HomeMy WebLinkAboutCertificate of Occupancy
..
J
CITY HALL
Inspection Services Div
215 Church Avenue
PO Sox 1130
~ ~~~~,'i.:
a!HKOfH
ON THE WATER
City of Oshkosh
Approved:
Issued:
1/10/05
1/11/05
Garry H. Decker
1113 Oregon Street
Oshkosh, Wisconsin 54902-6484
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby granted for the 4-unit condo located at 3220-3226 Isaac
Lane, Oshkosh, Wisconsin 54902 as described in Building Permit Application number(s)
106029.
This building is to be used only as four dwelling units and is located in the R-3PD,
Multiple Dwelling District with a Planned Development Overlay.
LIMITATIONS:
Maximum persons and/or living units: Four dwelling units
CONDITIONS:
1) Final grading must be done in accordance with the approved subdivision drainage
plan. This plan is on file in the public works office, 3rd floor of City Hall. .
2) Erosion control measures must be maintained until the lawn is estaqlished.
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 noteq above must be complied with in order
for this certificate to be valid. '
,
Building Permit Work Card
Job Address 3220-3226 ISAAC LN Permit Number 0106029 Create Date 7/1/03
Owner GARRY H DECKER Contractor GARRY H DECKER & CO LLC
Category 130 - New Multi-Family
Type . Building o Sign o Canopy o Fence o Raze I Plan 16-55-0703
'l .. C'lass of Const:
Zoning 5Bibc Size irreg Value $170,600.00
-
Unfinished/Basement 3538 Sq. Finished/Living 3538 Sq.Ft. Garage 960 Sq.Ft.
Ft. D Projection I
Rooms 0 Bedrooms 0 Baths 0
Stories Bi-Ievel Height 20 Ft. Canopies 0 Signs 0
-
Foundation . Poured Concrete o Floating Slab o Pier o Other
o Concrete Block o Post o Treated Wood
Occupany Permit Required Flood Plain No Height Permit Not Required
-
Park Dedication Required # Dwelling Units 4 # Structures 1
Use/Nature New 4 unit condo with attached single stall garages.
of Work
HV AC Contr Plumbing Contr
Electric Contr
Inspections:
Date 8/13/04
Type Insulation
Inspector Allyn Dannhoff
no time
REQUEST LINE / WILL BE READY THE END OF TODAY, LEAVE STICKER ON PATIO DOOR, OR IF INSPECTION WILL NOT BE
MADE BY FRIDAY PLEASE CALL
DatelTime requested: 8/11/04
Access:
09:33 AM
Notice Type:
Phone Number: GARRY 235-8035
]
Ready DatelTime: 8/11/04
PM
Requested By: GARRY H DECKER & CO LLC
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Date 1/10/05 : AM Type Final
:REQUEST LINE / FINALS FOR ALL TRADES
INOTIFY WHEN INSPECTION WILL TAKE PLACE
FINAL OK B&H
Inspector Allyn Dannhoff
approved
DatelTime requested: 117/05
Access:
IMASTER KEY
12:59 PM
Notice Type:
Phone Number: LINDA 235-8035
]
Ready DatelTime: 1/7/05
12:59 PM Requested By: GARRY H DECKER & CO LLC
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Building Permit Work Card
Job Address 3220-3226 ISAAC LN Permit Number 0106029 Create Date 7/1/03
Owner GARRY H DECKER Contractor GARRY H DECKER & CO LLC
Category 130 - New Multi-Family
Type . Building o Sign o Canopy o Fence o Raze I Plan 16-55-0703
. '" Ciass of Const:
Zoning 5Bibc Size irreg Value $170,600.00
Unfinished/Basement 3538 Sq. Finished/Living 3538 Sq.Ft. Garage 960 Sq.Ft.
