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HomeMy WebLinkAboutCertificate of Occupancy CITY HALL Inspection Services Div 215 Church Avenue PO B.ox 1130 ~ ~::;;~,';'ci OfHKOfH ON THE WATER City of Oshkosh Approved: Issued: July 9, 2007 July 9, 2007 Hunters Ridge of Oshkosh LLC 2990 Universal St Ste C Oshkosh, WI 54904-5903 CERTIFICATE OF OCCUPANCY An Occupancy Permit is hereby granted for the new 6-unit condominium located at 3190 White Tail Lane, Oshkosh, Wisconsin 54904 as described in Building Permit Application number(s) 120699. 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: Six 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 may be required for additional work to your property. A new Certificate of Occupancy shall be required prior to occupancy, should additional building(s) be erected, or should any buildings mentioned above be altered or moved. The use of land, or buildings, shall not be changed until a Certificate of Occupancy is issued for that occupancy. All conditions noted above must be complied with in order for this certificate to be valid. U\'wtAI~g Building Systems Inspe Cc: Midwest General Contractors Inc. . Building Permit Work Card Job Address 3190 WHITE TAIL LN . Permit Number 0120699 Create Date 7/20/2006 Owner MIDWEST GENERAL CONTRACTORS Contractor MIDWEST GENERAL CONTRACTORS INC Category 130 - New Multi-Family Plan T8-78-0706 Occupany Permit Required Flood Plain No Height Permit Not Required Class of Const: 8 Use/Nature COMM/6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468 of Work HVAC Contr BREWER HEATING Plumbing Contr WATTERS PLUMBING Electric Contr CUMINGS ELECTRIC INC Inspections: 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 ~ated compliance statement was received. DatelTime requested: 7/9/2007 Access: I Requested By: o Reinspect Fee 0 Fee Waived 07:38 AM Notice Type: Ready DatelTime: 7/9/2007 07:38 AM Phone Number: o Reinspect Fee Paid - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - -- Page 3 of 3 Job Address 3190 WHITE TAIL LN Building Permit Work Card Permit Number 0120699 Create Date 7/20/2006 Owner MIDWEST GENERAL CONTRACTORS Category 130 - New Multi-Family Contractor MIDWEST GENERAL CONTRACTORS INC Plan T8-78-0706 Occupany Permit Required Flood Plain No Height Permit Not Required Class of Const: UselNature COMM/6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468 of Work 8 I I HVAC Contr BREWER HEATING Electric Contr CUMINGS ELECTRIC INC Plumbing Contr WATTERS PLUMBING Inspections: Date 4/17/2007 Type Rough In Inspector Nicole Krahn approved Fax request / Flasing on porches & garages. Would like to pour porches this afternoon. Call & let Janell know if they can do this. Date/Time requested: 4/16/2007 08:17 AM Notice Type: Access: I Requested By: JOHN SKOTZKE CONCRETE CONST - Janell o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Ready Date/Time: 4/16/2007 09:00 AM Phone Number: 378-4380 Date 4/24/2007 Type Drain Tile Inspector Nicole Krahn Fax request NOTE: Only access to three of the units due to no ladders. approved Date/Time requested: 4/23/2007 03:29 PM Notice Type: Access: I Requested By: JOHN SKOTZKE CONCRETE CONST o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Ready Date/Time: 4/23/2007 04:00 PM Phone Number: 231-1667 Date 6/20/2007 Type Final