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Home My WebLink AboutCertificate of Occupancy !, CITY HALL Inspection Services Div 215 Church Avenue ~POBOX1130 ~ Oshkosh WI ~ 54903-1130 OfHKOfH ON THE WATER City of Oshkosh Approved: April 24, 2006 Bent Block Oshkosh LLC 377 City Center Oshkosh, Wisconsin 54901 CERTIFICATE OF OCCUPANCY An Occupancy Permit is hereby issued for the tenant space build out, located at "~,~--4: shkosh, Wisconsin 54901 as described in Building Permit Application number(s) 116575. This building is to be used only as "Oshkosh PC" and is located in the C-3DO, Central Commercial District with a Downtown Overlay. LIMITATIONS: Maximum number of persons:. 50 Occupants 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 certifiC8a valid. cc: Oshkosh PC Building Permit Work' Card , Job Address 460470480 N MAIN ST Permit Number 0116575 Create Date 9/30/2005 Owner BENT BLOCK OSHKOSH LLC Contractor OWNER Category 232 - Alteration Stores & Customer Service Type . Building o Sign o Canopy o Fence o Raze I Plan Q5-86-0905 Zoning Class of Const: Size Value $5,000.00 - U nfi nished/Basement 0 Sq. Finished/Living 0 Sq.Ft. Garage 0 Sq.Ft. - Ft. - Rooms 0 Bedrooms 0 Baths 0 D Projection I - - Stories 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 Not Required # Dwelling Units 0 # Structures 0 Use/Nature 480 N Main St / Oshkosh PC - Tenant space build out as per plans. of Work HV AC Contr CONDON TOTAL COMFORT Plumbing Contr FARMERS SUPPLY CO Electric Contr BEEZ ELECTRIC INC Inspections: Date 11/18/2005 Type Final Inspector Allyn Dannhoff not approved req,est Uoo TOP OK SEE FeN DatelTime requested: 11/16/2005 11:17 AM Access: IOpen 8-5 - would like on Friday 11/18/05 Ready DatelTime: 11/18/200508:00 AM Requested By: Kevin Notice Type: Phone Number: 203-0864 o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Type Final Inspector Allyn Dannhoff approved w/cond. Date 4/24/2006 BUSINESS NOT OPEN @ NOON. NOT ABLE TO CHECK FOR COMPLIANCE. CLOSE FILE ISSUE C.O. SUBJECT TO COMPLIANCE WITH 1/18/05 CORRECTION NOTICE. DatelTime requested: Access: Notice Type: Phone Number: Ready DatelTime: Requested By: o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Page 1 of 1 Electric Permit Work Card t, J,,;b Address 460470480 N MAINST Permit Number 116830 Create Date 09/30/2005 Owner BENT BLOCK OSHKOSH LLC Contractor BEEZ ELECTRIC INC Category 643 - Commercial-Addition/Remodels Service b New o ChangeO Temp . N/A I Type o Overhead o Underground . N/A I Volts Circuits 0 Fixtures 0 Amps 0 Switches 0 Receptacles 0 Fee $162.00 D Value $7,500.00 Appliances Use/Nature ~80 N Main St / Oshkosh PC - Tenant space build out as per plans. (debit acct) of Work , Inspections: Type Rough In Inspector Kevin Benner approved' Date 10/18/2005 Request Line (rec'd 10/17/052:21 PM - emailed application at same time) DatelTime requested: 10/18/2005 07:31 AM Access: Notice Type: Phone Number: 231-6655 Ready DatelTime: 10/18/200507:31 AM Requested by: BEEZ ELECTRIC INC-Jeff o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid -----------------------------------------------------------------------------------. Type Final Inspector Kevin Benner not approved Date 11/16/2005 Request Line- anytime 7:30-3:30 on Wed 11/16/05 See field notes reviewed with Andy from the E.C. DatelTime requested: 11/15/2005 02:04 PM Access: Electrician on site. Notice Type: Phone Number: 231-6655 Ready DatelTime: 11/16/2005 07:30 AM Requested by: BEEZ ELECTRIC INC-Jeff o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid ',-"',.",',".',,'.' Electric Permit Work Card , " ,t:)b Address 460470480 N MAIN ST Permit Number 116830 Create Date 09/30/2005 Owner BENT BLOCK OSHKOSH LLC Contractor BEEZ ELECTRIC INC Category 643 - Commercial-Addition/Remodels Service b New o ChangeO Temp . N/A I Type o