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Home My WebLink AboutCertificate of Occupancy CITY HALL Inspection Services Div 215 Church Avenue PO Box 1130 ~ 0,",,," W1 ~ 54903-1130 OJHKOJH ON THE WATER City of Oshkosh Approved: Issued: July 9, 2007 July 9, 2007 Briarwood of Hunters Ridge LLC 2990 Universal St Ste B Oshkosh, WI 54904-5903 CERTIFICATE OF OCCUPANCY An Occupancy Permit is hereby issued for the new 8-unit located at 3151 Elk Ridge Drive, Oshkosh, Wisconsin 54904 as described in Building Permit Application number(s) 119595. This building is to be used only as a multi-family residence and is located in the R-3, Multiple Dwelling District. LIMITATIONS: Maximum persons and/or living units: Eight living units CONDITIONS: 1) Final grading must be done in accordance with the approved subdivision drainage plan. This plan is on file in the public works office, 3rd floor of City Hall. 2) Erosion control measures must be maintained until the lawn is established. Note: Final grade must be a minimum of 6" below all siding. NOTE: 1) Copies of inspection results are available upon request in room 205, City Hall. 2) Future permits maybe required for additional work to your property. A new Certificate of Occupancy shall be required prior to occupancy, should additional building(s) be erected, or should any buildings mentioned above be altered or moved. The use of land, or buildings, shall not be changed until a Certificate of Occupancy is issued for that occupancy. All conditions noted above must be complied with in order for this certificate to be valid. UW6-~ Building Systems Inspector CC: Midwest General Contractors Building Permit Work Card Job Address 3151 ELK RIDGE DR Permit Number 0119595 Create Date 5/18/2006 Owner MIDWEST GENERAL CONTRACTORS Contractor MIDWEST GENERAL CONTRACTORS INC Category 130 - New Multi-Family Plan T2-43-0506 Occupany Permit Required Flood Plain No Height Permit Not Required Class of Const: Use/Nature COMM/8-unit Multifamily' State Trans ID # 1266970 of Work HVAC Contr BREWER HEATING Plumbing Contr WATTERS PLUMBING Electric Contr CUMINGS ELECTRIC INC Inspections: Date 4/20/2007 Type Insulation Inspector John Zarate REQUEST LINE / READY FOR AN INSULATION INSPECTION approved DatelTime requested: 4/19/2007 09:39 AM Notice Type: Access: IUNITS OPEN FRIDAY 4/20/07 Requested By: MIDWEST GENERAL CONTRACTORS INC-Jay o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Ready DatelTime: 4/19/2007 09:39 AM Phone Number: (920) 420-5878 Date 6/27/2007 Type Final ;REQUEST LINE / READY FOR A FINAL INSPECTION Inspector Nicole Krahn not approved Date/Time requested: 6/25/2007 01 :14 PM Notice Type: FC Ready DatelTime: 6/25/2007 01 :14 PM Access: ~ALL JAY WITH MIDWEST HE WILL OPEN UNITS AND HE WOULD ALSO LIKE TO BE PRESENT Requested By: MIDWEST GENERAL CONTRACTORS INC - Jay Phone Number: (920) 420-5878 o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Date 7/9/2007 Type Re Final Inspector Nicole Krahn approved NOTE: The signed and dated correction notice was submitted from Jay with Midwest. Close the file per office policy and signed and dated compliance statement was received. DatelTime requested: 7/9/2007 Access: I