Bidet 0
Beer Tap 0
Lab Sink 0
Sterilizer 0
Dip Well 0
Drink Ftn 0
-
Factory addition interior plumbing (Debit Account)
Sanitary Sewer
Stonm Sewer
Water Service
Date 7/11/2005
I~O ~OO,,;
Daterrime requested:
Access:
Size
Type Underground
7/8/2005 09:09 AM
Material
--
Type
Inspector Rich Wood
Create Date OS/27/2005
Value
Wait. St. 0 Shamp Sink ---.!1
Ice Chest 0 FlrlWst Sink ---.!1
Exam Sink 0 Catch Basin 0
Sculry Sink 0 Wash Ftn 0
Hand Sink 0 Urinal 0
Plaster Sink 0 Standp Rec ---.!1
Surgeons Sink 0 Ice Maker 0
F Prep Sink 0 Gar Drain ..-..-.2
Serv Sink ..-..-.2 Soda Disp 0
#
0
0
0
0
0
0
0
0
0
0
Conn.Type
0
0
0
0
0
approved
Notice Type:
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
PAT 589-2007
I
Telephone Number:
Ready DatelTime: 7/8/2005 08:45 AM Requested By: O'NEILL ENTERPRISE INC
0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
$8,300.00
0
0
---.!1
..-..-.2
..-..-.2
..-..-.2
..-..-.2
---.!1
I
i
mmmm"..Ohmm.......-......o..mmm.._..mm.........mmm.......mmmm_..mmmmmmm_mmmmmmmmmmm..mmm."mm...mm
Plumbing Permit Work Card
Job Address 3555 MOSER ST Permit Number 114310 Create Date OS/27/2005
OWner RHJ JKJ LLC Contractor O'NEILL ENTERPRISE INC
Category 440 - Industrial-Interior Plan Value $8,300.00
Bathtub 0 Shower 0 Water Softner 0 Wait.St. -..Q Shamp Sink 0 Coffee Maker ---.!>
Whirlpool 0 Floor Drain 2 Local Waste 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
Lavatory ~ Lndry Tray 0 Clothes Wshr 0 Exam Sink 0 Catch Basin ---.!> Ext Grease Trap ---.!>
Toilet 4 Disposal 0 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve ---.!>
Res. Sink ---.!> Dishwasher 0 BeerTap 0 Hand Sink 0 Urinal ---.!> Eye Wash Statn ---.!>
Bar Sink 1 Sump Pump 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0 Wtr Sewer Mtrs ---.!>
Water Heater 2 Classrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0 Deduct Meters ---.!>
Site Drain ---.!> Breakrm Sink 1 Dip Well 0 F Prep Sink 0 Gar Drain 0 Wtr Usage Mtrs ---.!>
Roof Drain ---.!> Ejector/Grind 0 Drink Ftn 0 Serv Sink 0 Soda Disp ---.!>
Misc. 0
Fixtures
Use/Nature I
of Work Factory addition interior plumbing (Debit Account)
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 8/3/2005
Type Rough In
Inspector Rich Wood
approved w/cond.
FAXED REQUEST - Rough was approved with a clear indication on how the water heater T&P would be provided approved receptors. Called contractor
DatelTime requested:
8/2/2005 08:30 AM
Notice Type:
Telephone Number:
PAT 589-2007
Access:
Ready DatelTime: 8/212005 08:30 AM Requested By: O'NEILL ENTERPRISE INC
0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
m --.. _--"'0 0 m m m m m m m mm- m m m m mm m m m m --mm-- - hOmm- m - -- 0 m m m-- mmm m m m m m m m m OO_mm--mO Omm _m m m -- --_mm h.. h no
Job Address 3555 MOSER ST
OWner RHJ JKJ LLC
Category 440 - Industrial-Interior
Bathtub ---..!! Shower
Whirlpool 0 Floor Drain
Lavatory 4 Lndry Tray
Toilet 4 Disposal
Res. Sink 0 Dishwasher
Bar Sink 1 Sump Pump
Water Heater 2 Classrm Sink
Site Drain ---..!! Breakrm Sink
Roof Drain 0 Ejector/Grind
Misc. ---..!!
