HomeMy WebLinkAboutCertificate of Occupancy
CITY HALL
Inspection Services Div
215 Church Avenue
PO Box 1130
~ OM~h~
~ 54903-1130
OjP.iKOJH
-----oN THE WATER
City of Oshkosh
Approved:
Issued:
7/20/04
1/9/06
Garry H. Decker & Co LLC
1113 Oregon Street
Oshkosh, Wisconsin 54902-6484
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby granted for the 4 unit condo located at 3210-3216 Isaac
Lane, Oshkosh, Wisconsin 54902 as described in Building Permit Application number(s)
104387.
This building is to be used only as 4 dwelling units and is located in the R-3PD, Multiple
Dwelling District with a Planned Development Overlay.
LIMITATIONS:
Maximum persons and/or living units: 4 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 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.
Building Permit Work Card
Job Address 3210-3216 ISAAC LN Permit Number 0104387 Create Date 7/1/2003
Owner GARRY H DECKER Contractor GARRY H DECKER & CO LLC
Category 130 - New Multi-Family
Type . Building a.Sign a Canopy a Fence a Raze I Plan 16-55-0703
",..,
Zoning Class of Const: 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 a Floating Slab a Pier a Other
a Concrete Block a Post a 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. * Project not to proceed beyond the first floor decking
of Work until a roadway has been accepted by Public Works.
HV AC Contr Plumbing Contr
Electric Contr
Inspections:
Date 5/5/2004
Inspector Allyn Dannhoff
no time
Type Insulation
Request Line (rec'd 5/3/044:48 p.m.) - call with results, no placard on site.
CALLED G.D.'S OFFICE ON 5/5 AND ADVISED OK TO CONTINUE
DatelTime requested: 5/4/2004
Access:
07:00 AM
Notice Type:
Phone Number: 235-8035
]
Ready DatelTime: 5/4/2004 12:00 PM Requested By: GARRY H DECKER & CO LLC
a Reinspect Fee a Fee Waived
o Reinspect Fee Paid
Type Final
Inspector Allyn Dannhoff
approved
Date 7/20/2004
REQUEST LINE / YOU WILL FIND PERSONAL POSSESSIONS IN 3216 BECAUSE THEY HAD TO CLOSE, HOWEVER NO ONE IS
LIVING THERE
DatelTime requested: 7/20/2004 07:04 AM Notice Type: Phone Number: 235-8035
Access:
!CALL GARRY DECKER A DAY AHEAD TO HAVE ALL UNITS OPEN
Ready DatelTime: 7/20/2004 07:04 AM Requested By: GARRY H DECKER & CO LLC
a Reinspect Fee a Fee Waived
]
D Reinspect Fee Paid
Page 3 of 3
Building Permit Work Card
Job Address 3210-3216 ISAAC LN Permit Number 0104387 Create Date 7/1/2003
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
,~
Zoning Class of Const: 5Bibc Size irreg Value $170,600.00
-
Unfinished/Basemer1t 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.* Project not to proceed beyond the first floor decking
of Work until a roadway has been accepted by Public Works.
HV AC Contr Plumbing Contr
Electric Contr
Inspections:
Date 4/28/2004 Type Rough In Inspector Allyn Dannhoff
Request Line- wants Tuesday PM or Wednesday - Garry called back 4/23/04 @ 1 :51 p.m. to say he prefers Wednesday.
no time
DatelTime requested:
Access:
~ants to be present
Ready DatelTime:
4/22/2004
08:38 AM
Notice Type:
Phone Number: 379-8035 235-8035
]
4/27/2004 12:00 PM Requested By: GARRY H DECKER & CO LLC-Garry
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Date Type Insulation Inspector Allyn Dannhoff
Request Line (rec'd 4-30-04 4:58 p.m.) - cancelled 5/3/04 4:48 p.m.
cancelled
DatelTime requested: 5/3/2004
Access:
IKey on door jam.
Ready DatelTime: 5/4/2004
07:00 AM
Notice Type:
Phone Number: 235-8035
]
07:00 AM Requested By: GARRY H DECKER & CO LLC-Garry
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Page 2 of 3
Building Permit Work Card
Job Address 3210-3216 ISAAC LN Permit Number 0104387 Create Date 7/1/2003
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
-#)
Zoning Class of Const: 5Bibc Size irreg Value $170,600.00
-
Unfinished/Basemerit 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.* Project not to proceed beyond the first floor decking
of Work until a roadway has been accepted by Public Works.
