HomeMy WebLinkAboutCertificate of Occupancy
CITY HALL
Inspection Services Div
215 Church Avenue
PO Box 1130
Oshkosh WI
54903-1130
City of Oshkosh
OfHKOfH
ON THE WATER
Approved:
Issued:
06/13/2007
06/25/2007
River Valley One LLC
222 Ohio St
Oshkosh WI 54902
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby issued for the Citi Financial tenant space located
at 510 S Koeller St as described in Building Permit #124786.
This space shall be used as a business/office and is located in the C-2 Planned
Development District.
LIMITATIONS:
Maximum number of persons: 15 occupants
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.
DIR
cc: CPM LLC
Building Permit Work Card
Job Address 500-550 S KOELLER ST Permit Number 0124786 Create Date 5/15/2007
Owner RIVER VALLEY ONE LLC Contractor CPM LLC
Category 223 - Alteration Offices, Banks, Professional Plan Y3-1968-0407
Occupany Permit Required Flood Plain Height Permit Class of Const:
Use/Nature 510 S Koeller - Tenant space build out for Citi Financial.
of Work
HVAC Contr TOWER MECHANICAL SERVICES INC Plumbing Contr TOWER MECHANICAL SERVICES INC
Electric Contr GROVER ELECTRIC
Inspections:
Date 5/30/2007 Type Rough In Inspector Allyn Dannhoff no time
REQUEST LINE / READY FOR A ROUGH INSPECTION
*WOULD LIKE THE INSPECTION THIS AFTERNOON**. Called contractor and also advised him to notify plbg and electrical
ontractors to call for inspections.
DatelTime requested: 5/30/2007
Access: I
Requested By: CPM LLC - Jeff
o Reinspect Fee 0 Fee Waived
08:03 AM
Notice Type:
Ready DatelTime: 5/30/2007 00:00 PM
Phone Number: (248) 520-0419
D Reinspect Fee Paid
Date Type Inspector Allyn Dannhoff
REQUEST LINE / READY FOR ROUGH MECHANICAL AND CEILING INSPECTION
Date/Time requested: 6/11/2007
Access: I
Requested By: CPM GROUP - JEFF
o Reinspect Fee 0 Fee Waived
06:54 AM
Notice Type:
Ready Date/Time: 6/11/2007 06:54 AM
Phone Number: (248) 520-0419
D Reinspect Fee Paid
Date 6/13/2007 Type Final Inspector Allyn Dannhoff
REQUEST LINE / READY FOR A FINAL INSPECTION FOR CITIFINANCIAL. No Concerns noted.
approved
DatelTime requested: 6/12/2007
Access: I
Requested By: CPM LLC - JEFF
o Reinspect Fee 0 Fee Waived
01 :40 PM
Notice Type:
Ready DatelTime: 6/12/2007 01:40 PM
Phone Number: (248) 520-0419
D Reinspect Fee Paid
Page 1 of 1
,~ Electric Permit Work Card
.
Job Address 500-550 S KOELLER ST Permit Number 124738 Create Date 5/10/2007
Owner RIVER VALLEY ONE LLC Contractor GROVER ELECTRIC
Service Ie New o ChangeO Temp o N/A I Type 0 Overhead o Underground . N/A I
Volts 120/208 Circuits 28 Luminaires 34
200 Switches 5 Receptacles 35 Value $10,000.00
Amps
Use/Nature 643 - Commercial-Addition/Remodels COMM (510- CITI FINANCIAL) / WIRE TENANT SPACE FOR NEW OFFICE
of Work
Inspections:
Date 05/16/2007
r""d to wes 5/1617
Date/Time requested: 05/15/2007 08:33 AM
Access:
Type Service
Inspector Kevin Benner
approved
Notice Type:
Ready Date/Time: 05/15/2007 08:33 AM
Requested by: GROVER ELECTRIC Phone Number: 379-7259
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
- - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - -- - - - - - -- - - - - - - - - - -- - - - - - -- - - - - - - - - - - - - -- - - - - --- - - - - - -- - - - - - - - - - - - - - - -- - - - - -- - - - - - - - - - --- - - - - - - - - - -- - - --
Date 05/30/2007 Type Rough In Inspector Kevin Benner approved
r a!ked 1Io Jeff from the G.C. 0" sHoo
Date/Time requested: 05/30/2007 08:05 AM Notice Type: Ready Date/Time: 05/30/2007 09:00 AM
Access:
Requested by: GROVER ELECTRIC Phone Number: 379-7259
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
- - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - --
Date 06/08/2007 Type Abv Ceiling Inspector Kevin Benner not approved
he luminaires & CL2 wiring devices were not installed in the ceiling.
