HomeMy WebLinkAboutCertificate of Occupancy
CITY HALL
Inspection Services Div
215 Church Avenue
~POBOX1130
~ Oshkosh WI
~ .. 54903-1130
OfHKOfH
ON THE WATER
City of Oshkosh
Approved:
Issued:
02/20/2007
02/20/2007
Kara Properties
2950 W Pheasant Ct
Oshkosh WI 54904
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby issued for the alterations to Dairy Queen located
at 1, 825 Taft Ave as described in Building Permit #119659.
This building is to be used as a restaurant and is located in the C-2 General
Commercial District.
LIMITATIONS: "
Maximum number of persons: No change
Note: Need to finish bath partitions and lavatory trap wraps.
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.
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DIR OR OF INSPECTIO
cc: Fred J Piette Co
.. " Building Permit Work Card
Job Address 1825 TAFT AVE' Permit Number 0119659 Create Date 5/18/2006
Owner KARA PROPERTIES Contractor FRED J PIETTE CO
Category 232 - Alteration Stores & Customer Service
Type . Building o Sign o Canopy o Fence o Raze I Plan R7-15-0206
Zoning Class of Const: Size Value $220,000.00
-
Unfinished/Basement Sq. Finished/Living Sq.Ft. Garage Sq.Ft.
- Ft. -- -
Rooms Bedrooms Baths D Projection I
- - -
Stories Height 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 Not Required # Dwelling Units 0 # Structures 0
-~~
Use/Nature Comm/ Interior and exterior alterations per approved plans.
of Work
HV AC Contr CENTRAL HEATING SERVICE INC Plumbing Contr GARDNER PLUMBING
Electric Contr BEEZ ELECTRIC INC
Inspections:
Type Rough In
Inspector Allyn Dannhoff
approved
Date 8/29/2006
Request line/exterior framing ready for inspection. 8/29/2006 - Discussed Heap entrance issues if a door is added and roof drainage over
jrive thru window.
DatelTime requested: 8/28/2006 09:26 AM
Access:
ICall Bob - 427-7633
Ready DatelTime: 8/28/2006 09:26 AM Requested By: none given
Notice Type:
Phone Number: none given
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Date Type Inspector Allyn Dannhoff
9/8/2006 - Reviewed misc issues with Bob - draft/fire stopping, convenience drive thru door (employee only-will not apply accessibility),
door swing/accessibility at north exit door - AD
Notice Type:
Phone Number:
DatelTime requested:
Access:
Ready DatelTime:
Requested By:
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Page 1 of 3
. , Building Permit Work Card
Job Address 1825 TAFT AVE' Permit Number 0119659 Create Date 5/18/2006
Owner KARA PROPERTIES Contractor FRED J PIETTE CO
Category 232 - Alteration Stores & Customer Service
Type . Building o Sign o Canopy o Fence o Raze I Plan R7-15-0206
Zoning Class of Const: Size Value $220,000.00
-
Unfinished/Basement Sq. Finished/Living Sq.Ft. Garage Sq.Ft.
- Ft. - -
Rooms Bedrooms Baths D Projection I
- -
Stories Height 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 Not Required # Dwelling Units 0 # Structures 0
Use/Nature Comm/ Interior and exterior alterations per approved plans.
of Work
HV AC Contr CENTRAL HEATING SERVICE INC Plumbing Contr GARDNER PLUMBING
Electric Contr BEEZ ELECTRIC INC
Inspections:
Date
Type Rough In
Inspector Allyn Dannhoff
no time
r1251200. . No 'me. AD
Date/Time requested: 9/20/2006 12:52 PM
Access:
Notice Type:
Phone Number:
Ready DatelTime: 9/20/2006 12:52 PM Requested By: FRED J PIETTE CO
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Date 9/28/2006
: AM
Type Rough In
Inspector Allyn Dannhoff
approved
I"""'est Iloelflnallo dooo oemo.