Fixtures
Use/Nature
of Work
0 WaterSoftner
2 Local Waste
0 Clothes Wshr
0 Bidet
0 BeerTap
0 Lab Sink
0 Sterilizer
1 Dip Well
0 Drink Ftn
-
Plumbing Permit Work Card
Penmit Number 114310
Contractor O'NEILL ENTERPRISE INC
Plan
Factory addition interior plumbing (Debit Account)
Size
Sanitary Sewer
Storm Sewer
Water Service
Date 10/5/2005
Type Final
Inspector Allyn Dannhoff
Material
Type
0
0
0
0
0
0
0
0
0
Walt. St.
Ice Chest
Exam Sink
Sculry Sink
Hand Sink
Plaster Sink
Surgeons Sink
F Prep Sink
Serv Sink
0 Shamp Sink ---..!!
0 FlrlWst Sink ---..!!
0 Catch Basin 0
0 Wash Ftn ---..!!
0 Urinal 0
0 Standp Rec ---..!!
0 Ice Maker 0
0 Gar Drain ---..!!
---..!! Soda Disp ---..!!
Conn.Type
Request LineNO STAFF AVAILABLE TO PERFORM INSPECTION, NO CONCERNS NOTED
no time
-
#
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Create Date OS/27/2005
Value
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
$8,300.00
---..!!
---..!!
---..!!
---..!!
0
---..!!
---..!!
0
I
DatelTime requested:
10/4/200508:52 AM
Notice Type:
Telephone Number:
230-2007
Ready DatelTime: 10/4/2005 08:52 AM Requested By: O'NEILL ENTERPRISE lNG-Laurie
0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Access:
m m m m --m m m m m mm--m m m m m m m m m--m_- -- m m m m--m Om_mm__--mh_-- - m - - m 0 - 0 h - - --_--0- 0-- h m - h --0 h__m-- -.. - h m m m m m m--__hm m h
Job Address 3555 MOSER ST
Owner RHJ JKJ LLC
Plumbing Permit Work Card
Permit Number 114310
Contractor O'NEILL ENTERPRISE INC
Create Date OS/27/2005
Category 440 - Industrial-Interior Plan Value $8,300.00
Bathtub -.JJ Shower 0 Water Softner 0 Walt.St. 0 Shamp Sink -.JJ Coffee Maker -.JJ
Whirlpool 0 Floor Drain 2 Local Waste 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
Lavatory 4 Lndry Tray 0 Clothes Wshr 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap -.JJ
Toilet 4 Disposal 0 Bidet 0 Sculry Sink 0 Wash Ftn -.JJ RPZValve -.JJ
Res. Sink 0 Dishwasher 0 BeerTap 0 Hand Sink 0 Urinal -.JJ Eye Wash Statn -.JJ
Bar Sink 1 Sump Pump 0 Lab Sink 0 Plaster Sink 0 Standp Rec -.JJ Wtr Sewer Mtrs -.JJ
Water Heater ~ Classrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker -.JJ Deduct Meters -.JJ
Site Drain 0 Breakrm Sink 1 Dip Well 0 F Prep Sink 0 Gar Drain -.JJ Wtr Usage Mtrs -.JJ
Roof Drain -.JJ Ejector/Grind 0 Drink Ftn 0 Serv Sink 0 Soda Disp -.JJ
Misc. 0
Fixtures
Use/Nature I
of Work Factory addition interior plumbing (Debit Account)
I
Size
Material
Type
#
0
0
0
0
0
Conn.Type
Sanitary Sewer
Storm Sewer
0
0
0
0
0
Water Service
Date 10/31/2005
Type Underground Rough Ir Inspector Allyn Dannhoff
no time
Request Line10/31/05 NO STAFF AVAILABLE TO PERFORM INSPECTION
DatelTime requested:
10/31/200!O9:38 AM
--
Notice Type:
Telephone Number:
230-2007
Access:
Ready DatelTime: 10/31/2001 09:38 AM Requested By: O'NEILL ENTERPRISE lNG-Laurie
0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
mmnn._---hmmmn---OUmommnnm..mmmmnonmmn_.mmmmmmmmmmmmmmmmnhm_.nmnUh_hmnmnOmmnn..mmmhhn.h.mo
Plumbing Permit Work Card
Permit Number 114310
Job Address 3555 MOSER ST
Owner RHJ JKJ LLC
Category 440 - Industrial-Interior
Bathtub ---.f> Shower
Whirlpool ---.f> Floor Drain
Lavatory 4 LndryTray
Toilet ~ Disposal
Res. Sink 0 Dishwasher
Bar Sink ----1 Sump Pump
Water Heater 2 Classrm Sink
Site Drain ---.f> Breakrm Sink
Roof Drain ---.f> Ejector/Grind
Misc. 0
Fixtures
0
2
0
0
0
0
0
1
0
Water Softner
Local Waste
Clothes Wshr
Bidet
Beer Tap
Lab Sink
Sterilizer
Dip Well
Drink Ftn
-
Use/Nature I
of Work Factory addition interior plumbing (Debit Account)
Size
Material
Type
Sanitary Sewer
Storm Sewer
Water Service
Date 11/7/2005
Type Rough In
Inspector Allyn Dannhoff
Contractor
Plan
O'NEILL ENTERPRISE INC
0
0
0
0
0
0
0
0
0
Wait. St.