Overhead o Underground . N/A I Volts Circuits 0 Fixtures 0 Amps 0 Switches 0 Receptacles 0 Fee $162.00 0 Value $7,500.00 Appliances Use/Nature 80 N Main St / Oshkosh PC - Tenant space build out as per plans. (debit acct) of Work . Inspections: Date 11/18/2005 Type Re Final Inspector Kevin Benner a~p-t()Ve-d'w/Cond. Arc Flash label in the west basement, closure for and old disconnect that is know used as a J-Box, K.O. plug on the wireway in the East basement. Andrew from Beez Electric called & stated the above noted vio.'s are corrected: 11/21/5 7:15AM DatelTime requested: 11/17/2005 01:11 PM Access: Meet AJ on site Ready Date/Time: 11/18/2005 11 :30 AM Requested by: BEEZ ELECTRIC INC Andrew Johnson o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid Notice Type: Phone Number: 379-5603 -----------------------------------------------------------------------------------. HVAC Permit Work Card Job Address 460470480 N MAIN ST Permit Number 116955 Create Date 09/30/2005 Owner BENT BLOCK OSHKOSH LLC Contractor CONDON TOTAL COMFORT Category 510 -Ind. & Comm-Heating & Ventilating Plan Q5-86-0905-H Fuel ~~ UOil I l!':j Electric I U Solar I U Solid I Value $1,650.00 System o New I D Replace I D Other I ~ Forced Air I U Radiant I U Steam I U A1C I ~ 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 80 N Main St / Oshkosh PC - Tenant space build out as per plans - install duct work on exisitng of Work equipment, and install 3 exhaust fans. Inspections: Date11/18/2005 Type Final ITOP OK SEE FCN Inspector Allyn Dannhoff not approved DatelTime requested: Notice Type: Phone Number: Access: Ready DatelTime: Requested By: o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Date 4/24/2006 Type Final Inspector Allyn Dannhoff .appfoveawlCorid. DatelTime requested: Notice Type: Phone Number: Access: Ready DatelTime: Requested By: o Reinspect Fee 0 Fee Waived o Reinspect Fee Paid " Plumbing Permit Work Card Job Address 460470480 N MAIN ST Permit Number 116776 Create Date 09/30/2005 Owner BENT BLOCK OSHKOSH LLC Contractor JIM'S PLUMBING & HEATING INC Category 440 - Industrial-Interior Plan Value $3,500.00 Bathtub 0 Shower 0 Water Softner 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0 Whirlpool 0 Floor Drain 1 Local Waste 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0 - Lavatory 2 Lndry Tray 0 Clothes Wshr 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0 Toilet 2 Disposal 0 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve 0 Res. Sink 0 Dishwasher 0 Beer Tap 0 Hand Sink 0 Urinal 0 Eye Wash Statn 0 Bar Sink 0 Sump Pump 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0 Wtr Sewer Mtrs 0 Water Heater 1 Classrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0 Deduct Meters 0 - Site Drain 0 Breakrm Sink 0 Dip Well 0 F Prep Sink 0 Gar Drain 0 Wtr Usage Mtrs 0 - Roof Drain 0 Ejector/Grind 0 Drink Ftn 0 Serv Sink 0 Soda Disp 0 - - - - Misc. 0 - Fixtures Use/Nature ~80 N Main COMM / ELECTRIC WATER HEATER * NO EIV PROVIDED, SEPARATE ELECTRICAL PERMIT IS REQUIRED 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 10/17/2005 Type Rough In Inspector no time FAXED REQUEST / PERMIT APPLICATION & INSPECTION REQUEST WERE FAXED TOGETHER, READY 10/14/05-2 PMNO STAFF AVAILABLE TO PERFORM INSPECTION DatelTime requested: 10/14/200101:38 PM Notice Type: Telephone Number: 757-5258 Access: ICALL KEVIN SAVITT 203-0864 Ready DatelTime: 10/14/200! 02:00 PM Requested By: JIM'S PLUMBING & HEATING INC o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid - - - - -- - - - - - - - --- - - - -- - - - - - - --- - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - '.. --- - - -- -- - - - - - -- - - - - - - --- - - - - - - - --- -,.. - - - - - - - - - - --- - - - - --- - - - - -- - - - - - -- - - - - -- -- - - - - - - --- - - - - --- - - - - -- - - - -- - - - --- - ---- - - - - -- - - - "" --- - - -,..