HomeMy WebLinkAbout2007-Certificate of Occupancy
CITY HALL
Inspection Services Div
215 Church Avenue
~. PO Box 1130
~ Oshkosh WI
~ 5490>-1130
OfHKOfH
ON THE WATER
City of Oshkosh
Approved:
Issued:
09/21/2007
10/11/2007
CSI WI Ltd Partnership
PO Box 2107
LaCrosse WI 54602-2107
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby issued for the Kwik Trip Store, diesel canopy,
gas canopy and car wash located at 2400 S Washburn St as described in
Building Permits #124773 (store), #124774 (diesel canopy), #124775 (gas
canopy) and #124776 (car wash).
This space shall be used for business/sales and is located in the M-3 General
Industrial District.
LIMITATIONS:
Maximum number of persons: Per State Approved Plan
Certificate of Occupancy shall be required priorto 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.
,J1t9lA ~~
Building Systems Inspector
Building Permit Work Card
Job Address 2400 S WASHBURN ST Permit Number 0124773 Create Date 5/2/2007
Owner C S I WI L TD PRTSP Contractor OWNER
Category 230 - New Stores & Customer Service Plan W5-1978-0507
Occupany Permit Required Flood Plain Height Permit Class of Const: 5Bibc
Use/Nature New 6160 sf Convenience Store and site improvements (parking lot.)* Note: Separate Permit required for signage. All conditions
of Work pf Zoning Review to be met prior to occupancy (including combining lots into one.
HV AC Contr Plumbing Contr
Electric Contr
Inspections:
Date 6/18/2007
re,".., Il,e f Plea,e 0311
DatelTime requested: 6/15/2007
Access: I
Requested By: Tri-State - Bob
o Reinspect Fee 0 Fee Waived
Type Footings
Inspector Nicole Krahn
approved
I
09:35 AM
Notice Type:
Ready DatelTime:
6/18/2007 02:30 PM
Phone Number: 608-606-1733
D Reinspect Fee Paid
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ -- _ _ _ _ _ _ -- _ _ _ _ _ _ -- _ _ _ _ _ _ _ _ _ -- _ _ _ _ _ - -- - - - - - - ,..-- - -.., - - - - - - - - -- - - - - -- - -.- - - - - - - - - - --:- - - - - - - - - - - - - - -- - - - --- - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - --- --
Date 6/21/2007 Type Foundation Backfill Inspector Nicole Krahn
IReq"e~ II",
Date/Time requested: 6/20/2007 07:13 AM Notice Type: Ready DatelTime: 6/21/2007 AM
Access: I
Requested By: Tri State Construction - Bob Phone Number: 608-606-1733
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
approved
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Date 7/9/2007 Type Foundation Backfill Inspector Nicole Krahn approved
Request line / Requesting the foam insulation and store floor plastic inspection late Monday afternoon 3:30-4:00. Will pour on Tuesday
morning.
Date/Time requested: 7/6/2007 02:21 PM Notice Type:
Access: I
Requested By: Dwayne Volden Concrete
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Ready DatelTime: 7/9/2007 03:30 PM
Phone Number: 608-792-0638
- - - --- - - - - -- - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - --- ~ - - - - - ~- - - - - - - - - - - - --- - ~ - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - -- - - - - - - - - - - -- - - - - --- - - - - - ~ - - - - - - -- - - - - - - ~ ~ - - - - - - -- - - - - - - --- --
Date 8/2/2007 Type Rough In
REQUEST LINE / READY FOR A ROUGH INSPECTION
*CALL JIM WHEN YOU KNOW WHEN THE INSPECTION WILL BE CONDUCTED**
Inspector Allyn Dannhoff
not approved
DatelTime requested: 7/31/2007 09:42 AM Notice Type: FC
Access: IBUILDING IS OPEN UNTIL 6PM EVERYNIGHT
Requested By: KWIK TRIP STORES - JIM
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Ready DatelTime: 7/31/2007 09:42 AM
Phone Number: (608) 386-2639
- - - - - - - - - - - - - - ~ ~ - - - - - - - - - - - -- ~ - - - - - --- - - - ~ - - -- - - - - - - - - - - - - - - -- ~ - - - - - - - - - - - - - - - - - - - - - - - -- - - ~ - -- - - - - - - - - - - - - - - -- - - - - --- - - -- - - - - ~ -- - - - - - -- - ~ ~ - - -- - - - - - - -- ~ - ~ - - - - - - - - - - - - - - ~ ~ - - - - --
Page 1 of 3
Building Permit Work Card
Job Address 2400 S WASHBURN ST Permit Number 0124773 . Create Date 5/212007
Owner C S I WI L TO PRTSP Contractor OWNER
Category 230 - New Stores & Customer Service Plan W5-1978-0507
Occupany Permit Required Flood Plain Height Permit Class of Const: 5Bibc
Use/Nature New 6160 sf Convenience Store and site improvements (parking 101.)* Note: Separate Permit required for signage. All conditions
of Work pf Zoning Review to be met prior to occupancy (including combining lots into one.