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
Create Date OS/27/2005
Value
Shamp Sink ---.f>
FlrlWst Sink ---.f>
Catch Basin ---.f>
Wash Ftn ---.f>
Urinal ---.f>
Standp Rec ---.f>
Ice Maker ---.f>
Gar Drain ---.f>
Soda Disp 0
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZ Valve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
no time
PHONE REQUEST / ROUGH-IN FOR NEW ADDITION REMODELNO STAFF AVAILABLE TO PERFORM INSPECTION
-
#
0
0
0
0
0
0
0
0
0
0
Conn.Type
$8,300.00
---.f>
---.f>
0
---.f>
---.f>
---.f>
---.f>
---.f>
I
DatelTime requested:
Access:
11/4/200503:32 PM
Notice Type:
0
0
0
0
0
Telephone Number:
230-2007 LAURIE
þPEN 8-5
Ready DatefTime: 11/4/2005 03:32 PM Requested By: O'NEILL ENTERPRISE INC
0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
m _mh_'" --- 0 - 0 - --- --- m - - -... m m m m - - m m m m ---_m m m m -- -- - m --m m m -- m m m m m mm_m m- m h m - - m ---- U... h - m m - --- h m_mm m m m---_h -.. "ho
Plumbing Permit Work Card
Permit Number 114310
Contractor O'NEILL ENTERPRISE INC
Plan
Job Address 3555 MOSER ST
OWner RHJ JKJ LLC
Category 440 - Industrial-Interior
Bathtub ~ Shower
Whirlpool ~ Floor Drain
Lavatory 4 Lndry Tray
Toilet 4 Disposal
Res. Sink 0 Dishwasher
Bar Sink 1 Sump Pump
Water Heater 2 Classrm Sink
Site Drain ~ Breakrm Sink
Roof Drain 0 Ejector/Grind
Misc. ~
Fixtures
0
2
0
0
0
0
0
1
0
Water Softner
Local Waste
Clothes Wshr
Bidet
Beer Tap
Lab Sink
Sterilizer
Dip Well
Drink Ftn
-
Use/Nature I
of Work Factory addition Interior plumbing (Debit Account)
Size
Material
Type
Sanitary Sewer
Storm Sewer
Water Service
Date 121212005
Type Final
Inspector Allyn Dannhoff
r~"'~~'
DatelTime requested:
1212/200503:38 PM
Notice Type:
Access:
0
0
0
0
0
0
0
0
0
Wait.St.
