HomeMy WebLinkAboutCertificate of Occupancy
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CITY HALL
Inspection Services Div
215 Church Avenue
PO Box 1130
Oshkosh WI
54903-1130
City of Oshkosh
ON THE WATER
Approved:
Issued:
05/10/2007
05/11/2007
Mercy Medical Center
2700 W 9th Ave
Oshkosh WI 54904
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby issued for the Cancer Center Addition located at
2700 W 9th Ave as described in Building Permit #118514.
This building is to be used as a Medical Center and is located in the C1-
Neighborhood Planned Development District.
NOTE: This Occupancy Permit is valid upon compliance with the following:
1. An inspection to verify compliance of noted violations as described on the
attached 2/15/07 and 3/28/07 Field Correction Notices were not able to be
made during the final Inspection. Compliance with these notices must be
provided.
2. The Emergency Power System supplying all required emergency systems
shall meet the required 10 second requirement as required in NEC 700.12.
3. Items listed in the 6/07/07 Correction Notice (attached) shall be addressed.
LIMITATIONS:
Maximum number of persons: Per State Approved Plan
J!..
CITY HALL
Inspection Services Div
215 Church Avenue
PO Box 1130
Oshkosh WI
54903-1130
City of Oshkosh
ON THE WATER
Certificate of Occupancy shall be required prior tooccupancy, 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 ~i
cc: C R Meyer
~
CORRECTION NOTICE / FIELD INSPECTION REPORT
JOB LOCATION: dv/bD u~ ~
CONTRACTOR: Su.,~..-'.oQ'" 1Z~c-
PROJECT TO BE INSPECTED: ~~ ~ ~~r\,
TYPE OF INSPECTION: A'on,,-'2- ~~\~
~
:; Ci!ty of Oshkosh
7""'"""""'~pection Services Division
,'5 Church Avenue, PO Box 1130
Oshkosh, WI 54903-1130
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
aneVor occupancy. Upon completing the corrections, the owner/contractor/agent must sign and date at the bottom of this notice
and return it to the Inspection Services Division by the Compliance Date of
11'ltM#I, COI)E INSPECTION RESULTS r--..i!~'T;:Zdi;:;:
t WOC"" ~ ~C)",. I..... c:;:::: "'-eLl \ L, -e... f)".,..., I) r ~ ~ ~ ~ -tk ~
\f A\l '<60 'X.. '''Ie c..... .
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,^H<\~~ ~ ~'\:.. - I '-~ ' \ I
~
,
I Print Name
~Me'
Company
Date
~
CORRECTION NOTICE / FIELD INSPECTION REPORT
JOB LOCATION: C).."1o~ W~
CONTRACTOR: fu-...",- ~~ t;- ~ e.. M"'-~
PROJECT TO BE INSPECTED: C-~ _ _ ~~ '" lO.{.. Ccr.~4:J
TYPE OF INSPECTION:
~
City of Oshkosh
(~ spection Services Division
15 Church Avenue, PO Box 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
FaK (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/agent must sign and date at the bottom of this notice
and return it to the Inspection Services Division by the Compliance Date of
tJOEM# r'conE INSPEC N R&SULtS
l '-45-
Ii-
~
o Not Approved! Insp. Report left on site ~ot Approved! Insp. Report given to
~~tlpection
I ' Print Name
~ature:
Company
Date
'J.
OSHKOSH
aN THE WATER
Issue Date 5/8/2007
Address 2700 W 9TH AVE
INSPECTlaN SERVICES DlVISlaN RaaM 205
DEPARTMENT aF caMMUNITY DEVELaPMENT
CORRECTION NOTICE
CITY OF OSHKaSH
215 CHURCH AVE
po. Box 1130
aSHKaSH WI 54903-1130
Compliance Date 6/7/2007 IMMEDIATELY
Compliance No
Sent to
l!J awner
Name Address
I MERCY MEDICAL CENTE_R O~_f:l_lt\I_Q__ Po. Bax 3370
City
aSHKaSH
State Zip Code
WI 54903 -3370
Introduction
-- rWhile conducting an electrical inspection for the Cancer Center addition and a emergency illuminaiton test of the clinic area~
he following violations were noted. I
I -- _H___J
Code NEC 110.26 Compliance No Compliance Date 06/07/2007 IMMEDIATELY
- -..---.---..-
Description ufficent acces san d working space shall be proVidedand maintained about all electrical equipment to permit ready and safe operatfon and-l
maintenance. (Physical Therapy panel LLF)
05/08/2007
Last
Updated
U Required for accupancy
Occupancy
Item #
___J
Item # 2
Description
Code NEC 517.18(C) Compliance No Compliance Date 06/07/2007 IMMEDIATELY
~ecePtacles located in the Childrens Physical Therapy area shall be listed tamper resistant receptacles or shall employ a listed tamper ---~I
r-~ I
L___ _ J
Code M.a. 11-32 Compliance No Compliance Date 06/07/2007 IMMEDIATELY
------
No electrical equipment shall be installed, altered, renewed, replaced, or connected without first procuring a permit. (Linear Accelerator & I
"'oclaled ....) I
___________J
05/08/2007
Last
Updated
Item # 3
Description
05/08/2007
Last
Updated
Item ~~ 4 Code NEC 700.12 Compliance Compliance Date 06/07/2007 IMMEDIATELY
-_._~-----.~----- '-~..._._-'--_.' .._----,--
Description urrent supply shall be such that, in the event oHaiureIo-the normal power supply to, or within, the building or group of bUildings concemecC
mergency lighting, power or both shall be available within 10 seconds. ( In the event that the power supply is lost the generator shall start and
05/08/2007 ransfer within 10 seconds)
Last
Updated
12547
Page 1 of 2
.
OSHKOSH
ON THE WATER
Issue Date 5/8/2007
INSPECTION SERVICES DIVISION ROOM 205
DEPARTMENT OF COMMUNITY DEVELOPMENT
CORRECTION NOTICE
CITY OF OSHKOSH
215 CHURCH AVE
PO Box 1130
OSHKOSH WI 54903-1130
Compliance Date 6/7/2007 IMMEDIATELY
Compliance No
Address
2700 W 9TH AVE
Sent to
I~Iowrier
Name
i MERCY MEDICAL CENTER OSH INC
Address
PO BOX 3370
City
OSHKOSH
State Zip Code
WI 54903 -3370
Introduction
I~Vhile conducting an electrical inspection for the Cancer Center addition and a emergency iIIuminaiton test of the clinic area I
/he following v;olatlons were noted. ~J
ORequired !~~_9ccupancy
Occupancy
Item # 5 Code NOTE Compliance Compliance Date 06/07/2007
~--,.--,._------.-
Description ifhelower level main Oakwood corridor and the Re-Hab office corridor appeared to be deficient of emergency illumination.
I
I
05/0812007 i
I
i
i
Last
Updated
"l
[
. i
I I
L____H __~--------.J
!fe-aVOid any further inconvenience, please correct the above noted violations immediately. Any questions or concerns please
[feel free to contact Kevin Benner at 236-5046 or email kbenner@ci.oshkosh.wi.us
Summary
L
Violations must be corrected and approved within 30 days unless otherwise noted. Call for reinspections prior to concealment
and/or occupancy. Upon completing the corrections, the owner/contractor/agent must sign and date at the bottom of this notice
and return it to the Inspection Services Division by the Compliance Date of 6/7/2007
Office hours for obtaining permits are Monday through Friday 7:30-8:30 a.m. and 12:30-1 :30 p.m. or by appointment. To schedule
inspections please call the Inspection Request line at 236-5128 noting the address, permit number (when applicable), and the
nature of what needs to be inspected.
Signature Date
Inspected by: Kevin Benner 236-5046 kbenner@ci.oshkosh.wi.us
I hereby certify the violations listed on this report have been corrected in compliance with the applicable codes.
Print Name
Company
Signature
Date
Also Sent to:
~ Ei~~ CR MEYER
E1~I~~_~ SUBURBAN ELECTRICAL EN~INEERINI
D~B'!~~=:J _________
U PI~fL~
U_p~~~~er I
D:?th._e!_--=::J
2:pri~~~or J Allyn Dannhoff
895 W 20TH AVE
709 N HICKORY FARM LN
OSHKOSH
APPLETON
WI 54902 -0
- ---- -
WI 54914 -3032
12547
Page 2 of 2
" . Building Permit Work Card
Job Address 2700 W 9TH AVE Permit Number 0118514 Create Date 3/14/2006
Owner MERCY MEDICAL CENTER OSH INC Contractor CR MEYER
Category 219 - Addition Hospitals & Institutions Plan S2-25-0306
Occupany Permit Required Flood Plain No Height Permit Not Required Class of Const: 2B
Use/Nature 3700 sf Cancer Center Addition and Remodel as per plans approved by DHFS 12-19-05 located at east side of south wing.