Requested By: o Reinspect Fee 0 Fee Waived 07:35 AM Notice Type: Ready DatelTime: 7/9/2007 07:35 AM Phone Number: o Reinspect Fee Paid Page 2 of 2 Building Permit Work Card Job Address 3151 ELK RIDGE DR Permit Number 0119595 Create Date 5/18/2006 Owner MIDWEST GENERAL CONTRACTORS Contractor MIDWEST GENERAL CONTRACTORS INC Category 130 - New Multi-Family Plan T2-43-0506 Occupany Permit Required Flood Plain No Height Permit Not Required Class of Const: Use/Nature COMM/8-unit Multifamily * State Trans ID # 1266970 of Work HVAC Contr BREWER HEATING Plumbing Contr WATTERS PLUMBING Electric Contr CUMINGS ELECTRIC INC Inspections: Date 7/20/2006 Type Note Inspector Nicole Krahn not approved Skotske called to state that they called in the wrong address 3131 Elk Ridge for this inspection. The footings were never inspected ~nd/or approved. DatelTime requested: 7/20/2006 Access: I Requested By: o Reinspect Fee 0 Fee Waived 01:05 PM Notice Type: Ready DatelTime: 7/20/2006 01 :05 PM Phone Number: o Reinspect Fee Paid Date 7/28/2006 Type Foundation Backfill Inspector John Zarate no time IReque~ 11M DatelTime requested: 7/27/2006 01:26 PM Notice Type: Ready DatelTime: 7/27/2006 01:26 PM Access: I Requested By: MIDWEST GENERAL CONTRACTORS INC Phone Number: Jay Hendricks-420-5878 o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Date 8/28/2006 Type Drain Tile Inspector Nicole Krahn Faxed Request / Slab is ready except for poly. Will pour late week of 8/28/06 or 1 st week of September approved DatelTime requested: 8/25/2006 09:02 AM Notice Type: Access: I Requested By: John Skotzke Concrete Construction Inc o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Ready DatelTime: 8/25/2006 09:00 AM Phone Number: (920) 231-1667 Date 4/17/2007 Type Rough In Inspector Nicole Krahn Request line 1) Seal elec box penetrations from the cable and phone jacks. ~) Seal elec holes in tire seperation wall through the attic area where the service cables were removed. approved w/cond. DatelTime requested: 4/13/2007 02:49 PM Notice Type: FC Ready DatelTime: 4/17/2007 02:49 PM Access: IOpen Requested By: MIDWEST GENERAL CONTRACTORS INC Phone Number: Jay - 420-5878 o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid --- - - - --- -- - - - ---- -- - - ---- - - ------- - - - - --- - - ---- - - - ------ - - - - -- -- - - - ---- - - ---- -- ---- - - --- -- - ---- - - ---- - - - ---- - - --- --- - - - -- --- - - ---- - - ----- - ---- - - ----- - - ---- - -- -- - - - --- ----- --- Page 1 of 2 Job Address 3151 ELK RIDGE DR Electric Permit Work Card Permit Number 124238 Create Date 4/16/2007 Owner BRIARWOOD OF HUNTERS RIDGE LLC Contractor CUMINGS ELECTRIC INC Service Ie New 0 ChangeO Temp 0 N/A I Type 0 Overhead . Underground 0 N/A Volts 120 / 240 Circuits 0 Luminaires 80 Value $25,000.00 Amps 600 Switches 90 Receptacles 200 Use/Nature 531 - Residential-New Multi-Family Wiring MULTI-FAMILY / WIRE NEW 8 UNIT **debt acct of Work Inspections: Date 04/17/2007 Type Service Inspector Adam Krause approved REQUEST LINE / READY FOR A SERVICE INSPECTION Faxed to WPS 1:00 PM 4-18-07 8:00 AM DatelTime requested: 04/16/2007 07:56 AM Access: Requested by: CUMINGS ELECTRIC INC - Jan