Date/Time requested: 06/08/2007 08:52 AM
Access:
Requested by: GROVER ELECTRIC Dave Phone Number:
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
-- -- - - ---- - - - --- - - ---- -- - ---- - - ---- -- - ------ - - ------- - ----- - - - -- -- - ---- - - --- - -- ---- - - ------ ----- - - ------------ - - ---------- - -------------- - - - ----- ------ -----
Date Type Abv Ceiling Inspector Kevin Benner
re-;osp,ct
Notice Type:
Ready Date/Time: 06/08/2007 00:00 PM
DatelTime requested: 06/08/2007 02:30 PM
Access:
Notice Type:
Ready Date/Time: 06/11/2007 09:00 AM
Requested by: GROVER ELECTRIC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 379-7259 Dave
- - ------ - - - ----. - - -- -- - ---- - - ---- - - - -- -- - - - - - -- -- - - - - - --- - - - - - - - - ---- - - - ---- - ---- -- ---- - - - ----- - - -- --- -- - --- - - ---- - - ----- ---- - ---- -- --- - - - ---- ------ - - ---- --
,r Electric Permit Work Card
Job Address 500-550 S KOELLER ST Permit Number 124738
Owner RIVER VALLEY ONE LLC
Service :. New 0 ChangeO Temp
Volts 120/208 Circuits
Amps 200 Switches
Use/Nature 643 - Commercial-Addition/Remodels COMM (510 - CITI FINANCIAL) / WIRE TENANT SPACE FOR NEW OFFICE
of Work
Create Date 5/10/2007
Contractor GROVER ELECTRIC
ON/A Type 0 Overhead o Underground . N/A
28 Luminaires 34
5 Receptacles 35 Value $10,000.00
Inspections:
Date 06/11/2007
Type Final
Inspector Kevin Benner
not approved
DatelTime requested: 06/08/2007 02:30 PM
Access:
Requested by: GROVER ELECTRIC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type: FC Ready DatelTime: 06/11/2007 09:00 AM
Phone Number: 379-7259 Dave
Date 06/12/2007 Type Re Final Inspector Kevin Benner
FCN items # 2,3&4not corrected, Em III did not function correctly, signage is not installed
not approved
DatelTime requested: 06/11/2007 04:12 PM
Access:
Requested by: GROVER ELECTRIC Dave
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type: FC Ready DatelTime: 06/12/200700:00 PM
Phone Number: 379-7259 Dave
Date 06/13/2007 Type Re Final Inspector Kevin Benner approved w/cond.
he front signage has not been installed. I had discussion with the G.C. and E.C. as to the installation requirements and who can wire the
ign.
DatelTime requested: 06/12/2007 00:00 PM
Access:
Requested by: GROVER ELECTRIC Phone Number: 379-7259 Dave
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
--- - -- ---- - - ------ - - - ---- -- - - ------ - - - ---- - - - ---- - - ---- - - - --- - -- - --- - - - - ---- - - ---- - - - ---- - - - ---- ----- - - - ------ --- - - - --- - ----- - - ---- - - - -- -- - -- - - - - - ---- - - - ---
Date 06/22/2007 Type Re Final Inspector Kevin Benner
~ign Wiring / Sign contractors did not install the sign as scheduled. Dave Grover will call with a new schedule.
