HomeMy WebLinkAboutCertificate of Occupancy
CITY HALL
Inspection Services Div
215 Church Avenue
PO Box 1130
~ Oshkosh WI
. ~ 54903-1130
OfHKOfH
ON THE WATER
City of Oshkosh
Approved:
Issued:
December 28, 2006
January 3, 2007
Hunters Ridge of Oshkosh LLC
2990 Universal St Ste C
Oshkosh, WI 54904-5903
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby granted for the new 6-unjt condominium located at
3160 White Tail Lane, Oshkosh, Wisconsin 54904 as described in Building Permit
Application number(s) 120700
This building is to be used only as a multi-family residence and is located in the R-3,
Multiple Dwelling District.
LIMITATIONS:
Maximum persons and/or living units: Six living units
CONDITIONS:
1) Final grading must be done in accordance with the approved subdivision drainage
plan. This plan is on file inthe public works office, 3rdfloor 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.
~h~ -
Building Systems Inspector
Cc: Midwest General Contractors Inc.
Building Permit Work Card
J~J:)Address 3160 WHITE TAIL LN
Owner MIDWEST GENERAL CONTRACTORS
Ca\egory 130 - New Multi-Family
Permit Number 0120700
Create Date 7/20/2006
Contractor MIDWEST GENERAL CONTRACTORS INC
Type . Building
o Sign
o Canopy
o Fence
o Raze
Plan T8-78-0706
Zoning
Class of Const:
Size
Finished/Living 8276 Sq. Ft.
12 Baths 14
Value
$564,000.00
Unfinished/Basement 5380 Sq.
Ft.
Rooms 21 Bedrooms
Garage 2850 Sq. Ft.
o Project~<:>nJ
Height
24 Ft.
Canopies
Signs
Stories 2
Foundation . Poured Concrete
o Concrete Block
o Floating Slab
o Post
o Pier
o Treated Wood
o Other
# Dwelling Units 6
Height Permit Not Requir~
# Structures
Occupany Permit Required
Park Dedication Required
Flood Plain No
..---
Use/Nature COMM/6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468
of Work
...-.-
HVAC Contr BREWER HEATING
Electric Contr CUMINGS ELECTRIC INC
Plumbing Contr WATTERS PLUMBING
Inspections:
Date
Request line
Type !nsulation
Inspector Nicole Krahn
-~
DatelTime requested: 11/2/2006 01:08 PM
Access:
Notice Type:
Phone Number: 420-5878
Ready DatelTime: 11/2/2006 01 :08 p~ Requested By: MIDWEST GENERAL CONTRACTORS INC - Jay _____
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Type final
Inspector John Zarate
approved w/cond.
Date 12/28/2006
REQUEST LINE / READY FOR A FINAL INSPECTION
'THURSDAY 12/28/06 IN THE MORNING"
DatelTime requested: 12/26/2006 09:20 AM
Access:
IPLEASE CALL JAY WITH MIDW!::sfEEYVILL GET YOU IN AND WOULD LIKE TO BE PRESENT
Ready DatelTime: 12/28/2006 Q():OOI\r.1_ Requested By: MIDWEST GENERAL CONTRACTORS INC-Jay
Notice Type:
Phone Number: (920) 420-~8!~___
o Reinspect Fee 0 Fee Waived
o Reinspect Fee Paid
Page 3 of 3
Jbb Address 3160 WHITE TAIL LN
Building Permit Work Card
Permit Number 0120700
Create Date 7/20/2006
Owner MIDWEST GENERAL CONTRACTORS
Category 130 - New Multi-Family
Contractor MIDWEST GENERAL CONTRACTORS INC
Type . Building
Zoning
o Sign
o Canopy
o Fence
o Raze
Plan T8-78-0706
Class of Const:
Size
Value
$564,000.00
Unfinished/Basement 5380 Sq.
Ft.
Rooms 21 Bedrooms
Finished/Living 8276 Sq. Ft.