-- " Plumbing Permit Work Card Job Address 460470480 N MAIN ST Permit Number 116776 Create Date 09/30/2005 .' Owner BENT BLOCK OSHKOSH LLC Contractor JIM'S PLUMBING & HEATING INC Category 440 - Industrial-Interior Plan Value $3,500.00 Bathtub 0 Shower 0 Water Softner 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0 - Whirlpool 0 Floor Drain 1 Local Waste 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0 Lavatory 2 Lndry Tray 0 Clothes Wshr 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0 Toilet 2 Disposal 0 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve 0 Res. Sink 0 Dishwasher 0 Beer Tap 0 Hand Sink 0 Urinal 0 Eye Wash Statn 0 Bar Sink 0 Sump Pump 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0 Wtr Sewer Mtrs 0 Water Heater 1 Classrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0 Deduct Meters 0 Site Drain 0 Breakrm Sink 0 Dip Well 0 F Prep Sink 0 Gar Drain 0 Wtr Usage Mtrs 0 - Roof Drain 0 Ejector/Grind 0 Drink Ftn 0 Serv Sink 0 Soda Disp 0 - - - - Misc. 0 - Fixtures Use/Nature 480 N Main COMM / ELECTRIC WATER HEATER * NO EIV PROVIDED, SEPARATE ELECTRICAL PERMIT IS REQUIRED 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 11/18/2005 Type Final IrOP OK SEE FCN Inspector Allyn Dannhoff not approved DatelTime requested: Access: Notice Type: Telephone Number: Ready DatelTime: o Reinspect Fee 0 Fee Waived Requested By: o Reinspect Fee Paid . Plumbing Permit Work Card Job"Address 460470480 N MAIN ST Permit Number 116776 Create Date 09/30/2005 Owner BENT BLOCK OSHKOSH LLC Contractor JIM'S PLUMBING & HEATING INC Category 440 - Industrial-Interior Plan Value $3,500.00 Bathtub 0 Shower 0 Water Softner 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0 Whirlpool 0 Floor Drain 1 Local Waste 0 Ice Chest 0 FlrlWst Sink 0 'nt Grease Trap 0 Lavatory 2 Lndry Tray 0 Clothes Wshr 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0 Toilet 2 Disposal 0 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve 0 - Res. Sink 0 Dishwasher 0 Beer Tap 0 Hand Sink 0 Urinal 0 Eye Wash Statn 0 Bar Sink 0 Sump Pump 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0 Wtr Sewer Mtrs 0 Water Heater 1 Classrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0 Deduct Meters 0 - Site Drain 0 Breakrm Sink 0 Dip Well 0 F Prep Sink 0 Gar Drain 0 Wtr Usage Mtrs 0 - Roof Drain 0 Ejector/Grind 0 Drink Ftn 0 Serv Sink 0 Soda Disp 0 - - - - Misc. 0 - Fixtures Use/Nature 80 N Main COMM / ELECTRIC WATER HEATER * NO EIV PROVIDED, SEPARATE ELECTRICAL PERMIT IS REQUIRED 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 3/15/2006 Type Final Inspector Paul Wolf approved FINAL FOR 460 N MAIN ST UNISEX RESTROOM AND LAUNDRY TRAY AND RI FOR BREAKROOM SINK DatelTime requested: 3/14/200608:49 AM Notice Type: Telephone Number: Access: 15240 LOCK BOX JERRY FROM JIMS Ready DatelTime: 3/14/2006 08:49 AM Requested By: JIM'S PLUMBING & HEATING INC o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid ~ CORRECTION NOTICE / FIELD INSPECTION REPORT JOB LOCATION: 180 /U~ ~ < CONTRACTOR: Ot>>~ PROJECT TO BE INSPECTED: ...dt.9S/~ TYPE OF INSPECTION: ~r~ ~ City of Oshkosh Inspection Services Division 215 Church Avenue, PO Box 1130 Oshkosh, VVI54903-1130 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/agen must sign and ate at the bottom of this notice and return it to the Inspection Services Division by the Compliance Date of SPEC1'lONQSULTS :z-- Post-it@ Fax Note To t~ Co./Dept. Phone # Fax # .2.-.i'o Phone # 2.-3 Fax # - .s-tO .y S- Print Name Company Signature: Date ~ ~ CORRECTION NOTICE / FIELD INSPECTION.REPORT JOB LOCATION: <f8tO /C/..~ CONTRACTOR: t2u.9 ~ ~ PROJECT TO BE INSPECTED: ~~tlfA4.ff-_ TYPE OF INSPECTION: p,r.-.