Notice Type:
Ready DatelTime: 06/13/200700:00 AM
DatelTime requested: 06/15/2007 07:43 AM
Access:
Requested by: GROVER ELECTRIC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type:
Ready DatelTime: 06/22/2007 00:00 AM
Phone Number: 379-7259 Dave
,~, Electric Permit Work Card
Job Address 500-550 S KOELLER ST Permit Number 124738
Create Date 5/10/2007
Owner RIVER VALLEY ONE LLC Contractor GROVER ELECTRIC
Service Ie New 0 ChangeO Temp 0 N/A I Type 0 Overhead 0 Underground. N/A
Volts 120/208 Circuits 28 Luminaires 34
Value
$10,000.00
Amps 200 Switches 5 Receptacles 35
Use/Nature 643 - Commercial-Addition/Remodels COMM (510 - CITI FINANCIAL) / WIRE TENANT SPACE FOR NEW OFFICE
of Work
Inspections:
Date 07/02/2007
Type Re Final
Inspector Kevin Benner
approved w/cond.
~ignage is to be wired this AM.
Late AM Inspection or this PM
~ould not inspect above the ceiling for the sign wiring only.
DatelTime requested: 07/0212007 06:54 AM
Access:
Requested by: GROVER ELECTRIC Dave
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Notice Type:
Ready DatelTime: 07/02/200700:00 AM
Phone Number:
-- - - - - -- - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --
HVAC Permit Work Card
Job Address 500-550 S KOELLER ST Permit Number
124858
Create Date 05/15/2007
Owner RIVER VALLEY ONE LLC Contractor AIR TECH HEATING INC
Fuel ~ Gas I l J Oil I I I Electric I I I Solar U Solid I Value
System [?] New I D Replace I D Other
~ Forced Air U Radiant I U Steam I U AlC I U Vent
U Electric I U 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 510 S Koeller - Tenant space build out for Citi Financial. Install HVAC system including RTU.
of Work
$10,100.00
I
I
Inspections:
Date 6/13/2007 Type Final
ro ,""oem' ooled.
DatelTime requested:
Access: I
Requested By:
o Reinspect Fee 0 Fee Waived
Inspector Allyn Dannhoff
approved
Notice Type:
Ready DatelTime:
Phone Number:
D Reinspect Fee Paid
,
Plumbing Permit Work Card
Job Address 500-550 S KOELLER ST Permit Number 124910 Create Date 05/15/2007
Owner RIVER VALLEY ONE LLC Contractor TOWER MECHANICAL SERVICES INC
Category 440 - Industrial-Interior Plan Value $5,100.00
Bathtub Shower - Water Softner Wait. St. Shamp Sink Coffee Maker
- - - - -
Whirlpool Floor Drain Local Waste Ice Chest FlrlWst Sink Int Grease Trap
- - - - - -
Lavatory 1 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 Urinal Eye Wash Statn
- - - -
Bar Sink 1 Sump Pump Lab Sink Plaster Sink Standp Rec Wtr Sewer Mtrs
- - - - -
Water Heater 1 Classrm Sink Sterilizer Surgeons Sink Ice Maker Deduct Meters
- - - - -
Site Drain 1 Breakrm Sink Dip Well F Prep Sink Gar Drain Wtr Usage Mtrs
- - - - - -
Roof Drain Ejector/Grind Drink Ftn Serv Sink 1 Soda Disp
- - - - -
Misc. -
Fixtures
Use/Nature Interior plumbing in tenant space 510, per plan approval.
of Work
Size Material Type # Conn.Type
Sanitary Sewer
Storm Sewer
Water Service
Inspections for Work Card 92011
Date 5/14/2007 Type Underground Inspector Paul Wolf
approved
Stopped at jobsite to verify work has not started before plans have been submitted and permit is issued.
DatelTime requested: 5/15/200707:41 AM Notice Type: Telephone Number:
Access: I
Ready DatelTime: 5/15/2007 07:41 AM Requested By: TOWER MECHANICAL SERVICES INC
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Date 5/23/2007
Type Underground
Inspector Paul Wolf
not approved
Plan #Y2-251-0507-P. Water distribution material shall comly with COMM 84.30.
DatelTime requested: 5/23/200708:34 AM Notice Type: FC Telephone Number:
Access: I
Ready DatelTime: 5/23/2007 08:34 AM Requested By: TOWER MECHANICAL SERVICES INC
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Date 5/24/2007
Type Underground
Inspector Paul Wolf
, approved
Corrections completed. Pex installed.