HV AC Contr Plumbing Contr
Electric Contr
Inspections:
Date 8/3/2007
Type Re Rough In
Inspector Nicole Krahn
approved
DatelTime requested: 8/3/2007
Access: I
Requested By:
o Reinspect Fee 0 Fee Waived
10:51 AM
Notice Type:
Ready DatelTime: 8/3/2007 10:51 AM
Phone Number:
o Reinspect Fee Paid
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - - - -- - - - - - - - - - - - - - -- - - - - - - - - - - - - -- - - - - - - - - - - - -- - - - - - - -.- - - - - - - - - - - - - - - - - - - - - - -- - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - --
Date 9/11/2007 Type Final Inspector Nicole Krahn not approved
IRequest line / Requesting temporary occupancy for Tues afternoon 9/11. NOTE: The inspection was not ready. It was a consultation
with Jim regarding what needed to be finished. He'll call for a final inspection when the project is ready.
DatelTime requested: 9/6/2007 02:31 PM Notice Type:
Access: IOpen
Requested By: Kwik Trip Stores - Jim
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Ready DatelTime: 9/11/2007 PM
Phone Number: 608-386-2639
- - - - - -- - - - - - - - - - - - - -- - - - - - -- - - - - - - -- - - - - - - --- - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - --- - - - - - - - - - - - -- - - - - - -- - -"- - - - - - - --- - - - - - - - - - -- - - - - - - - - - - - - - --- - - - - - - - - - - - -- - - --
Date 9/18/2007 Type Re Final Inspector Nicole Krahn
roo'''' "'0 - "",, to< o=,,"cy
DatelTime requested: 9/12/2007 02:36 PM Notice Type: FC Ready DatelTime: 9/17/2007 02:00 PM
Access: ppen
Requested By: Jim - Kwik Trip Stores Phone Number: 608-386-2639
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
not approved
I
- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - -- - - - - - - -- - - - - - - - - - - - - - - - - -- - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - --- - - - - - - - - - -- - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - -- - - --
Type Re Final
Inspector Nicole Krahn
not approved
Date 9/18/2007
DatelTime requested: 9/18/2007
Access: I
Requested By:
o Reinspect Fee 0 Fee Waived
07:42 AM
Notice Type: FC
Ready DatelTime: 9/18/2007 07:42 AM
Phone Number:
o Reinspect Fee Paid
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Page 2 of 3
Building Permit Work Card
Job Address 2400 S WASHBURN ST Permit Number 0124773
Create Date 5/2/2007
Owner C S I WI L TO PRTSP
Contractor OWNER
Category 230 - New Stores & Customer Service
Plan W5-1978-0507
Occupany Permit Required Flood Plain Height Permit Class of Const: 5Bibc
Use/Nature INew 6160 sf Convenience Store and site improvements (parking lot.)" Note: Separate Permit required for signage. All conditions
of Work of Zoning Review to be met prior to occupancy (including combining lots into one.
HV AC Contr
Plumbing Contr
Electric Contr
Inspections:
Date 9/17/2007
Type~
;"',~"'~,1IY::!;3i,~w.~
Inspector Nicole Krahn
~...~.::~
appro l'!d ~
-~-r
Date/Time requested: 10/10/2007 12:33 PM Notice Type:
Access: I
Requested By: ____~____
o Reinspect Fee 0 Fee Waived tJ Reinspect Fee Paid
Ready Date/Time: 9/17/2007 12:33 PM
Phone Number:
Page 3 of3
Building Permit Work Card
Job Address 2400 S WASHBURN ST Permit Number 0124774
Create Date 5/2/2007
Owner C S I WI LTD PRTSP
Contractor OWNER
Category 240 - Other Non-Residential
Occupany Permit Required Flood Plain
Use/Nature INew '.6X48 Diesel Pump Island Canopy.
of W..k
HV AC Contr
Plan W5-1978-0507
Height Permit
Class of Const:
Plumbing Contr
Electric Contr
Inspections:
Date 6/28/2007 Type Footings Inspector Allyn Dannhoff
REQUEST LINE / WOULD LIKE A FOOTING INSPECTION AT 10AM TODAY (6/28/07). 6/28/07 - Nicole off, gave OK to pour (AD)
DatelTime requested: 6/28/2007 08:19 AM Notice Type:
Access: I
Requested By: TRISTATE CONSTRUCTION - BOB
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Ready DatelTime: 6/28/2007 10:00 AM
Phone Number: i608) 60~1733____
Date 9/17/2007
Ty
Inspector Nicole Krahn
DatelTime requested: 10/10/2007 12:32 PM Notice Type:
Access: I
Requested By:
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Ready DatelTime: 9/17/2007 12:32 PM
Phone Number:
Page 1 of 1
Building Permit Work Card
Job Address 2400 S WASHBURN ST Permit Number 0124775
Create Date 5/2/2007
Owner C S I WI L TO PRTSP
Contractor OWNER
Category 240 - Other Non-Residential
Occupany Permit Required Flood Plain
Use/Nature INew4O"20 G", Pomp ',',nd """"'y.
of WO<k
HV AC Contr
Plan W5-1978-0507
Height Permit
Class of Const:
Plumbing Contr
Electric Contr
Inspections:
Date 6/26/2007 Type Footings Inspector Nicole Krahn not approved
REQUEST LINE / READY FOR AN INSPECTION
l*WOULD LIKE INSPECTION TODAY AT 2:30** HE SAID HE WOULD ALSO LIKE AN INSPECTION ON THE SIGN
(NOTE: This inspection was for the sign footings and gas pump canopy footings. I was out of the office and the footings were poured
ithout an inspection.)