of Work
HVAC Contr .Plumbing Contr ~ .. >,,~ ..~. .~... ~,
Electric Contr
Inspections:
Date 4/5/2006 Type Footings Inspector Allyn Dannhoff
REQUEST LINE / STARTING TO POUR FOOTINGS, READY TO BACKFILL ON MONDAY. CALL WITH CONCERNS
no time
DatefTime requested: 4/4/2006
A<:cess: I
Requested By: CR MEYER
o Reinspect Fee 0 Fee Waived
01 :39 PM
Notice Type:
Ready DatefTime: 4/4/2006 01 :39 PM
Phone Number: TOM 379-5539
D Reinspect Fee Paid
-- -.. - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - --- - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - - - --- - - - - - - -- - - - - --- - - - - -- - - - - - -- - - - - - - - - - - - -- - - - - - - - - - - - - - --- - - - -- - - - - - - - - - -- - - - ---
Date 5/17/2006 Type Rough In Inspector Allyn Dannhoff approved
[QUEST LINE I ABOVE CEILING PHASE 1 - WOULD LIKE INSPECTION FRIOA Y AM No "",oems nole, steel 'sop, 00 walls yet
DatefTime requested: 5/11/2006 08:44 AM Notice Type: Ready DatefTime: 5/11/2006 08:44 AM
Access: ISHIPPING & RECEIVING GRAVEL DRIVEWAY IS CLOSE TO ENTRANCE
Requested By: CR MEYER Phone Number: TOM 379-5539
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
- - --- - - - - - - - --- - - - - - - - - - - - - - -- -- - - - - - - - - - - - - - -- - - - - -- - - - - - - --- - - - - - - -- - - - - - -- - - - - --- - - - - - - - - - - - - --- - - - - - - -- - - - - - -- - - - - --- - - - - -- - - - - - -- - - - - - -- - - - - - - -- - - - -- - - - - - - - - - - -- - - - -- - - --
Date Type Final
REQUEST LINE /6 SMALL EXAM ROOMS, PHASE 1
Inspector Allyn Dannhoff
DatefTime requested: 5/16/2006 11 :54 AM Notice Type:
Access: IGRAVEL DRIVEWAY BY SHIPPING & RECEIVING
Requested By: CR MEYER
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Ready DatefTime: 5/16/2006 11:54 AM
Phone Number: TOM 379-5539
- - - - - - -- - - - - - - - - -- - - - - - - -- - - - - - -- -- - - - - --- - - - - -- - - - - - - --- -- - - - - -- - - - - - - - - - - - - - -- - - - - - - - - - - - --- - - -- - - -- - - - - -- - - - - - --- - - - - - - - - - - - ---- - - --- - - - - - - -- - - - - - -- - - - - - - - - - --- - - - -- - - - -- --
Date Type Rough In Inspector Allyn Dannhoff no time
~quest Iineflooking for Phase 2 steel stud framing inspection. Tom
L"'d I;ke 10 be the", '''' the los_on 8I9l2OO6 - 00 time - AD
Date/Time requested: 8/212006 09:31 AM Notice Type: Ready DatefTime: 8/212006 09:31 AM
Access: IDrive by shipping/receiving dock
Requested By: CR MEYER Phone Number: Tom Witkowski-379-5539
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
- - - - - - - - - -- - - - - - - -- - - - - - - - -- -- - -- - -- - - - - - -- - - - - - - --- - - - - - - -- - - - - --- - - - - - - -- - - - ---- - - - - -- - - - - - -- - - - - - - --- - - - - - - - -- - - - --- - - - ---- - - - - -- - -- - - -- - - - - - - -- - - - - -- - - - - -- - - - -- - - - --- - - ---
Page 1 of4
. -, Building Permit Work Card
Job Address 2700 W 9TH AVE Permit Number 0118514 Create Date 3/14/2006
Owner MERCY MEDICAL CENTER aSH INC Contractor CR MEYER
Category 219 - Addition Hospitals & Institutions Plan S2-25-0306
Occupany Permit Required Flood Plain No Height Permit Not Required Class of Const: 2B
Use/Nature 13700 sf Cancer Center Addition and Remodel as per plans approved by DHFS 12-19-05 located at east side of south wing.
of Work
HY AC Contr - .. Plumbing Contr ' . .' t ~..~. - .-, ';:,
Electric Contr
Inspections:
Date Type Inspector Allyn Dannhoff
["esl IIneIT om """'" '" fa< an aixwe 00111". '_on. He wanls 10 be "'e... 0" ~te 7-3. 91112006 - no time - AD
DatelTime requested: 9/1/2006 09:56 AM Notice Type: Ready DatelTime: 9/1/2006 09:56 AM
Ac:cess: IGravel drive to addition near shipping & receiving
Requested By: CR MEYER - Tom Witkowski Phone Number: 379-5539
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
no time
-- -.- - - -- - - - - - - -- - - - --- - - - - - - -- - - - - - - - - - - - - - - - - - -- - - - - -- - - - - - - - - - - - - - -- - - - - - - --- - - - - - - -- - - - - - -- - - - - - - -- - - - - - -- - - - - - - - - - - - --- - - - - -- - - - - - -- - - -- - - - - - - -- - - - - --- - - - - -- - - -- --- - - - - ---
Date Type Final Inspector Allyn Dannhoff not approved
Request Line / Ready for the 2nd phase of the Cancer Center expansion and remodel area. The state inspector will be there 9/19/06.
om would like you to inspect Mon. 9/18 between 7 & 3. Let him know if you can't make it. 9/18/06 Final/Phase II-need to add emergency
illumination in 1 area on south side of door separating physical therapy from infusion & outside north exit door of addition. Relying on
[Electric inspection to veryfiy compliance.
DatelTime requested: 9/14/2006 02:50 PM Notice Type: Ready DatelTime: 9/18/2006 00:00
Ac:cess: !rom will be there 9-18-06 from 7am-3:30pm please call if you cannot make this time
Requested By: CR MEYER - Tom W. Phone Number: (920) 379-5539
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
- - -- - - - -- -- - - - - - - - -- - - - - - -- - - - - - - -- - - - - - - - - -- - - - - --- - - - - ---- - - - - - -- - - - - ---- - - - - - - - - - - - - - -- -- - - - - - -- - - - - -- - - - - - -- - - - - - -- - - - - --- - - - - --- - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - -- - - --
Date 11/17/2006 Type Rough In Inspector Allyn Dannhoff no time
~quest line/Looking for an above ceiling inspection for a small corridor tie-in area and about 6 offices and exams rooms. Tom is there
em 7,00 10 3,30 and WO"1d like 10 be "'e,e 10' "'e InspectiOn.
Date/Time requested: 11/13/2006 03:41 PM Notice Type: Ready DatelTime: 11/15/2006:
Access: I
Requested By: CR MEYER - Tom Witkowski Phone Number: 379-5539
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
- - - - - - - -- - - - - - -- - - - - - -- - - - - - ---- - - - - - - -- - - - - - - -- - - - - - -- - - - - - - -- - - - - - -- - - - - - - ---- - -- - - -- - - - - --- - - - - - - -- - - - - --- - - - - -- -- - - - -- - - - - - -- - - - - - -- - - - -- - - - - --- - - - - -- - - - - - - -- - - -- - - - - - -- --
Date 11/27/2006 : AM Type Final Inspector Allyn Dannhoff approved
Request line/Tom wants to be there for inspection. Will be there 7 - 3:30 on Mon, 11/27. Electrical closet will be closed off. Phase III
~nal (CR Meyer designated phase) - will add temporary exit placards to route occupants until project is complete. Will need permanent
!exit lites for newlredirectred exit path. AD
DatelTime requested: 11/22/2006 11 :19 AM Notice Type:
Access: !rom will be there from 7:00 to 3:30
Requested By: CR MEYER - Tom Witkowski
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Ready Date/Time: 11/27/2006
Phone Number: 379-5539
- - - -- - - - - -- - - -- - -- -- - - -- -- - - - - - - --- - - - - - - -- - - - - - - --- - - - - -- - - - -- ---- - - - - -- - - - -- - --- - - - - - - - - - - - - - -- -- - - -- - - -- - -- -- --- - -- - - - - - --- -- - -- - - - - - - - - - - - -- - - - - - -- - - - - --- - - - - - - - - - --- - - - --
Page 2 of4
. Building Permit Work Card
Job Address 2700 W 9TH AVE Permit Number 0118514 Create Date 3/14/2006
Owner MERCY MEDICAL CENTER aSH INC Contractor CR MEYER
Category 219 - Addition Hospitals & Institutions Plan 52-25-0306
Occupany Permit Required Flood Plain No Height Permit Not Required Class of Const: 28
Use/Nature 3700 sf Cancer Center Addition and Remodel as per plans approved by DHFS 12-19-05 located at east side of south wing.
of Work
HV AC Contr . .. Plumbing Contr. 'e";" . ~ ~,' . ....^.-. .~...' ..
Electric Contr
Inspections:
Dalte 1/2/2007 Type Rough In Inspector Allyn Dannhoff approved
[.esl Uee/I""pecll'" ot m,'e lobby. Tom wonts 1<> be lhe<e lud""",clI"'. The", betweee 7,00 & 3,30. 112/07. No "'e","" oofed.
DatelTime requested: 1/2/2007 07:42 AM Notice Type: Ready DatelTime: 1/3/2007 AM
Access: rEnter thru cancer center main entrance off 9th
Requested By: CR MEYER - Tom Witkowski Phone Number: 379-5539
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
- - - - - -. - --- - - - - - - - - - - - - - - -- - - - - - -- -- - - - - - - -- - -- -- -- - - - - - - - - - - - - - -- - - - - - - -- - - - --- - - - - -- - - -- - ---- - - - - -- - - - - - - -- - -- - --- -- .'. - - - -- - - - - --- - - - - - - - -- --- - - - - -- - - - - - -- - - - - --- - --- -- - - ---
Date 2/16/2007 Type Rough In Inspector Allyn Dannhoff
[.est Uee/Loo""" foe ,bove ",lIIe9 ,_", foe the oo,,"PI ph"". Tom wo.'d Uke 10 be thme (7,00 10 3,30)
DatelTime requested: 2/15/2007 08:23 AM Notice Type: Ready DatelTime: 2/15/2007 08:23 AM
Access: IEnter thru main cancer center entrance
Requested By: CR MEYER - Tom Witkowski Phone Number: 379-5539
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
no time
- - - - -. - - -- - - -- -- - - - - - - -- - - - - - -- - - - - - - - - - - ----- - - - -- - --- - - - - - - -- -- - - - - - - ~ - - - - - - - - - - - - -- - - _. - -- - - --- - - -- -- --- - - - - --- -- - - - - -- - - - - - -- - - ---- - - - --- - - - - -- - - - - - -- - - - - --- - - - --- - -- - - - --
Date 2/26/2007 : AM Type Final Inspector Allyn Dannhoff approved
Fuest line/ This is final for the phase currently in. Tom wants to be there. Please call and let him know when you will do inspection.