DatelTime requested: 5/24/200708:45 AM Notice Type: Telephone Number:
Access: jLock box 0510 or Jeff at 248-520-0419
Ready DatelTime: 5/24/2007 08:45 AM Requested By: TOWER MECHANICAL SERVICES INC
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Date 5/30/2007
Type Rough In
Inspector Paul Wolf
approved w/cond.
Hangers required per COMM 82.60 on horizontal overhead vent piping. Left note on violation with GC.
DatelTime requested: 5/31/200708:00 AM Notice Type: FC Telephone Number:
Access: I
Ready DatelTime: 5/30/2007 08:00 AM Requested By: TOWER MECHANICAL SERVICES INC
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Inspections for Work Card 92011
Date 6/11/2007 Type Rough In Inspector Paul Wolf
REQUEST LINE / READY FOR AN ABOVE CEILING PLUMBING INSPECTION
approved
DatelTime requested: 6/8/2007 03:47 PM Notice Type:
Access: I
Ready DatelTime: 6/8/2007 03:47 PM Requested By: Jeff Gunderson
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Telephone Number: (248) 520-0419
- - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - -- - - - - -- - - - - - - - -::- ~:'" .,..'---.,...,.. - -- -"": - .::'~"'-7--"" - - -.- - - - ,.-,- -.,- - - - -- - - - - - - - - -.- - - - - - - - -- - - -,... - - - - - - - - -.,. - -.,..:," -.,.. - - - - - - - - - - -..., - - - - -- - - - - - -- - - - - - - --- - - - - - - - - - - - - --- - - - - - - - - - - -- - - - - - - - - - -- --
Type Finaf
Inspector Paul Wolf
Date 6/12/2007
REQUEST LINE / READY FOR A FINAL INSPECTION
,-".:._.. ."'::".':' ..:.'-,:,,: -,<.~',:-.< -",
Date/Time requested: 6/12/200707:17 AM Notice Type: Telephone Number: (248) 520-0419
Access: I -.-J
Ready DatelTime: 6/12/2007 07:17 AM Requested By: CPM GROUP - JEFF
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
~
CORRECTION NOTICE / FIELD INSPECTION REPORT
JOB LOCATION: -<;/0 ~. Kn-e/ Ie,
CONTRACTOR: C~PH J-LC-
PROJECT TO BE INSPECTED: o(;Ci c... ~
TYPE OF INSPECTION: ~/\~ /
~
City of Oshkosh
Inspection Services Division
215 Church Avenue, PO Box 1130
Oshkosh, VVI54903-1130
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
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
;~Ml ..QO>>E INSPECTION RESULTS
I
"2-
1
Print Name
Company
Signature:
Date
".
..,
~
OJHKOJH
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
May 14, 2007
Glenn Dik
P AEP Architecture Engineering, PC
18114 Mile Road NE
Grand Rapids, MI 49525
Fred Jaques
Alliance Development
601 Oregon St Ste A
Oshkosh, VVI54902
Hank Hondorp
Progressive AE, PC
18114 Mile Road NE
Grand Rapids, MI 49525
Site: Plan Number: Y3-1968-0407
Citifinancial
510 S Koeller St
Oshkosh WI 54902
For:
Description: Tenant space alterations
Object Type: Building and HV AC
Class of Construction: lIB -1405 Sq Ft.; sprinkIered
Occupancy: B: Business I Office
Maximum No of Occupants:
The submittal described above has been reviewed for conformance with applicable VVisconsin Administrative Codes and
VVisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in Chapter
101.01(10), VVisconsin Statutes, is responsible for compliance with all code requirements
Key Hem(s) / Conditions:
· IBC 711.3 Any penetrations of fire rated assemblies are required to be protected with a listed firestopping
system that matches the rating of the wall assembly being penetrated. Copies of the firestopping systems
are required to be provided at the time of inspection.
· IBC 901.2 Fire protection systems shall be installed, repaired, operated and maintained in accordance with
this code and the international fire code. Construction of new walls may require the addition anti or
relocation of sprinkler heads to maintain required coverage, and not obstruct spray patterns of fire
sprinklers.
· IBC 906.1 /IFC 906.3 The maximum travel distance allowed to a fire extinguisher is 75 feet.