Date/Time requested: 6/25/2007 08:28 AM Notice Type: Ready Date/Time: 6/25/2007 02:30 AM
Access: I ~
Requested By: ~RI STAR C9NSTRUCTION - Bob Schiettle Phone Number:(608)_606-1?~3_~_____
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
1~~ng;;;!2;;~~nnmmm;~.B~~;nJ~nmmm;~~~;..n~;~~~;;;h~mmnnmnnmnnnnnnnr
Date/Time requested: 9/17/2007 12:31 PM Notice Type: Ready Date/Time: 9/17/2007 12:31 PM
Access: I
Requested By: Phone Number:
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Page 1 of 1
Building Permit Work Card
Job Address 2400 S WASHBURN ST Permit Number 0124776
Create Date 5/2/2007
Owner C S I WI L TD PRTSP
Contractor OWNER
Plan W5-1978-0507
Height Permit
Class of Const:
5Bibc
Plumbing Contr
Electric Contr
Inspections:
Date 6/20/2007
r~"~t II",
DatelTime requested: 6/20/2007 07:13 AM
Access: I
Requested By: Tri State Construction - Bob
o Reinspect fee 0 Fee Waived 0 Reinspect Fee Paid
Type Footings
Inspector Nicole Krahn
approved
Notice Type:
Ready DatelTime:
6/20/2007 03:00 PM
Phone Number: 608-606-1733
Date 9/17/2007
Inspector Nicole Krahn
...k'~d'
;aEP.r()ve' ...
DatelTime requested: 10/10/2007 12:31 PM Notice Type:
Access: I
Requested By:
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Ready DatelTime: 9/17/2007 12:31 PM
Phone Number:
Page 1 of 1
..
Electric Permit Work Card
Job Address 2400 S WASHBURN ST Permit Number 125544 Create Date 6/27/2007
Owner C S I WI L TO PRTSP Contractor TO PADESKY ELECTRIC INC
Service Ie New 0 ChangeO Temp 0 N/A I Type 0 Overhead . Underground 0 N/A
Volts 120/208 Circuits 170 Luminaires 279
Amps
800 Switches 15 Receptacles 125
~42 - Commercial-New Building Wiring COMM / NEW KWIK TRIP - STORE WIRING, FUELING SYSTEMS, CANOPIES,
LOT SIGNS AND POLES
Value
$175,000.00
Use/Nature
of Work
Inspections:
Date 08/09/2007 Type Service
r"'" to WPS 8-"071,30 PM
DatelTime requested: 08/09/2007 01:19 PM
Access:
Inspector Adam Krause
approved
Notice Type:
Ready DatelTime: 08/08/2007 01 :19 PM
Requested by: TO PADESKY ELECTRIC INC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number:
Date Type Note Inspector Adam Krause
.See permit addtionlremodel permit for the carwash for all "site" inspections. ASK 8-9-07
Date/Time requested: 08/09/2007 01:20 PM
Access:
Requested by: TO PADESKY ELECTRIC INC Phone Number:
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
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Date 09/05/2007 Type Consultation Inspector Kevin Benner not approved
Take pies of the condensing unit installations for work space concerns
Notice Type:
Ready DatelTime:
DatelTime requested: 09/04/2007 11 :30 AM Notice Type:
Access:
Requested by: Department of Commerce / Joe Hertel
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Ready DatelTime: 09/04/2007 11 :30 AM
Phone Number: 608-566-5649
Date 09/20/2007 Inspector Kevin Benner
~Iso see permit #125545 for additional inspections that could be associated with this permit
DatelTime requested: 09/20/2007 07:21 AM
Access:
Requested by:
o Reinspect Fee 0 Fee Wavied
Notice Type:
Ready DatelTime: 09/20/2007 00:00 PM
Phone Number:
o Reinspect Fee Paid
:
,'. .... ~.,
Electric Permit Work Card
,ipb...lCIdress 2400 S WASHBURN ST Permit Number 125545
Create Date 6/27/2007
Owner C S I WI L TD PRTSP Contractor TO PADESKY ELECTRIC INC
Service Ie New o Change 0 Temp o N/A Type 0 Overhead . Underground o N/A
Volts 120/208 Circuits Luminaires 26
Amps 600 Switches 4 Receptacles 20 Value $70,000.00
Use/Nature 643 - Commercial-Addition/Remodels COMM / NEW KWIK TRIP - CAR WASH WIRING TO INCLUDE BOILER,
of Work RADIANT HEATERS AND CAMERA SYSTEM
Inspections:
Date 06/28/2007 Type Underground Inspector Kevin Benner approved
Field RequesU Raceways for the Petroleum equipment. Piping under the floor in the building only. Additional raceways will be installed
directly under the slab at a later date for store wiring.
DatelTime requested: 06/28/2007 03:00 PM
Access:
Requested by: TD PADESKY ELECTRIC INC Kent
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type:
Ready DatelTime: 06/28/2007 03:00 PM
Phone Number:
Date 07/03/2007 Type Underground Inspector Kevin Benner approved wieand.
Partial Store inspection so they can backfill for the plumber. I discussed with Kent and the other electricians on site that the raceways that
bross the plumbing drains are to be supported before additional fill is to be placed over the raceways.
DatelTime requested: 07/03/2007 07:33AM
Access:
Requested by: TD PADESKY ELECTRIC INC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type:
Ready DatelTime: 07/03/200707:33 AM
Phone Number: 608-769-2796 Kent
Date 07/09/2007 Type Underground
r;''''' F",' ."pe"'o. ",eo
DatelTime requested: 07/05/2007 12:35 PM
Access:
Requested by: TD PADESKY ELECTRIC INC Paul Huss
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Inspector Kevin Benner
no time
Notice Type:
Ready DatelTime:07/09/2007 00:00 AM
Phone Number:
Date 07/11/2007
Type Underground
Inspector Kevin Benner
approved wieand.