Ft. D Projection I
Rooms 0 Bedrooms 0 Baths 0
-
Stories Bi-Ievel Height 20 Ft. Canopies 0 Signs 0
- -
Foundation . Poured Concrete o Floating Slab o Pier o Other
o Concrete Block o Post o Treated Wood
Occupany Permit Required Flood Plain No Height Permit Not Required
-
Park Dedication Required # Dwelling Units 4 # Structures 1
Use/Nature New 4 unit condo with attached single stall garages.
of Work
HV AC Contr Plumbing Contr
Electric Contr
Inspections:
Date 8/4/04
Type Rough In
Inspector Allyn Dannhoff
cancelled
REQUEST LINE /WOULD LIKE INSPECTION FRIDAY, PM. LEAVE STICKER ON PATIO DOOR
CANCELED 8/4 @ 10:12 AM BECAUSE HVAC WILL NOT BE READY
DatelTime requested: 8/4/04
Access:
07:30 AM
Notice Type:
Phone Number: GARRY 235-8035
]
Ready DatelTime: 8/6/04
PM
Requested By: GARRY H DECKER & CO LLC
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
----------------------------------------------------------------_._------------------------~--
Date 8/9/04
Type Rough In
Inspector Allyn Dannhoff
no time
REQUEST LINE / READY MONDAY 8/9, PM (ALSO HVAC)
LEAVE STICKER ON PATIO DOOR
DatelTime requested: 8/4/04
Access:
10:12 AM
Notice Type:
Phone Number: 235-8035
Ready DatelTime: 8/9/04
PM
Requested By: GARRY H DECKER & CO LLC
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
-----------------------------------------------------------------'-------------------------~--
,
Building Permit Work Card
Job Address 3220-3226 ISAAC LN Permit Number 0106029 Create Date 7/1/03
Owner GARRY H DECKER Contractor GARRY H DECKER & CO LLC
Category 130 - New Multi-Family
Type . Building o Sign o Canopy o Fence o Raze I Plan 16-55-0703
. C'lass of Const:
Zoning 5Bibc Size irreg Value $170,600.00
Unfinished/Basement 3538 Sq. Finished/Living 3538 Sq.Ft. Garage 960 Sq.Ft.
Ft. -
Rooms 0 Bedrooms 0 Baths 0 D Projection I
Stories Bi-Ievel Height 20 Ft. Canopies 0 Signs 0
-
Foundation . Poured Concrete o Floating Slab o Pier o Other
o Concrete Block o Post o Treated Wood
Occupany Permit Required Flood Plain No Height Permit Not Required
-
Park Dedication Required # Dwelling Units 4 # Structures 1
Use/Nature New 4 unit condo with attached single stall garages.
of Work
HV AC Contr Plumbing Contr
Electric Contr
Inspections:
Date 5/19/04 Type Footings
re""" Uoe (..dd 5118104 .008 PM)
DatelTime requested: 5/19/04 07:00 AM
Access:
Inspector Allyn Dannhoff
no time
Notice Type:
Phone Number:
]
Ready DatelTime: 5/19/04
07:00 AM Requested By: JB Miller-Jeff
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Date 5/26/04
rEQUEST LINE
DatelTime requested:
Access:
Type Foundation Backfill
Inspector Allyn Dannhoff
no time
5/25/04
12:15 PM
Notice Type:
Phone Number: JEFF 376-0646
]
Ready DatelTime: 5/25/04
12:15 PM Requested By: JB MILLER
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
HVAC Permit Work Card
Job Address 3220-3226 ISAAC LN Permit Number 107771 Create Date 04/29/2004
Owner GARRY H DECKER Contractor CONDON TOTAL COMFORT
Category 502 - Residential-Both Plan
Fuel 1"'1 Gas I UOil 1 U Electric I U Solar 1 1 I Solid 1 Value $9,990.00
System ~ New 1 D Replace I D Other I
~ Forced Air I U Radiant 1 U Steam I ~ A1C 1 U Vent I
U Electric I U Hot Water 1 U Suppl. I U Con. Burner 1
Chimney Type o Chimney A o Chimney B o Direct Vent . Not Applicable 1
Heat Loss o As Approved o Existing . Not Applicable I Value 0
BTU Rate o As Per Plan o Variable . Other 1 Value
Use/Nature New 4 unit condo/Installing 2 forced air fumaces, 2 1.5 ton a/c units and associated ductwork. Plan
of Work approval number 16-55-0703.