Ice Chest
Exam Sink
Sculry Sink
Hand Sink
Plaster Sink
Surgeons Sink
F Prep Sink
Serv Sink
0 Shamp Sink 0
0 FlrlWstSink ~
0 Catch Basin 0
0 Wash Ftn ~
0 Urinal 0
0 Standp Rec ,~
0 Ice Maker ~
0 Gar Drain 0
~ Soda Disp ~
Conn.Type
no time
Telephone Number:
Create Date OS/27/2005
Value
Coffee Maker
Int Grease Trap
Ext Grease Trap
RPZValve
Eye Wash Statn
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs
PAT 230-2007
$8,300.00
~
~
~
~
~
~
~
~
#
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Ready DatelTime: 121212005 03:38 PM Requested By: O'NEILL ENTERPRISE INC
0 Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
--m m m m m -- m -- m m m -- m h mhm --m" h m m m -- --.... m_--m - u. -- --.. --... - --.0.0... 0.. -- 0 mm 0."'" -- m m----m---- mmm--m--m -- m.. -- m_mm_m m m no
Party
DUANE HELWIG
MARTIN GANTHER GROUP
4825 COUNTY A
OSHKOSH WI 54901
ADDITIONAL INFORMATION PHONE CALL
rs'
SITE:
Pacur Inc
3555 Moser St
City of Oshkosh, 54901
Winnebago County
FOR:
Object Type: Building ICC Regulated Object ID No.: 1013106
Major Occupancy: Business; Type IIB Metal Frame Unprotected class of construction; Addition-Alteration plan; 6,439
project sq it; Occupancy: B Business
The submittal described above has been placed on HOLD and the review and approval is pending subject to receipt
of the ADDITIONAL INFORMATION and accompany the resubmittal:
Key Item(s)
Comrn 61.31(2) Submit one (I) set of revised building envelope calculations in accordance with Comm
63.0001 on fonus or computer printouts approved by the department. When the total building volume exceeds
50,000 cubic feet, the calculations shall be stamped, signed, and dated by the professional who prepared them.
The factor for unheated slab cannot be utilized unless the perimeter insulation is continuous from the
foundation to the building wall.
Reminders
Comrn 61.31(2)(e) Provide additional calculations or infonnation to substantiate that the submitted plans
conform to this code.
-Required for steel framing for column line B, footings, headers and lintels.
~ commerce.wi.gov
'. . ~)~C., E
ISCOnSlnÌhb",~;":'"
. Department of Commerce' .... ....=
MAY 0 5 2005
Safety and Buildings
2331 SAN LUIS PL STE 150
GREEN BAY WI 54304
TDD #: (608) 264-8777
www.commerce.wi.gov/sb/
www,wisconsin,gov
Jim Doyle, Governor
Mary P. Burke, Secretary
May 03, 2005
CUST ill No.903302
ATTN: Buildings & Structu,:es Inspector
DUANE HELWIG
MARTIN GANTHER GROUP
4825 COUNTY A
OSHKOSH WI 54901
BUILDING INSPECTION
CITY OF OSHKOSH
POB 1130
OSHKOSH WI 54902
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/0312007
SITE:
Pacur Inc
3555 Moser St
CityofOshkosh,54901
Winnebago County
FOR:
Object Type: Building ICC Regulated Object ill No.: 1013106
Major Occupancy: Business; Type lIB Metal Frame Unprotected class of construction; Addition-Alteration plan; 6,439
project sq ft; Partially Sprinklered; Occupancy: B Business; Sprinkler Design: NFPA-13 Sprinkler; Allowable area
determined by: Fire Walls, Separated Use
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Submit
Comm 61.30(3) This review does not include heating, ventilating or air conditioning. The owner should be
reminded that HV AC plans, calculations, and appropriate fees are required to be submitted for review and
apFov~1 prior to insta!l2tion. The sub!rJtted HV AC pl3ns shall match the approved building plans.
Submit, prior to installation, one (I) set of properly signed and sealed precast plans, a completed SB-118
application form including this transaction number and signed by the building designer, and $100 submittal fee
to Safety & Buildings, P.O. Box 7162, Madison, WI 53707-7162.
Reminders
Comm 61.30(3) This review does not include lighting. Comm 63.0001 Prior to'installation, lighting plans and
calculations shall be prepared in compliance with the code and properly signed and sealed. The plans shall be
available at the joh site as requested by the Department representative or local official.
mc 1003.2.10 Provide exit, exit access doors, and egress stairways with exit signs and directional exit signs in
compliance with this section. Address the need for 90 minute continued illumination in case of power loss.
.
Comm 62.1106 Refer to Table Comm 62.1106 for the required number ofaccessible parldng spaces as based
on the total number of parking spaces provided for the facility. The accessible parldng spaces shall be compliant
with the requirements ICCI ANSI A117.1 sec. 502. Three (3) accessible parking spaces are required.
mc 714.2.7 Provide required fire doors with self-closing or automatic-closing device per this section unless an
exception can be met.
DUANE HELWIG
Page 2
5/312005
The addition is not sprinklered.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. If plan index sheets
were subll1itted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to
plans that correspond with the copy on file with the Department. All pennits required by the state or the local
lI1unicipality shall be obtained prior to conunencell1ent of construction/installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise lI1aking thell1 necessary for code compliance. AB per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or coll1ponent.