UG to the Car Wash
Support raceways when the backfill is installed. Reviewed with Paul Hester
DatelTime requested: 07/10/2007 12:53 PM
Access:
Requested by: TD PADESKY ELECTRIC INC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type:
Ready DatelTime: 07/11/2007 00:00 PM
Phone Number: 608-769-3242 Paul Hester
/,4
'.
,
Electric Permit Work Card
Job Address 2400 S WASHBURN ST Permit Number 125545 Create Date 6/27/2007
r
Owner C S I WI L TD PRTSP Contractor TD PADESKY ELECTRIC INC
Service Ie New o ChangeO Temp o N/A I Type 0 Overhead . Underground o N/A I
Volts 120/208 Circuits Luminaires 26
600 Switches 4 Receptacles 20 Value $70,000.00
Amps
Use/Nature 643 - Commercial-Addition/Remodels COMM / NEW KWIK TRIP - CAR WASH WIRING TO INCLUDE BOILER,
of Work RADIANT HEATERS AND CAMERA SYSTEM
Inspections:
Date 07/12/2007 Type Underground Inspector Kevin Benner approved
jXFMR pad to the building for the service raceways, Building to gas islands and raceways to the sign as far as the edge of the fuel islands.
Date/Time requested: 07/11/2007 04:21 PM
Access:
Requested by: TD PADESKY ELECTRIC INC
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Notice Type:
Ready Date/Time: 07/12/200700:00 PM
Phone Number: 608-769-3240 Paul Hester
- --- ---- ---- --- - - - ---- - - ---. - - - ---- - - - ---- - - - - ---- - ------ ------- - - .--- - - ----.- - ---- ----_.- ------ - - ---- - - ------ ---- - -- ---- -- --- ------ - - ---- - - ----- ---- - - _.-- --
Date 08/02/2007 Type Rough In Inspector Kevin Benner
Does not include the carwash building. Reviewed bonding of other systems.
approved
Date/Time requested: 07/31/2007 08:07 AM
Access:
Notice Type:
Ready Date/Time: 08/02/2007 00:00 PM
Requested by:
o Reinspect Fee 0 Fee Wavied
Phone Number:
D Reinspect Fee Paid
Date 08/09/2007 Type Service
r"'d ro wes B~7 1145 AM
Date/Time requested: 08/09/2007 08:38 AM
Access:
Inspector Adam Krause
approved
Notice Type:
Ready Date/Time:
08/07/200709:21 AM
Requested by: TD PADESKY ELECTRIC INC
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Phone Number:
Date 08/30/2007 Type Service Inspector Kevin Benner
GARWASH BUILDING ONLY!!
MCB is 65KAIC. If the available fault current is less that the MCB it is approved to energize.
approved w/cond.
DatelTime requested: 08/28/2007 08:58 AM
Access:
Requested by: TD PADESKY ELECTRIC INC Paul Hester
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Notice Type:
Ready DatelTime: 08/29/2007 00:00 PM
Phone Number: 608-769-3240
- - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - -- - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -- - - - - - - - - - - _.- - - - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - --
Electric Permit Work Card
) Job Atldress 2400 S WASHBURN ST Permit Number 125545 Create Date 6/27/2007
Owner C S I WI L TD PRTSP Contractor TD PADESKY ELECTRIC INC
Service . New 0 Change 0 Temp 0 N/A Type 0 Overhead . Underground 0 N/A
Volts 120/208 Circuits Luminaires 26
Amps 600 Switches 4 Receptacles 20
Value
$70,000.00
643 - Commercial-Addition/Remodels COMM / NEW KWIK TRIP - CAR WASH WIRING TO INCLUDE BOILER,
RADIANT HEATERS AND CAMERA SYSTEM
Use/Nature
of Work
Inspections:
Date 08/30/2007
r;'1d R'"",
Date/Time requested: 08/30/2007 00:00 AM
Access:
Type Abv Ceiling
Inspector Kevin Benner
approved
Notice Type:
Ready Date/Time: 08/30/2007 00:00 AM
Requested by: TD PADESKY ELECTRIC INC
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Phone Number:
-------------------------------------------------------.------------------------------'-----------------------------------------------------------------------
Date 08/30/2007 Type Consultation Inspector Kevin Benner not approved
Discussed the Work Space issues with the condensing units for the coolers & freezers & the power wiring and CL2 wiring in the same
raceway to the fuel dispensers
Date/Time requested: 08/30/2007 00:00 AM
Access:
Requested by: TD PADESKY ELECTRIC INC Paul Hester
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Notice Type:
Ready Date/Time: 08/30/2007 00:00 AM
Phone Number: 608-769-3240
------------------------------------------------------------------------------------------------------------------------------------------,------------------
Date 08/31/2007
Type Consultation
Inspector Kevin Benner
approved w/cond.