Inspections:
Type Rough In
Inspector Allyn Dannhoff
no time
Date 8/4/04
REQUEST LINE / READY MON 8/9, PM
DatelTime requested: 08/04/2004 10:12 AM
Notice Type:
Phone Number: 235-8035
Access:
~
Ready DatelTime: 08/09/2004
PM
Requested By: GARRY DECKER
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Date 1/10/04
REQUEST LINE
FINAL OK B&H
Type Final
Inspector Allyn Dannhoff
approved
Notice Type:
Phone Number: LINDA 235-8035
DatelTime requested: 01/07/2005 12:59 PM
Access:
IMASTER KEY
=:J
Ready DatelTime: 01/07/2005 12:59 PM
Requested By: GARRY H DECKER
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
------------------------------------------------------------------------------------------~-
Electric Permit Work Card
Job Address 3220-3226 ISAAC LN Permit Number 108419 Create Date 06/0212004
Owner GARRY H DECKER Contractor CUMINGS ELECTRIC INC
Category 631 - Resi~ntial-New Multi-Family Wiring
"-
Service b New o ChangeO Temp ON/A I Type o Overhead . Underground ON/A I
Volts 110/220 Circuits 0 Fixtures 0
Amps 400 Switches 0 Receptacles 0
Fee $204,00 D Value $12,000.00
Appliances range, waterheater, disposal, dryer, dishwasher, fan, furnace, a-c
Use/Nature NMFR
of Work
Inspections:
Date 11/10/2004
Type Final
Inspector Jon Fischer
not approved
REQUEST LINE
ac disconnect to close to gas meter
DatelTime requested: 11/08/2004 10:16 AM
Access:
Notice Type:
Phone Number: NOT GIVEN
Ready DatelTime: 11/08/200410:16 AM Requested by: CUMINGS ELECTRIC INC
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Date 11/16/2004
Type Reinspect
Inspector Kevin Benner
approved
disconnect
DatelTime requested: 11/15/2004 08:46 AM
Access:
Notice Type:
Phone Number:
Ready DatelTime: 11/15/200408:46 AM Requested by: Decker
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Electric Permit Work Card
Job Address 3220-3226 ISAAC LN Permit Number 108419 Create Date 06/02/2004
Owner GARRY H DECKER Contractor CUMINGS ELECTRIC INC
Category 631 - Resid~ntial-New Multi-Family Wiring
Service b ~ew o ChangeO Temp ON/A I Type o Overhead . Underground ON/A I
Volts 110/220 Circuits 0 Fixtures 0
Amps 400 Switches 0 Receptacles 0
Fee $204.00 D Value $12,000.00
Appliances range, waterheater, disposal, dryer, dishwasher, fan, furnace, a-c
Use/Nature NMFR
of Work
Inspections:
Date 06/04/2004
Type Service
Inspector Jon Fischer
approved
Request Line
6/4/04 called in
6/7/04 mailed in
DatelTime requested: 06/03/2004 02:59 PM
Access:
Notice Type:
Phone Number:
Ready DatelTime: 06/03/2004 02:59 PM Requested by: CUMINGS ELECTRIC INC-Jan
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Date 08/06/2004
Type Rough In
Inspector Kevin Benner
approved
REQUEST LINE
Discussed the NC locations in reference to the natural gas supply with the HVAC installer
DatelTime requested: 08/05/2004 08:03 AM
Access:
Notice Type:
Phone Number: 231-5946 NANCY
Ready DatelTime: 08/05/2004 08:03 AM Requested by: CUMINGS ELECTRIC INC
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Plumbing Permit Work Card
Job Address 3220-3226 ISAAC LN Permit Number 107501 Create Date 03/26/2004
Owner GARRY H DECKER Contractor WATTERS PLUMBING
Category 440 - Industrial-Interior Plan C5-86-0304-P Value $18,830.00
Bathtub 4 Shower 0 Ejector/Gri nd 0 Dip Well 0 F Prep Sink 0 Gar Drain 0
Whirlpool 0 Floor Drain 4 Water Softner 0 Drink Ftn 0 Serv Sink 0 Soda Di$p 0
-
Lavatory .. '8 Lndry Tray 0 Local Waste 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0