DatelTime requested: 9/27/2006 09:38 AM
Access:
Notice Type:
Phone Number: 427-7633
Ready Date/Time: 9/27/2006 09:38 AM Requested By: FRED J PIETTE CO - Bob
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Page 2 of 3
Job Address 1825 TAFT AVE'
Owner KARA PROPERTIES
Building Permit Work Card
Permit Number 0119659
Contractor FRED J PIETTE CO
Create Date 5/18/2006
Category 232 - Alteration Stores & Customer Service
Type . Building
o Sign
o Canopy
o Fence
o Raze
Plan R7-15-0206
Zoning
Class of Const:
Size
Value
$220,000.00
Unfinished/Basement Sq.
Ft.
Rooms Bedrooms
Finished/Living
Baths
Sq.Ft.
Garage Sq. Ft.
D Projection I
Stories
Height
Ft.
Canopies
Signs
Foundation . Poured Concrete
o Concrete Block
o Floating Slab
o Post
o Pier
o Treated Wood
o Other
Occupany Permit Required
Flood Plain No
Height Permit Not Required
Park Dedication Not Required
# Dwelling Units 0
# Structures
o
Use/Nature Comm/ Interior and exterior alterations per approved plans.
of Work
HVAC Contr CENTRAL HEATING SERVICE INC
Plumbing Contr GARDNER PLUMBING
Electric Contr BEEZ ELECTRIC INC
Inspections:
Date 10/5/2006
Type Final
Inspector Allyn Dannhoff
approved
Request Line / Would like a final inspection on 10-5-06. Final OK - AD - need to finish bcath partitions and lavatory trap wraps.
DatelTime requested: 10/3/2006 09:56 AM
Access:
Notice Type:
Phone Number:
Ready DatelTime: 10/5/2006 00:00
Requested By: FRED J PIETTE CO - Bob
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Page 3 of 3
1ft
"Job Address 18;25 TAFT p'-'VE Permit Number 121557 Create Date 5/23/2006
Owner KARA PROPERTIES Contractor BEEZ ELECTRIC INC
Service ~ew 0 ChangeO Temp 0 N/A I Type 0 Overhead 0 Underground. N/A
Volts Circuits 11 Luminaires 63
Amps Switches 9 Receptacles 22
Use/Nature 643 - Commercial-Addition/Remodels Comm/ Interior and exterior alterations per approved plans '.debt acct
of Work
Electric Permit Work Card
Value
$26,820.00
Inspections:
Date 09/12/2006
[" "'0"' ro'9" ;"
DatelTime requested: 09/12/2006 06:07 AM
Access: A.J. will be on site
Type Rough In
Inspector Kevin Benner
approved
Notice Type:
Ready DatelTime: 09/12/2006 06:07 AM
Requested by: BEEZ ELECTRIC INC Rob Phone Number: 379-5603 A.J.
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
- - - - - - - - - - - - - -,. - - -,. -,. - --- - - -- -- -,. -_. --- -- - - - -- - --- -- -,. - - --,. --- --- -,. - - -. - -- ---- - - --- -,. --,. --- -- -- -- -- - - -- -,.,. -,. -- -,. - -- - -,. -,. -- -- -- - -- -- - --- --- - -- ----- ---- -- ----
Date 09/18/2006 Type Rough In Inspector Kevin Benner approved
DatelTime requested: 09/15/2006 03:32 PM
Access: Andrew will be on site
Requested by:
o Reinspect Fee 0 Fee Wavied
Notice Type:
Ready DatelTime: 09/18/2006 08:16 AM
Phone Number:
D Reinspect Fee Paid
. . .
-,. - - -,. -,. - - - - - .-. - - - -,.,.,.,. - - - - - - - - -- - - - -- - ----,.,. - - - - --- - - - - -- -- -,. -- --- -- --- -- - - ---- - ----- - - - - -- - -,. - -- - - - - -- - - -,.,. - -,.,. --,. - - - -,.,. --- - -- - - - -- - -- - - --- - - -- - - ----- -,. --.-
Date 09/28/2006 Type Abv Ceiling
Inspector Kevin Benner
__~ approved w/cond.
ill be closing the ceiling on Friday.
how window receptacles & CL2 wiring support. Reviewed with Andrew.