Heview the work space issues for the cooler / freezer condensing units
Date/Time requested: 08/30/2007 01 :33 PM
Access:
Requested by: TD PADESKY ELECTRIC INC
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Notice Type:
Ready Date/Time: 08/30/200701:33 PM
Phone Number: 608-769-3240 Paul
---------- - - - ---- - ---- -. - - - --- - - - ------ - - ---- --- ---- - - - -_.- - - ---------- - - ----- - - ---- - - - ---- --- ----- - ---------- ----- - ---- - -- -- -- - ---- - - --- --- ------ ---- - - - ---
Date 09/10/2007 Type Consultation Inspector Kevin Benner not approved
Pre-Final Inspection
fsupport for speakers in the store ceiling, secure luminaires to the grid again, breaker blanks, GFCI's for counter receptacles where
~quipment is not difficult to move. These were the violations that we discussed the installation wasnot complete and this was not the finall
inspection. We also discussed Work Space violations with the car wash equipment & several disconnecting means issues to be corrected
'<'-
DatelTime requested: 09/10/2007 09:21 AM
Access:
Requested by:
o Reinspect Fee 0 Fee Wavied
Notice Type:
Ready DatelTime: 09/10/200709:21 AM
Phone Number: 608-769-3240 Paul
D Reinspect Fee Paid
- --- ---- - ---- - - - ---- - - - ---- - -- - ---- - - - ----- - - - ---- - - - ---- - ---- -- - ---- - - - ---- - -- --- -- - ---- - - ----- - - ----- - ---- - ---- ----- - - --- - - - --- - ----- - - - ---- - - ---- - ----- --
Electric Permit Work Card
, Job Address 2400 S WASHBURN ST Permit Number 125545 Create Date 6/27/2007
Owner C S I WI L TD PRTSP Contractor TD PADESKY ELECTRIC INC
,
Service . New o ChangeO Temp o N/A I Type 0 Overhead . Underground o N/A I
Volts 120/208 Circuits Luminaires 26
600 Switches 4 Receptacles 20 Value $70,000.00
Amps
Use/Nature ~43 - Commercial-Addition/Remodels COMM / NEW KWIK TRIP - CAR WASH WIRING TO INCLUDE BOILER,
of Work RADIANT HEATERS AND CAMERA SYSTEM
Inspections:
Date 09/12/2007 Type Final Inspector Kevin Benner not approved
ISeal seal offs, rec. for HVAC equipment, ground lugs for pylon signs, CL2 wiring in light poles with power wiring, ceiling speaker support,
GFCI protected rec.'s for counter by coffee equipment.
Date/Time requested: 09/07/2007 08:26 AM
Access:
Requested by: TD PADESKY ELECTRIC INC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type:
Ready DatelTime: 09/12/200700:00 AM
Phone Number: 608-769-3240 Paul
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - --
Date 09/13/2007 Type Re Final Inspector Kevin Benner not approved
~-Store Building Only! Power and CL 2 wiimg seperation in light pole for camera eq., work Space for the refrigeration compressors.
DatelTime requested: 09/13/2007 07:27 AM
Access:
Requested by: TD PADESKY ELECTRIC INC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type:
Ready DatelTime: 09/13/2007 00:00 PM
Phone Number: 608-769-3240 Paul
- - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --
Date 09/13/2007 Type Final Inspector Kevin Benner not approved
Carwash Building Only! Work space for the chemical.feed controllers, power and CL2 wiring seperation, K.O. closure, panel covers to be
'nstalled. Reviewed and agreed with Paul Hester.
DatelTimerequested: 09/13/2007 08:10 AM
Access:
Requested by: TD PADESKY ELECTRIC INC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type:
Ready DatelTime: 09/13/200708:10 AM
Phone Number: 608-769-3240 Paul
- - - - - -- - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - ~ - - -- - ~ - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - --
Date
Type Note
Inspector Kevin Benner
Paul stated that all violations are corrected except the work space issues for the refrigeration compressors. FCN was faxed to the E.C.
Date/Time requested: 09/13/2007 07:11 PM
Access:
Requested by: TD PADESKY ELECTRIC INC
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type: FC Ready DatelTime: 09/14/200707:11 PM
Phone Number: 608-769-3240 Paul
- - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - -.- - - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - ~ - - - -- - - - - - - - - - --
Electric Permit Work Card
Job Address 2400 S WASHBURN ST Permit Number 125545
Create Date 6/27/2007
Owner C S I WI L TO PRTSP
Service Ie New 0 ChangeO Temp 0 N/A
Volts 120/208 Circuits
Amps 600 Switches 4
Contractor TO PADESKY ELECTRIC INC
I Type 0 Overhead . Underground 0 N/A
Luminaires 26
Use/Nature 643 - Commercial-Addition/Remodels COMM / NEW KWIK TRIP - CAR WASH WIRING TO INCLUDE BOILER,
of Work RADIANT HEATERS AND CAMERA SYSTEM
Receptacles
20
Value
$70,000.00
Inspections:
Date 09/19/2007 Type Re Final Inspector Kevin Benner
he refrigeration contractor will be on site Thur 9/20/7 to finish the corrections for the refrigeration controls. All other violations will be
corrected on 9/17/7
Date/Time requested: 09/17/2007 01:42 PM
Access:
Notice Type:
Ready Date/Time: 09/21/2007 00:00 AM
Requested by: TO PADESKY ELECTRIC INC
Phone Number: 608-769-3240 Paul
o Reinspect Fee 0 Fee Wavied
o Reinspect Fee Paid
Date 09/19/2007
Type Re Final
Inspector Kevin Benner
approved w/cond.
Per Paul: all of the violations are now corrected.
The CarWash chemical feed pump work space violations are still not corrected.
Faxed notice to the E.C. \ The "C" Store is approved and Carwash has Temprary approval for 30days or until the violation is corrected which
evere comes first.
Date/Time requested: 09/18/2007 02:48 PM
Access:
Requested by: TO PADESKY ELECTRIC INC Phone Number: 608-769-3240 Paul Hester
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -.- - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - --
Date 09/21/2007 TYP~~ Inspector Kevin Benner
Iso see permit #125544 for additional inspections that could apply to this permit.