Toilet 8 Lndry Stndp 4 Clothes Wshr 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
- - -
Res. Sink 4 Disposal 4 Bidet 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
-
Bar Sink 0 Dishwasher 4 Beer Tap 0 Sculry Sink 0 Wash Ftn 0
- - -
Water Heater 4 Sump Pump 4 Dent. Oper. 0 Hand Sink 0 Urinal 0
Site Drain 0 Classrm Sink 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0
- - -
Roof Drain 0 Breakrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0
- - - - -
Use/Nature
of Work
NEW 4 UNIT INTERlEXTER PLBG WITH ELEC WTR HTR'S
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 11/3/04
Type Final
Inspector WJ (Chip) Callies
approved
Request Line
DatelTime requested: 11/2/04 02:16 PM
Notice Type:
Telephone Number: 235-7061
Access:
IKey in normal place
Ready DatelTime: 11/2/04 02:16 PM Requested By: WATTERS PLUMBING-John
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
]
---------------------------------------------------------------------------------------------------------
Plumbing Permit Work Card
Job Address 3220-3226 ISAAC LN Permit Number 107501 Create Date 03/26/2004
Owner GARRY H DECKER Contractor WATTERS PLUMBING
Category 440 - Industrial-Interior Plan C5-86-0304-P Value $18,830.00
Bathtub 4 Shower 0 Ejector/Grind 0 Dip Well 0 F Prep Sink 0 Gar Drain 0
Whirlpool 0 Floor Drain 4 Water Softner 0 Drink Ftn 0 Serv Sink 0 Soda Disp 0
- - -
Lavatory , '8 Lndry Tray 0 Local Waste 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0
Toilet 8 Lndry Stndp 4 Clothes Wshr 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
- -
Res. Sink 4 Disposal 4 Bidet 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
- -
Bar Sink 0 Dishwasher 4 Beer Tap 0 Sculry Sink 0 Wash Ftn 0
- - - - -
Water Heater 4 Sump Pump 4 Dent. Oper. 0 Hand Sink 0 Urinal 0
Site Drain 0 Classrm Sink 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0
Roof Drain 0 Breakrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0
- - - - -
Use/Nature
of Work
NEW 4 UNIT INTERlEXTER PLBG WITH ELEC WTR HTR'S
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
Type Rough In
Inspector WJ (Chip) Callies
no time
Date
REQUEST LINE
DatelTime requested: 7/29/04 10:15 AM
Notice Type:
Telephone Number: JOHN 235-7060
Access:
]
Ready DatelTime: 7/29/04 10:41 5M Requested By: WATTERS PLUMBING
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
---------------------------------------------------------------------------------------------------------
Plumbing Permit Work Card
Job Address 3220-3226 ISAAC LN Permit Number 107501 Create Date 03/26/2004
Owner GARRY H DECKER Contractor WATTERS PLUMBING
Category 440 - Industrial-Interior Plan C5-86-0304-P Value $18,830.00
Bathtub 4 Shower 0 Ejector/Grind 0 Dip Well 0 F Prep Sink 0 Gar Drain 0
Whirlpool 0 Floor Drain 4 Water Softner 0 Drink Ftn 0 Serv Sink 0 Soda Disp 0
- -
Lavatory . '8 Lndry Tray 0 Local Waste 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0
Toilet 8 Lndry Stndp 4 Clothes Wshr 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
- - -
Res. Sink 4 Disposal 4 Bidet 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
-
Bar Sink 0 Dishwasher 4 Beer Tap 0 Sculry Sink 0 Wash Ftn 0
- - - - -
Water Heater 4 Sump Pump 4 Dent. Oper. 0 Hand Sink 0 Urinal 0
Site Drain 0 Classrm Sink 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0
- - - -
Roof Drain 0 Breakrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0
- - - - -
Use/Nature ~