12 Baths 14
Garage 2850 Sq. Ft.
o Projection i
Stories 2
Heig~t
24 Ft.
Canopies
Signs
Foundation . Poured Concrete
o Concrete Block
o Floating Slab
o Post
o Pier
o Treated Wood
o Other
pccupany Permit Required
Park Dedication Required
# Dwelling Units 6
Height Permit Not Require~
# Structures
Flood Plain No
Use/Nature COMM/6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468
of Work
HVAC Contr BREWER HEATING
Electric Contr CUMINGS ELECTRIC INC
Plumbing Contr WATTERS PLUMBING
Inspections:
Date 10/4/2006
Type Drain Tile
Inspector John Zarate
approved
Faxes Request / Ready for a drain tile bsmt fir / flashing inspection
DatelTime requested: 10/3/2006 08:31 AM
Access:
Notice Type:
Phone Number: (920) 231-1667
--~
Ready DatelTime: 10/3/2006 12:00 PM Requested By: John Skotzke Concrete Construction Inc
o Reinspect Fee .0 Fee Waived
o Reinspect Fee Paid
Type Rough In
Inspector Nicole Krahn
not approved
M'. "'OM will 'P~ ro fu~m~~
Phone Number: 420-5878
Date 10/30/2006
ccessibility required to 1 story units. I discussed this with the state plan examiner and the architect.
or a revision.
DatelTime requested: 10/27/2006 07:29 AM
Access:
~~---
Notice Type: FC
-=:J
Ready DatelTime: 10/27/2006 07:29 ~~ Requested By: MIDWEST GENERAL CONTRACTORS INC - Jay
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Page 2 of 3
Building Permit Work Card
Job Address 3160 WHITE TAIL LN Permit Number 0120700 Create Date 7/20/2006
Owner MIDWEST GENERAL CONTRACTORS Contractor MIDWEST GENERAL CONTRACTORS INC
Category 130 - New Multi-Family
Type . Building o Sign o Canopy o Fence o Raze I Plan T8-78-0706
Zoning Class of Const: Size Value $564,000.00
-
Unfinished/Basement 5380 Sq. Finished/Living 8276 Sq.Ft. Garage 2850 Sq.Ft.
- Ft. -
Rooms 21 Bedrooms 12 Baths 14 o Projection I
- - -
Stories 2 Height 24 Ft. Canopies Signs
- -
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 COMM/ 6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468
of Work
HV AC Contr BREWER HEATING Plumbing Contr WATTERS PLUMBING
Electric Contr CUMINGS ELECTRIC INC
Inspections:
Date 8/3/2006
Type Footings
Inspector Nicole Krahn
not approved
I"equest IIoe Pomed wlo '0 i"pectioo.
DatelTime requested: 8/3/2006 04:45 AM
Access:
Notice Type:
Phone Number: Mike or Tom-231-1667
Ready DatelTime: 8/3/2006 01 :00 PM Requested By: JOHN SKOTZKE CONCRETE CONST
o Reinspect Fee 0 Fee Waived
o Reinspect Fee Paid
- - ----. ----- --- - - -- -- - - - ----- ------ - ------- -- -._---- -- -------- ----------- ------- - - -------------- ------ - - -------- ---- - - - -- -- - - - ---- - - - ---- ------ -. .-.-..---------- --- - ------ - - --
Date 8/16/2006
Type Foundation Backfill
Inspector Nicole Krahn
approved
Request line
DatelTime requested: 8/15/2006 11:47 AM
Access:
L-~:-~:~~~
Notice Type:
Phone Number: Jay Hendricks-420-5878
Ready DatelTime: 8/15/2006 11:47 AM Requested By: MIDWEST GENERAL CONTRACTORS INC
o Reinspect Fee 0 Fee Waived
o Reinspect Fee Paid
---- - - - ----- - - - - - - - - - - - - - --- - - - ---- - - -- --.- - - - - ------- -- --- ----- - - -- - --- - - - ------- ------------- - - - ----- --- ---- -- ----- - - - - - - - - - - - - - - - - ---- - - ------ - -- -----.;. -------- - - - - - -.- - - --