-(J ~ City ofO~hkosh Inspection Servlce$ Divi~jon 21 S Church A V~TlUC. PO BOll; \130 Oshl..'Osh, WI 5490.3- 1130 Phone: (920) 236-5050 Fax (920) 236-5084 liolati()ns must be correGted and approved within 30 days unless otherwise noted. Call for re-ir.ispections prior to concealment mellor c)ccupancy. Upon completing the corrections, the owner/oonlnlctor/agen~ sign and date at the bottom of this notice iDd return it to the Inspection Services Dlviswn by the Compliance DaU of J- ......: 1'; , A.}: ~ ;:;'.r,!.:.r- ~ . 'SPECTlONRtS'tlLTS . ;;?;- s ~ /1 y;,~_~;_~_~J ".~ ~~: ';:~~~~d-e ~k~t-r~ +~~~/ ~ I~~" i- ~~ - r 11 K ~ 0 {- I,e . "-7 /nt' kl;' ~= !,~~~.,~ ~~ ~~ Post-l~ Fax Note Tel {. CeJDept. Phone It ~.r~.ys- 1=8)( It ~...? 0 u. ~ - S-~~~ # (;L~ &oi/r;h"f : lrint Name ~~tr Company ~~ .~ 'b~~\b.f'., Date ~J~ :ignature: ~ ~ OJHKOJH City of Oshkosh Division of Inspection Services 215 Church Avenue PO Box 1130 Oshkosh WI 54903-1130 www.ci.oshkosh.wi.us ON THE WATER September 30, 2005 Rick Schoreder Rick Schroeder AlA Architecht 581 North Main St Oshkosh, WI 54901 Peter Jungbacker Bent Block Oshkosh LLC 377 City Center Oshkosh, WI 54901 Site: Plan Number: Q5-86-0905 Oshkosh PC 480 North. Main St Oshkosh WI 54901 For: Description: Interior Alterations Object Type: Building only Class of Construction: IIIB - 4230Ft.; Sprinklered Occupancy: B Business / Office Maximum No of Occupants: 24 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 Key Item(s) I Conditions: . IBC 711.3 Any penetrations of fire rated assemblies are required to be protected with a listed firestopping system that matches the rating of the wall assembly being penetrated. Copies of the firestopping systems are required to be provided at the time of inspection. . mc 901.2 Fire protection systems shall be installed, repaired, operated and maintained in accordance with this code and the international fire code. (Construction of new walls may require the addition and or relocation ofsprlnkler heads to maintain required coverage, and not obstruct spray patterns offire sprinklers) . IFC 901.4 Fire protection systems shall be maintained in accordance with the original installation standards for that system. Required fire protection systems shall be extended, altered, or augmented as necessary to maintain and continue protection whenever the building is altered, remodeled or added to. Alterations to fire protection systems shall be done in accordance with applicable standards. Submit plans for fire sprinkler modifications. . IBC 906.1/ IFC 906.3 The maximum travel distance allowed to a fire extinguisher is 75 feet. . IBC 1003.2.11 Means of egress illumination is required to be installed per this section. All paths of egress through The Retail Display area are required to have adequate emergency lighting to meet the performance requirements ofIBC 1003.2.11.3. II:\bri<mn\2005 COffim Plan Review:,:'Q5-86-0905 480 N .Main Sl Bidg 0]]1y,do" Page I of2 . IBC 1209.1 Provide toilet room floors with smooth, hard, nonabsorbent surface extending minimum 6 inches up onto walls. . COMM 62.1109 (l1)Seating at tables, counters and work surfaces. (a) General. Where seating at fixed or built-in tables, counters or work surfaces is provided in accessible spaces, at least 5 percent of the seating, but not less than one, shall be accessible. (b) Dispersion. Accessible fixed or built-in seating at tables, counters or work surfaces shall be distributed throughout the space or facility containing such elements. . COMM 62.1109 (12) Where counters are provided for sales or distribution of goods or services, at least one of each type provided shall be accessible. . Comm 61.30(3) / IMC 507.2 This plan review does not include heating, ventilation, or air conditioning. HV AC plans are required to be submitted and approved prior to installation ofHV AC equipment. . Comm 61.31(4) Revisions to approved plans. All