C07. Ph,,,, IV (SE rom.. ",e"", """""). no "",,,,ms eoled.
Daf-elTime requested: 2/23/2007 11: 13 AM Notice Type: Ready DatelTime: 2/26/2007 PM
Access: !Enter thru main entrance to cancer center
Requested By: CR MEYER - Tom Witkowski Phone Number: 379-5539
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
- -- - - - - ---- - - - - - - -- - - - - - - - -- - - - - - -- - - - - --- - - - -- - -- - - - - - - -- -- - - - - --- -- - - -.. --- - - -- - - - - - -- - - - - ---.- - - -- - -- - -----.--- - - - - -- ---- - -- - -- ---- - --- --- - - - - -- -.- -- - -- - - - - --- - - - -- - - - --- - - - - --
Date 3/29/2007 Type Rough In Inspector Allyn Dannhoff
r'es! llee I """'" ","e9 ;"",eolloe ot the lest 3 'n,,,, (oooopled d.""" the .-emodeI). Tom "'PIs 10 be th.",.
ou could inspect on Wed 3/28.
DatelTime requested: 3/27/2007 01:21 PM Notice Type: Ready DatelTime: 3/28/2007
Access: [Enter thru main entrance of Cancer Center
Requested By: CR MEYER - Tom Witkowski Phone Number: 379-5539
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
no time
Would appreciate it if
- - - ---- - -- - - - - --- - - - - -- -- - - - - - -- - - -- --- - - - - -- - - - - - - ---- - - - - -- --- - - - - ---. -- - -- - - - - - -- - - - - - -- - - - - --- - -.. - ------ - ------. - - -- - - - - --- - - - - ----- ------ --- --- - -- - --- - --- - - - - -- - - - -- - - --
Page 3 of 4
'" .
Building Permit Work Card
Job Address 2700 W 9TH AVE Permit Number 0118514 Create Date 3/14/2006
Owner MERCY MEDICAL CENTER OSH INC Contractor CR MEYER
Category 219 - Addition Hospitals & Institutions Plan S2-25-0306
Occupany Permit Required Flood Plain No Height Permit Not Required Class of Const: 2B
Use/Nature ~700 sf Cancer Center Addition and Remodel as per plans approved by DHFS 12-19-05 located at east side of south wing.
of Work
HVAC Contr . , ,. .,-,,.,..,, Plumbing Contr 'ij. . .<-. ~~" .- ,.." ....... "",. .
Electric Contr
Inspections:
Date 5/9/2007 : AM Type Final Inspector Allyn Dannhoff
FE. QUEST LINE / READY FOR A FINAL FOR EVERYTHING ON THE REMODEL FOR THE CANCER CENTER
PL.EASE CALL TOM HE WOULD LIKE TO BE PRESENT FOR THE INSPECTION- No concerns noted.
DatelTime requested: 5/2/2007 08:29 AM Notice Type: Ready DatelTime: 5/4/2007 00:00
Access: jMain Entrance off of 9th Ave
Requested By: CR MEYER - Tom Witkowski Phone Number: . (920) 379-5539
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
approved
- - - - - - - ~ - - - - --- - - - - - - - - -- - - - - - - ---- - - - - - - -- - - - - --- - - - - -- - -- - - - - -- - - - - - - - - -- - - - - -- - - - - - - - -- - -- -- - - - - - -- - -- - -- - -- -- -- - - - - - - ----- - - -- -- - - -- ---- -- - - -- - - - - -- - - ~ --- - - --- - - -- -- - - - - --
Page 4 of 4
Building Permit Work Card
Job Address 2700 W 9TH AVE Permit Number 0122640 Create Date 11/20/2006
Owner MERCY MEDICAL CENTER OSH INC Contractor CR MEYER
Category 219 - Addition Hospitals & Institutions Plan W3-112-1106
Occupany Permit Required Flood Plain Height Permit Class of Const:
Use/Nature Medical Center /28'8"x40'10" Canopy Addition to South end of Cancern Center.
of Work
HVACContr Plumbing Contr '; 'I"~ ~ .,"_ ~~ . >,_' -
Electric Contr
Inspections:
Date 2126/2007
AM
Type Rough In
Inspector Allyn Dannhoff
approved
[
DatelTime requested:
Access: I
Requested By:
o Reinspect Fee 0 Fee Waived
Notice Type:
Ready DatelTime:
Phone Number:
o Reinspect Fee Paid
- - - - - - --- - - - - - -- - - - - - - - - - - - -- - - - - - - - - --- - - - - - - - - - - - - - - - - -- - - - - - - --- - - - - -- - -. - - -- - - -- --- -- -- - --- - - - - - -- - - - - --- - - - - -- - - - - - -- - - - - - -. - - - - -- - - - - - - - -- - - - - -- - - - - - --. -- - -- - - -- -- - -- ---
DaIle 5/9/2007
Type Final
Inspector Allyn Dannhoff
approved
[
DatelTime requested:
Ac(:ess: I
Requested By:
o Reinspect Fee 0 Fee Waived
Notice Type:
Ready DatelTime:
Phone Number:
o Reinspect Fee Paid
-- -- - - - - - - - - - - -.- - - - -- - - - - - - -- - - - - - - -.-- - - - - - - - - -- - - -- - - -.- - - - - - - .'w __ _ _ ___ _ _ _ _ ___ _ _ _ _ __ _ _ _ _ _ ____ _ _ _ _ __ _ _ _ _ _ __ __ _ _ _ __ _ _ _ w'.__ _ _ __ __ _ _ _ _ .'__"... _ __ __ .'__ __ _ _ _ _ _ _ _ __ _ _ _ _ _ __ _ _ _ _ _ _ __ _ ___
Page 1 of 1
Electric Permit Work Card
J(>b Ad&ress 2700 W 9TH AVE
,
Owner MERCY MEDICAL CENTER OSH INC
Service b New 0 ChangeO Temp . N/A
Volts 277/480 Circuits 106
Permit Number 118290
Create Date 2/23/2006
Contractor SUBURBAN ELECTRICAL ENGINEERIN(
J Type Q9_~rhead 0 Underground . N/A
Luminaires 207
Value
$131,296.00
Amps
Use/Nature 1643 _ Commercial-Addition/Remodels Mercy-Medica!Offlce Building / Cancer Center Addition
o,f Work
400
Switches
74 Receptacles 300
I
I
Inspections:
Date 04/04/2006 Type Rough In
~:QUEST LINE / PARTIAL ROUGH-IN
Gall Greg 223-0201 or 223-2000
~'ound Tails were not installed
DatelTime requested: 04/04/2006 12:51 PM
Access:
Inspector Kevin Benner
approved
Notice Type:
Ready DatelTime:
04/04/2006 12:51 PM
- - ----- --- - - ----- - - - ------ - - ---- ---- - ----- -------- - - ---- - ------ - - ----- - - - - - - - ---- - - - - - -- - - ---- -- - -- -- - ------- - - ----- -------- ----- ----- - - --- - -- ----- -- --- ----
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 841-2103 Tom
Date Q~~~_ Type Final Inspector l<E3vio_Benner approved w/cond.
~EQUEST LINE I PHASE 1 REHAB AREA. WANTS INSPECTIONFRIDA Y AM. """'<ate pa"el ""'edo~' are to be ma'"lal"ed do"". I
L remodeH".. AI'o d\oCUosed the ."",od aOO bond'"" of the add"o".
DatelTime requested: 05/11/2006 08:53 AM
Access:
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type:
Ready DatelTime: 05/12/2006 08:53 AM
Phone Number: TOM
- ----- - -- - - ------- - ------ ------ - ---- ---- -- ------- ------ - ------------- ---- - - - -- -- - - - - - - - - - - -- - - - -------- .---------- --- ---- - - ------------ ---- - - ----- -- - -------
Date 06/07/2006 Type Underground Inspector l:S~yi~ Benner not approved
~EQUEST LINE / UNDER SLAB ELECTRICAL INSP, WOULD LIKE TOMORROW PM IF POSSIBLE 1 The floor duct is to be fed with
relalllC wi"". me~. D;acuosed ,.;lh Tom.
DatelTime requested: 06/06/2006 02:08 PM
Access:
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type:
Ready DatelTime: 06/06/2006 02:08 PM
Phone Number: TOM 841-2103
---- - ----------- ---- ---- - ------ - - ---- - ------- --- ------ - ---- -- ---- ------ - - - -- - - ~ - --- - - - --- - - - - ------------- ------- - ---- -- --- -- - ----- -- ---- - - -- - - - - - ----------
Date 06/07/2006 Type Reinspect Inspector ~~~_l3enner approved w/cond.
rhe G.C. formed the concrete around the PVC raceway so that they can pour concrete until the electricians can replace it.
I
DatelTime requested: Q?!QZJ2006 12:36~ Notice Type:
Access:
Ready DatelTime: <106/07/200612:36 PM
-- -- ------ - - ------ - - -- ---- -- - - - - - - -- - - - - - - - -- ------ - ---- - -- ----- ---- ~ - - -- - - - - - - - ~ - - - - ~ - - ~ - -- -- - - -- ---- - -- ---- ------- ~- -- --- ----- - - - ---- - -. - - - - --- --- - -------
Requested by: _________
o Reinspect Fee 0 Fee Wavied
Phone Number:
o Reinspect Fee Paid
,
~ob Address 2700 W 9TH AVE
Electric Permit Work Card
Permit Number 118290
Create Date 2/23/2006
Owner MERCY MEDICAL CENTER OSH INC Contractor SUBURBAN ELECTRICAL ENGINEERIN<
--.-.- ---- --
Service tL New 0 ChangeO Temp . N/A I Type 0 Overhead 0 Underground. N/A
277/480 Circuits 106. Luminaires 207
_._~._---
Amps ."__~ Switches 74 Receptacles ___ 300
~;~:.:u.. r - Comme<cial-AddltioolRemodel, Me,cy Med1ial Office Bulldl"" I Coo,,", Ceole< Add"oo
Volts
Value
$131,296.00
Insipections:
Date 92/1-8/2006__ Type Underground Inspector !<.e:lli.rl Benner m~".__ approved w/cond.