of Work
NEW 4 UNIT INTERlEXTER PLBG WITH ELEC WTR HTR'S
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 6/3/04
Type Underground
Inspector WJ (Chip) Callies
approved
Request Line
DatelTime requested: 6/2104
12:14 PM
Notice Type:
Telephone Number: 235-7060
Access:
l
Ready DatelTime: 6/2/04 12:14 PM Requested By: WATTERS PLUMBING-John
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
-----------------------------------------------------------------~---------------------------------------
FEB-7-2005 08:18 FROM:GRIES ARCH 7222445
TO: 2365084
P:2/2
4l.. ~."... ~
BUILDINGS, HVAC, COMPLIANCE STATEl\fENT SBD-9720
This form is required to be submitted by the supervising professional (architect. el1gineer. 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 SO.26/Comm 61.23
and/or local ordinances,
Generallnstruetions: 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 s.og
· 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)J.
1. PROJECT INFORMATION: Please flll in the following with information from your plan approval letter.
Project Name r;vy ~~ ~~~.v ' Transaction 10 Number t17If4.5
Site Number /'*/57/~~
Site location (number & '_1) ~~ _ /_
)l! City 0 Village CJ Town of __ .___ _ CountYOf~4'"
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 n~cessary.)
Check those which apply; .a: Building Object 10 # ~t:5,9.5 ~ 0 HVAC Object 10 #
o Lighting Object 10 #
CI Partial Completion
Description of Portion Completed
A) at $tatemel1t of Substantial Compliance
To the best of my knowledge, belief. and based on onsite observation, construction of the following building and/or HVAC
Items applicable to this project have been completed in sub$tantial compliance with the approved plans and
specifications.
It' BUILDJNGJl.IGHTING ITEMS
1 " SlnJcturalll~tem including Submittal and erection of 2111 building components
(11'l.l5DCII. precast. mEl~1 building, etc.)
2, I=lro protoctlon systems (sprinklers. lllalT11S. smoke detectors) deslgned.
InS'tlltod. cnd tested (Including forward flow on back IIow devices) by
appropriately nilgistered prnfelWionals
3. Shaft l:Ind stairway enclosure
4. EJdtll Jllcluding exit and diJectionalllghlS
5. Flro-reslsllve ooostructlOl'l, enclosure of hS2;~rds, t1ra walla, Iilbeled doors, class CI I1VAC ITEMS
0' COl"HltnJctlon, fire stopped peneb'ations
6, Sanitation system (toilets. sinks, drinking facilities)
"f, etlml:lr-frco including Comm 18 elclvators and lifts
8, enorgy onvelope requirements
9. All cOMll1ons of bl,lilding plan approval and applicable varlancea
The fOllowing Items are not In compliance and must be addressed:
10. ~8rior lighting & control requirements
11. Intenor lighting & control requirements
12. All conditions of lighting plan approval
and appli~b'e varlanC(ls
1. HV AC systatn inCIUdiO!il final test
2_ All COnditions of HVAC plan approval and
appllC.!lble variances
B) CI Statement of Noncompliance
Due to the following listed violations, this project is not ready for occupancy:
C} 0 $upervlslng Professional Withdrawn From Project (Use A Or B above to indicate project status as of this date.)
0) 0 Projoct Abandoned
3. SUPERVISING PROFESSIONAL SIGNATUf!1; FpR: .
.A Building 0 HVAC Cl Lighting 7~ 6e/f5
(' 7/~) Name (please print oflype)
Phone number- "7/?~5Customer ID # 2tk:>9C1t Signature
- (J <;;;'
SBD-97:Z0 (Il.O 111003)
JUL-22-2004 14:26 FROM:GRIES ARCH 7222445
TO: 23650B4
P:3/3
52 Z 0 ~ '"3 '2 c G. ::c..sAA c. L-.N
. ..