proposed revisions and modifications which involve rules under this code and which are made to construction documents that have previously been granted approval by the department or its authorized representative, shall be submitted to the office that granted the approval. All revisions and modifications to plans shall be approved in writing by the department or its authorized representative prior to the work involved in the revision or modification being carried out. A revision or modification to a plan, drawing or specification shall be signed and sealed in accordance with Comm 61.31(1). SUBMIT: . Comm 61.50 (4) Supervision. Prior to the initial occupancy of an alteration the supervising professional shall file a compliance statement form SBD-9720 with this office. A copy of the approved plans, specifications, and this letter shall be on-site during construction. All permits are required to be obtained prior to commencement of work. In granting this approval the City of Oshkosh Inspection Services Department 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 number listed below or the address on this letterhead. oe Building Systems Consultant (920) 236-5051 Monday - Friday 7:30 A.M. to 8:30 A.M and 12:30 A.M to 1 :30 P.M. bnoe@ci.oshkosh.wi.us cc: Property file Fee Required $ Fee Received $ Balance Due $ 390.00 390.00 0.00 II:".l,n,um'2005 Cumm Plan Review:""Q5-86-0905 <-180 N .r..'lain Sl Bldg Oniy,dl)(, Page 2 of2 " ~ OJHKOIH City of Oshkosh Division of Inspection Services 215 Church Avenue PO Box 1130 Oshkosh WI 54903-1130 www.ci.oshkosh.wi.us ON THE WATER October 25, 2005 Arthur Warren Condon Total Comfort Inc 11 Blackburn St Ripon WI 54971 Peter Jungbacker Bent Block Oshkosh LLC 377 City Center Oshkosh, WI 54901 Site: Plan Number: Q5-86-0905-H Oshkosh PC 480 North Main St Oshkosh WI 54901 For: Description: Interior Alterations Object Type: HV AC only Class of Construction: nm - 4230Ft.; Sprinklered Occupancy: B Business I Office Maximum No of Occupants: 24 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 Key Item(s) I Conditions: . IBC 711.3 Any penetrations of fIre rated assemblies are required to be protected with a listed firestopping system that matches the rating of the wall assembly being penetrated. · IBC 1101.2/ ANSI A117.1-308.2 & 3 -Mechanical system controls shall be located a maximum of 48" above the finished floor if the floor space allows a forward approach by a wheel chair or if the clear space allows a parallel approach. . Comm 61.31(4) Revisions to approved plans. All proposed revisions and modifIcations which involve rules under this code and which are made to construction documents that have previously been granted approval by the department or its authorized representative, shall be submitted to the offIce that granted the approval. All revisions and modifIcations to plans shall be approved in writing by the department or its authorized representative prior to the work involved in the revision or modifIcation being carried out. A revision or modification to a plan, drawing or specifIcation shall be signed and sealed in accordance with Corom 61.31(1). SUBMIT: · IECC 503.3.3.7 [Comm 63.0503(2)(f)] Balancing and documentation ofthe HV AC system shall conform to the !MC. Balancing report required to be submitted prior to fInal occupancy being allowed. · Comm 61.50 (4) Supervision. Prior to the initial occupancy of an alteration the supervising professional shall me a compliance statement form SBD-9720 with this offIce. H:\briann'2005 Comm Plan Review$\Q5-86-0905-H 480 N Main St IIVAC Only,do(; Page 1 of2 A copy of the approved plans, specifications, and this letter shall be on-site during construction. All permits are required to be obtained prior to commencement of work. In granting this approval the City of Oshkosh