~e-lnspecHheraceway to the floor duct (was not installed atr the tlme"of insection, Tom did have the raceway with him.
lUG to the nurses station
L
DatelTime requested: 07/18/2006 07:43 AM
Access:
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Notice Type:
Ready DatelTime: 07/18/200610:30 AM
Phone Number: 841-2103 Tom
--_.- - ------ - - ----- - -- -------------- - - -- - ---- ---- ------------------ - -- ---- - - --- - - - - - - -- - -- - -- -- - - - - - ----- -- - --- - - - -- - - - - ------ - ---- - ------- --- --------- -----
Date 07/18/2006
~alls
Lot Ready
Type Rough In
Inspector Ke:'.'i!!.!=lenner
not approved
DatelTime requested: 07/18/2006 07:43 AM
Access:
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Notice Type:
Ready DatelTime: 07/18/200610:30 AM
Phone Number: 841-2103 Tom
---- - ---- - - - ---- - - - - ----- -- - - - - --- -- - - - ------ -- ------- ------- ------- ------ ---- - - - -- - - - - ----- - ----- ------ - - ---------- - - ---- - - - ----- - ---- --------- ------------
Date 08/04/2006
Iilterior walls
!
L
Type Rough In
Inspector Kevin Benner
approved
DatelTime requested: 08/03/2006 07:48 AM
Access: Call Tom when on site
Requested by: SUBURBAN ELECTRICAL ENGINEERING Phone Number: 841-2103 Tom
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
__ _ ______ _____ __ ______ _ _ _ _ ___ __ _ _ _ ____ __ ___M_____________ ____________ - - ----- - - ---- - - - -- -- - - - -- -- - ------------ -------------- ---- - - ---- -- ------ --- ------------
Date 09/06/2006 Type Abv Ceiling Inspector Kevin Benner not approved
~emporary wiring to be removed, wiring to the up-lights to be installed correctly, CL2 wimg to be supported for the sound system. Required
L at a oou~e of Ules be left out ;0 ea'" a<ea of the ~olaUon' fe, ;",pectkm pu'"""".
Notice Type:
Ready DateJTime: 08/04/2006 00:00 AM
DatelTime requested: Q~/01/2006 06:28 AM
Access: Call when on site
Notice Type:
Ready DatelTime: 09/06/2006 00:00 PM
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Phone Number: 841-210~13_rian Borsky
--- - - - ----- - - - ----- --- - - -- - - - - - - - - --- - - - - ------ - ------------- -- ---- - -- ---- - - -- - - - - - - - - - - - - -- - -- ---- ----- - - - --------- --- --- -- -- - - -- - - - - - - - - - - -- ----- ---------
-
.
~ob Address 2700 W 9TH AVE
Electric Permit Work Card
Permit Number 118290
Create Date 2/23/2006
Owner MERCY MEDICAL CENTER OSH INC Contractor SUBURBAN ELECTRICAL ENGINEERIN(
--..~._-_._-_._... ---.~-.._--
Service pNe~==--O ChangeO Temp . N/A I Type 0 Overhead 0 Underground. N/A
277/480 Circuits 106 Luminaires 207
----"._.~--..._._- -~
Amps ~____,__~Q Switches 74 Receptacles 300
Use/Nature 164:f~commercial-Addition/Remodels Mercy Medical Office Building / Cancer Center Addition
of Wo.. I
L
Volts
Value
$131,296.00
Inspections:
Date 09/12/2006 Type Abv Ceiling
~equesfWhenon site / Re-Inspect
Lone senso~ to be_removed from above the ceiling
Date/Time requested: 09/06/2006 03:00 PM
Access:
Inspector Kevin Benner
----____u_u___ approved w/cond.
Notice Type:
Ready Date/Time: 09/11/2006 00:00 PM
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 841-2103 Tom
- -- -- - --- ---- -- - - --. - - ~ -- - - -_ _ __ ____ __w_____ _ _ ~ ______ ___.____ _________ _ _____ _____ _. _____ ___._ _ __ ____ _ ____ __ ___ _ _ __ _ __ ____ ____ _ _ _____ _ _ _ ____ _ ______ _ _ _.___ ___
Date 09/18/2006 Type Final Inspector Kevin Benner ____uuuu,_ __ not approved
Cequest when on sfte'\ Missing coverplates, Exterior Emergency Illumination, 10 OCPO's in panelboards'and location of disconnects,
Provide calculations and acceptance from the Electrical Engineer to provide a feeder from a Sub-Panel in lieu of the main service
----~---
Date/Time requested: 09/12/2006 10:00 AM
Access:
Notice Type:
Ready Date/Time:
09/18/2006 00:00 AM
Requested by: SUBURBAN ELECTRICAL ENGINEERING
Phone Number: 841-2103 Tom
o Reinspect Fee 0 Fee Wavied
o Reinspect Fee Paid
-- -- --- - - - - -- --- - -. - - -- - - - - ~ ---- - - --------- ------------------ ----- - ------------- ------ ----- ------ ----- -- ----- - - - -- - -- ---- - - - -- --- - - -------------------- -----
Date QgI~QI.?gO()__ Type Re Final Inspector Kevin Benner
~m Hoheisel for theE.C. stated that the reviewed violations are corrected
Jeff Redman Cr Meyer Fax # 235-3419 (Need copy of the Final Inspection Report)
opy was faxed on 9/19/6 PM, Will fax an additional copy when the Final Re-Inspection is approved.Still needed better 10 of Circuits and
ocation of disconnects for panels. Reveiwed with Tom from Suburban Electric.
'~,,"~~_...J.h~
Date/Time requested: 09/19/2006 12:36 PM Notice Type: Ready DatelTime: 09/19/2006 12:36 PM
Access: Call Tom when on site
approved w/cond.
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 920-841-2103 Tom
----- - -- ---- - - - - - -- -- - - - - - -- - - ------ --------- - ------ ------------~------ ----- - --"--. - ---.._----- - - ------------ ------- ---- --- -- --- -. ------ ----------------------
Date 10/17/2006 Type Rough In
Inspector Kevin Benner
approved
[~2
DatelTime requested: 10/16/2006 02:09 AM
Access:
Notice Type:
Ready Date/Time: 10/17/200600:00 PM
Requested by: SOLAR ELECTRIC SERVICES INC Tom
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 841-2103 Tom
- - ---- ---- - -- - -- - - - - - - - - - - - - - - - - - ------------- --- - -------- - ------ - - - ----- - --- - - - - -- -- ------ ---- ------------ ------ - -- - ----- - - ----- - - - -- -- ------ - -------------
;Job Address 2700 W 9TH AVE
Electric Permit Work Card
Permit Number 118290 Create Date 2/23/2006
Owner MERCY_.MEDICAL CENTER OSH INC Contractor SUBURBAN~!:~~:rB!~~L E:NGINEERIN(
Service b N~~ 0 ChangeO Temp . N/A I Type 0 Overhead 0 Undergroul!d . N/A
Volts 277/480 Circuits 106 Luminaires 207
---,-_._~._--~-~
Jl\mps _____'!QQ Switches __~ Receptacles 300
Use/Nature 1643 _ Commercial-Addition/Remodels Mercy Medical Office Building / Cancer Center Addition
of Work 1
L
Value
$131,296.00
Inspections:
Date Type ~~~e!I!..r~~L~ Inspector Kevin Benner
['" S,""p109 inhe fle. alaem ",,,way system shall be oomplete.
...___ not approved
Date/Time requested: 11/13/2006 07:42 AM
Access:
Notice Type: FC Ready Date/Time: 11/15/2006 00:00 AM
-_.~_._._-_.~------_.-~----------------.
-- - - --- - -- - - -~- - - -- -- - - - - - - -- - - -- -- -- -- - - - -- - ---- - - -- - --- - - -- ---- --- - ------- ---- --- .-------- -------------- - - --- -- - -- - - - - - - - - - - - -- - - ---- - - -- -- - ----- - - ---- - --
Requested by: ~'::J.I?_~BAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 841-2103 Tom
Date .!.:111 ~!~QQE>___ Type ~~_~ Inspector Kevin Benner __ -______ not approved
~ouble check(or- the required working space in the electrical closet from the previous Final Inspection that was to be corrected with this
l ",a ",model.
Date/Time requested: 11/13/2006 07:42 AM
Access:
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type: FC Ready Date/Time: 11/15/200600:00 AM
Phone Number: 841-2103 Tom
-- - ---- - - - ---- - -. - - - - - - - --- - - - .--- - -- ---- - ------- - ------ -- ------ --------- - - ------ - ---------- - ------ ------ -- ---- -- - - -- - - -- - - - - -- - - - ----- ---- --- ------ ---- - ---
Date 11/16/2006 Type Abv Ceiling
Inspector Kevin Benner
._~___ approved w/cond.
e-Inspect
Need the "listed system" for the Fire-Stopping that was used through the floor/ceiling
DatelTime requested: 11/16/2006 07:34 AM
Access: Will be on site till noon
Requested by:
o Reinspect Fee 0 Fee Wavied
Notice Type:
Ready DatelTime: 11/16/2006 09:49 AM
Phone Number:
---- -- - ---- - - - - -- - - - - - - -- - - - ---- - - ------------ - - ----- - - - -- - --- -- -- - --- - -- ------- ---- ------------ -- ---- -- - ---- - - - ---- - - -- - - - - - - - -- -- -- ------ -------------.---
o Reinspect Fee Paid
Date ~!~~ Type Re Final Inspector Kevin Benner
he electrical closet does not provided the required "Work Space". Reviewed with Tom from the G.C. & Tom from the E.C.
eff Redman of CR Meyer stated that the Work Space issue is corrected. I approved for the space to be occupied and I would inspect on
he next R11 inspection for the next phase. 12/6/6 10:20 AM
DatelTime requested: 11/16/2006 07:34 AM Notice Type:
Access: ~i~_~l:lon_~ite till noon today and Friday till n~l!_
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Ready Date/Time: 11/16/2006 07:34 AM
Phone Number: 841-2103 Tom
-- ---- - -- - - -- - - - - - - - -.- . - - - - - - - - - ---- - ----- - - -------- - ------ - - - - -- ---- - - - --- -. - - -- - -- ---- ------- ------- ---- - - - - --- - - - - -- - - -.. - - - - - -. ------ - ------------ ------
.