HV AC Contr Plumbing Contr
Electric Contr
Inspections:
Date 10/10/2003
Type Footings
Inspector John Zarate
no time
req,... Line- ,oady .roo," I""'" ho",
DatelTime requested: 10/9/2003 04:01 PM
Access:
Notice Type:
Phone Number: 376-0646
]
Ready DatelTime: 10/10/200312:00 PM Requested By: JB Miller-Jeff
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Date 10/15/2003 00:00 PM
Type Foundation Backfill
Inspector Allyn Dannhoff
approved
REQUEST LINE. They are hoping to backfill garages on 10/16 PM. Please call with results. Stone not installed yet. Ok when stone is
placed - AD.
DatelTime requested: 10/14/2003 03:35 PM
Access:
Notice Type:
Phone Number: 235-8035
Ready DatelTime: 10/16/200307:30 AM Requested By: GARRY H DECKER & CO - Garry
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Page 1 of3
HV AC Permit Work Card
Job Address 3210-3216 ISAAC LN Permit Number 106970 Create Date 03/12/2004
Owner GARRY H DECKER Contractor CONDON TOTAL COMFORT
Category 502 - Residential-Both Plan
Fuel LJ Gas I LJ'Oil I LJ Electric I LJ Solar I LJ Solid I Value $9,900.00
System o New I D 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 . Chimney B o Direct Vent o Not Applicable I
Heat Loss o As Approved o Existing . Not Applicable I Value 0
BTU Rate o As Per Plan o Variable . Other I Value 40,000
Use/Nature MUL TI-FAMIL Y /2 GARDMAN FURNACES, 2 GARDMAN 1 1/2 TON A1C SYSTEMS, 2 DUCT
of Work SYSTEMS WITH 9 SUPPLY, 4 RETURNS
Inspections:
Date 7/20/2004 Type Final
REQUEST LINE
Inspector Allyn Dannhoff
approved
Date/Time requested: 07/20/2004 07:04 AM
Phone Number:
Notice Type:
Access:
ICALL GARRY DECKER A DAY AHEAD TO HAVE UNITS OPEN 235-8035
Ready DatelTime: 07/20/2004 07:04 AM
Requested By:
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
~
\. ~1~J
Electric Permit Work Card
Job Address 3210-3216 ISAAC LN Permit Number 104223 Create Date 09/16/2003
Owner GARRY H DECKER Contractor CUMINGS ELECTRIC INC
Category 631 - Rlilsidential-New Multi-Family Wiring
Service b.New o ChangeO Temp ON/A I Type o Overhead . Underground ON/A I
Volts 120/240 Circuits 1 Fixtures 1
Amps 400 Switches 1 Receptacles 1
Fee $186.00 0 Value $12,000.00
Appliances Range, Dishwasher, Water Heater, Fan or Blower, Garbage Disposal, Furnace, Dryer & A1C.
Use/Nature NEW MUL TI-FAMIL Y/ Wiring for new 4 unit condo with attached single stall garages. * Job #6557.
of Work
Inspections:
Date 07/21/2004
Type Final
Inspector Kevin Benner
approved w/cond.
REQUEST LINE
Caulk the light fixtures on the masonary
Date/Time requested: 07/20/2004 07:00 AM Notice Type: Phone Number:
Access:
CALL GARRY DECKER A DAY AHEAD TO HAVE ALL UNITS OPEN 235-8035
Ready DatelTime: 07/20/2004 07:00 AM Requested by: CUMINGS ELECTRIC INC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Electric Permit Work Card
Job Address 3210-3216 ISAAC LN Permit Number 104223 Create Date 09/16/2003
Owner GARRY H DECKER Contractor CUMINGS ELECTRIC INC
Category 631 - Re,sidential-New Multi-Family Wiring
Service p::New o ahangeO Temp ON/A I Type o Overhead . Underground ON/A I
Volts 120/240 Circuits 1 Fixtures 1
Amps 400' Switches 1 Receptacles 1
Fee $186.00 D Value $12,000.00
Appliances Range, Dishwasher, Water Heater, Fan or Blower, Garbage Disposal, Furnace, Dryer & A1C.