Inspector Nicole Krahn Request line / For occupancy Jay called to cancel the inspection cancelled Date/Time requested: 6/18/2007 11 :37 AM Notice Type: Access: IOpen Requested By: MIDWEST GENERAL CONTRACTORS INC o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Ready Date/Time: 6/20/2007 Phone Number: Jay - 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 :15 PM Notice Type: FC Ready Date/Time: 6/25/2007 01 :15 PM Access: ~ALL JAY WITH MIDWEST HE WILL OPEN UNITS AND WOULD LIKE TO BE PRESENT FOR THE INSPECTION Requested By: MIDWEST GENERAL CONTRACTORS INC - Jay Phone Number: (920) 420-5878 o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Page 2 of 3 Building Permit Work Card Job Address 3190 WHITE TAIL LN Permit Number 0120699 Create Date 7/20/2006 Owner MIDWEST GENERAL CONTRACTORS Contractor MIDWEST GENERAL CONTRACTORS INC Category 130 - New Multi-Family Plan T8-78-0706 Occupany Permit Required Flood Plain No Height Permit Not Required Class of Const: 8 Use/Nature COMM/6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468 of Work HVAC Contr BREWER HEATING Plumbing Contr WATTERS PLUMBING Electric Contr CUMINGS ELECTRIC INC Inspections: Date 8/7/2006 Type Footings Inspector Nicole Krahn 'Request Line / Ready for footing inspection between 9:30-10:30am Poured w/o an inspection not approved DatelTime requested: 8/7/2006 08:07 AM Notice Type: Access: I Requested By: John Skotzke Concrete Construction Inc o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Ready DatelTime: 8/7/2006 10:30 AM Phone Number: (920) 231-1667 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - -- Date 8/21/2006 Type Foundation Backfill Inspector Nicole Krahn REQUEST LINE / READY FOR A FOUNDATION INSPECTION approved DatelTime requested: 8/21/2006 07:50 AM Notice Type: Access: I Requested By: Midwest General Contractors Inc-Jay o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Ready DatelTime: 8/21/2006 07:50 AM Phone Number: (920) 420-5878 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - - - - - -- - - - - --- - - - - -- - - - - - -- - - - - - -.-- - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - -- - - - -- - - - - - -- Date 4/5/2007 Type Rough In REQUEST LINE 1 READY FOR A ROUGH INSPECTION Inspector Nicole Krahn approved w/cond. DatelTime requested: 4/5/2007 10:37 AM Notice Type: Access: I Requested By: MIDWEST GENERAL CONTRACTORS - JAY o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid Ready DatelTime: 4/5/2007 10:37 AM Phone Number: (920) 410-5878 - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - --- - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - -- Date 4/12/2007 Type Insulation Inspector Nicole Krahn reqee" Uoe DatelTime requested: 4/11/2007 07:12 AM Notice Type: Ready DatelTime: 4/11/2007 07:12 AM Access: IOpen Requested By: MIDWEST GENERAL CONTRACTORS INC Phone Number: Jay - 420-5878 o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid approved - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - -- - - - - - - --- - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - - -- - - - - --- - - - - - - - - - - - - - -- - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - -- Page 1 of 3 Electric Permit Work Card Permit Number 123678 Create Date 7/24/2006 Job Address 3190 WHITE TAIL LN Owner. MIDWEST GENERAL