· IBC l101.2/ANSI A117.1-308.2 & 3 - Mechanical system controls shall be located a maximum of 48"
above the finished floor if the floor space allows a forward approach by a wheel chair or if the clear space
allows a parallel approach.
· IBC 1209.1 Provide toilet room floors with smooth, hard, nonabsorbent surface extending minimum 6
inches up onto walls. Sheet Ai 05 shows 4 inch base, please revise to be 6 inch.
hInspedions\Pbn Heview\Commen:ial Piau Rf;V.if;W :2007\Y3- i 96;>;.0407 5l 0 S Koeller S, Bldg 8: nVAc.do(
Page 1 of2
~
,,<
· IRC 2406.2 Glazing in an individual fixed or operable panel adjacent to a door where the nearest exposed
edge of the glazing is within a 24 inch arc of either vertical edge of the door in a closed position and where
the bottom exposed edge of the glazing is less than 60 inches above the walking surface is requires safety
glazing materials. The windows in the closing rooms will need to be glazed with safety glazing
materials.
· IBC 2902..1/ Table 2902 Drinking water is required to be provided, since no drinking fountain is shown
on plans a bottled water cooler is required to be provided.
· Comm 2902 (4) Separate facilities shall not be required in mercantile occupancies in which the occupant
load is 50 or less. Note: if the occupancy changes in the future, the requirements for plumbingflXtures
will need to be reviewed for compliance.
· IMC 302.1 The building or structure shall not be weakened by the installation of mechanical systems.
VerifY that existing structure is capable of supporting the additional weight of the proposed rooftop
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
Corom 61.31(1).
· 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.
· MUN 30-35 (1)(5) All roof top and ground level mechanical equipment and utilities shall be fully screened
from view of any street or residential zoning district. Contact David Buck - Associate planner (920) 236-
5062 for additional information on screening requirements. All screening shall be properly anchored in
place to resist wind loads. Additionally me 1608.8 Roofprojections - Drift loads due to mechanical
equipment, penthouses, parapets and other projections above the roof shall be determined in accordance
with Section 7.8 of ASCE 7.
· Comm 80 This plan review does not include plumbing. Prior to installation of plumbing, plans and
calculations are required to be submitted and approved.
· MVN 30 This review does not include review for sign age. Applications for and questions regarding
signage permits should be directed to Todd Muehrer - Associate Planner (920) 236-5057
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.
correspondence may be made to me at the number listed below or the address on this letterhead.
Fee Required
Fee Received
Balance Due
$
$
$
480.00
480.00
0.00
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@cLoshkosh.wi.us
cc: Property file
LJn,peclinns'J'lanRcvit'w\(\,om'erciaJ Pian Rev.1t'w 2007\"Y3-1968-0407 510 SKueller Sl B!dg & IIV AC.doc
Page 2 of2
PAEP Architecture Engineering,P.C.
1811 4 Mile RQad,NE
Grand Rapids, MI 49525 2442
616 361 2664 VOICE
616 361 1493 FAX
www.progressiveae.com
R
I
JUN 2 1 2007
June 19,2007
DEPARTf\1ENT OF
COMMUNTIY DEVELOPMENT
INSPECTION SERVICES DIVISION
Allyn DannHoff
City of Oshkosh
215 Church Avenue
Oshkosh, WI 54901
Re: Compliance Statement for the CitiFinancial Branch located at 510 South Koeller
Street, Oshkosh, Wisconsin
Dear Mr. DannHoff:
Enclosed with this letter are the following documents:
Building, HVAC, Compliance Statement (SBD-9720) signed by the architect,
mechanical engineer, and electrical engineer for the above referenced project.
Copy of the Wisconsin Department of Commerce Conditional Approval.
Copy of a Letter of Compliance executed by the contractor of record.
Based on the above, I ask that a Certificate of Occupancy be issued for the work
completed for CitiFinancial at 510 South Koeller Street, Oshkosh, Wisconsin.
Please issue the Certificate to me and I will ensure that it is distributed to the proper
individuals.
Please contact me at 616/365-8557 if you have any questions.
Sincerely,
PROGR SIVE ARCHITECTURE ENGINEERING
Ii JJ.