Use/Nature NEW MUL TI-FAMIL YJ-Wiring for new 4 unit condo with attached single stall garages. * Job #6557.
of Work
Inspections:
Type Service
Inspector Jon Fischer
approved
Date 10/28/2003
REQUEST LINE.
10/28/03 called in
11/3/03 mailed in
DatelTime requested: 10/27/2003 08:06 AM
Access:
Notice Type:
Phone Number:
Ready DatelTime: 10/27/2003 08:06 AM Requested by: CUMINGS ELECTRIC - Jan
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Date 04/27/2004
Type Rough In
Inspector Jon Fischer
no time
REQUEST LINE
DatelTime requested: 04/27/2004 08:48 AM
Access:
Notice Type:
Phone Number: NOT GIVEN
Ready DatelTime: 04/27/2004 08:48 AM Requested by: CUMINGS ELECTRIC INC JAN
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Plumbing Permit Work Card
Permit Number 104811 Create Date
Contractor WATTERS PLUMBING
Plan Value
Water Softner 0 Wait. St. 0 Shamp Sink 0 Coffee Maker
Local Waste 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap
-
Clothes Wshr 4 Exam Sink 0 Catch Basin 0 Ext Grease Trap
Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve
-
Beer Tap 0 Hand Sink 0 Urinal 0 Eye Wash Statn
Lab Sink 0 Plaster Sink 0 Standp Rec 0 Wtr Sewer Mtrs
-
Sterilizer 0 Surgeons Sink 0 Ice Maker 0 Deduct Meters
Dip Well 0 F Prep Sink 0 Gar Drain 0 Wtr Usage Mtrs
Drink Ftn 0 Serv Sink 0 Soda Disp 0
Job Address 3210-3216 ISAAC LN
Owner GARRY H DECKER
Caiegory 410 - Residential-I nterior
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature Plumbing installation new 4-unit apartment
of Work
4 Shower 0
~-
0 Floor Drain 4
~ Lndry Tray 0
8 Disposal 4
4 Dishwasher 4
0 Sump Pump 4
4 Classrm Sink 0
0 Breakrm Sink 0
0 Ejector/Gri nd 0
0
Size
Material
Sanitary Sewer
Storm Sewer
Water Service
Date 6/30/2004
Type Final
REQUEST LINE / REMAINDER OF UNITS
Type # Conn.Type
0
0
0
0
0
0
0
0
0
0
o
o
o
o
o
Inspector WJ (Chip) Callies
approved
~~
DatelTime requested: 7/20/200407:49 AM
Notice Type:
Telephone Number: JOHN 233-7060
Access:
!CALL GARRY DECKER A DAY AHEAD TO HAVE UNITS OPEN 235-8035
Ready DatelTime: 7/20/2004 07:49 AM Requested By: WATTERS PLUMBING
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
]
Job Addre~s 3210-3216 ISAAC LN
Owner GARRY H DECKER
Plumbing Permit Work Card
Permit Number 104811
Contractor WATTERS PLUMBING
Create Date 10/16/
Category 410 - Residential-Interior Plan Value $18,830.00
Bathtub 4 Shower 0 Water Softner 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0
-,.-
Whirlpool 0 Floor Drain 4 Local Waste 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
Lavatory .8 Lndry Tray 0 Clothes Wshr 4 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
-
Toilet 8 Disposal 4 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve 0
Res. Sink 4 Dishwasher 4 Beer Tap 0 Hand Sink 0 Urinal 0 Eye Wash Statn 0
Bar Sink 0 Sump Pump 4 Lab Sink 0 Plaster Sink ~ Standp Rec 0 Wtr Sewer Mtrs 0
Water Heater 4 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 Plumbing installation new 4-unit apartment ~
of Work
Size
Material
Type
# Conn.Type
o
o
o
o
o
Sanitary Sewer
Storm Sewer
Date 6/30/2004
Type Final
o
o
o
o
o
o
o
o
o
o
Inspector WJ (Chip) Callies
approved
Water Service
Request Line - 3214 & 3216 ISAAC LN
DatelTime requested: 6/30/2004 07:46 AM
Notice Type:
Telephone Number: 235-7060
Access:
L-
Ready DatelTime: 6/30/2004 07:46 AM Requested By: WATTERS PLUMBING-John
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Job Addres.s 3210-3216 ISAAC LN
Owner GARRY H DECKER
Plumbing Permit Work Card
Permit Number 104811