o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Notice Type: Ready DatelTime: 04/17/200700:00 PM Phone Number: Date 04/17/2007 Type Rough In Inspector Adam Krause REQUEST LINE / READY FOR A ROUGH INSPECTION Data boxes on ext. walls not caulked. Will call low-voltage installer. approved Date/Time requested: 04/16/2007 07:56 AM Access: Requested by: CUMINGS ELECTRIC INC - Jan o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Notice Type: Ready DatelTime: 04/17/200700:00 PM Phone Number: Date 06/27/2007 Type Final Inspector Kevin Benner not approved REQUEST LINE / READY FOR A FINAL INSPECTION Unit "D" the GFCI circuit for the bathroom was tripped and would not reset. Date/Time requested: 06/26/2007 09:40 AM Access: Notice Type: Ready DatelTime: 06/26/2007 09:40 AM Requested by: CUMINGS ELECTRIC INC - Jan o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Phone Number: Date 06/27/2007 Type Re Final Inspector Kevin Benner approved DatelTime requested: 06/27/2007 00:00 PM Access: Requested by: o Reinspect Fee 0 Fee Wavied Notice Type: Ready Date/Time: 06/27/2007 00:00 PM Phone Number: D Reinspect Fee Paid Job Address 3151 ELK RIDGE DR HVAC Permit Work Card Permit Number 123883 Create Date 05/18/2006 Owner MIDWEST GENERAL CONTRACTORS Contractor BREWER HEATING Fuel l.!J Gas I U Oil I I I Electric I U Solar U Solid I Value System 0 New I D Replace I D Other l.!J Forced Air U Radiant I U Steam I ~ 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 Use/Nature COMM/8-unit Multifamily. *Trans ID 1314646 of Work $36,000.00 I I . Not Applicable Inspections: Date 4/17/2007 Type Rough In Inspector Nicole Krahn Request line I They want to be there for inspection approved Date/Time requested: 04/13/200701:57 PM Notice Type: Ready DatelTime: 04/13/2007 01:57 PM Access: I Requested By: BREWER HEATING - Mike Phone Number: 920-748-6494 o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Date 6/27/2007 Type Final Inspector Nicole Krahn approved DatelTime requested: 06/27/2007 01 :41 PM Access: I Requested By: o Reinspect Fee 0 Fee Waived Notice Type: Ready DatelTime: 06/27/2007 01:41 PM Phone Number: D Reinspect Fee Paid ~,j. Plumbing Permit Work Card Job Address 3151 ELK RIDGE DR Permit Number 120967 Create Date 05/18/2006 Owner MIDWEST GENERAL CONTRACTORS Contractor WATTERS PLUMBING Category 440 - Industrial-Interior Plan Value $28,000.00 Bathtub 8 Shower Water Softner Wait. St. Shamp Sink Coffee Maker - - - - - - Whirlpool Floor Drain 16 Local Waste Ice Chest FlrlWst Sink Int Grease Trap - - - - - - Lavatory ~ Lndry Tray Clothes Wshr 8 Exam Sink Catch Basin Ext Grease Trap - - - - - Toilet 8 Disposal 8 Bidet Sculry Sink Wash Ftn RPZ Valve - - - - Res. Sink 8 Dishwasher 8 Beer Tap Hand Sink Urinal Eye Wash Statn - - - - - - Bar Sink - Sump Pump Lab Sink Plaster Sink Standp Rec 8 Wtr Sewer Mtrs - - - - - Water Heater 8 Classrm Sink Sterilizer Surgeons Sink Ice Maker Deduct Meters - - - - - - Site Drain - Breakrm Sink - Dip Well - F Prep Sink - Gar Drain - Wtr Usage Mtrs - Roof Drain - Ejector/Grind - Drink Ftn - Serv Sink - Soda Disp - Misc. 3 hose bibs - Fixtures Use/Nature COMM/8-unit Multifamily * State Trans ID # 1266970 of