Notice Type: FC Ready Date/Time: 09/18/200702:48 PM
Date/Time requested: 09/20/2007 08:16 AM
Access:
Requested by: Reliable Plus Car Wash Systems
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Notice Type:
Ready Date/Time: 09/20/2007 00:00 PM
Phone Number: 920-538-1766 James
HVAC Permit Work Card
Job Address 2400 S WASHBURN ST Permit Number
125261
Create Date 06/06/2007
Owner C S I WI LTD PRTSP Contractor RON HAMMESS REFRIGERATION INC
Fuel U Gas I U Oil I ~I Electric I U Solar I I Solid I Value $60,000.00
System 0 New I 0 Replace I 0 Other I
l!'J Forced Air U Radiant I U Steam I l!'J AlC I U Vent I
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
~;~~U~ rSIDrn ~ IM~" HVAC b",w,_
Inspections:
Date 9/11/2007 Type Final Inspector Nicole Krahn not approved
NOTE: The inspection was not ready. It was a consultation with Jim regarding what needed to be finished. He'll call for a final inspection
when the project is ready.
DatelTime requested: 09/12/2007 07:08 AM
Access: I
Requested By:
o Reinspect .Fee 0 Fee Waived
Notice Type:
Ready DatelTime: 09/12/2007 07:08 AM
Phone Number:
o Reinspect Fee Paid
- - -- - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - -- - - --
Date 9/17/2007 TYP~
Inspector Nicole Krahn
Jrll~mllbve~
~~,,.,,~;~~~
DatelTime requested: 10/10/2007 12:30 PM
Access: I
Requested By:
o Reinspect Fee 0 Fee Waived
Notice Type:
Ready DatelTime: 09/17/2007 12:30 PM
Phone Number:
o Reinspect Fee Paid
- - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - - - - - - -- - - - - - - --- - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - - - - - - - - - - - -- - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - - - - - - --
HVAC Permit Work Card
Job Address 2400 S WASHBURN ST Permit Number 125~ Create Date 06/06j?007
Owner C S I WI LTD PRTSP Contractor RON HAMMESS REFRIGERATION INC
Fuel [:?~[Gas-I OOTI--i U ElectriC] OSOfar] OSoildl Value $38,000.00
System 0 New ~ 0 Replace ~ U Other I
D-Forced~ ~~_~~::J U Steam ~---, DA7C---::J U Vent I
D~EiectiiCl ~ Hot Water] QSUPP["==:J U Con. Burn~
Chimney Type 0 Chimney A 0 Chimney B 0 Direct Vent . Not Applicable -.J
Use/Nature f.'ar Wash /Install hot water radiant heat for ingress and egress to car wash and infra-red heat in wash bays.
of Work
l
I
Inspections:
Date 8/2/2007 Type Rough In
Inspector Nicole Krahn
approved
[~e" 11",
Date/Time requested: Q.!3.IQ.1~QQZ..~~_ Notice Type: __ n____ Ready Date/Time: 08/01/2007 08:22 AM
Access: Qpen -=~-=_=_:=-===-===---=---_--_:=---=o~:~o:~-:~----::J
Requested By: RON HAMMESS REFRIGERATION INC Phone Number: Ron - 608-788-3110
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
---.-----------l
I
,
..._.___.____,---------.J
_ _ ~ _ ~. ~ _ _ _ .__ _ _ M ____ _ _ __ _ _____ ~ _____ _ ______ w ___ ~ _ ~ _ _ _._ _ _ _ __ ~__. __.___ _ ______ ~ __ _ _ _ ______ M ____ _ _ .__ _ ______ _ _ ___ _ _.__ _ ______ _ ___ _ _ ______ _ _____ _ ____ _ - __ -- M - ---- - - - -- - _.- -- - ---
Date 9/11/2007 Type Final Inspector Nicole Krahn not approved
tOTE: The inspection was not ready. It was a consultation with Jim regarding what needed to be finished. He'll call for a final inspection II
I hen the project is ready.
L ----~
Date/Time requested: 09/12/2007 07:08 AM
Access: I'
Requested By:
o Reinspect Fee 0 Fee Waived
Notice Type:
Ready Date/Time:
09/12/2007 07:08 AM
--~:::o===-_=
Phone Number:
o Reinspect Fee Paid
..---.--------------------------.-------------------------------..,----------------------------------------------------.----------------------.--------------------------------
Date 9/17/2007 Type'f'jn<lC~lilir~~,
'~:~}-;'>:\\"":~ff.:"''C1':~:i,,,~;'''0(<'iili<i;...
Inspector Nicole Krahn
approve
~
Date/Time requested:
,--
Access: l_,__
Requested By:
o Reinspect Fee 0 Fee Waived
10/10/2007 12:29 PM
Notice Type:
Ready Date/Time:
09/17/2007 12:29 PM
----_.._.._-----~ .----_.... '.-..,--
._----_._-~...,--,--_.~_._"'_._-~---------~-_._----~--- ._--,_.__._,~~----_.,.,-'-_.__.