Contractor WATTERS PLUMBING
Create Date 10/16/
Category 410 - Residential-Interior Plan Value $18,830.00
Bathtub 4 Shower 0 Water Softner 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0
-.:"-
Whirlpool 0 Floor Drain 4 Local Waste 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
Lavatory ,8 Lndry Tray 0 Clothes Wshr 4 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
-
Toilet 8 Disposal 4 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve 0
-
Res. Sink 4 Dishwasher 4 Beer Tap 0 Hand Sink 0 Urinal 0 Eye Wash Statn 0
-
Bar Sink 0 Sump Pump 4 Lab Sink 0 Plaster Sink 0 Standp Rec 0 Wtr Sewell' Mtrs 0
Water Heater 4 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 Plumbing installation new 4-unit apartment ~
of Work
Size
Material
Type # Conn. Type
0
0
0
0
0
0
0
0
0
0
Sanitary Sewer
Storm Sewer
Water Service
Date
Type Rough In
o
o
o
o
o
Inspector WJ (Chip) Callies
REQUEST LINE
DatelTime requested: 4/12/200410:11 AM
Notice Type:
Telephone Number: JOHN 733-7060
Access:
Ready DatelTime: 4/12/2004 10:11 AM Requested By: WATTERS PLUMBING
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Plumbing PefiTlit Work Card ~cMtV~
.'.
Job Address 3210-3216 ISAAC LN Permit Number 104811 Create Date 10/16/ ~ro....
Owner GARRY H DECKER Contractor WATTERS PLUMBING --... ......
Category 410 - Residential-Interior Plan Value $18,830.00
Bathtub 4 Shower 0 Water Softner 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0
-,-
Whirlpool 0 Floor Drain 4 Local Waste 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
Lavatory .8 Lndry Tray 0 Clothes Wshr 4 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
-
Toilet 8 Disposal 4 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve 0
Res. Sink 4 Dishwasher 4 Beer Tap 0 Hand Sink 0 Urinal 0 Eye Wash Statn 0
-
Bar Sink 0 Sump Pump 4 Lab Sink 0 Plaster Sink 0 Standp Rec 0 Wtr Sewell" Mtrs 0
Water Heater 4 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 Plumbing installation new 4-unit apartment
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 10/20/2003 Type Underground
Inspector Rich Wood
approved
DatelTime requested: 10/20/200:03:26 PM
Notice Type:
Telephone Number:
Access:
Ready Datemme: 10/20/200: 03:26 PM Requested By:
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Job Address 3210-3216 ISAAC LN
Owner GARRY H DECKER
Plumbing Permit Work Card
Permit Number 104811
Contractor WATTERS PLUMBING
Create Date 10/16/20
Category 410 - Resident~I-lnterior Plan Value $18,830.00
Bathtub 4 Shower 0 Water Softner 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0
-
Whirlpool \) Floor Drain 4 Local Waste 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
Lavatory 8 Lndry Tray 0 Clothes Wshr 4 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
-
Toilet 8 Disposal 4 Bidet 0 Sculry Sink 0 Wash Ftn 0 RPZ Valve 0
Res. Sink 4 Dishwasher 4 Beer Tap 0 Hand Sink 0 Urinal 0 Eye Wash Statn 0
-
Bar Sink 0 Sump Pump 4 Lab Sink 0 Plaster Sink 0 Standp Rec 0 Wtr Sewer Mtrs 0
Water Heater 4 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 Plumbing installation new 4-unit apartment ~
of Work
Size
Material
Type
# Conn.Type
o
o
o
o
o
Sanitary Sewer
Storm Sewer
o
o
o
o
o
Water Service
o
o
o
o
o
Date
Type Underground Rough Ir Inspector Rich Wood
REQUEST LINE.
DatelTime requested: 10/20/200:12:44 PM
Notice Type:
Telephone Number: 235-7060
Access:
IOpen
Ready DatelTime: 10/20/200: 12:44 PM Requested By: WATTERS PLUMBING - John
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
..