Page 1 of 3
...~:
~
Electric Permit Work Card
Job Address 3160 WHITE TAIL LN Permit Number 122067 Create Date 7/24/2006
--
Owner MIDWEST GENERAL CONTRACTORS Contractor CUMINGS ELECTRIC INC
Category 610 - Residential-New Single Family Service
Service . New o ChangeO Temp ON/A I Type 0 Overhead . Underground ON/A _--.J
Volts 120/240 Circuits 40 Luminaires 100
Amps 600 Switches 50 Receptacles 200
Fee $273.00 0 Value $20,000.00
-.-- I
Appliances Range, garbage disposal, dryer, dishwasher, fan, furnace, A1C
Use/Nature COMM/6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468
of Work
Inspections:
Date 10/31/2006
Type Rough In Inspector Kevin Benner
approved
Request Line / Ready for a rough inspection
DatelTime requested: 10/30/2006 _.2_1_:~5.J='~ Notice Type:
Access:
Phone Number:
Ready DatelTime: 10/30/200601:25 PM Requested by: CUMINGS ELECTRIC INC - Jan
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Type Final
Inspector Adam Krause
approved
Date 12/28/2006
REQUEST LINE / READY FOR A FINAL INSPECTION ON A NEW 6-UNIT
DatelTime requested: 12/27/2006!2:0~1\~__ Notice Type:
Access:
PLEASE CALL CUMINGS TO SET UP TIME FOR TOMORROW
Ready DatelTime: 12/28/2006 OO:gg.I\~___ Requested by: CUMINGS ELECTRIC INC - JAN
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number:
...
... Electric Permit Work Card
Job Address 3160 WHITE TAIL LN Permit Number 122067 Create Date 7/24/2006
Owner MIDWEST GENERAL CONTRACTORS Contractor CUMINGS ELECTRIC INC
Category 610 - Residential-New Single Family Service
Service . New o ChangeO Temp ON/A I Type o Overhead . Underground ON/A I
Volts 120/240 Circuits 40 Luminaires 100
Amps 600 Switches 50 Receptacles 200
Fee $273.00 0 Value $20,000.00
Appliances Range, garbage disposal, dryer, dishwasher, fan, furnace, NC
Use/Nature ~OMM/6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468
of Work
Inspections:
Date
Type Temporary
Inspector Adam Krause
Request line/Inspection of temporary pole behind the condo
Date/Time requested: 08/29/2006 10:41 AM
Access:
Notice Type:
Phone Number: 231-5946
Ready Date/Time: 08/29/200610:41 AM Requested by: CUMINGS ELECTRIC INC - Nancy
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
--.,..,. - ---- -.,. - ----- ------ - - ---- - -.,. ------.,. - -- ----- --.,. ----- - -- -- ----.----- ------------ ----------- ----.--- ------- --- --.,. --.,..,. --- -.- ----------- -- -------- ----- ---------
Date 10/27/2006
Type Service
Inspector Adam Krause
approved
Request line
Faxed to WPS 11:00 AM 10-27-06
Date/Time requested: 10/26/2006 09:37 AM
Access:
Notice Type:
Phone Number:
Ready Date/Time: 10/26/2006 09:37 AM Requested by:
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
CUMINGS ELECTRIC INC - Jan
- - - - -.,..,..,..,..,. - --.,..,. - -- -- -.,. -- - - --- -.,. ---- - -- - --- - -- - ------.,. - -.,. - -.,..,. --.,. --.,. ------ - - ---- -- ------- -- - - ---- -.,..,. - ----- - - ---- -.,. -.,. -- - - - - ----.- -- -- --.,. --- -- -- -----.,..,. ---------
HVAC Permit Work Card
Job Address 3160WHITE TAIL LN Permit Number 122068 Create Date 10/11/2006
Owner MIDWEST GENERAL CONTRACTORS Contractor BREWER HEATING
Category 502 - Residential-Both Plan