Work Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water Service Inspections for Work Card 86334 Date 8/11/2006 Type Underground Inspector Paul Wolf approved Fax request Date/Time requested: 8/9/2006 12:45 PM Notice Type: Telephone Number: 920-733-8125 Access: I Ready Date/Time: 8/9/2006 02:00 PM Requested By: WATTERS PLUMBING o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Type Rough In Inspector Paul Wolf approved Date 4/12/2007 Fax request Date/Time requested: 4/11/200709:18 AM Access: I Ready Date/Time: 4/11/2007 09:00 AM Requested By: WATTERS PLUMBING - Jamie o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Notice Type: Telephone Number: 920-733-8125 Type Final Inspector Paul Wolf approved Date 6/26/2007 Fax request Date/Time requested: 6/25/200701:50 PM Notice Type: Telephone Number: 920-733-8125 Access: ~a" Jay 420-5878 Ready Date/Time: 6/26/2007 09:00 AM Requested By: WATTERS PLUMBING - Jamie o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid City of Oshkosh Inspccliol1 Services Division 2] 5 Church Avenue, PO flox 1130 Oshkosh. WI 54903-1130 Pl1onc~ (920) 236-5050 Fax (920) 236-5084 Jun.27. 2007 12: 14PM ~ CORRECTION NOTICE I FmLD INSPECTION REPORT JOB LOCATION: :3 \~ ~ <Z~t- ~ ~ 'S)?- CONTRACTOR: l.... ,~vtc::.\" PROJECT TO BE INSPECTED: ~ - lJ\J(~ TYPE OF INSPECTION: ~ ~ ,.11'::'" t-h4.(' inspect ion services No. 3447 P. 2 ~ Violations must be corrected and approved within 30 days unless otherwise noted. Can 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 Divi5ion by the Compliance Date of .mM# ,EOOE INSP'ECTroN RESULTS ..:. ;~: ~.;:.r;~:'.~~~ft~~~~~? ',:~.';~ ,', lY ~/ O""z.~ ~ 'f't.- .J:x..-cR.. L.,\) I ~..:> 11.uz..u'\;Ut ~ Q-L I L.t UJ.- ;:::: ~~. ~/ 1411".. OCL ~ ~e..- ^~_.........S ?~L~ W..H 'V ~. s: '-" .<:n r\:V ~~~~ 'H-VAC..... ~~~("1U2f~ ~ - , ()\~tO ! Got\! I': ~ _ 0\7 b - o-r; r-- ( \~ V/ ~)(' ZFiL.. ~Ci J FX '-r c;,~, ...' ..". "',',' .. ., ': ,:,~ :::'::>',+,~.:::.; ,~:,::'~.~ ..:A'C'JION''tAKEN~, , " ,.. . ..~.~. . ._:,,,~~~ ."~;';i\::~~:~~11\~7;:.~~..:~~~~ ~.7~i>~:~:~~;~':!.~";~5;.?"~:7~~r. . ".,i': ' ., o Not Approved! Ins~. Report left on site D Not ApprovcdJ Insp. Report given to _ ~~ailedIFaxed Signed f\. ~ IC-Ge.~ IRl Z-llbL 2~.~5lJ5~ Inspection Services Division Dale ofInspection Phone # :;),";iihii~~~~~',: c..erti: ..: ~l,,;;a"'t.. .,~t;;;e:;vlQl."~4i:lM1S!.:;list~d:,~bni:.:this.:N.. :~ .titireiRe .,;.;6~:1I~~~~en:;;":" :'..:'n:.:~:.-.::~.I:~~Y: ..:.;, ,'.". : ..:~U;1i ""~~'~' ....:..,;..",.." ~~,.. . - '" . ~.: ,', .... " ,'.. .... ~.. ,,'.., ~~ ,..~~iy.~.~~s.s'. ' ,.." PrinrName JCl.t tl\dt:cv-'s Company ~:JVt.ff be^erc..l Co1tr",~~r.f Signamreo .J '1 ~[ Date t - 'J. 7 -07 Buildings, HV AC Compliance Statement 580-9720 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 exceeding 50,000 cubic feet or greater and bleachers (Comm 50.10/Comm 61.50). Failure to submit this form may result in penalties as specified in Comm 50.26/Comm 61.23 and/or local ordinances. 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 and · Safety and Buildings, 10541 N Ranch Road, Hayward, WI 54843 Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)). 