DatelTime requested: 09/28/2006 07:57 AM
Access:
Requested by: BEEZ ELECTRIC INC Andrew
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee P;ilid
Notice Type:
Ready DatelTime: 09/28/2006 07:57 AM
Phone Number:
-,. - - - - -,. -,. -,. - --,.,.,.,.,. -,. -,. -- _ -- _ _ _ _ --,. _ _ _ _ _ -- -- _ _ _ _ _ _ -- _ _ -- _ _ _ _ _ - - - - - - - - - - -- - - ---. -- - -.-- - - -.- -- -. - - - -- - -- - - - - - - - - - - - -- - - - - -- - - - - - - - - - - -- - - - - ---- - - - - - - --- -- - ---
Date !~Q~~?~ Type Final Inspector Kevin Benner approved w/cond.
Partial Final for"temporary occupancy: GFCI protection for kitchen receptacles, exterior illumination is not complete. (incomplete wiring is to
e disconnected from the source and all GFCI's issues are to be addressed)\ 10/6/6 3:39 PM Andrew called and stated that he did not get
he incomplete work and the violations done. Will do Monday AM.
DatelTime requested: 10/04/2006 02:42 PM
Access:
Requested by: BEEZ ELECTRIC INC
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Notice Type:
Ready Date/Time: 10/05/2006 00:0000
Phone Number: 379-5600 Gary
--- --- - -- -- - -. - - - - -- -- - - ----- --------- ----------------- --- ---- - - -- -------- --- ------------------------- ---- -- --- --- -- _ -- -- -- _ ------------ ----------------.---
. .
c Electric Permit Work Card
~ Job Address 1825 TAFT. AVE Permit Number 121557 Create Date 5/23/2006
Owner KARA PROPERTIES Contractor BEEZ ELECTRIC INC
Service . New o ChangeO Temp ON/A I Type 0 Overhead o Underground . N/A I
Volts Circuits 11 Luminaires 63
Switches 9 Receptacles 22 Value $26,820.00
Amps
Use/Nature 643 - Commercial-Addition/Remodels Comm/ Interior and exterior alterations per approved plans ""debt acct
of Work
Inspections:
Date 02120/2007 Type Re Final
r"om fOHn ~e B""dlog ,,,..dOc
DatelTime requested: 02120/2007 08:51 AM
Access:
Requested by:
o Reinspect Fee 0 Fee Wavied
Inspector Kevin Benner
approved
Notice Type:
Ready DatelTime: 02120/2007 08:51 AM
Phone Number:
D Reinspect Fee Paid
HVAC Permit Work Card
1825 TAFT AVE . 121859
Job Address Permit Number Create Date OS/23/2006
Owner KARA PROPERTIES Contractor CENTRAL HEATING SERVICE INC
Category 510 -Ind. & Comm-Heating & Ventilating Plan
Fuel U Gas I UOil I U Electric I U Solar I U Solid I Value $2,101.00
System D New I D Replace I D Other I
U Forced Air I U Radiant I U Steam I ITA'C I U Vent I
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/ Interior and exterior alterations per approved plans. Change registers due to remodeling.
of Work
Inspections:
Date 10/5/2006 Type Final
Inspector Allyn Dannhoff
approved
DatelTime requested:
Notice Type:
Phone Number:
Access:
Ready DatelTime:
Requested By:
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
,
Plumbing Permit Work Card
Job Address 1825 TAFT AVE Permit Number 121453 Create Date OS/23/2006
Owner KARA PROPERTIES Contractor OGDEN PLUMBING
Category 440 - Industrial-Interior Plan Value $6,000.00
Bathtub Shower Water Softner Wait. St. - Shamp Sink - Coffee Maker
- - - -
Whirlpool Floor Drain - Local Waste Ice Chest - FlrlWst Sink - Int Grease Trap
- - -
Lavatory 2 Lndry Tray Clothes Wshr Exam Sink - Catch Basin - Ext Grease Trap
- - -
Toilet 1 Disposal Bidet Sculry Sink - Wash Ftn - RPZ Valve
- - - -
Res. Sink Dishwasher Beer Tap Hand Sink 1 Urinal 1 Eye Wash Statn
- - - - - -
Bar Sink - Sump Pump - Lab Sink Plaster Sink - Standp Rec - Wtr Sewer Mtrs
- -
Water Heater - Classrm Sink - Sterilizer - Surgeons Sink - Ice Maker - Deduct Meters -
Site Drain 5 Breakrm Sink Dip Well F Prep Sink - Gar Drain - Wtr Usage Mtrs
- - -
Roof Drain 1 Ejector/Grind Drink Ftn Serv Sink 1 Soda Disp
- - - -
Misc. 1 hose bibb
-
Fixtures
Use/Nature Comm/ Interior plumbing alterations. **debit acct
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Date 9/11/2006
Type Underground
Inspector Paul Wolf
approved
Phone call/Requesting partial underground Underground for mop sink and site drain and vent near mop sink not completed at time of inspection.