Fuel ~ Gas I UOil I ~ Electric I U Solar I U Solid I Value $27,000.00
System ~ New i o Replace I o 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 o Direct Vent . Not Applicable I
Heat Loss o As Approved o Existing . Not Applicable I Value
BTU Rate o As Per Plan o Variable . Other I Value
,
Use/Nature COMM/lnstall HVAC for 6 unit townhouse style condos.' State Approval #1314647, Object ID #
of Work 1093085
Inspections:
Date 10/30/2006 Type Rough In
Inspector Nicole Krahn
not approved
DatelTime requested: 11/01/2006 07:04 AM
Notice Type: FC
Phone Number:
Access:
Ready DatelTime: 11/01/2006 07:04 AM
Requested By:
o Reinspect Fee 0 Fee Waived
o Reinspect Fee Paid
Date 12/28/2006 Type Final
Inspector John Zarate
approved
DatelTime requested: 12/28/2006 12:32 PM
Notice Type:
Phone Number:
Access:
Ready DatelTime: 12/28/2006 12:32 PM
Requested By: BREWER HEATING
o Reinspect Fee 0 Fee Waived
o Reinspect Fee Paid
Plumbing Permit Work Card
Job Address 3160 WHITE TAIL LN Permit Number 121051 Create Date 07/24/2006
"'Owner MIDWEST GENERAL CONTRACTORS Contractor WATTERS PLUMBING
Category 410 - Residential-Interior Plan Value $36,351.00
Bathtub 6 Shower 10 Water Softner Wait. St. Shamp Sink Coffee Maker
- - - - -
Whirlpool Floor Drain 6 Local Waste Ice Chest FlrfWstSink Int Grease Trap
- - - - - -
Lavatory 22 Lndry Tray Clothes Wshr 6 Exam Sink Catch Basin Ext Grease Trap
- - - -- -
Toilet 22 Disposal 6 Bidet Sculry Sink Wash Ftn RPZ Valve
- - - -
Res. Sink 6 Dishwasher 6 Beer Tap Hand Sink Urinal Eye Wash Statn
- - - - -
Bar Sink Sump Pump 6 Lab Sink , Plaster Sink Standp Rec 6 Wtr Sewer Mtrs
- - - - - -
Water Heater 6 Classrm Sink - Sterilizer Surgeons Sink Ice Maker Deduct Meters
- - - - -
Site Drain - Breakrm Sink - Dip Well - F Prep Sink - Gar Drain - Wtr Usage Mtrs -
Roof Drain - Ejector/Grind - Drink Ftn - Serv Sink - Soda Disp -
Misc. 12 Hose Bibs
-
Fixtures
Use/Nature COMM/ 6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1;285468 .
of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
Date 12/27/2006 Type Final
Inspector Paul Wolf
approved
Dishwashers in units C, D & E are not installed. New owner will pick color and model type.
DatelTimerequested:
12/28/200E07:32 AM
Notice Type:
Telephone Number:
Access:
. .=-~.- -----r
Ready DatelTime: 12/27/200E 97:32 AM Requested By: WATTERS PLUMBING
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Plumbing Permit Work Card
Permit Number 121051
Job Address 3160 WHITE TAIL LN
Owner MIDWEST GENERAL CONTRACTORS
Category 410 - Residential-Interior
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
6 Shower
Floor Drain
22
22
6
Lndry Tray
Disposal
Dishwasher
Sump Pump
6 Classrm Sink
Breakrm Sink
Ejector/Grind
12 Hose Bibs
Contractor
Plan
WATTERS PLUMBING
10
6
Create Date 07/24/2006
Value
$36,351.00
Water Softner Wait. St. Shamp Sink Coffee Maker
Local Waste Ice Chest FlrlWsfSink Int Grease Trap
Clothes Wshr 6 Exam Sink Catch Basin Ext Grease Trap
Bidet Sculry Sink Wash Ftn RPZ Valve
Beer Tap Hand Sink Urinal Eye Wash Statn
Lab Sink Plaster Sink Standp Rec 6 Wtr Sewer Mtrs
Sterilizer Surgeons Sink Ice Maker Deduct Meters
Dip Well F Prep Sink Gar Drain Wtr Usage Mtrs
Drink Ftn Serv Sink Soda Disp
6
6
6
Roof Drain
Misc.