Electric Permit Work Card
)
~ob Address 2700 W 9TH AVE Permit Number 118290 Create Date 2/23/2006
Owner MERCY MEDICAL CENTER OSH INC Contractor SUBURBAN ELECTRICAL ENGINEERINI
-------~~~----~----. - ---...-.
Service b New 0 ChangeO Te~p~ N~ Type 0 Overhead 0 Underground. N/A
Volts 277/480 Circuits 106 Luminaires 207
Value
$131,296.00
Amps 400 Switches 74 Receptacles 300
Use/Nature ~43 - Commercial-Addition/Remodels Mercy Medical Office Building / Cancer Center Addition
of Work
Inspections:
Date 01/03/2007 Type
Lore, Ceo~ Rerept;oo he,
~c>l,l~~!r1 Inspector Kevin Benner
'___ approved
.~
DatelTime requested: 01/02/2007 OI=35 ~~._ Notice Type:
Access:
Ready DatelTime: 01/03/200700:00 AM
Requested by: ~\:l.~URBAN E::~CTRICA~ I::f\I~II\I1=ERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 841-2103 Tom
Date ~~9~_ Type ~fi.!:l~......_...__.. Inspector Kevin Benner _____.____~ approved
[~ " "" the Wo'" 'p,re ~oIati"" ooted ootheT1716ib6 Floal,",pe~iOO
DatelTime requested: 01/03/2007 2,0:00 AM _ Notice Type: Ready DatelTime: 01/03/200700:00 AM
Access:
.......~I
Requested by:
o Reinspect Fee 0 Fee Wavied
Phone Number:
o Reinspect Fee Paid
Date ~!~_ Type Abv Ceili~.__ Inspector Kevin Benner.______._ approved w/cond. '.
[:ecePtion Area: Fire Alarm equipment is to be relocaTecF.vhTCi1 cannot be done until the next phase-remodel is sta, rted. Work space, "" ~l
AV.'s, CL2 wiring support.
om Called @ 12:55 PM 2/15/7 and stated that the violations are corrected. I approved for the ceiling tile to be installed.
DatelTime requested: 02/14/2007 12:38 PM Notice Type: FC Ready DatelTime: 02/15/200700:00 AM
Access:
Requested by: SUBURBAN ELECTRICAL ENGJ!'!.EERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 841-2103 Tom
Date Type Final Inspector Kevin Benner
Eception Area: A 1/2 wall in the reception area was not concealed and the receptacles in that wall were not energized and the covers
'nstalled, The NFPA 72 requirements for the FACP identification was to be done, some Fire Alarm wiring has to be corrected but cannot be
one until the next phase is started.. Reviewed with Tom H. of the E.C.
-- -- - ----- - -
DatelTime requested: 02/20/2007 01 :08 PM.__ Notice Type:
Access:
Ready DatelTime: 02/21/2007 00:00 AM
Requested by: SUBURBAN ELECTRICAL EI\I~I_~EJ::RING
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Phone Number: 841-2103 Tom H.
....."...,..
:lob Address 2700 W 9TH AVE
Electric Permit Work Card
Permit Number 118290
Create Date 2/23/2006
Owner MERCY MEDICAL CENTER OSH INC Contractor SUBURBAN ELECTRICAL ENGINEERIN(
______._u.__.. "._____~
Service b New 0 Change 0 T~J:>_ .~2~~ Type 0 Overhead
277/480 Circuits 106 Luminaires 207
_~___"~_u.,___
400 Switches _____J-": Receptacles 300
Use/Nature 643 - Commercial-Addition/Remod'els' Mercy Medical Office Building / Cancer Center Addition
of Work
o Underground. N/A
I
.J
Volts
Value
$131,296.00
Amps
~~--~--l
J
Inspections:
Date 03/07/2007 Type ~..ll!:!~.Ir1 Inspector Kevin Benner approved
~anging & waiting area - - . - --- -- - --
L-='" with the G.C. & E.C. that V A V 07 4 wo"~ "ee' to be ,e4ocaled 10 """,Ie .wo""pa",. fo, the clectioal """'pment.
,
I
______.J
DatelTimerequested: 03/07/2007 12:41 PM
Access:
Notice Type:
Ready DatelTime: 03/07/200712:41 PM
Requested by: SUBURBAN ELECTRICAL ENG1f'::J.!=ERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 841-2103 Tom
--- - ---- - - - -------- ------ -------- ------ - - -- ---- - - - -- -- - - -.. - - -. - --- - - - -- - -- -- -- -- ----- -- - ------ --- -- ----- - --- - -. ---- - - ----'--- --- -- ---- -- --- - - - - - - -- - - - -- - - ~ --
Date 03/28/2007 Type ~.f_~!~~Q
r"" & Walti"" mea
DatelTime requested: 03/27/2007 07~~~___. Notice Type: FC Ready DatelTime: 03/28/200700:00 AM
Access:
Inspector Kevin Benner
not approved
-------..-.--'. . --'-j
i
i
___.__......-.l
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 841-2103 Tom H.
- -------- - ----- - - - --------------------------- - - - ---- - - - --- - - - - - - - ~ ~ - --- ------ ------- - ------------ ----- ------- ------,----------------~-- ------------ --- -- - - ---
Date 03/29/2007
[E_INSPECT
Type Abv Ceiling Inspector Adam Krause
approved
________ ul
_~__u__.J
DatelTime requested: 03/28/2007 02:06 PM Notice Type: Ready DatelTime: 03/29/2007 00:00 AM
Access: Enter at the Cancer Center @ the_~:."'{~_~rner of the facility. Call Tom when you get on site.
Requested by: Phone Number: 841-2103
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
- ---- - - - ----- - ------ - ------ ---------- - ~---- - - - ---- -- - - - -- - - - - - -- ~ - --- ----- --- ------ - -----~------------------- ---- ~- ----- ---- - ---- - - --------------- ------ ----
Date 05/04/2007 Type Final Inspector Kevin Benner approved w/cond.
~as not able to inspect above the ceiling for compliance of the VAV. relocation and some of the CL2 wiring corrections and the FA - l
r rrectioos beca<>s, th, acea was ",~"g pa'e"ts. Dis",.,ed wlth Tom H. that th, COO"1erlop ",,,,plade '" th, bcea'"""",hall be GFCI :
rotected. A performance test of the Em. Lighting system needs to be conducted. ~J
DatelTime requested: 05/0212007 Q?~11 jl.M
Access:
Notice Type:
Ready DatelTime: 05/04/2007 09:00 AM
Requested by: SUBURBAN ELECTRICAL ENGINEERING
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 841-2103 Tom H
'," ,,".
,Job Address 2700 W 9TH AVE
Electric Permit Work Card
Permit Number 118290
Create Date 2/23/2006
Volts
Owner MERCY MEDICAL CENTER OSH INC Contractor SUBURBAN ELECTRICAL ENGINEERIN(
.. ---.---.- ---.-
Service p New 0 Change02~~E_ . N1Auu-1 Type 0 Overhead 0 Underground. N/A
277/480 Circuits 106 Luminaires 207
-.--.- ~--
400 Switches 74 Receptacles _U~
Use/Nature p43 - Commercial-Addition/Remodels Mercy Medical Office Building / Cancer Center Addition
of Work
,~
Value
$131,296.00
)!\I1l ps
--J
Inspections:
Date 05/08/2007 Type ~J:!nalu,u,,_,,_ Inspector Kevin Benn~~_
lee Computer Correction Notice and notes'state,ifrom the-previous inspection."
L
not approved
_J
DatelTime requested: 05/07/2007 .. ~I:~~~ Notice Type: CC Ready DatelTime:
Access: Meet Tom by the mair:!~':l_~f!<:~~n_tranc~___
05/08/2007 02:00 AM
Requested by:
o Reinspect Fee 0 Fee Wavied
Phone Number:
D Reinspect Fee Paid
HVAC Permit Work Card
Job Address 2700 W 9TH AVE Permit Number 118502 Create Date 03/09/2006
Owner MERCY MEDICAL CENTER OSH INC Contractor TWEET GAROT MECHANICAL INC
Fuel ~ Gas I U Oil I ~ Electric I U Solar I Solid I Value $303,090.00
System ~ New I D Replace I D Other I
l.!J Forced Air U Radiant I U Steam I l.!J AlC I ~ Vent I
U Electric I l.!J Hot Water I U Suppl. I U Con. Burner I
Chimney Type 0 Chimney A 0 Chimney B 0 Direct Vent . Not Applicable
Use/Nature Iinic / HVAC system as per plans approved by DHFS for addition on SE end of clinic.
of Work
Inspections:
Date 2/26/2007 TyrrEi"Fr;:;~i . <,,~~ Inspector Allyn Dannhoff
Phase IV (SE corneTeancer center) - no concerns noted.