CONTRACTORS Service Ie New 0 Change 0 Temp 0 N/A Volts 120/240 Circuits 132 Contractor CUMINGS ELECTRIC INC Type 0 Overhead . Underground 0 N/A Luminaires 60 Value $17,000.00 Amps Use/Nature of Work 400 Switches 40 Receptacles 200 1631 - Residential-New Multi-Family Wiring COMM/ 6 unit multifamily. Four units are two story and two units are 1 story. ria'" App"".1 #1285488. ""DEBIT ACC.,.". Inspections: Date 07/02/2007 Type Re Final Inspector Kevin Benner not approved REQUEST LINE / READY FOR A FINAL REINSPECT/ON (CORRECTIONS HAVE BEEN MADE) Date/Time requested: 06/28/2007 11 :40 AM Access: Notice Type: FC Ready Date/Time: 06/28/2007 11 :40 AM Requested by: CUMINGS ELECTRIC INC - JAN o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Phone Number: NONE - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -- - - - - - - - - - - - --- - - - - -- - - - - - - - - - - - - -- - - -'- - -- - - - - - - - - - - - - - -..; -'-- - - - - - -'- -- '-- Date 07/05/2007 Type Re Final Inspector Kevin Benner a~proved roo,"" "" Date/Time requested: 07/03/2007 10:25 AM Access: Notice Type: Ready Date/Time: 07/03/200710:25 AM Requested by: CUMINGS ELECTRIC INC -Jan o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Phone Number: Job Address 3190 WHITE TAIL LN Electric Permit Work Card Permit Number 123678 Create Date 7/24/2006 " Owner MIDWEST GENERAL CONTRACTORS Service Ie New 0 ChangeO Temp 0 N/A Volts 120/240 Circuits 132 Amps Contractor CUMINGS ELECTRIC INC I Type 0 Overhead . Underground 0 N/A Luminaires 60 Value $17,000.00 400 Switches 40 Receptacles 200 631 - Residential-New Multi-Family Wiring COMM/ 6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468. "DEBIT ACCT". Use/Nature of Work Inspections: Date 04/05/2007 Type Rough In Inspector Kevin Benner not approved REQUEST LINE / READY FOR A ROUGH INSPECTION Bundling of cables and caulking of penetrations. Reviewed with Wes of Cumings Electric on site. DatelTime requested: 04/04/2007 01 :09 PM Access: Requested by: CUMINGS ELECTRIC INC - Nancy o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Notice Type: Ready DatelTime: 04/04/2007 01 :09 PM Phone Number: (920) 231-5946 Date 04/05/2007 Type Service Inspector Kevin Benner approved REQUEST LINE / READY FOR A SERVICE INSPECTION Faxed to WPS 4/5/7 Date/Time requested: 04/04/2007 01 :09 PM Access: Requested by: CUMINGS ELECTRIC INC - Nancy o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Notice Type: Ready DatelTime: 04/04/2007 01 :09 PM Phone Number: (920) 231-5946 Date 04/09/2007 Type Re Rough In Inspector Kevin Benner approved REQUEST LINE / READY FOR A ROUGH RE-INSPECTION Date/Time requested: 04/05/2007 01 :20 PM Access: Requested by: CUMINGS ELECTRIC INC - Jan o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Notice Type: Ready Date/Time: 04/05/2007 01 :20 PM Phone Number: Date 06/27/2007 Type Final Inspector Kevin Benner not approved REQUEST LINE / READY FOR A FINAL INSPECTION DatelTime requested: 06/26/2007 07:01 AM Access: Requested by: CUMINGS ELECTRIC INC - Jan o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Notice Type: FC Ready DatelTime: 06/26/2007 07:01 AM Phone Number: HVAC Permit Work Card Permit Number 122192 Create Date 10/20/2006 Job Address 3190 WHITE TAIL LN Owner MIDWEST GENERAL CONTRACTORS Contractor BREWER HEATING Fuel ~ Gas