Inquiries concerning this correspondence lI1ay be made to lI1e at the telephone nwnber listed below, or at the address
on this letterhead.
lJd)/
Donald L Diedrick
Plan Reviewer, Integrated Services
(920)492-5606 , Monday - Friday 6:30 all1 - 4:00 pll1
ddiedrick@conunerce.state.wi.us
Fee Required $
FeeReceived $
Balance Due $
580.00
580.00
0.00
cc: Peter R Ochs, Building Inspector, (920) 948-3500, Friday, 7:45 AM. - 4:30 P.M.
Pacur Inc
DEPARTMENT OF PUBLIC WORKS
215 Church Avenue
P.O. Box 1130
Oshkosh, Wisconsin
54903-1130
~
OfHKOfH
(920) 236-5065
April 25,2005
Mr. Dean Glatting
Martin Ganther Group
P.O. Box 12
4825 County Road A
Oshkosh, WI 54901
Re: Pacur Inc. (3555 Moser Street)/Drainage, Grading, and Erosion Control Plan Review #1
Dear Mr. Glatting:
The following review comments pertain to the Drainage, Grading, & Erosion Control Plan for the
proposed building addition for Pacur Inc.:
1. Provide a note that prior to making connection to the City of Oshkosh watennain, it will
be necessary to contact Mr. Jim Wolf with the City of Oshkosh Water Distribution
Division.
2. Please include a note on the plans that the Contractor will need to obtain and City of
Oshkosh right-of-way pennit from the Department of Public Works.
Please respond in writing to each of the above noted questions. If any additional changes are
incorporated into the plan on the next submittal please indicate what those changes are.
Sincerely,
Jason Brown
Civil Engineer IT
Cc: David C. Patek, Director of Public Works
Scott Erickson, Asst. Director of Public Works
Ed Potempa, Civil Engineer II
Page 1 of 1
Dannhoff, Allyn J.
From:
Brown, Jason
Sent: Tuesday, April 26, 2005 11 :14 AM
To: 'Dean Glatting'
Cc: Dannhoff, Allyn J.
Subject: RE: Pacur, Inc. addition
Dean,
I've completed my review and have two notes that we would like to have added to the plans (see attached
word document). Since the request to add these notes is a relatively minor issue, I will approve the plans and
ask the inspection department to include the addition of the review comments from Engineering to be
included on the permit as a condition of approval.
Once the notes have been added to the plans, a final copy sent to our office, or emailed, would be
appreciated. If you have any questions, please feel free to contact me. Thanks.
Jason Brown, P.E.
Civil Engineer II
City of Oshkosh - Dept. of Public Works
Phone: (920) 236-5065
Fax: (920) 236-5068
E-mail: jbrown@cLoshkosh.wLus
From: Dean Glatting [mailto:dglatting@martinganther.com]
Sent: Tuesday, April 26, 2005 10:02 AM
To: jbrown@ci.oshkosh.wLus
Subject: Pacur, Inc. addition
Importance: High
Jason,
Please let me know the approval status of the proposed site plan package for the Pacur, Inc.
building that was submitted to you on April 8, 2005.
Thank you,
Dean G. Glatting
MARTIN GANTHER GROUP
Architecture & Project Development
4825 County Road A, Oshkosh WI 54901
920.426.4774 phone
920.426.4788 fax
4/26/05
.i commerce.wi.gov
~ i!~9Jl!lQ
Safety and Buildings
2331 SAN LUIS PL STE 150
GREEN BAY WI 54304
TDD #: (608) 26408777
wwwocommerce.wi.gov/sb/
www.wisconsin.gov
JUL 152005
, . .lJEPARTMFNT n¡:
¡;OWIIIIWNITY DEVEU)PMfNT
Jim Doyle, Governor
Mary P. Burke, Secretary
July 13,2005
CUST ID No.259120
ARTHUR WARREN
.CÜNl)Üìi TÜT ALCÜMFÜRT INC
11 BLACKBURN ST
PÜ BÜX 184
RIPÜN WI 54971
A7TN: Buildings & Structures Inspector
BUILDING INSPECTIÜN-
CITY .oF ÜSHKÜSH
PÜB 1130
ÜSHKÜSH WI 54902
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 07/13/2007
SITE:
Pacur Inc
3555 Moser St
City of .oshkosh, 54901
FOR:
.object Type: HV AC ICC System
6,439 sq ft Area Heated
Smoke Detection system
Regulated .object ID No.: 1024445
The subnrittal described above has been reviewed for conformance with applicable Wisconsin Adnrinistrative Codes
and Wisconsin Statutes. The subnrittal has been CÜNDITIÜNALL Y APPRÜVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing inlthe state unless licensed to do so by the Department s. 145.06,
stats.