Inspection Services Department reserves the right to require changes or additions should conditions arise makirig them necessary for code compliance. As per state stats 10 1.12(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 number listed below or the address on this letterhead. Re~y, ~~ Building Systems Consultant (920) 236-5051 Monday- Friday 7:30 A.M. to 8:30 A.M and 12:30 A.M to 1:30 P.M. bnoe@ci.oshkosh.wi.us cc: Property file Fee Required $ Fee Received $ Balance Due $ 230.00 230.00 0.00 Il:\briann\2005 Comm Plan Revie"',s\Q5-86-0905-H 480 N Main St TIV.AC Only. doc Page 2 of2 ~01/03/2006 14:58 FAX 920 233 0421 RICK S~HROEDER AlA BUILDINGS, BV AC, COMPLIANCE STATEMENT 8BD-9720 This form is required to be submitted by the supervising professional (architect, engineer, HVAC designer or electricat designer) observing construction of projects within buifdings with total areas 50,000 cubic feet or greater and bfeachers (Comm 50.10/Comm 61.50). Failure to submit this fonn may result in penalties as specified in Comm 50.261Comm 61_23 and/or local ordinances. This form must be submitted prior to the plan approval expiration date or another submittal may be required. Generallnstructions: 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 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.YOIJ provide may be used for secondary purposes [privacy Law, S. 15.04 (1)(m)). 1. PROJECT INFORMATION: Please fiU in the following with information from your plan approval letter. 141 001 Transaction ID Number Site Number Site location (number & street) 480 North Main Street- Oshkosh P.C. X City 0 Village 0 Town of Oshkosh County of Winnebaao 2. PURPOSE OF THIS STATEMENT: (Check Box A. e, C, or 0 to indicate purpose and complete any other applicable boxes and information. Attach additional pages if necessary.) Check those which apply: X Building Object 10 '# D HVAC Object 10 # o Lighting Object 10 # CJ Partial Completion Desciiption of Portion Completed A) X Statement of Substantial Compliance To the best of my knowledge, belief, and based on onsite observation. construction oflhe following building ancllor HVAC items applicable to this project have been completed in subsmntial compr.anee wittI the approved plans and specifications. X SUILDINGlLIGHTtNG ITEMS 1, Structural system InclUding submittal and erection of all bU.ilding components (trusses, precast, metal building, etc.) 2. Foe protection systems (sprinklers, alanns, smoke detectolS) designed. Installed. and tested (induding forward flow on bade: flaw devices) by appropriately regls1ered professionals 3. Shaft and stairway enclosure 4. Exifs Including exit and diredionallights 5. Fire-resistive construel/on, enclosure of hazards, lire walls. labeled doors, dass 0 HVAC rrEMS of constl1Jction, tint stopped penetrations 6. Sanitation system (toilets. sinks, drinking facilities) 7. Barrier-free induding Comm 18 eleYators and lifts 8. Energy envelope 18ql.lilements 9. All conditions of building platl approval and apprlCable variances The following items ani not in compliance and must be addf9$8ed: B) Cstatement of Noncompliance Due to the following listBd violations. this project is not ready for occupancy: 10. exteriOr lighting & control requirements 11. Interior lighting & control requiremenas 12, All conditions of fighting plan approval and ar>pllcable variances 1. HVAC system inc:luding final test 2. All conditions of HVAC plan <lpprovaI and applicable variances C) 0 Supervising Professional Withdrawn From Project (use A or B abo1/8 to indicate project status as of thl$ date.) D) [] Project Abandoned 3. SUPERVISING PROFESSIONAL SIGNATURE FOR: x Building 0 HVAC D Ugl'ltlng ~Schlt)6der. AlA Date Name (please pnnt or Phone number 920.233-0476 Customer 10.. 2ti5242 SIg SBD-9720 (R.02I2004) SBD.9720 (R02J2004)