=====~--=]
Phone Number:
.----
o Reinspect Fee Paid
Owner
Job Address 2400 S WASHBURN ST
~.,--------~~--~.._--
C S I WI LTD PRTSP
Plumbing Permit Work Card
Permit Number 125574
Category
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
440 - Industrial-Interior
._._"_.._-----_.~-~--------------
Shower Water Softner
-
Floor Drain 8 Local Waste
--
5 Lndry Tray _ Clothes Wshr
~ Disposal __ Bidet
___ Dishwasher __ Beer Tap
Sump Pump ~. Lab Sink
Classrm Sink _ Sterilizer
_ Breakrm Sink _ Dip Well
_ Ejector/Grind _ Drink Ftn
4 2silcock,1 mallmix,1 smoolhie macho
2
1
12
Roof Drain
Misc.
Fixtures
Use/Nature Interior plumbing for new Kwik Trip store.
of Work
Sanitary Sewer
Storm Sewer
Water Service
Size
Material
Contractor
Plan
Create Date 06/29/2007
ACTION PLUMBING
--_.._'-_._..~._-----_.._._--,---------
C3}-2~~:Q.I06-,=-___ Val ue___ ____J30, 000.:92
Coffee Maker 6
Int Grease Trap _J
Ext Grease Trap
RPZ Valve
Eye Wash Statn ~_
Wtr Sewer Mtrs
Deduct Meters
Wtr Usage Mtrs _m..
2 Wait. St. -,~--- Shamp Sink
--- ----~
Ice Chest -_._~ Flr/Wst Sink -
--
Exam Sink Catch Basin
- - -
Sculry Sink 1 Wash Ftn
- -
Hand Sink 1 Urinal 3
- - -
Plaster Sink --- Standp Rec --
-
- Surgeons Sink --- Ice Maker ---
F Prep Sink 1 Gar Drain
- --.--
Serv Sink 1 Soda Disp 2
--- - ----
.-
Type
#
Conn.Type
,
Inspections for Work Card 92884
Date !~?!}007 _ Type Underground _ Inspector Pa~1 W~_
approved
--I
1
IPartiaf underground. -
i
Date/Time requested: 7/3/2007 07:59 AM
Access: I
L
Notice Type:
Telephone Number:
---~=-------~
Ready Date/Time: 7/3/2007 07:~~~~ Requested By: AC!!()_"!E'=-UMBINQ.______________~
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
____________w________________________________________________.________________________________..____________----0..---------------------------,----------------------------------..-------------------
Date 7/3/2007
Type~dergr()und______ Inspector Paul\flJ'I~lf___
not approved
jRellervenfrequTredonClrcuTtvent wlth4Oi--nrore-fixtu res per COM r.,irS2_3f.
i
I
I
.. I
i._. ~_~_.______
I
I
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I
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__---.J
DatelTime requested: 7/5/2007 07:31 AM Notice Type: FC Telephone Number:
Access: [----------
Ready Date/Time: 7/5/2007 07:31 AM Requested By: ACTION PLUMBING
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
----~
..._._ _-.--J
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ __ _ _ _ _ _ _ _ _ _ _0_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ w _ _ _ _ _ _ _ _ _ _ _ ~ _ _ _ ~ _ _ _ - - - - - - ~
Type Underground
Inspector Paul Wolf
approved
Date 7/5/2007
[OWV completed, installing water will be ready late afternoon.
i
____J
Date/Time requested: 7/9/2007 09:48 AM
Access:
Notice Type:
Telephone Number:
Ready Date/Time: 7/5/2007__ Q.~~~~~_ Requested By: ~CTIQN PLU~~I~Q.
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
_ w ~ ~ _ _ _ _ _ _ _ _ _ _ _ w ~ _ ~ _ _ _ _~ __ _ _ _ __ ~ __ _ _ ~ _ w ~___. _ _ _ ~ _ ___ __ _ _ _ ___ _ ____ _ _ ____ _ ~ __ ~_ ~ ______ _ ___ _ _ __ ~_~ _ ~ -~ M _ M __ ~__ _ _ _ _ ~ _ ~ ~ _ _ ~ M _ _w - - ~ - -- ~ - ~ ~--- - -- ~ ~ ~ ~ ~ ~ - ~ --
Date 7/5/20QZ___ Type Undergr~!!.!!~~ Inspector ':l_a_ul~o_I~_____~______ approved
~eSfi)assea-on-DWV. .Water has been installed underlfOorfomechanici:iTroorn.---------------------~-------------~----- --1
I
I
I
i
_ ___________________J
i
l..
Date/Time requested: 7/9/2007 09:56 AM
Access: 1-
Ready Date/Time: 7/5/2007 12:00 PM Requested By: ACTION PLUMBING
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Notice Type:
Telephone Number:
-----------~=====J
Inspections for Work Card 92884
Date 7/31/2_q07 _ Type '3-9~~hln______ Inspector ~<3_~I_'{II_ol!__
approved
Date/Time requested: 7/31/2.0.07.08:18 AM
Access:
Notice Type:
Telephone Number:
Ready Date/Time: 7/31/2.0.07 .08:18 AM Requested By: ~CT~OJ'JJ'J:~~~If',/~___
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Date 9/12/2.0.07 Type Final
Inspector Paul Wolf
approved w/cond.
lI\cces-s-requTred at floor clean out per 82.35 near fountain area and test report required for RPZ valve.
i
i
L ___
Date/Time requested:
Access:
.__.___._____~_,_________....__.J
9/12/2.0.07 .08:2.0 AM
Notice Type: Telephone Number:
Ready Date/Time: 9/12/2.0.07 .08:2.0 AM__ Requested By: J:\gIIQN_i'.!-~rv1~If',/g
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Date 9/17/2.0.07 -- --- _______;~~-~~~~~;--~-~~I-;;;~;;u------ h_______________ __h____:___~p~~-;;;------- - h__ ---- ---- ---- - ---- ----- ___u ------------
;.4.~._-..- ________~_~.______~___~_~~_________._____~"'~.,:.>,.-"~.~..,'><,.~,;..;;,-,_,;:;,.'.,'>.~
.---------~~----,--- --I
'Corrections completed.