DatelTime requested: 9/8/2006 12:35 PM
Notice Type:
Telephone Number: none given
Access:
Ready DatelTime: 9/11/2006 01 :00 PM Requested By: OGDEN PLUMBING - Roger
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
.1.......-...-..--...----.--'-----.
Plumbing Permit Work Card
Job Address 1825 TAFT AVE Permit Number 121453 Create Date OS/23/2006
Owner KARA PROPERTIES Contractor OGDEN PLUMBING
Category 440 - Industrial-Interior Plan Value $6,000.00
Bathtub Shower - Water Softner Wait. St. Shamp Sink Coffee Maker
- - - - -
Whirlpool - Floor Drain - Local Waste Ice Chest FlrlWst Sink - Int Grease Trap
- - -
Lavatory 2 Lndry Tray Clothes Wshr Exam Sink Catch Basin Ext Grease Trap
- - - - -
Toilet 1 Disposal Bidet Sculry Sink Wash Ftn RPZ Valve
- - - - - -
Res. Sink Dishwasher Beer Tap Hand Sink 1 Urinal 1 Eye Wash Statn
- - - - - -
Bar Sink Sump Pump Lab Sink Plaster Sink Standp Rec Wtr Sewer Mtrs
- - - - - -
Water Heater - Classrm Sink - Sterilizer Surgeons Sink - Ice Maker - Deduct Meters -
-
Site Drain 5 Breakrm Sink Dip Well F Prep Sink Gar Drain Wtr Usage Mtrs
- - - - -
Roof Drain 1 Ejector/Grind Drink Ftn Serv Sink 1 Soda Disp
- - - -
Misc. 1 hose bibb
-
Fixtures
Use/Nature 'Comm/ Interior plumbing alterations. **debit acct
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Type Underground Rough Ir Inspector Paul Wolf
approved
Date 9/13/2006
Cooler condensate shall discharge to approved receptor.
Date/Time requested: 9/12/200607:35 AM
Notice Type:
Telephone Number:
Access:
Ready Date/Time: 9/12/2006 07:35 AM Requested By: OGDEN PLUMBING
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
, , .
Plumbing Permit Work Card
Job Address 1825 TAFT AVE Permit Number 121453 Create Date 05/23/2006
Owner KARA PROPERTIES Contractor OGDEN PLUMBING
Category 440 - Industrial-Interior Plan Value $6,000.00
Bathtub Shower Water Softner Wait. St. - Shamp Sink - Coffee Maker
- - - -
Whirlpool Floor Drain Local Waste Ice Chest - FlrlWst Sink - Int Grease Trap
- - - -
Lavatory 2 Lndry Tray Clothes Wshr Exam Sink - Catch Basin - Ext Grease Trap
- - -
Toilet 1 Disposal Bidet Sculry Sink - Wash Ftn - RPZ Valve
- - - -
Res. Sink Dishwasher Beer Tap Hand Sink 1 Urinal 1 Eye Wash Statn
- - - - - -
Bar Sink - Sump Pump - Lab Sink Plaster Sink - Standp Rec - Wtr Sewer Mtrs -
-
Water Heater - Classrm Sink - Sterilizer - Surgeons Sink - Ice Maker - Deduct Meters -
Site Drain 5 Breakrm Sink Dip Well F Prep Sink - Gar Drain - Wtr Usage Mtrs -
- -
Roof Drain 1 Ejector/Grind Drink Ftn Serv Sink 1 Soda Disp
- - - -
Misc. 1 hose bibb
-
Fixtures
Use/Nature Comml Interior plumbing alterations. "debit acct
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Date 10/5/2006
Type Final
Inspector Paul Wolf
approved
DatelTime requested: 10/4/200609:59 AM
Notice Type:
Telephone Number:
Access:
Ready DatelTime: 10/4/2006 09:59 AM Requested By: OGDEN PLUMBING
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
~
OJHKOfH
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
March 3, 2006
Clark Meyer
Larson Meyer Architects LLC
5523 Integrity Way
Appleton, WI 54913
Richard Dworak
Dairy Queen
1825 Taft Ave
Oshkosh, WI 54902
Site: Plan Number: R7-15-0206
Dairy Queen
.1825 Taft Ave
Oshkosh WI 54902
For:
Description: Interior / Exterior Remodel
Object Type: Building only
Class of Construction: VB - 6000 Sq Ft.; UnsprinkIered
Occupancy: A-2: Assembly
Maximum No of Occupants: 82
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) / Conditions:
. ANSI 303.4 Changes in level greater than Yz inch shall be ramped in compliance with Section 405 or 406.