1. PROJECT INFORMATION: Please fill in the following with information from your plan approval letter. Transaction 10 Number Site Number 669115 Site location (number & street) o City 0 Village 0 1266970 3151 ELKRIDGE DR. BLDG. #4 Town Of OSHKOSH County of W1NNEBAGO 2. PUR.POSE OF THIS STATf;I\IIENT: (Check Box A, B, C, or 0 to indicate purpose and complete any other applicable boxes and information. Attach additional pages if necessary). Check those which apply: 0 Building Object 10# 1073473 0 HVAC Object 10# o Lighting Object 10# o Partial Completion Description of Portion Completed A)) 0 Sfatement of Substantial Compliance To the best of my knowledge, belief, and based on onsite observation, construction of the following building and/or HVAC items applicable to this project have been completed in substantial compliance with the approved plans and specifications. o BUilDING/LIGHTING ITEMS 1. Structural system including submittal and erection of all building components (trusses, preqilst, metal building, etc.) 2. Fire protection systems (sprinklers, alarms, smoke detectors) designed, installed, and tested (including forward flow on back flow devices) by appropriately 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 The following items are not in. compliance and must be addressed: 10. Exterior lighting & control requirements 11. Interior lighting & control requirements 12. All conditions of lighting plan approval and applicable variances o HVAC ITEMS 1. HVAC system including final test 2. All conditions of HVAC plan approval and applicable variances 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 3. SUPERVISING PROFESSIONAL SIGNATURE FOR: o Building [J HVAC 0 Lighting DON HAANEN 6/9/2007 Name (Pleas: enm 9r type) Phone # 920-497-5007 Customer 10# 649536 Signature SBD-9720 (R. 0 1/2003) ~ i ) :r ,', '..~,,:j;.,~,.....,....,..- l: i ~ i ~ This 10m is required to be submitted by the supeNising professional (architect, engineer, HVAC designer or electrical . deiignef) observing construction of projects within buildings with total areas exceeding 50,000 cubic feet and construction f antennas, towers. and bleaohers (llHR 50.10). Failure to submit this form may result In penalties as specified in .HR 50,26. and/or local ordinances. ~ene!'a! tnstructlons: Prior to the initial occupancy of new buildings or additions and the finat occupancy of altered existing buildings. submit this completed and signed form to: -: , ,,' ': . ~ !-,.~2~:...._ :...........__J:..... .....Ff":,..C"; -'lIt.....f . .;, 1 ;:'..;. j!:.:..:lU""'~t"aJ V\,oIf",,,ul.-= .i"~""\,r""'f_." .......~-....:. ~ II ~::f..fv ~~d Bl!iidino:~. P.O. Box 7i62, M80tS()f,. w; S~7G7-7162 P€rsr'lr.~! !:'lfnrmfl'IM \,O~! p.rCl\l!d~ l'!'I:!y b~ U3.~t'l for ~cc:jr.dar{ illlrp;;~~1i.. iFrl'.'a':y i.a\~. S. 1 j.'J4 t ~ )(:-r;)]. 1. PROJECT INFORMATION: Plr:l8~~ WI in the TOIiOWiiig WlIflllllliC:H.::tlvIJ 111..>111 YI.IUI ~Ii::::; "1.J~I\JYat h:.Li'..,I, Tr- --~-~;,,,~ ID N......,h.c:.l" /":' /-11'? .cyr(., COI'...,n""ut.,.u$ . ...,.___. ""_. ,_,_ ~ ~ ~ ~ ~ ~ l i~;;)' ~ ~ ~:,i'iC ;~~:";fitb::~r {.:.:::: .~ /.,,' of .....'-.. .....--... .... I ~;._---~.....-<. 6'L'''. h..J'~~ .' I ~r..~-- - :.~:. <::~- ~...~-=__31~l €-J{ e ntl'(- <.7~~-='>7'i. L.c-umy OJ ..