DatefTime requested:
Access: I
ReqUlested By:
o Reinspect Fee 0 Fee Waived
Notice Type:
Ready Date/Time:
Phone Number:
D Reinspect Fee Paid
'" " r
Plumbing Permit Work Card
Job Address 2700 W 9TH AVE Permit Number 119094 Create Date 04/25/2006
Owner MERCY MEDICAL CENTER OSH INC Contractor BASSETT MECHANICAL
Category 440 - Industrial-Interior Plan Value $101,000.00
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 5 Lndry Tray 0 Clothes Wshr 0 Exam Sink 16 Catch Basin 0 Ext Grease Trap 0
Toilet 5 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 -. St~nclp Rec 0 Wtr Sewer Mtrs ----.J1
Water Heater 0 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. 2 hose bibb
-
Fixtures
Use/Nature NEW CANCER CENTER ADDITION PER STATE APPROVED PLUMBING PLANS TRANSACTION ID NO. 1143960 **CHECK #202034
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
Inspections for Work Card 85778
Da1te 4/24/2006 Type Consultation Inspector Paul Wolf
NEED STATE APPROVED PLANS ONSITE TO DO UG INSPECTION
not approved
DatelTime requested: 4/25/200607:25 AM Notice Type: Telephone Number:
Access: I
Ready DatelTin1e: 4/21/2006 07:25 AM Requested By: BASSETT MECHANICAL
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
- - - - - - - - - - --- - - - - - - - --- - - - - -- -- - - - - - - - - - - - - - - - -- - - - - - - - - -- - - - - ---- - - - - - -- - - - - - - -- - - - - - -- - - -- - - -- - - -- - - - - - - - - - - - - - - --- - - - - - --- - - - - --- - - - - --- -- --- - - - - -- - -- - --- - - - - - - --- - - - - -- - - - - - -- - - - -- - - --- - - - -- - --
Date 4/24/2006
Type Underground
Inspector Paul Wolf
approved
DatelTime requested: 4/25/200607:27 AM Notice Type: Telephone Number:
Access: I
Ready DatelTime: 4/21/2006 07:27 AM Requested By: BASSETT MECHANICAL
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
- - - - - - ."- - - - - --- - - - - - - - --- - - - - - - -- - - - - - -- - - - - - - -- - - - - - - - - -- - - - - - - --- - - - - - - -- - - - - --- - - - - --- - -- - -- - - - - - - - - - - - --- - - - - - - -- -- - - - - -- - - - - - - - -- - - - -- - - - -- - - - - - -- - - - - --- - - - - - - -- -- - - --- - - --- - - - - - - - - - -- - - -- - - --
Date 6/23/2006
Type Underground
Inspector Paul Wolf
approved
'Request line/requesting underground plumbing inspeciton inside for new
ddition.
Date/Time requested: 6/22/200603:31 PM Notice Type: Telephone Number: Nick-920-841-0332
Access: I
Ready DatelTime: 6/23/2006 08:00 AM Requested By: BASSETT MECHANICAL
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
- - - - - - --- - - - - - - - - - - - - - - - - -- - - - - -- -- - -- -- -- - -- - - - -- - - - - - - ---- - - - - - -- - - -- - - --- - - - --- - -- - - -- - - - - --- - - --- -_ _ _ _ _ __ _ _ _ _ _ _ ___ _ _ _ _ _ _ __ _ _ _ _ ___ _ _ _ _ ___ _ ____ _ _ _ _ __ _ w _ _ _ __ _ _ __ _ _ _ ____ ____ _ _ _ ___ _ _ ___ __ ____ _ __ _ _ __
Date 8/4/2006
Type Rough In
Inspector Paul Wolf
approved
Request Iinelwould like to start drywalling on Monday
DatelTime requested: 8/3/2006 10:24 AM Notice Type: Telephone Number: Robin-740-1546
Access: I
Ready DatelTime: 8/3/2006 10:24 AM Requested By: BASSETT MECHANICAL
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
-- - - - - - ..- - - - - - - -- - - - - - - -- -- - - - -- - --- - - - - --- -- - - - - -- - -- - - - -- - --- - - --- -- - -- - -- - - - - --- - - - - --- - - - - -- - --- - --- --- --- - - - - - - -- -- - - - - ----.- -- -- - - - - - -- - -- -- - - - - - -- - - -- --- --- ---.- -..; - -. -- -.---- -..; - -.- - - - --- -.;. -.-- - ---
Inspections for Work Card 85778
Da1te 917/2006 Type Rough In Inspector Paul Wolf
Request line/Please call Robin before you go for the inspectionOverhead work in new addition.
approved
DatelTime requested: 9/5/2006 08:47 AM Notice Type: Telephone Number: 740-1546
Access: I
Ready DatelTime: 9/6/2006 08:00 AM. Requested By: BASSETT MECHANICAL - Robin
() Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Date 9/13/2006
Type Final
Inspector Paul Wolf
approved w/cond.
Final inspection for addition phase 1 & 2 only.
DatelTime requested: 9/13/200609:17 AM Notice Type: Telephone Number:
Access: I
Ready DatelTime: 9/13/2006 09:17 AM Requested By: BASSETT MECHANICAL
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Date 10/3/2006
Type Underground
Inspector Paul Wolf
approved
Partial underground for phase 3 of cancer center addition.
DatelTime requested: 9/28/200607:35 AM Notice Type: Telephone Number:
Access: I
Ready DatelTime: 9/28/2006 07:35 AM Requested By: BASSETT MECHANICAL
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
- - - - -- - - - - - - - - -- - - - --- - - - - - - -- - - - - - - --- --- - - - ---- - - - - -- -- - - - - --- -- - - -- - - -- - - --- - - - - -- - --- - -- -- - - - -- - - - - - -- - - - - --- - - - - -- -- - - - - -- -- - - - - - -- - -- - --- - - - - - -- - ---- - - - - -- - - -- - --- - - - - --- -. -- - - - - --- - -- - - - -- --
Date 1/3/2006
Type Rough In
Inspector Paul Wolf
approved
Request Iine3 sinks at south end of cancer center.
DatelTime requested: 1/212007 07:23 AM
Access: I
Ready DatelTime: 1/3/2007
o Reinspect Fee 0 Fee Waived
Notice Type:
Telephone Number:
740-1546
Requested By: BASSETT MECHANICAL - Robin
D Reinspect Fee Paid
-- - - - - -- - - - - - - -- - - - - - - -- - - - - - - -- -- - - - - -- -- - - - - - - - -- - - - - - - -- - - - - -- -- - - ---- - - - - - - -- - - - - ---- - -- - - -- - - - - -- - - - - -- - - - - ---- - - - -- - - - - - - - - -- - - --. ---- - - --- - - - - --- --- ----- - -- - - - - - -- - -- -- -- - - - -- -- - --- - - - - - - - --
:.~
Inspections for Work Card 85778
Date 2/26/2007 Type Final Inspector Paul Wolf
approved
REQUEST LINE / READY FOR A FINAL INSPECTION
*-*. BEFORE NOON ON MONDAY **-**New office area.
DatelTime requested: 2/23/200701:20 PM Notice Type: Telephone Number: none given
Access: IEnter off of 9th Ave
.'Ready DatelTirne: 2/26/200712:00 PM Requested By: BASSETT MECHANICAL _ Robin
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
- - --- - - - -- - - - - - -- - - - - - - -- - - - - - - --- - - - - - - ------ - - -- - --- - - - - - - -- - -- - ----- ~ - --- - - - - - - -- - ~ - - --- - - - - --- - - - - -- - - - - - -- - - - - --- - - - - -- - - - - - - --- - - - - --- - - - - -- - - - - - -- - - - - - -- - - - - ---- - -- - - - - - - - - - - - - - - - - - - - - - - ---
Date 3/8/2007
Type Rough In
Inspector Paul Wolf
approved
Lav and water closet in old office area.
DatelTime requested: 3/9/2007 07:32 AM Notice Type: Telephone Number:
Access: I
Ready DatelTime: 3/8/2007 07:32 AM Requested By: BASSETT MECHANICAL
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
- - - - - --.. - - - - - - - - - - - - -- - - - - - -- - - - - - - -- - - - - - - -- -- - -.,. -,..,.. --- - - - - - - --- - - - - - - - - ~ - -- - - - - - - - -- - - - - - - - - - - - - - - - - - - -- - - - - - -- - - - - --- - - - - - - -- - - - - - -- - - - - --- - - - - - - - - - - - - - - - - - - -- - - - - - - - - - --- - - - - - - - - - -- - - - - -- - ~ - ---
Date! 4/11/2007
Ty~ir<Finar"<."".
,.;;,>4:
.,>::!"'"
Inspector Paul Wolf
approved
REQUEST LINE / READY FOR A FINAL INSPECTION ON 2 SINKS AND 1 TOILET
DatelTime requested: 3/29/200703:17 PM Notice Type: Telephone Number: (920) 740-1546
Access: Find Tom with CR Meyer on site and he will take you to them
Ready DatelTime: 4/2/2007 00:00 Requested By: BASSETT MECHANICAL - Robin
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
- -- - - - - --- - - - - --- - - - - -- - - - - - -- -- - - - - - - -- - - - -- - -- -- - - - - -- -- - - - - - -- - - - - - ---- -- ---- - - - - - -- - - - ~ --- - - - - --- - - - - -- - - - - - -- - - - - --- - - - - ---- - ~ - - - -- - - - - --- - - - - - - - - - - - --- - - - - -- - - - -- - - - - -- - -- - -- - - - - -- --
.;.
Jim Doyle
Governor
DIVISION OF DISABILITY AND ELDER SERVICES
BUREAU OF QUALITY ASSURANCE
2917 INTERNATIONAL LANE, SUITE 300
MADISON WI 53704
Helene Nelson
Secretary
State of Wisconsin
Department of Health and Family Services
Telephone: 608-243-2024
FAX: 608-243-2045
dhfs. wisconsin.gov
October 13, 2006
Peter Lecompte
CR Meyer
895 W. 20th Avenue
Oshkosh, WI 54902
(PLecompte@crmeyer.com)
(JRedman@crmeyer.com)
Dear Mr. Lecompte,
RE: DHFS #4766-7061, Proj #760381
Glass Canopy- South MOB Entry
Mercy Cancer Center
500 S. Oakwood Road
Oshkosh, WI 54904
Final architectural plans that were received in the Department of Health & Family Services on
September 27,2006 have been stamped CONDITIONALLY APPROVED on October 13,
2006. These plans were reviewed based conformance with the current edition of the Wisconsin
Administrative Building and Heating, Ventilating and Air Conditioning Code (Chapters Comm
61-65). The plans have NOT been reviewed for conformance to the Plumbing Code (Chapters
Comm 81-86), the Elevator Code (Chapter Comm 18) and any other Commerce code not
specifically mentioned.