Verify that entrance / exits meet accessibility requirements.
. 716.2.2 Concealed wall spaces. Fireblocking sh3:ll be provided in concealed spaces of stud walls and
partitions, including furred spaces, at the ceiling and floor levels and at lO-foot (3048 mm) intervals both
vertical and horizontal. It would appear thatfireblocking will be needed in Section 2 A 200.1.
. IBC 906.1 /IFC 906.3 The maximum travel distance allowed to a fire extinguisher is 75 feet.
. IBC 1003.2.2.5 Posting of occupant load. Every room or space that is an assembly occupancy shall have
the occupant load of the room or space posted in a conspicuous place, near the main exit access doorway
from the room or space. Posted signs shall meet the requirement of municipal code section 13-5. Min 12
inches in length, min 4 inches in height with min Yz inch lettering and the numbers being minimum 3
inches in height. The sign shall state "Limit (number) Persons".
/
. IBC 1003.2.10 Exit signs are required to be installed per this section
kiST fKOSTIMJSFS\USERS\briann\20G(i Comm Plan Rt;vi",,,\R7.15-0206 :1 825 Tan .''''t'gldg Only.d()(
Page 1 of2
. .
· IBC 1003.2.11 Means of egress illumination is required to be installed per this section. All paths of egress
are required to have adequate emergency lighting to meet the performance requirements of IBC
1003.2.11.3. Existing means of egress emergency lighting is permitted to be maintained in compliance
with the code in effect at the time of construction. Any altered path of egress, or new path of egress,
and any new emergency lighting being installed is required to comply with current code requirements.
. IBC 1209.1 Provide toilet room floors with smooth, hard, nonabsorbent surface extending minimum 6
inches up onto walls.
. 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) This review does not include lighting. Comm 63.0001 Prior to installation, lighting
plans and calculations shall be prepared in compliance with the code. The plans shall be available upon
request.
· Comm 61.30(3) I 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).
· MUN 30 This review does not include review for signage. Applications for and questions regarding
signage permits should be directed to David Buck - Associate Planner (920) 236-5062.
· MUN 30 This review does not include review for parking & zoning requirements Applications for
and questions regarding zoning review should be directed to David Buck - Associate Planner (920) 236-
5062.
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.
~/
~~
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{cV,ci. oshkosh. wi. us
cc: Property file
Fee Required
Fee Received
Balance Due
$
$
$
320.00
320.00
0.00
\\OSH!<:OSHMISrS\USERS\briann\2006 Cumm Plan Il,evie\v\R7.j5.0206 1825 Taft Av~ Bldg Only.doc
Page 2 of2
OCT-06-2006(FRI) 11: 18
FRED j PIETTE CO INC
(FAX)9207395010
P.002/002
BUILDINGS, BVAC, COMPLIANCE STATEMENT SBO-9720
This 10rm Is required to be submitted by the supervising professIonal (archlle~, engineer, HVAC designer or electrlcal
desIgner) observing construction 01 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 50.26/Comm
61.23 and/or local ordinances. This form must be submitted prIor to the plan approval expiration date or another
submittal may be required.