BUILDINGS, HV AC, COMPLIANCE STATEMENT SBD.9720 .
This form 18 required to be ~ubmined by the supervising profei$sional (architKt. engineer, HVAC designer or eJectrical
designer) observing construction of projects within buildings with total are. 50,000 cubic feet or greater and bleachers
(Comm 50. 10/Cornm 61.50). Failure to submit this form may result in penalties as specir.ed in COf'I1m 5O.261Comm 01.23
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 ~
· 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.
Personelln'onnallon you provide may bo used fOf secondary purposes (Privacy Law, 5. 15.04 (1 )(m)).
1. PROJECT INFORMAnON: Please fdl in the folfowil\g with Information from your plan approval letter.
Project Name ~#: 4r~ R~.~) Transaction 10 Number B11iM
Site Number M"'1-/24.
Site location (number & street) , /~~ ~~
}If City 0 Village 0 Town of d~N County of ~~~(!:J
2. PURPOSe OF THIS STATEMENT: (C,,*k Box A, B, C, or 0 to indicate purpose and complete any other
applicable boxes and information. Attach additional pages If ~ssary.)
Check those whk:h apply: "-Building Object 10 1# 9<161;95,,"? 0 HVAC Object ID"
C I.ighting Object 10 1#
o Partlel Completion
Description of Portion Completed
A) 14 Statement of Substantial Compliance
To the beer of my knowledge. ber.er, and besed on onslle observation, construellon of the following building and/or HVAC
Items applicable 'to thl, project have been completed In sub$tantial compliance with the approved plans and
specJfleetions.
AI BUll.OfNG/LIGHTlNG ITeMS
1, SkuGluroIlIYltem including 8ubmlltal and eteclfon of aIt building c:omponents
CII\IhO., proc:o&t, mell11 bUilding, etc.)
2. FIro protllCltion SY$l8ml (sprlnklela, .IannI, emoko _llKlIoB) deelgrled,
lnalollod. and loslOd (including fOJWard now On back ftCM dQW:es) ~
CI~DlDIy re"lIf1el1ld professionals
,. snon 0114 *lIway ern:;losuro
". IiJdls including old! end dil'8elionalllgllll
s. Flro-rOlllsl1lIo COnstrucllon, e~ro of haz8nfs. rll'e walls. labeled dool'&. den 0 HVAC ITI;MS
or COl1lIINCIIoI'I. fIrO "opped ""etrllllons
6. Sanlltitlollll)'lllOrn (toilets. sinks. drinking faclllIles)
7. Somer-frllO Includirlt Comm 18 elo'ial~ -.let Ilfta
a. El'lOflW onvelopo raqllirernonls
9. All COnellllOn, of building plan apprOVal and oppUcablo variances
Tho following Itoms ate not In compliance and must bo addressod:
10. SllIotfo, IighIIng & control roqul$ments
11. tntenor lighting & controll1iPqvlremonts
12, All c:ondlllons or lightlng plan 8pptOYa'
and app&cable variances
1. HVAC lI)'l1tem Including finallQ$1
2. AI' condldons of HVAC plan approval and
applicable v3llan~s
B) 0 Statomont of Noncompliance
Duo 10 lho 'ollowlng listed violations, this projoells not ready for occupancy:
C) 0 Suporvlslng Professional Withdrawn From Project (Use A. or a a.bove to indiCate project status as of Ihis date.)
D) C ProJoctAba"doned '
3. SUPERVISING PROFESSIONAl SIG~U~~/:.r: ~
)II Building 0 HVAC 0 lighting <~ ~
('~p) Namo se pltnl or \y )
Phone number~2~~.Z4IG ~uslomer I.D # 2C,.?IJ~+ Signature
~'Z~ -
~ l\1C{_
58D.9720 (Jl.o'I200))