Fixtures
Use/Nature COMM/6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1:285468
of Work
Sanitary Sewer
Storm Sewer
Water Service
Size
Material
Type
#
Conn.Type
Date 10/30/2006 Type Rough In Inspector Paul Wolf
No basement work included.
I
DatelTime requested:
Access:
approved
10/30/200!O8:47 AM
Notice Type:
Telephone Number:
Ready DatelTime: 10/30/20.Q! ()~:~~t0_ Requested By: WATTERS PLUMBING
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Plumbing Permit Work Card
Job Address 3160 WHITE TAIL LN Permit Number 121051 Create Date 07/24/2006
Owner MIDWEST GENERAL CONTRACTORS Contractor WATTERS PLUMBING
Category 410 - Residential-Interior Plan Value $36,351.00
Bathtub 6 Shower 10 Water Softner Wait. St. Shamp Sink Coffee Maker
- - - -- -
Whirlpool , Floor Drain 6 Local Waste Ice Chest FlrlWst Sink Int Grease Trap
- -- - - - -
Lavatory 22 Lndry Tray Clothes Wshr 6 Exam Sink Catch Basin Ext Grease Trap
--"- - - -- -
Toilet 22 Disposal 6 Bidet Sculry Sink Wash Ftn RPZ Valve
- - -- -
Res. Sink 6 Dishwasher 6 Beer Tap Hand Sink Urinal Eye Wash Statn
- - - - -
Bar Sink Sump Pump 6 Lab Sink Plaster Sink Standp Rec 6 Wtr Sewer Mtrs
- -- - - - -
Water Heater 6 Classrm Sink Sterilizer Surgeons Sink Ice Maker Deduct Meters
- --- - - -- -
Site Drain - Breakrm Sink -- Dip Well - F Prep Sink - Gar Crain - Wtr Usage Mtrs -
Roof Drain - Ejector/Grind -- Drink Ftn - Serv Sink - Soda Disp --
Misc. 12 Hose Bibs
-
Fixtures
Use/Nature ~OMM/ 6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468
of Work
Size Material Type # Conn. Type
Sanitary Sewer
Storm Sewer
Water Service
.
Date 9/25/2006
Type Water
Inspector Paul Wolf
approved
Water distribution install below basement floor. air test completed.
Date/Time requested:
9/20/200607:34 AM
Notice Type:
Telephone Number:
(920) 733-?125
Access:
c-
. _____ J
Ready Date/Time: 9/20/2006 !Q:Q.q~I\;1__ Requested By: WATTERS PLUMBING - Jamie
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
, Plumbing Permit Work Card
Job Address 3160 WHITE TAIL LN Permit Number 121051 Create Date 07/24/2006
Owner MIDWEST GENERAL CONTRACTORS Contractor WATTERS PLUMBING
Category 410 - Residential-Interior Plan Value $36,351.00
Bathtub 6 Shower 10 Water Softner Wait. St. - Shamp Sink Coffee Maker
- - - -
Whirlpool Floor Drain 6 Local Waste Ice Chest - FlrlWst Sink Int Grease Trap
- - - - -
Lavatory 22 Lndry Tray Clothes Wshr 6 Exam Sink Catch Basin Ext Grease Trap
- - - - -
Toilet 22 Disposal 6 Bidet Sculry Sink Wash Ftn RPZ Valve
- - - -
Res. Sink 6 Dishwasher 6 Beer Tap Hand Sink - Urinal Eye Wash Statn -
- - -
Bar Sink Sump Pump 6 Lab Sink Plaster Sink - Standp Rec 6 Wtr Sewer Mtrs -
- - - -
Water Heater 6 Classrm Sink Sterilizer Surgeons Sink - Ice Maker - Deduct Meters -
- - -
Site Drain - Breakrm Sink - Dip Well - F Prep Sink - Gar Drain - Wtr Usage Mtrs -
Roof Drain - Ejector/Grind - Drink Ftn - Serv Sink - Soda Disp -
Misc. 12 Hose Bibs
-
Fixtures
Use/Nature ~OMM/ 6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Date 8/23/2006
Type Underground
Inspector Paul Wolf
approved
Request Line / Ready for the underground inspectionDWV ONLY, UG WATER DIST. NOT INSTALLED AT TIME OF INSPECTION.