I U Oil I U Electric I U Solar U Solid I Value System 0 New I D Replace I D Other ~ Forced Air I 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 . Direct Vent Use/Nature New multifamily 6-unit. State Approval #1314647. **DEBIT ACCT**. of Work $27,000.00 I I o Not Applicable I Inspections: Date 4/5/2007 Type Rough In Inspector Nicole Krahn REQUEST LINE I READY FOR A ROUGH INSPECTION approved w/cond. DatelTime requested: 04/05/2007 10:37 AM Notice Type: Ready DatelTime: 04/05/2007 10:37 AM Access: I Requested By: MIDWEST GENERAL CONTRACTORS - Phone Number: (920) 410-5878 o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -- - - - - - - - - - - -- - - - - - - - - - - -- - - - - - - - - - - - - -- - - - - -- - - - - - - -- Date 4/13/2007 Type Rough In Inspector Nicole Krahn Request line / They want to be there for inspection approved DatelTime requested: 04/13/2007 01 :58 PM Notice Type: Ready DatelTime: 04/13/2007 01 :58 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 01:42 PM Access: I Requested By: o Reinspect Fee 0 Fee Waived Notice Type: Ready Date/Time: 06/27/2007 01 :42 PM Phone Number: D Reinspect Fee Paid - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - -- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - --- - - - - --- - - - - - - - - - -- - - - - - - - - - - -- - - - - - -- - - - - --- - - - - - -- - - - - -- - - - - - - - -- '" Plumbing Permit Work Card Job Address 3190 WHITE TAIL LN Permit Number 121053 Create Date 07/24/2006 Owner MIDWEST GENERAL CONTRACTORS Contractor WATTERS PLUMBING Category 410 - Residential-Interior Plan Value $36,351.00 Bathtub 6 Shower 10 Water Softner Wait. St. Shamp Sink Coffee Maker - - - - - Whirlpool Floor Drain 6 Local Waste Ice Chest FlrlWst Sink Int Grease Trap - - - - - - Lavatory 22 Lndry Tray Clothes Wshr 6 Exam Sink Catch Basin Ext Grease Trap - - - - - Toilet 22 Disposal 6 Bidet Sculry Sink Wash Ftn RPZ Valve - - - - Res. Sink 6 Dishwasher 6 Beer Tap Hand Sink Urinal Eye Wash Statn - - - - - Bar Sink Sump Pump 6 Lab Sink Plaster Sink - Standp Rec 6 Wtr Sewer Mtrs - - - - - Water Heater 6 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. 12 Hose Bibs - Fixtures Use/Nature COMM/6 unit multifamily. Four units are two story and two units are 1 story. State Approval #1285468 of Work Size Material Type # Conn.Type Sanitary Sewer Storm Sewer Water Service ,. Inspections for. Wor.k Car.d 87602 Date 3/27/2007 Type Rough In Inspector Paul Wolf approved Fax request Date/Time requested: 3/27/200707:25 AM Notice Type: Telephone Number: 920-733-8125 Access: I Ready Date/Time: 3/27/2007 08:00 AM Requested By: WATTERS PLUMBING - Jamie o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid - - - - - - - - - - - - - --- - - - - - - - - - - - - - -- - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _.- -- - - - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -- Date 4/17/2007 Type Underground Inspector Paul Wolf approved !Fax request Date/Time requested: 4/17/200708:15 AM Notice Type: Telephone Number: 920-733-8125 Access: I Ready Date/Time: 4/17/2007 08:30 AM Requested By: WATTERS PLUMBING o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - -- - - - -- - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - -- - - - - -- - - -.