Additionally, these plans and specifications have been reviewed for compliance with Medicare
(Title XVIII-Fed) and Medicaid (Title XIX-State) regulations including the applicable NFPA 101
2000 Life Safety Codes 101 Edition.
This review does not include lighting. The owner should be reminded that lighting plans are
required to be submitted for review and approval prior to installation.
This conditional approval does not constitute a guarantee or endorsement that the plans and
specifications are free of design defects or omissions; or that the systems submitted will be
installed in conformity with the plans, or that the systems will operate acceptably even if installed
in conformity with the plans, calculations, and specifications. The Department approval is
limited to a determination that the systems, as detailed in the submittal, adequately conform to the
above-referenced code requirements.
This conditional approval is only for the physical environment referenced in the above codes and
does not serve as certification or licensure as a hospital per HFS 124 or State Statute Chapter 50.
Approval of these construction plans does not constitute approval of the facility for a specific
Medicaid reimbursement rate. For further assistance with billing rate questions, contact Russell
Pederson, Chief, Hospital Fee for Services Section, at (608) 266-1720.
Wisconsin.gov
Mercy Cancer Center-Glass Canopy on MOB
October 13,2006
Page 2 of2
DHFS #4766-7061
Subject to local regulations, construction may proceed, except for those conditions listed below.
The necessary corrections shall be made before construction begins. Any deviation from or
additions to the plans made subsequent to this review is specifically not approved.
Evidence of Plan Approval. The architect, professional engineer, designer, builder or owner shall
keep one set of plans bearing the appropriate stamp of approval at the building site. COMM 61.33
The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for compliance
with all code requirements. The owner shall notify the Department and local officials before
taking possession of the building. The facility will be inspected during and after construction by
an engineer of this Department to ensure compliance with NFPA 101 Chapter 38 Federal
Regulations, at which time additional code implications can be identified by the Department.
Plan Review Comments: None.
The below listed documentation shall be submitted to this office prior to the final inspection for this
project. Until such documentation is received and approved, no patients or facility employees are allowed
to occupy or use the project area.
Documentation
Local or state plumbing inspection report.
Local or state electrical inspection report.
Local fire department inspection report.
Local building inspection approval or copy of occupancy permit.
Copy of the Comm SBDB-9720 or DSL-2495 compliance statement submitted to the
Department of Health and Family Services or letter of completion from the architect, engineer or
designer.
4 copies of the approved plans are enclosed (1 full size, 3 half size).
These plans were reviewed on behalf of Ganesh Strestha, who is on vacation. Upon his return he
will continue will other aspects of the inspection process. If you have any further questions,
please contact me at (608) 444-4846.
Sincerely,
BJ)Q~
Health Services Section
Bureau of Quality Assurance
cc:
City of Oshkosh Building Inspection
215 Church Ave
PO Box 1130
Oshkosh, WI 54903-1130
Tom Laabs, Affinity Health Sys (tlaabs@affinityhealth.org)
. .
DEPARTMENT OF HEALTH AND FAMILY SERVICES
Division of Disability and Elder Services
DDE..2457 (Rev. 10-05)
REQUEST FOR PERMISSION TO START FOOTINGS, FOUNDATION AND/OR DEMOLITION
Submission and Departmental approval on the form will allow footings and foundation work and/or remodeling, demolition work prior to plan
review. If ou have uestions about com letin this form call 608-243-2088 or FAX 608-243-2045.
Facility Name
MERCY MEDICAL CENTER
Street Address
500 S. Oakwood Road
City
Oshkosh
Project Description
New glass canopy attached to the South elevation of the existing Medical Office
Building.
STATE OF WISCONSIN
Bureau of Quality Assurance
.Date Plans Received (By HSS)
State Project 10 No. (By HSS)
State
WI
Zip Code
54904
County
Winnebago
We, the undersigned, request to begin (check one)
00 FOOTING AND FOUNDATION WORK ONLY 0 REMODELING PROJECT - DEMOLITION WORK ONLY
prior to approval of the plans in accordance with COMM 61, HFS 124.27(5) and HFS 132.84(17)(b). Submit this form with
the DDE-2333 Plan Approval Application and appropriate fees (page 3 of the Plan Approval Application, Miscellaneous
Fees).
· We understand that the Department at this time may not have completed a detailed review.
· We have reviewed the specific code requirements for the building or structure and its use, as set forth in COMM 61-65,
and HFS 124, HFS 132, or HFS 134, and have shown compliance on the drawings where applicable.
· We agree to make any changes required after the plans have been reviewed and to remove or replace non-code
complying parts of the building or structure.
· We understand that, prior to the start of construction, a Building Permit may be required from the local authorities having
jurisdiction in accordance with the laws and ordinances.
· We understand that if this project is in an unsewered area, a sanitary permit must be obtained prior to the issuance of a
local building permit, s 1 01.12(3)(h), Wis. Stats.
Title
Project
Name - Owner (print or type)
Tom Laabs
Street Address
500 S. Oakwood Road
City
Oshkosh
ARTMENT ACTION:
Approved 0 Not Approved
e iew Comments:
· We understand that if this project will disturb 1 or more acres of land, an EROSION CONTROL NOTICE OF INTENT,
per COMM 50.115 and NR 216.47, shall be filed with the Department of Commerce.
KEEP A COPY OF THIS FORM FOR YOURFlq;= ~~~MI!Q8.!GIN~L WITH FORM DDE.2333 TO:
Bureau of Quality Assurance
Health Services Section
29171nternationaJ Lane, Suite 300
Madison WI 53704-3100
SIGNATU
Date Signed
esigner (print or
Peter R. LeCom te
Name - Designer Firm (print or type)
CR Meyer
Street Address
895 W. 20th Avenue
City
'os k sh
State
WI
Jim Doyle
Governor
DIVISION OF DISABILITY AND ELDER SERVICES
BUREAU OF QUALITY ASSURANCE
2917 INTERNATIONAL LANE, SUITE 300
MADISON WI 53704
Helene Nelson
Secretary
State of Wisconsin
Department of Health and Family Services
Telephone: 608-243-2024
FAX: 608-243-2045
E C E IVEljn.90v
DEe 3 0 2005
DEPARTMENT OF
COMMUNITY DEVELOPMENT
December19fu,2005
HGA Architects
Attn. Scott Zube and Cherie K. Claussen, AIA
135 West Wells Street
Milwaukee, WI. 53202
RE:
Project # - 396l-5841R
Building Addition and Alterations
Mercy Oakwood - MOB
Business "B" Occupancy
24,380 sq.ft.-Total; 3,700 sq.ft.-New
500 South Oakwood Ave.
Oshkosh, WI. 54914
Dear Mr. Zube and Ms. Claussen,
· Final Revised Building, HV AC and Lighting Addition and Alteration plans that were
rece.ived in the Department of Health & Family Services on December 19fu, 2005 have been
stamped CONDITIONALLY APPROVED these plans were reviewed based conformance
with the current edition of the Wisconsin Administrative Building and Heating, Ventilating
and Air Conditioning Code (Chapters Cornrn 61-65). The plans. have NOT been reviewed for
conformance to the Plumbing Code (Chapters Cornrn 81-86), the Elevator Code (Chapter
Cornrn 18) and any other Commerce code not specifically mentioned.
· Additionally, these plans and specifications have been reviewed for compliance with
Medicare (Title XVIII-Fed) and Medicaid (Title XIX-State) regulations including the
applicable NFP A 10 1 2000 Life Safety Codes 10 1 Edition. .
This conditional approval does not constitute a guarantee or endorsement that the plans and
specifications are free of design defects or omissions; or that the systems submitted will be
installed in conformity with the plans, or that the systems will operate acceptably even if installed
in conformity with the plans, calculations, and specifications. The Department approval is
limited to a determination that the systems, as detailed in the submittal, adequately conform with
the above-referenced code requirements.
This conditional approval is only for the physical environment referenced in the above codes and
does not serve as certification nor licensure as a hospital per HFS 124 or State Statute Chapter 50.
Approval of these construction plans do not constitute approval of the facility for a specific
Medicaid reimbursement rate. For further assistance with billing rate questions, contact Russell
Pederson, Chief, Hospital Fee for Services Section, at (608) 266-1720.
Wisconsin.gov
t
}
I
December 27, 2005
Page 2
· Subject to local regulations, construction may proceed, except for those conditions listed
below. The necessary corrections shall be made before construction begins. Any deviation
from or additions to the plans made subsequent to this review is specifically not approved.
· The owner, as defined in chapter 101.01(2) (e), Wisconsin Statutes, is responsible for
compliance with all code requirements. The owner shall notify the Department and local
officials before taking possession of the building. The building will be inspected during and
after construction, at which time additional code implications can be identified by the
Department.
· The facility will be inspected during and after construction by an engineer of this Department to
ensure compliance with NFPA 101 Chapter 38 Federal Regulations.
· COMM 61.33 Evidence of Plan Approval. The architect, professional engineer, designer,
builder or owner shall keep one set of plans bearing the appropriate stamp of approval at the
building site.
· Item #1- Sprinkler plan addition and modifications shall be submitted for review before
installation. per NFPA 13.
· Item #2- Passage doors GK585 and GK610 cannot be locked in exit egress passage ( NFP A
LSC 101 - 38.2.5.).