DatelTime requested:
8/23/2006 10:53 AM
Notice Type:
Telephone Number:
(920) 733-8125
Access:
L_____
=:]
Ready Date/Time: 8/23/2006 02:00 PM Requested By: WATTERS PLUMBING - Jamie
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
--- _ -- ----- M _ _ --~ _ ~ ---- -- _ _ _ ----- _ _ --- _ -- -- ---__.. _ _______ _ _ _ ______ _ _ _ _ _______.. ______'______ _ _ ___ _..__ _ __,_' ___ _ _ __ __.. _ _ _.. _,_ _ _ _ ____.. _ _____.....;____-_ '_';' ___ ___ __'_'_ ___ _ __'M _ _ __ _ _ _ _____ __.. ______ _____ __________,__
~ lJ .\:'
.....'8Htt~i~~,.,H,.yAqg<.>mptiance Statement SBD~9720
~.,' , ", '.
." em :\is ;C'r:;;:1j~;;i J;;;be.~~irteq by. the supervising prQf~slonai 1architect. engineer. HVAOdesigher>or efectricai
designer) observi.ng"gQlJsfntctiQO, Qfprojects,withi,n. buiidings,with.total.areas exceeding ,oO.QOO;cUbic; feet Or: greatefJ ano .
bleachers (Comru.SO.lO/Qqmf\l81.50kJ:;j:lilure;to~ufJmit tf)is form may result in penaities:aSi~ecifrt;drIT Cornm'i:"'.,:,'.;;,
50.26/Comm; 61':fq~nQ(QrIQcaLo~inaO~~<:,:;i;s:.,;;:: ,c".:;.(.!:,,; ')" i,:; ;:.,' hi i,;D."'; " c:;;;;;j; iG:::'i;;;3,;:.,,;;t,
,_.:~w'; s.--:>:r-:~;'~:'~i:'f"(':'\r']::;,L~ ~;t(-:;, ;.~,C::IY?
GenerallnStructions:P-f:)i1odo the'initial occupancy of new buildings or additions and the final occupancy of
altered exj4:tk19'bt"~dingsvsubmiHhiscompleted'and;'signecl;formto:"cii:uc?' -'/1:\, :}.::; '.":!G.)'..'';; :):'.'To:1;!<;
,., fj>:' :/,':;;::', ;,,;; :G::~.1-..i'Fti~FmunldpafHuiid'intriil'sp-ebti6'tfaff\tei!i~.dj 0: ;;", ,,' , , . '-"'I',r:.; ','
';':;;",;31'1"';')' ;;;;\;~:~r:;)~7SafetY)an(fB(jlidings, 10541N Ranch Road, Hayward, WI 54843
Personal information you provide ~aY.~~'.lJ~qf()r SeC9Ilcl?l'yj::>~rPo$e~JPIiy~c;yL~w,s.J~.Q4 (1.)(m)J
1. pFiOJ~CT 'If.iFOR'MA TION:
Transaction ID Number
SiteN~rnbe?':669'15
Site'locafiO'n(number&'street) , 316()WHITeTALe'6UN1T #7
'0 CItY' d Vill~g~' :;EF'TownOr':- 'OSHKOSH C-oii'ntYo(' WW~NEBAGO
;', , i '.-~ : t;'.", , . ,j':.\.: ),,' '" : ,.:.;' ~ , } .:, .. ;'::;"', ;j~'.