- - - - - - - - - - - - -- - -- -- Date 6/27/2007 Type Final Inspector Paul Wolf approved Fax request Date/Time requested: 6/20/200708:47 AM Notice Type: Telephone Number: 920-733-8125 Access: iCall Jay 420-5878 Ready Date/Time: 6/20/2007 08:30 AM Requested By: WATTERS PLUMBING o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid City of Oshkosh Inspection SerYiccs Di."ision 215 Church Avenue, PO Box 1130 Oshkosh, WI 54903-1130 Phone: (920) 236-5050 Fax (920) 236-S084 Jun.27. 2007 12: 13PM inspect ion servl ces No. 3447 P. ~ CORRECTION NOTICE / FIELD INSPECTION REPORT JOB LOCATION: 3',t1o 101-nT"t: '~IL u0 CONTRACTOR: h,1)~<:..s\ PROJECT TO BE INSPECTED: Lo Ui"- 1 ,- TYPE OF INSPECTION: ~ ~ / ;' ~ . , . 1 ~ 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 ofthi~qtice and ,eturn it to the Inspection SCI"Vices Division by the Compliance Date of .. , TCEM# ConE INSPECTION. RESULTS . . .. .7 ;:.'-..r~~,;;,~;;I:i,;~J~C;..'. U<'.::> ,. ~c:.?s ~ it'r'"c.. ~~ bt:.~ k\~." .~c:.. ~~ - U/S~ ~~~~ ~ i"\~'l...)L+{ ---nre.. C."'Z:.I ~:~ SU\..P ?\..A? ---nfi.- .:00?~ ~~" .... "i~.";:'::;.~::...:.;i:/::"','. ;", . .~CT:(ON.'tAKlN::. :.. : . o Not Approvedl Insp, Report left on site 0 Not Approved! Insp. Report given to Signed ~)I~J~ /.p/z1/cs, Inspection Services Division Date ofInspection . "'. ':.:, .,,'.... ~!;~'~:~:,:~~"}i~~;t~~::~:",~.~:~;.<'~ S'l:,~~:~?;;!:~::.::~~~~:"~~~;;~?~::::..":' .~:',: aiI~axed !?:;;;~;l.:h~reb.~'<:;:~e . ".:.: .....;triat Jle";Y101.:a~on~~~Jisw.Q.t)n~t'ijis'~:NoticeJ.R.e''.:'ojji11:~~~~~.~~~i\[f'J Print Name JQ}' HtI\dt('c~ Company f\l\zclwuf (jC:I\U",/ CO'1k~Jor/ S;groture, ~ ~L.;-H Dale (, - H - 0 7 ?~-.51J--ap Phone # ,; ~,~ Buildi~ngs, HVACCompliancE{~hatemeot 580;.9720 This form is req(Jire~to'beslJbmittedbythe supervising' professional (architect, engineer, HVAC designer or electrical designer) obs'elVing~cdristruction;ofprOjeCtswithinbuildings\ivithtotal areas exceeding50,000ct1bideet or greater and bleachers (Comrr150.10/C'oFrtm6fSO): ~ Failure to'submlt tliis'form may result in penalties aS$p~cifiedlhComm 50.26/Comm :61 ;23' and/orldC'a1 orcilnance's?"::1'}UG, .:;; '1 :'j-:;,;;:;j n" "'" r.!':;' '-"'D'~-1,<\;~::\':~ ~ ,.~{' LU:'~ t,';' Generallnstruction~: .., Prior to the initial occupan:y of new buildings or additions and the final occupancy of altered eXistfn~'~~it~f~~~{'s~~rT,~!,@sci?~piet€~'~l1(j:si9!1~d/fomfto:' .. :,/. ';","'" -d,,":;,;> 'J::.v;. "'''{, ',f'-, r :,' L,.iid.",,; c;' ~,.\;,!fv~ :.~L~~ ',;/):~' ;,; ('j}-.):.':~;;;:';t~;.~~.,~~;.,,:..~:~::,;:,,:~, -,:n)'r-';:';'J:~-J-_!"l.'; .)1 ;~.;l'';; ~\:;;.).:',:~;, ~" , .' ,'" . ,.,. ",. r~e,xn,unlcIPC3'!?U1ldlng Inspection office and " " ',' . "." '''':.''~~afet~ic3ndB~ildings,10541N Ranch Road, Hayward, WI 54843 >"P:ersonal information you proyide may be~s~a'forse~ndary pU~oSes[Privacy Law, s. 15.04 (.1)(m)J. 1. PROJECT INFORMATION: Please fi.U in the fOll9""ing with information from your plan approval letter. Tral1ssctionlO, Number ~]~:Number 66,9115 .,. '.. ., Site Ideation (number 8. street), ' 3190 WHITETALE. 6UN,Ir #9 ~ ",:; , 1'- ' ~~ i .'" : , '..' [2] City 0 Village 0 Town Of OSHKOSH " County of ..- , '", , ~.PUR~OSE ,OF THIS STATEMENT: (Check Box A, B, C, or 0 to indicate purpose and complete any other ).,;,appli~ble boxes and information. Attach additional pages if necessary). ,..