The following conditions shall be met during construction or installation anp prior to occupancy or use:
Key Item(s) (
. IMC 403/Conun 64.0403(6)(a)1. Provide a nrinimum of outside \,ir in the amount of-7.5 coo per person in the
building. Simultaneously exhaust an equal amount of air. See Conim Table 64.0493.
Reminders
.
IMC IIOI/Conun 64.1101 Provide mechanical refrigerating systems that are constructed and installed in
compliance with the standards of the American Society of Mechanical Engineers, as adopted under Comm 45.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. Ifplan index sheets
were subnritted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to
plans that correspond with the copy on file with the Department. All pemrits required by the state or the local
municipality shall be obtained prior to commencement of construction/installation/operation. .
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
ARTHUR WARREN
Page 2
7113/2005
Fee Required $
Fee Received $
Balance Due $
320.00
320.00
0.00
Plan Reviewer, Integrated Services
(920)492-5606, M-t 6:30 am - 4:00 pm, Fri a.m. Only
ddiedrick@commerce.stateowi.us
cc:Pelèt R Ochs, Btiìldifig IhSpeCtor;(920) 948-3500 ,Friday, 7:45A.M:' 4:30 P.M.
Pacur Inc
DC!
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 61.50). Failure to submit this form may result in penalties as specified in Comm.!io.Z()/Ço.mn'\,"6J..23.
and/or local ordinances. This form must be submitted prior to the plan approval expiration date or another submittal may
be required.
General Instructions: Prior to the initial occupancy of new buildings or additions and the final occupancy of
altered existing buildings, submit this ODmpleted and signed form to:
. The municipal building inspection office and
. Safety and Buildings, 10541N Ranch Road Hayward, Wi. 54843
Note: If the review was done by the municipality, the ODmpliance statement goes only to the municipal building
inspector. A ODpy is not needed by Safety & Buildings.
Personal information you provide may be used for secondary purposes [privacy Law, so 15.04 (1 )(m)].
1. PROJECT INFORMATION: Please fill in the following with information from your plan approval letter.
Transaction ID Number ~1Z-5B37
Site Number lo/&) 6fi 2
Site location (number & street) 3555 IV/a~, ~
~ City 0 Village 0 Town of ðSif.¡?oSH- County of \J /J~, 0
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:)iJ Building Object ID # If)/SIO(" 0 HVAC Object ID #
0 Lighting Object ID #
~ Partial Completion '£,iA/UJklr.. ~lnðJ ,.,¡\JJ.y j 4:t-~J'i.Ø(ÚJ~t191 ~1J.h}Ç74:111mGUT
escríption of ortion Completed
AI 'm Statement of Substantial Compliance
r 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.
D BUILDINGILIGHTING ITEMS
1. Structural system Including submittal and erection of all building components
(trusses, precast, metal building, etc.)
2. Fire protection systems (sprinklers, alanns, smoke detectors) designed,
installed, and tested Oncludlng folWard flow on back flow devices) by
appropriately registered professionals
3. Shaft and stairway enclosure
4. Exits including exit and directional lights
5. Rre-reslstive construction, enclosure of hazards, fire walls, labeled 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