· The below listed documentation shall be submitted to this office prior to the final inspection for
this minor remodeling project.
Documentation
-Local plumbing inspection report.
-Local electrical report.
-Local building inspection approval or copy of occupancy permit.
-Provide documentation sprinkler system installation and test report, and certification that the
system is fully operative (Use NFPA 13).
- Provide Information on Medical Gases certification and Testing per NFPA 99.
-Provide documentation that the heating and ventilation systems have been rough balanced and
are fully operative, final balancing report to follow or provide final balancing report (Comm
64.53)
-Provide certification that all fire and smoke dampers have been field tested and provide a
description of where they were installed in accordance with NFP A 90A.
-Provide documentation of electrical performance criteria and testing per NFPA 99, Chapter 7.
J
I
December 27, 2005
Page 3
-Provide copy of manufacturer's carpet specification test report from the testing laboratory.
-Letter from installer certifying that carpet that is installed is the same as that tested.
-Documentation of wall and ceiling finishes as to flamespread characacterists.
· Three copies of the revised approved plan covers were previously returned.
If you have any further questions, please contact me at (608) 243-2037.
Sincerely,
cc: - City of Oshkosh Building Inspection Dept.
- Tom Laabs, Project Coordinator c/o Mercy Hospital - Oshkosh
- Affiliated Engineers - Attn. Scott Moll, PE. 5802 Research Park Boulevard, Madison, WI.
53719
- C.R. Meyer & Sons - 895 West 20th Street, Oshkosh, WI. 54903
HSSMOBPLN3-1-05
~
CORRECTION NOTICE / FIELD INSPECTION REPORT
JOB LOCATION: 2. 7nCJ W 9d ~ r:'
City of Oshkosh " )-..
Inspection Services Division CONTRACTOR: ~ C. M -I=' :L e f"--
215 Church Avenue, PO Box 1130 t1~
Oshkosh, WI 54903-1 130 PROJECT TO BE INSPECTED: .1'1
Phone: (920) 236-5050 '>-,.
,,, (920) 236-5084 TYPE OF INSPECTION: Ic..,~ .. r-~.....; :J.
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/agent must sign and date at the bottom of this notice
and return it to the Inspection Services Division by the Compliance Date of
INSPECTION RESULTS
~
t--
23 ~ -;..t-O.vS-
Phone #
Print Name
Company
Signature:
Date
DEPARTMENT OF HEAl. TH AND FAMILY SERVICES
l :on of Disability and Elder Services
~2495 (Rev. 7-05)
STATE OF WISCONSIN
COMPL~NCESTATEMENT
Completion of this fonn is required by COMM 61.50, Wis. Admin. Code, prior to initial Occupancy of a new buHding or addition, and prior to final occupancy of an
alteration of an existing bullding. The supervising architect, engineer or designer shall file a written statement with the department certifying that, to the best of
his or her knowledge and belief, construction of the portion to be occupied has been performed in substantial compliance with the approved plans and
specifications.
GENERAL INSTRUCTIONS: This form must be completed and available at the lime of the final construcfion inspection: If you have questions about completing
this form, lease call 608 243-2088.
.. .,..... ......... '. '" . ,". . . , . . .- " :i~' ""_ ',:>" . _'0'.':." .. ...
OWNER PROJECT
Name Building Occupancy Chapter(s) and Use
Gary Kusnierz Business Group B
Company Name Tenant Name (If any)
Affinity Health System Fox Valley Hematology
Number and Street Building Localion (number and street)
500 Oakwood Road 5j)0 South Oakwood Road
City City and Zip Code
Oshkosh Oshkosh 54904
- Stale and Zip Code County
Wisconsin 54904 Winnebago
- Plan or Reference Number Building Supervising Professional Name and Registration Number
3961-5841R Kurt Spiering A-5708
-
Fl.ROJECJ: INFORMATION
Project Descnplion
Mercy Medical Cancer Center Addition and Remodel
PURPOSE OF STATEMENT
Check appropriale box or boxes and complete any other applicable information to indicate compliance with the approved plans and
s ecifications. Attach additional a es if necessa .
....
~ Building I2:a HVAC e!J lighting'
o Partial Completion (Describe Completed Portion or Phase)
BUILDING ITEMS MAY INCLUDE BUT ARE NOT LIMITED TO THE
FOLLOWING:
-Structural system including submittal and erection of all building
components (trusses, precast, metal building, etc.)
-Fire protection systems (sprinklers, alarms, smoke detectors)
designed, installed, and tested (including forward flow on back flow
devices) by appropriately registered professionals
-Shaft and stairway enclosure
-Exits including exit and directional lights
-Fire-resistive construction, enclosure of hazards, fire walls, labeled
doors, class of construction
-COMM barrier-free requirements (COMM 62 Ch. 11)
-All conditions of building plan approval and applicable variances
: SUPERVISING PROFESSIONAL SIGNATURES (As Applicable)
Statement of Substantial Compliance
To the besl of my knowledge, belief, and based on ansite observation, construction of the building, HVAC and/or lighting ilems applicable to this project
have been com leted in substantial com liance with the a roved lans and s eclfications.
SIGNATURE. Building Supe';4s~ Pr~fesslonal Dale Signed
~ t.. ~ .3 /1'1 t>
SIGNATURE - HVAC Supee;;in r . oal Dale Signe
,,~ 3-R-1)7
SIGNATURE. Lighting Su . in Dale Signed
3-8 -07
HVAC ITEMS MAY INCLUDE BUT ARE NOT LIMITED
TO THE FOLLOWING:
-HVAC System including final balancing
(COMM 64.0313)
-All conditions of HVAC plan approval
and applicable variances
LIGHTING ITEMS MAY INCLUDE BUT
L1MTED TO THE FOLLOWING:
Lighting Controls installed per COMM 63.50
-An conditions of lighting plan approval and
applicable variances
ARE NOT
....
CENTRAL
OF=FICE
MADISON
608-243-2088
F'AX 608-243-2026
715-365-2800
FAX 715-365-2815
NORTHEASTERN
REGIONAL OFFICE
GREEN BAY
920-448-5240
F A920-448-5254
SOUTHERN
REGIONAL OFRCE
MADISON
608-243-2370
FAX 608-243-2389
SOUTHEASTERN
REGIONAL OFFICE
MILWAUKEE
414-227-5000
FAX 414-227-4139
WESTERN -
REGIONAL OFFICE
EAU CLAIRE
715-8236-4752
FAX 715-836-2535
f_9I18n~06
12:45 FAX 8207384787
I
~nrnrnmmlA\r:\Il
~ ;LECT~
ENGINEERSfCONTRACTORS. INC.
709 HICKORY FARM LANE
APPLETON, WI 54914-3074
PH. (920) 739-51l:iEl FAX (920) 739-4767
SUBURBAN ELECTRIC
141 001/004
. COMMERCIAL f INDUSTRIAL
Ezperdy Managed - Design JJuiJd - Total SoLutions
. ELECTRONIC SECURITY
ccrV - Card Access - Fire &: Burglar
. DATA f COMMUNICATIONS
BICSI- RCDD - Sound Systems
. INSTRUMENTATION I CONTROLS
PLC - VFD - HMI- Total Uptime
. SERVICE
Fast Response When &: How it'. war/led
. ELECTRICA" PREVENTIVE MAINTENANCE
Infrared - lRtrasound - ARC Flash Ana/ysf.r
. MACHINE INSTALLATIONS
Relocate - Upgrade - Across the Continellt
FAX COVER SHEET
DATE: q-It--O&J
TO: 4)/(11 ~ /(/t.fA./
COMPANY:~' ~
FAX NUMBER. dO-
FROM:~ ~/a(
REMARKS:
our review
r'
\
fER OF PAGES: L/
PHONE & EXT:
\
I
o Re I as soon as ossible 0 Please Comment
'.
~
POWERFUL COMMITMENTS · PROVEN I?ESULTS
09/18/2008 12:45 FAX 9207394787
SUBURBAN ELECTRIC
141 002/004
. -'
Page 1
...........
SI No. 6
\..._ .UrPLEMENT AL INSTRUCTIONS
HAMMEL GREEN AND ABRAHAMSON, INC., ARCHITECtS AND ENGINEERS'
135 West Wells Street, Suite 800, Milwaukee, Wisconsin 53203
PROJECT:
MeTCY Medical Center
Cancer Center - Addition and Remodeling
500 S. Oakwood Road
Oshkosh, Wisconsin 54904
Date:
May 11, 2006
HGA Commission Number: 1678-026-00
OWNER:
Affinity Health Systems, Inc.
1506 S. Oneida Street
Appleton, Wisconsin 54915
Copy:
Tom Laabs - Affinity
.r eff Redmal"t - CRM
Cherie Claussen - HGA
Erik Hansen- HGA
Jeff Mi11mann - HGA
Kay Sene - BOA
Jil"i Rush - AEI
CA - File
CONTRACTOR: C. R. Meyer and Sons Company
895 W, 20~ Avenue
Oshkosh, Wisconsin 54903
1,-'
P1.1t~1l1l.nt to (jenE:l'~l ~nd S1.1pplamontnry Condition!' of the COl\trnct. the followinB instnlctions :lrc inch,ldeo in the wor1<.
Plcnse ncknowlcdse yO\lt accept::mcli: and rch.lIil a copy to the Architect.
DESCRIPTION OF THE WORK:
Gel1eral
A.
fu2ecificatiQns
A. None
Drawings
A. Sheet E600
1. Revise plan as shown per attached Sheet E600.
A l'T ACHMENTS:
See above
\_"COMMENTS:
08/18/2008 12:45 FAX 8207384787
SUBU~8AN ELECTRIC
141 003/004
Page 2
Received By:
~ ~ /<JIl"~~ Ef-n-
Contractor
UIJI--
.'-.J
By:
HAMMEL GREEN AND ABRAHAMSON) INC.
Scott D. Zube
***
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