-", ','"' '"'-''' ;,C-,,"< Check those which apply: 0 Building Object 10# 1082803 ""DUghting Object 10# 1285468 , :.,,". :' . ~ ~ ~. L' WINNEBAGO o HVAC Object 10# ;. "~ ,0 Pal1:ial Completion Descripti6rto,f E~~i()n Completed '/,L;" <'; , A) 0 Statement of SUbstant;l~t Compiiililce,' ", ' ..... ,. . ." -; , ' ~ .-".{",,""~~ .,.-, "",'.",.,,> ,:' ",l';_~ "S.' .'..;:..----,',':;.~,-'..",'~.~t..,.,~ '..j;'_.;.,I'",c"~' \':":,,: , , ,,' TO, the best ormy knowledge; belief, and based oil orysite observation, c::Onstruction of the following building and/or HVAC "Yt~rR$'ap~ir~bl~'t6 tHi's',s'rojebi n~v~b'~~'r\'iidn1~I&t~;I~~&bslantiaic:o~pliance with the approved plans and specifications. ~ t.Y~l t'7;.~: .~\,~; tl,);J"-:,:c ~ r.~!. ~\': ~: ,:\>:~ .- U:3,,1 ;,.,_;~/- i'.'; ::\'J;:Cr. (,1 tr~;L'::~ ,~, .:'_~ p ;'.." . > ~':(r.'":: ;iL,"')) "~;. ::.i :,I~~_~ ",; o BUILDING/LIGHTING ITEMS' . ,"" . ", ,~, , " " , , :;C:,,;'/'/': . ilt." Structul'af'systefu inciudlrl~f ~libmittal and erection of all building 10. Exterior lighting & control requirements :;"'80r1i'pon~nts(tfu$ses:preca~fmEitarbujjd'ng,etc:) .,', " .. j 11: Ihteiior lighting &'C'ontrol requirements ; 2. 'FIre ptotl:!'CiiOii$ystem~'(sp'rinklers;alarmS;sn1oke' detectors) '<,j :12. All conditions Of lighting plan approval "'de~igned: insfallec(an'd' tested (iricluding1o'rwarcfflowoh'baCk'f1ow' and applicable variances devices) by aPPfoprjately regi~tered professionals" ,., "', " ....' " ,.' 3. Shaft and stai'rway enclosure' '" ',',.! , o HvAC ITEMS 4. Exits including exit and directiohallights 1. HVAC system including final test 5. Fire-resistive construction, enclosure of ha~ards, fire walls, labeled 2. All conditions of HVAC plan approval doors, class of construction, fire stopped penetrations and applicable variances 6. S~mrtation sV,Stem (tOilf;lts,sin~s,(drinking facilities) 7, B~rriE?r-free including Goinm ,18.elevators an9lifts 8. Energy em/~lope'reqliiremenis " 9. All conditions of building 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 3. SUPERVISING PROFESSIONAL SIGNATURE FOR: o Building 0 HVAC 0 Lighting Name (please print or type) 649536 Signature -... .~~ ~>~\ """'" ..' ",,' Phone # 920-497-5007 Customer 10# SBD-9720 (ROl/20D3) r, ~ ~ ~ t,1i5 if,. , ,,;,,;..~ h,; f-';; r'-' _UII""" ItlI;;:J, I'''' -"', _''''''''III,~':''''''II'tlllal''''lW "'''GI\'VU''VIII. 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 areasexoeeding 50,000 cubic feet and construction f antennas, towers. end bleachers (llHR 50.10). Failure to submit this form may result in penalties as specified in .....HR 50.26 and/or local ordinances. ~.' ;'..~:,,~! !:1~trllctinns: Prior tn the initial occupancy of new buildings or additiot'lS and the final occupancy of ?!te-r~rl existinQ buildings, suomit this compieLeo ana sIgnee iorm to: . . I... ... ~ .. c - .,...~....... _.u~ ~..~~....::_...... ~ f"'. ~.... ;~~" ~.~..r~~.:-.-,';"". '....'! ~.,7n~_7~~., ::-.... ..".1 :.,f,-.,:-r.::.!:r." ;;.-." ,..,,...~,;~'" m.~-': Joo:!' ~~~:!>1 ~:" !::e':~~~~..". C"..'~~~"~ f~,;.,.?,=,,:, !.RIN,':: 1Fi 0.4 (1:I(m!~. ,'~ \ ., It ~' ,t ~. '. 1. PRO"IECT INFORMAlION: j-llear..e 1111 In me TQHOWJf1Y WIVllniUllildLiUIJ IIVIII YVI)1 ~;j"'lI ..J~;jJIU"'CII II.::HCI. lr::.lr'l~::lr":tj('ln H"l NllmbAr 6(/. ~~_ ~ ~__."".. ~11~'N'IN'lbr;lor ~""'''~-/'''''...:l..'".. ,. . / Sit~ If)~~ti{'ln (nu!T\h~r 8, Sfr?:F.i). -~~~'~-:.::....,4'~ '~_',:_ 319.0. ,_',w..hiw -D~~ !P-'r.i'!v C! V!ll;.ol!' n Town of-L~-'-'~"....