2. PURPOSE OF THIS STATEMEN!:(CheckBox A, B,C,or D toindlcate purpose and complete any other
....applicable ~oxes an~1~forination. Attach adcfitional pages if necessary).
. "Check those which. apply: --0Suilding.Object ID# 67341&
) '.' :~,"',~ ~ >' j ,. '. ... '.
. . 0 Lighting Object ID1#
:,.' ;'.("":,'" '-,'1,;"5" . ,.~..:" 'C ;'>' ,;: ~..:..;;.:":.-"",,,':~,"
D'" Partial C6mpletioll .'
Please fill in the~().I,I?wing with information from your plan approval letter.
12854&8 . ..
o HVAC Object 10#
",1; :;: '}, ;)");' /' Del;lcnplieh aT PortidriCompleted i:, " . ....." ,,, ' ,
A) 0 Statement of SUbstantta.:CbrTlP'iahce:;,", . .... ~H ':i;;;,':;.''''~.:~\ ,\'d ::"5
To the best of my knowledg'e; ;tlei!ef,'~~d:b~~~lC;h:(Nisite~o6si;NatlOn,:COl{str~~ti~n of the fOllowing building and/or HVAC
.i\~r:rf$ ~OJ)!iyabtEf. ta,.th!S;nroi~ct:have 'b'e~El;~eteaifu ~~$lhtlalroompliance with the approved plans and specifications.
;!1ft~UfL.bf~8i(IGHW~G~'iT~'ij$;Ln~;Sl C!;Cr;t)cHX7\ ()l :j,:;:;f 'n(n!'u~: ::iU) ~fic; dU8)
~,o:cn\c:,.;;;;uJ q~tft:!O!:~J~(~~temiil)gMdiDg,S!J!:>mittal and erection of all building 10. Exterior lighting & control requirements
,... r c::' ;P9.lTlP?~~n~.Jtr:I.!~~l!;p(~~t,:fil1etalbujldingietc;) ;.'<:; un.\ :,~"";,';; ::" :::;~::;"'1'tJ:: Interiorligf:lting & gontrolrequirements
"., ";~,:::i7:WiPr9J~Qtipn~ystelT1$:($pril)!del'$; ,alarms, 'smokecl~t~ctors }:iP." ':: L" j'i,;,.:;;, ;.: ctZ. rAil cen:ditiGhS:oflighfing'plsn 'approval
. .c1e$igned,;il)sta,llecl.and tested (including forward flow on 'back flow .' ",' ,:, /., and\applicable:Qariances
devices) by appropri~teIY.re~ist~rE?dprofe~~,i!>!,lfl~,
3.' Shaft and stairway encloslire .,; ';, ." '.j., '",
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 elevato~ and lifts
8. Energy envelope requirements ,"
9. All conditions of building plan approval and applicable variances
O!HVAc,rtEMS
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) D Statement of Noncompliance
Due to th~ 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;
,./"""
o Building 0 HVAC D Lighting "', . OIV
Name '(please print or type)
,~0
Phone #
920-497-5007
Cu~tomer 10#
649536
Signature
D
Dt.=.
SBD-9720 (R.Ol/2003)
This form is requlrlC to De sucmlttea cy tne supervtslng profe5slcn~1I ~ilr~n11~t;;1. enljllneer, nv,...~ Ut:~lylltilT gr C!1et;IrIcaJ
designer) observing construction of projects within buHding5 with total areas 50.000 cubic feet or greater and bleaChers
(Comm 50.10fComm 61.50). Failure to aub~it tnls form ma.y result in penalties 8$ specified in Comm SO.26fComm 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
e Safety and Buildings, 10541 N Ranch Road Hayward. Wi. 54843
Pe~nal information yoo provide may b. used fer secondary purposes {privacy Law, s. 15.04 (1 )(m)).