g. All conditions of building plan approval and applicable variances
4 2005
:;::J!:i~T
10. Exterior lighting & control requirements
11. Interior lighting & control requirements
12. All conditions of lighting plan approval
and applicable variances
1. HV AC 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.)
D) 0 Project Abandoned
3. SU~RVlSING PROFESSIONAL ~R:
Building 0 HVAC 0 Lighting It/l
Name(please rintortype)
Phone number <17.JJ Au. .4-n4--customer ID # 903 30 "'2-
Date UJ '1~'otJ
,,- 4J¡ldo#j
SBD-9720 (RO2/2004)
(I)
CORRECTION NOTICE I FIELD INSPECTION REPORT
JOB LOCATION.:.. "Z.<,~-S- /¥~el
CONTRACTOR: ¿;"¿¡ V\JJ-f..t'r-' ~.. ::r:tJ-
PROJECT TO BE INSPECTED: ~kt' ~,jJ~
TYPE OF INSPECTION: P~/
(I)
City of Oshkosh
Inspection SeTVices Division
215 Church Avenue, PO Box 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax (920) 236-5084
Violations must be corrected and approved within 30 days unless otherwise noted. Call for re-inspections prior to concealment
and/or occupancy. Upon completing the corrections, the owner/contractor/agent must sign and date at the bottom of this notice
and return it to the Inspection Services Division by the Compliance Date of
: °CO])E INSPECTION RESULTS
~
Post-it" Fax Note
To
7671
Fax.
"'f78'2'
Fax.
0 MailedIFaxed
Company
Signature:
Date
MARTINIGANTHER
GR0UP Rê EC
I .~. .;;;, /7"-"
Architecture 6 Project Development Service 1 'I!.. 1
TRANSMITTAL
MAY 2 6 2006
To: Safety and Buildings
10541 North Ranch Road
Hayward, Wisconsin 54843
DEPAHYMENT OF
Date: May 25, ~6~MUNiTY
Project: Pacur Addition
Oshkosh, Wisconsin
From: Duane Helwig, AlA
We are sending you:
D Plans D Digital Files
D Submittals ~ Copy of Letter
D Specifications
D Samples
D Shop Drawings
D Other (see below)
Copies Date Description
1 5/25/06 Compliance Statement SBD-9720
These are transmitted as checked:
~ For your use D For review D As requested
D Other
Remarks:
~ '/ ~4i'
Dua e ~g, AlA ~
Cc: Mr. Allyn Dannhoff
City of Oshkosh - Building Inspection
PO Box 1130
Oshkosh, Wisconsin 54903
Martin Ganther Group, LLC
4825 County Road A . Oshkosh, Wisconsin 54901
P 920.426.4774 . F 920.426.4788
www.martinganther.com
('O"""E
,< \, ,,~, i.,,","
BUILDINGS, HV AC, COMPLIANCE STATEMENT SBD-9720
This form is required to be submitted by the supervising professional (architect, engineer, HVAC de~r9r ¡jleçl,liiqal
designer) observing construction of projects within buildings with total areas 50,000 cubic feet or gréä!ë/ afrd'ßléâßHèrs
(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. This form must be submitted prior to the plan approval expiration date o~}!tiP1t¡~n~~J[rf\¡!fa~y
be required';OIVlMUNITY DEVElOPMENT
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, 10541 N Ranch Road Hayward, Wi. 54843
Note: If the review was done by the municipality, the compliance statement goes only to the municipal building
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 112- t?33ï?
fc(C;~2-
Site Number
Site location (number & street) ;::¡5e:;c; M,() ~ 51JUl'd1
):§ City 0 Village 0 Townof ¿15H1?o'5sri County of tAl~70
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: '!&1JBuilding Object ID # tOt ~LD (, 0 HVAC Object ID #
0 Lighting Object ID #
0 Partial Completion
Description of Portion Completed
A) X Statement of Substantial Compliance
To the best of my knowiedge, belief, and based on onsite observation, construction of the following building andlor 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 fiow on back fiow 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, labeled doors, class 0 HV AC ITEMS
of construction, fire stopped penetrations
6. Sanitation system (toilets, sinks, drinking facilities)
7. Banier-free Including Comm 18 elevators and lifts
8. Energy envelope requirements
9. All condllions of building plan approval and applicable variances
The following items are not in compliance and must be addressed:
10. Exterior lighting & control requirements
11. Intertor lighting & control requirements
12. All conditions of lighting plan approval
and applicable variances
-----
1. HV AC 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 as of this date.)
D) 0 Project Abandoned
3. SUPERVISING PROFESSIONAL SIGNATURE FOR:
\,( Building 0 HVAC 0 Lighting
/" ~. ~114 ame pleaseprintortype)
Phone number ~ Customer 10 # ""3301..
Date ~z¡:; -0&
,,;- [k"p 11
SBD-9720 (RO2/2004)