__ ~oumy or ~~:!:!!,:'..~~~ 2.' PUP-POSE OF THIS STATEMENT: (Check Box A. B. C. or U to lrltllcate PU~CC$;C ana C'.m;;;l(.:\~ ~ny Olner ~ ~ ~ It 11 ",~~ I!'" it f-' ,~ t:l.)of....I~'-c.aa..,.:1w. ....",'r.'-\oJ w'I'loIII! 11"V'-'~"'_'I. .'......:..._.. ..:..--......... , wJ ../ -,. -. ...,' ....J.....::......,... SOrl_......... "......... -r-~'I. -- --..-. ''''' . "I ~_...,- . _ . ...1 . ......,_. --...,....--.-.. ~.~..:r~..;:--;fir"',:-; ;-"if r"......~~,--:""l r:"':~~!!"-:~~~ a ~ r: ~':t~~m""t of SB~~~"ttal C!)m~!!!!~~p I. I! I': 1/ !;} k 1" It ft 1'\' ! t , \ [ "'r' I,' I" '< 1\,1 ill'.... u~." -1."1 ".'v..'--::r-. __......, _._....._~:..__ _.. _.._.._ "'. _ _ :~~..~ ~=~.~:,,:,,:.Io:J.'\ ,.~. fi-.;... :"".....~_..... L~'"':."f." ""c...::.~. '-'.rT;rJ~7",~ i.. ~q"'c:t~r.~i~! r:.;'"':~:,,:H~~~~ "".~~~P'-: '~f"" :"~(\~\''=cJ ~le~s: .s~d specmc;atlons / o BUILDING ITEMS l.t2 tlv,:\~ II t;M~ . to ," ...... ___ _.. ........ ... . " .', I...... enml'lt'ln~nts (trus~e~. creCi!!t metal buildjn~. etc.) (llHR 64.53) l.t .c::... ii;"";..;;....a..:....."'........j..:.:.;.;.:..,,_,.:,......_.-... :.:.:.:' .~'.,,: ,...",'. ~.... ~" .' ';'""'. :~:~~~~~. ~~~ ~-!'!.~"'" ~.",..hrtf:...~ fn"..,~rt1 ""W I")n h:=lr-:k flow rJPtJ~r.(':~~ ~~ appJtlpriia\tl'i11t:YI:!>it:'n~u plwi'l:~.I"'it~l~ ~. :. !: . __.a...:....... ._: :.... aooheable Yaria"~s ~ ~. it I$". 1'. 1\ I, ~ I.. , '._ ..":;:....~ ..7<-':'.,f :..';..::':~~~ ':. ........ _0.", . . 7"~~:" ~'.:~:',::.::':~.;: _':':: L, :....~.'ii ..":~~:~.';"":~:-;:' ~,- .....':..~~~t.""; ................... . ." -,~" . ,.., I I~ 1J"nl~ :",~...r: I. CXl'llliul Ilgntln~ iI. ..oniloi I l!:qul.tlllJel Ill> --. ~::~~:;~:: ;:":;';;';';.:;'" ~':'i;:'_'; :~",~,':"I..""-:':;-:~-; 4. !:xito (nelUding exit ilnd dirccticnalllghtS doors. class of construction 3. All ...onditions ot Iightin9 OIan approval anO ,.. '.. . ',". .. ...-..........--.....--. _......u....~.._.. ;,...]';..::.... \.:"-'.'-'-1 _.. "....,. ... .," ., Q::>...-IM.~r.".. :"''''h.v:r.'"!g C<:,~m .,~ ",I"'v='i"lr~ l:Il'Irllift1; o. i...rir; r;~ e:;, IC;' 1:11 ....,V'Ol....jJV ':. ,;;~ '-:"\':.'::;:.':':",.;' :::' ~;J~~'::-':~ ;:.~::-: :.~;:;-:..::! :~: ::::t::-::~: ':"~~~~~~.~! . .. .... '. . '. ~ '. .o', . . i~ t' !~. ~: ~ ~ ..r.. "!"~!:' ~':'!!~':".'!~ !~,:,M4 ~N>- ,,~t I~ ~f'\m!,"h:m~.. SInd must tip a~ctrt'!$$ed: B) 0 Statement of Non~ompliance .--. ~ - .... 4c.. .. c..'._. ..:_.. 1~...1",..I ..~_t...:....._... ,~~,.. .......:....,._. :,.. ....^t "l'l.~J"fH ,,,,. "":".....: T~~n....\r ,.....u."......:.u....._o..,..._........,_........,......, '_, ","_"_ ... . . C) Cl SUP6rvislnq Professional Withdr.twn From Pr~jc:t (Uze A or B a!::ove to Indicate pmjl!!ct statU!! !!!'1I)Hhi!?o ~A'~ , D) C Project Abandoned l. ~utJ~~~~~b ~~~b~:U~~~..~I"~~.~ ~~~ rU~F vf<; ~'7Y '" I'. ~.' ..... w'W.tw.n..u .......~,.., ~ .....~~.,....- ...... ...,... ~,..- - "...- Name (please Olinl ortype) Customer 10 * _~ 0 9" ,,~ /.... ... n,:",.. ~"*,~..... c.."r . "'T" { i t } r?~ )..J......~ .,__/ , ''''J'~.....,....", Phon" number ~i9natl.lfe ~ ---"""'" #"'" ~~V ~ SBD-9720 ~.OSJV8l E/Zd Jlt".. f'''' ..'lor 17617Z9Z170Z6 << OZS9817LOZ6 Cf3M3Cf8 SS:60 SZ-90-LOOZ