General Instructions: Prior to the initial occupancy of new buildings or additions and the final occupancy of
altered existing buildings, submit this completed and signed form to: .
. The municipal building inspection office (refer to the plan approval latter for agency address and
. Safety and Buildings, 10541 N Ranch Road Hayward, Wi. 54843
Note: If the revIew was done by the municIpality. the compliance statement goes only to the municipal
building Inspector. A copy is not needed by Safety & Buildings.
Pel'Sl;lMellnformatlon you prClvlde may be used for secondary purposes [Privacy Law, s. 15.04 (1}(m}1.
1. PROJECT INFORMATION: Please fill In the fOllowing with Information from your plan approval letter.
Transaction 10 Number Project Name~ r1-i IVJ~
Site Number ~L..A....\ ~ -e-, - I~ - 07.t'?CP (r;:..l1Y 0::. ~~ ~C~~.()
SIte location (number & street) \ ~z.~ --r~ e-.V'ff>.
* City CI Village Cl Town of ~f+ CDunty of ),.-\ \ NNE...~ec::,
2. PURPOSE OF THIS STATEMENT: (Check. Box A, 8, C, or 0 to Indicate purpose and complete any other
applicable boxes and Information. Attach additional pages If necessary.)
Check those which apply: CI Building ObJect 10 # 1:1 HVAC Object 10 #
1:1 Lighting Object 10 #
c] Partial Completion
OescrlptJon 01 Portion CQm~letl!d
A) '*' Statement of S'ubstantial Compliance .
io the best 01 my knowledge, belief, and based en enslte observation, construction 01 the following buUdlng and{or
HVAC Items appllcablo to this project helve been completed In 'slJbstantlal compliance with tho apl'rQved plElns and
. specifications.
, ~ BUILDING/LIGHTING ITEMS
....{' Structural system InclUding submlttnl and erecUon or all building r;cmpanan~
(tl1JSlICS. pracast, mlltl'.ll building, etc.)
2. Fire prolol:1lan systems (sprinklers. alarms, smako dClloctom) designed, Instlllted,
Ilnd tested (Including fotward flow an blck now del/Ices) by llpprcprlately regl5tor.d
proronlonals
3. Shalt Ilnd stairway enclosure
4, EJtlls InclUding alllt and dlrectlonolllghts
5. Flrc-rOllllstll/ll constr1Jcth:m, enclcmure Dr hlmltds, rlre walls, IlIboled doors, C~" ar C HVA~ ITEMS
canstrucUan, lire stopped ponCllraUonc
6. Sanitation system (lol/cts, slnlcl, drinking fllcllllltlft)
7. Burrlor.rreo Including Camm 1 a elevators and IIrla
6. Enllrgy envelapll requirements
9. All conditions or building pllln epprol/'al nnd Ilppllcable varllllnces
The followIng Itl!ms arc not In compli;ance ;and must be .tlddrQssod:
10. Extqrlor lighting & control requirements
1 1 . Interior lighting & contral rllqulromantll
12. All conditions ar lighting plan apptaVllI
llnd llppllC8ble wrlllnces
1. HVAC system Including finlll tast
2. All conditions of HVAC plnn epprovlllllnd
nppllcnble wrlllnce!l
8) 0 Statement of Noncompliance
OUe la lhe fallowing IIslet! \/Iollllons, 1111$ projoct Is not ready far accupatlcy:
C) CI Supervising Professional Withdrawn From Project (Use A or a abOl/110 Indl~lo pro]echllllusas arthls dllte.)
D) 0 Project Abandoned
3. SUPERVISING PROFESSIONAL SIGNATURE FOR:
~ulldlng C HVAC C Llghllng ~ 'i-l\e..-{~i=-
~ Name (plllllllll print or typo)
Phoncnl.lmber~o~~~' QflCCustomorlO# 9&o"'~EI.?-.-
Ofttft-'~ -~ -h"'~
slgnlllUrO_( j?~-~r
-
Qt>" 0"""" <1> n'l"""A~
581).9"/::0 (ll.Uo4t:!(JO')