~:::-:'~:.c:<::..:'~~_:::. ~~~lE ;~,cst;::Jn {n~:'nbe:- -& stree!) r: /.4_'~ ltJ" . [3" Cily o Viilage o Town oJ 2.. ~U~FOSE or TWS STATEM~NT: {C'~ed: !3c:x A. E<, C, or D hJ 1f:~iICi:lf: p'.irpn:.c ailC: compie.te any omcr C,i~pi;::~uif.; U~,1.~~ .;t. ~~ ~i1rCE i: I~" ''-0' :. i ',,:,01 .i~.,j i ~..,......,._. ..... :"'....,: _... .. .. _ '- .. i ~ Eft vi ;-.:~~ ii IU:'C ':\': .t...., i "'Pj.i'i. . . , . , , , . ___ __..._..._ _"'__.1_ .. ..,..,~, ,.,- r~,,,,,_. t,', J~ /.4 9 P~?O . . . . ., . ., ..... .....:;"....1..:;0 .... -)-.... .- .. .... L....: !'t.~;"\CI'i vvi;i~~~L;w;. _ .... .... [)p~~plion of Fortion L..t.lIfI"Lete.\l A.! Gd/Statement of Substantiiil Ccmpil.ncc j' 0 sne c..'1t;~,t ~i 1,IY P..J .W'nit:\.oi~,,=. l~~:J1t:'1 i::: ~1W i.;~~~w ;,,;.. ..,....:..: _....~.l... ...; .;_... _ _' ~_~. _.. "" . ..- ~... :" _.. . :; :- ,..L -....: ___lJ.." U\ :~...... It..rif~ ol"lnlir..:'lhl"" to th~~ oroisct h~e been cnmrlleted in S1J~SIEr~tiC'i comfiliallCf: wiltllhe fJtll,lIo'ied pliins and . i l [" [' .pt::;irJc::~;cn~. / lit! HV,AC l1'EMS i U~: !.f" ""..I..... inl"l...rli"" fln~[ !p~t o BUILDING ITEMS . , ~ .... _.... _ _I _111.....:1...:1:__ '" ..;;~.\.llw,U1QI ~1..,l,,~~.j I.."".....'--l..~ .,..,.,......... ,,, components (trusses. precast, melal buildln9. etc.) 2. Fire protection sysrems {Spnnir.ler:i, ch:lllll:>, :'{,II.:l\Ct ;,jf&'c;",~"",:"~ ;;;.~::;,,_.:, inst::tlled. and tested ~mcludi"Q forward flow 01'1 back flow devices) by apprgpriately registered profe5sionals . (llH~ C4.~3) I'~' .. ....,., ,,.,... _1_.. ___......001II,1 "'If\..( _. .',I__....:.IU_'._...... "f' 'r. apphC8ble variance~ ~ ~ l ~ ~ c:-..-.... """........ ........~....,"'2,. O,","""^i:'..ra ..." .i ;C,;i..... ," ...... .....: . . ..........,. o LIGHTING ITEMS " Extel'lor ligrlting & et:lntrol reqUIrements ? 1~1?::':'~ ....~.....~ J!. ~~n'r.,l rO"'lirll:mfl!n~!l 3. All condli;ons of lighting plan appr~al and .. . I .. ..... _ ..__ 1J;"..."~.v'_ 1......._;.___ 4. Exits including exit and dile~tionalljghts b. ru~"C::3~&~.c ~("r~~ii'u....ii~n. ~;,,,,iv~.....;"" _~ :i_':";':':~':'. ~;:~ "i..:~~:, J~~:-'":,~ doors. class of construction 6, Sanitation system (toilets. SInKS. cinnKlflQ i;lI:IIlUt::.j 7 R:Ilrriltr.fr'u~ locludina Comm 18 elevators and lifts 8. ILHR 63 energy envlilope 9 ,I'.!I ::::~~:~~~!'!!'\ ~~ ~'2r!r;lI...~ rl:!,,: ~t'~rryv~l And al:lolit:'2lblp. Ira.rf:mcss Thf.! following Items are not in eompli:ance and must be addressed: i-; t;.- ~ * g l ~ B) 0 Statement of Noncompliance , uue to me Toiiowing hS\E.!d Ylui<:lilUII:S, i.i II;:' j.li\ij1i:~ ~ it.;,;. i~Olci, ;;;i C......:o......, ....,. - i & ~ ~; t :j ~ ~upc:-;!s~~!l: ~:"~!~~!::~~~, \A.~~h~~'.:"!!! F!'o!:'~ !'~io~~ I'-'~'!' to I"lr R ~hr:lV'" to intfir.Mp. project stalUs as oft"is date.) D) a Project Abandoned }. SUPERVISING P~FESSIONAL SIGNATURE FOR: ... .. ." ..r H .0 - - ./J. -_./ U bUI/Olng ... oj i..;.;. i.l ~'ijll\II'I:;' ,;" ~~. "".,;",-...", -..;- '" ;: _. I _. ". . _, Name (please print or type) , .,-,.'.,/ ;"',iI-.7'~." . Phon, number _ Cuslomer 10 # .4 ~ D 7 ;~ :2.:.,,- 4./?;, h", 7' ~-/' , /-' Signature.&..~ /~-r--'. SBD.9720 (lLQS/9&' E1Ed v6vZ9ZvOZ6 << OZS98vLOZ6 C13M3C18 9S:60 SZ-90-LDOZ