1. PROJECTINFORMATlON: Please fill in the following with information from your plan approval letter.
Transaction 10 Number ~..rY ~P'
Site Number ~ ~ j? tI'.(1-
Site location (number & street) ~"I- D ~A:<'l'4 ,.~ ./~
lB"City 0 village [J Town of 1J.,J~,l County of . ~~.:- ~....
2. PURPOSE OF THIS STATEMENT: (Che<:k Box A. S, C. or D to indicate purpose and complete any other
applicable boxes and information. Attach additional pages if necessary.)
Checl<. those which apply: 0 Buildi~g Ob!ect ID #- ~HVAC Objed 10 # ~'Y..J~"/
o LightIng Object 10 'II
~~c~
A.e, ~~1
o Pirtial Completior.
, Description of Portion Completed
A) ~taternent of Substantial Compliance
To the best of my knowledge. belief. end based on onsite Or,)~ervation, construeliof'l of the following huildlng anclo( HVAC
items applicable to this project have been completec in substantial compnaf1" Wll;) tl",e approved plan:s and
specifications.
[j BUILDING/LIGHTING ITEMS
1, S!JtJctul'll &YSll!:Tl inclcdin; lut>l!Iltt31 anC ere<::icn of '" :l!:i1e.ng c;mpor.e~lS
(trUDes. preeas:. metal el.lilclnlil. e!C.)
2. Fir. protection $)'$:ems ($Olrinklers. alarms. smOke eete:;:crs) c:eSI~!llt~
il'ls:.allec. an~ ttt:ed (indudin!; fO/"oltar~ f.o.... on bac!< now ~INicC!~) l)'f
appropriately re;iSlereo grcfessicni'ills
3. Shaft ilnd s:au'....ay enclO$ur~
4. Exits including tlJolt anCl C1ireC'jonalliiP\1$
S. Fire-resistivt ccnstNcllon. enclo5ul1t cf flQzgrr.2S. lire wailS.. la:;el.c eoc~. t::aS$
of CCl'llltrl.iCtion, fire stopped penetr.ticns
6. Sanitation SYSI'~ (tcilet!l. sinks. dntlking fadlltles)
7. Samer.free jn~1.l0ing Comm 18 efe"310rs an~ lif's
a. energy envelQ~ tf!QuiremenlS
9. All coneilions of building plan a~pro"'al anclllllplicable varianee!
The following items ani not in compliance and must bt addl'f!ssed:
,
, C. !:.x.:e":cr hshtll'':<; & cor-Irel re:I,;,rl',!r:'1anlS
, i. lr.t2~Cr Io!;;:-;ir:~ 5. l::)rllrcl re:\,;ire~en:s
'''' A;! :::.r.~:t;cn$ of li,r.:Ir.S ~lan a;::or:lVal
.~,~ a:::-;iGll:le 'nari:ances
c::: K"'I\C ITEMS
1. r.W..C sy:l:e~ ir.:;:ccing final tes~
2. A~I ..::;:t'u:::..cr.s of I-!VAC plan appro..al 'tie
5~;::jGS::le lIa~I!~C:l?~
B) C Statement of Noncompnance
Due to the following listed violations. \tIis project is not ready for occupancy:
C) [J Supervising Professional Withdrawn From Project (Use A or B above tc incic&te project status as of ~Is da"ta")'
OlD Project Abandoned
3. SUPERVISING PROFESSIONAL SIGNATURE FOR:
I:l eulldlng u1,VAC C I.lg1'ltil'l9 ~~~4.4 KA'II~,."#f Octe "".y'~#'
( 9~) ~4,rtl ~. Name (plene l)ril'lt or r;.lllj
Fhone number . . customer 10 # J'~/j ,,, Signature ~ iIfIJ' ~
50D.9;20 0,,0112002)
23
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