~w. ondorp /
Senior Pr6ject Manager
HWH/dmc
58781702/777
Enclosures
cc: Critical Path Management - Bob Sullivan (1)
X:\WGEN5\58781702\2007\hh0619I.doc
BUILDINGS, HV AC, COMPLIANCE STATEMENT SBD-9720
This form is required to be submitted by the supervising professional (architect, engineer, HVAC designer or electrical
designer) observing construction of projects within buildings with total areas 50,000 cubic feet or greater and bleachers
(Comm 50.1 O/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 letter for agency address and
. Safety and Buildings, 10541N Ranch Road Hayward, Wi. 54843
Note: If the review was done by the municipality, the compliance statement goes only to the municipal building
inspector. A copy is not needed by Safety & Buildings.
Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1 )(m)].
1. PROJJ;CT INFPRMATION: Please fill in the following with information from your plan approval letter.
. v 1', .
Transact(oll ILJ :. Jmoer ....L5t:U//lI!)t'J -_ Project Name tJ/ 77 / /;</~/A~
Site Number IPS 1/'2. ~ t)
Site location (number & street) s/o 5 ,L::'Oc=t.-t.-&b 5.r-
p( City 0 Village 0 Town of {)s.;./,e::os#;, County of D(?TYj~
2. PURPOSE OF THIS STATEMENT: (Check Box A, B, C, or D to indicate purpose and complete any other
applicable boxes and information. Attach additional pages if necessary.)
Check those which apply: 0 Building Object ID # 0 HVAC Object ID #
o Lighting Object ID #
o Partial Completion
-. "7 Description of Portion Completed
A) p/ Statement of Substantial Compliance
Jao t e best of my knowledge, belief, and based on onsite observation, construction of the following building and/or HVAC
it s applicable to this project have been completed in substantial compliance with the approved plans and specifications.
BUILDING/LIGHTING ITEMS
1. Structural system including submittal and erection of all building components 10. Exterior lighting & control requirements
(trusses, precast, metal building, etc.) 11. Interior lighting & control requirements
2. Fire protection systems (sprinklers, alarms, smoke detectors) designed, installed, 12. All conditions of lighting plan approval
and tested (including forward flow on back flow devices) by appropriately and applicable variances
registered professionals
3. Shaft and stairway enclosure
4. Exits including exit and directional lights
5. Fire-resistive construction, enclosure of hazards, fire walls, labeled doors, class
of construction, fire stopped penetrations
6. Sanitation system (toilets, sinks, drinking facilities)
7. Barrier-free including Comm 18 elevators and lifts
8. Energy envelope requirements
9. All conditions of building plan approval and applicable variances
~~EMS
1. HJAC system including final test
2. All conditions of HVAC plan approval and
applicable variances
The following items are not in compliance and must be addressed:
B) 0 Statement of Noncompliance
Due to the following listed violations, this project is not ready for occupancy:
C) 0 Supervising Professional Withdrawn From Project (Use A or B above to indicate project status as of this date.)
D) 0 Project Abandoned S. 7;bv ~.4S Wv,e. t.
3. SUPEI3)IISING P~FESSI9NAL SIGNATURE FOR: /?..:l.o A--L. /J.. ,C'~/2. o.VN:~
ilZ'Building IYHVAC I;YlJghting $ ,c~,R~ L~A)p Et.L./ A...NJ'1tJE J<-..> Oat ....I v""/'
Name (please print Q7tYpe) ,
Phone number ~/~. 5/,/. 1?~6 ~ Customer 10 # Signature
/.
/
SBD-9720 (R.04/2005)
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Critical Path Management, LLC.
4318 Plainfield Ave. NE, Suite G
Grand Rapids, MI 49525
Tel. 616.301.0673 Fax 616.301.0674
experienceC P M@cpmgm.com
June 13, 2007
Progressive AE
1811 4 Mile Rd.
Grand Rapids, MI 49525
Re: Citifinancial
Branch Number 49.0139
510 S. Koeller St.
Oshkosh, WI 54903
LEnER OF COMPLIANCE
Critical Path Management, LLC certifies that as of this date, the referenced project has
been completed in accordance with the project plans and specifications dated
5/4/07, as issued by Progressive AE.
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Director of Construction
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