JUL-22-2004 14:26 FROM:GRIES ARCH 7222445
TO: 2365084
P:2/3
BUILDINGS; HV ACt COMPLIANCE'STATEMENT SBD-9720
This form is required to be submitted by the supervising professional (architect. engineer. HVAC desig".r or efectric:.el
designer) observing construction of projects within bUildings with total areas 50.000 Cubic feet or greater and bleachers
(Comm SO:10/eomm 61.SO). Failure to submit this form may result in penafties as specified in Comm SO.261Comm 61.23
and/or local ordinances.
Genera' 'nstructions: Prior to the initial occupancy of new buildings or additions and the final occupal1cy of
altered existing buildings, submit this completed and signed form to:
· The municipal building Inspection office i.Q{f
· Safety and Suildings. 10541N RanCh Road Hayward. Wi. 54843
Note: If the review was done by the municipality, the compliance statement g08S only to the municipal buirding
inspector. A copy is not needed by Safety & Buildings.
Pet$On81 informotion you provlde may.,. Used for secondary purposes (Privacy Law. s. 15.04 (1)(m)).
1. PROJECT 'NFORMAnON: Please fill in the following with information from your plan approval letter.
ProJectNam.___~tfI" k4/~(/;'1~) Transaction ro Number ~1ff~~
Site Number tp~~/.2~ .
SlI8-I_&streel. ~~
]:t'CIty C Village C Townof County of "';;~~4
2. PURPOSe OF nt.S STATEMENT: (CheCk Box A. o. C. or 0 to Indicate puJ'PO$e and complete any other
applicable boxes and Information. Attach additional pages if n~assary.)
Check those whic,h apply. )!I BUilding Object 10 'II ~5,?~~ C HVAC Object 10 'II
C Ughting Object 10 #.
C Partial Completion
DesCriptfon of Portion Completed
A) /II Statement of Substantial Compfiance
To tho best or my knowledge. belief. and based on onsite observation, construction or the following buDding and/or HV"C
'Iems t1pp1lcable to this project heve been cOI'i1p1Bted in substantial compliance with the approved plans and
specifications.
11 eUIt.DINGlLIOHT'NG ITEMS
1. Struclural ,"lorn including &ubmlUal and erection ClllII buIklir1v componenlt
(""II.... prac:.ast. metal building. etc.)
2. Flro ptOIoc;tIon systems (sprinklo~, aIatm.. smoke detottors) dosigoed,
Inslllllod, end t..tad (indudJng ro~!Iow on back flow devices) by
t1ppr_riOlOIy registered Jl(ofossionals
3. Shoft and stoll'Way eneloeur.
... ExltD /ncIudlng oldl tmd dllectionalliglU
5. ~Jro.rosl.tlv. I:onllluclion, enclosure of hazards, fire walls, labeled doors. eta" 0 HVAC m;MS
of con"Mllon. lire Slopped PGnelralions '
6. Sonltotlon lIyl1l0m (lvilob. oinks. drinking radlltlell)
7, BorrIor-fro. 11ICludlnO CoIntft 18 elov$totS and nfts
8. enorgy en'lOlOpe requiremen15
t. AI conditions or building pl~ apjlrO\I8l and appUceble varilltJCeS
'rho fotlow'nlllltems lIro not In compUanC:1l and mUll be addrns.d:
10. ElltoItor lighting & control reqWcmant,
11. Interior IIglltiqg & con,"" RKlulremenl$
1~. All CCWldiIlonll of IIghdng plan appnwal
and appUcable varla~
1. HVAC tlyslem ~Iucrrng tintllest
2. An IlOndltiOns of HVAC plan approva' ~ncII
applicablo varianecs
8) 0 Statomont of Noncompliance
011& to tho following listed violations. this project i$ not toady ror oceUpllncy:
J l
C} C Supervising Profossional Withdrawn From Project (Use" or 8 above to Indicato project stat4s as of this dale.)
D) 0 ProJoct Abandoned '
3. SUPERVISING PROFESSIONAL SIGNAT.ORE FOR:
}Ii Building a HVAC 0 Ughting ~~~ ":/t/F4 ~Dale~~"z, ~ _
r ?,"'o..) Name~eptinlartyper
Phone numbet~ 7??e#.?' Customer ID # 260~i Signature
581>-9120 (IUJI2003)