I
I
___ J
Date/Time requested: 9/18/2.0.07.08:.05 AM Notice Type:
Access: 1-----
Ready Date/Time: 9/17/2.0.07 .o8:.o? A~ Requested By: ~CTIQf',/ PLUMBING
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Telephone Number:
..-----------.--..-.-..---.--------,
j
Job Address 2400 S WASHBURN ST
Owner C S I WI L TO PRTSP
Category 440 - Industrial-Interior
-~--_.._--~._~~-_.
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature
of Work
Shower
Floor Drain
Lndry Tray
Disposal
Dishwasher
Sump Pump
Classrm Sink
4 Breakrm Sink
1 Ejector/Grind
3 hose bibb
Plumbing Permit Work Card
Permit Number 125575
Contractor ACTION PLUMBING
-----.._~------_._-
Plan G2-202-0706-P Value
Water Softner
4 Local Waste
Clothes Wshr
Bidet
Beer Tap
Lab Sink
Sterilizer
Dip Well
Drink Ftn
Create Date 06/29/2007
__~____ $30,Q.OO.Og
Wait. St. Shamp Sink Coffee Maker
Ice Chest Flr/Wst Sink Int Grease Trap
Exam Sink Catch Basin 2 Ext Grease Trap
Sculry Sink Wash Ftn RPZ Valve
Hand Sink Urinal Eye Wash Statn
Plaster Sink Standp Rec Wtr Sewer Mtrs 1
Surgeons Sink Ice Maker Deduct Meters
F Prep Sink Gar Drain Wtr Usage Mtrs
Serv Sink Soda Disp
lfilterlor-plumbing for new Kwik Trk,-carwash center:----------~-----------~-----
I
!
i
L
Sanitary Sewer
Type
#
Conn.Type
Storm Sewer
Water Service
Size
Material
Inspections for Work Card 92885
Date 7/10/29-~~ Type Underground _ Inspector .':~ul~0__________________ approved
--1
i
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DatelTime requested: 7/12/200708:36 AM
Access: r----------
L_______
Ready Date/Time: 7/10/2007_ 08:36 AM Requested By: ACTI9N PLUMBING
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Notice Type:
Telephone Number:
____=:J
Date 8/1/2007
Type Rough In
Inspector Paul Wolf
approved
---l
I
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I
I
i
1.._____
I
-----.-------_____~__..__,_____,__._______,~___._.__._-_oj
Date/Time requested:
Access:
8/1/2007 07:55 AM
Notice Type:
Telephone Number:
Ready Date/Time: 8/1/2007 Q?y5 A~___ Requested By: ~_~!!9_t>l_.!'_~l}J\'1~~t_JQ...
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Date 9/12/2007
Type !"l~___~____ Inspector !:~LJI_'!Y~L_________________ not approved
~i1(fhead requ-ired on irrigation system between AVB and zone vaives_ Called Kwik Trip designer, Lea. -------------~---------l
i
I
I
I
l_____~_______ --------________________________________J
Date/Time requested: ~~~~_ Notice Type: FC Telephone Number: ________ _______________
Access: e-- -=----------------------~-----:-==_=.:::J
Ready Date/Time: 9/12/2007_ 08:2~ Requested By: ACTI~N PLUMBI~2.____
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Date 9/17/2007
Inspector Paul Wolf
~liTj(Thead installed serving irrigation system and test report filed for RP valve.-
I
I
,
i
l._________________..________.._...__.___..._______._."'_'_
Date/Time requested:
_.~,____~.___..H_.._.
Access:
9/18/200708:06 AM
Notice Type:
Telephone Number:
Ready Date/Time: ?!1Z~Q2~ ~:Q6 A~__ Requested By: ~CT!2.N PLUMBIN.s;_________
o Reinspect FeeQ Fee Waived 0 Reinspect Fee Paid
CITY OF OSHKOSH - DEPT. OF COMMUNITY DEVELOPMENT
SITE PLAN REVIEW - ZONING
Location of Property: 2400 S Washburn Street (Kwik Trip)
Date Rec'd: 6/21/06 & 5/4/07
Applicant Name: Leah Nicklaus Berlin, Kwik Trip, Inc.
Phone: 608-79.3-6461. . Fax:. 608-781-8960
Applicant Address: 1626 Oak Street
City: La Crosse
State: WI Zip: 54602-2107
Owner: KIN, LLC
Parcel Number(s): 13-2550-0000.1 3-2550-0 1 00.1 3-25 50-0200
Zoning: M-3PD
Type of Construction: Convenience/Gas Station with 2 Bay Carwash
Compliance Checklist
Yse
Lot Width
Lot Depth
Lot Area
Floodplain
~
Height
Front Setback
Comer Side Setbaok
Interior Side Setback
Rear Setback
Building Area
Access Regulations
Parlong Standards
Loading Standards
Vision Clearanco
Trans. Yard Standards
Screening
Landscaping
Lighting
Signage .
Meohanical Screening
:varJCUP/FI} Conditions
Gther
Comments/Conditions
Received CUP on May 23,2005. Attached is Res. 06-180B.
The three individual parcels must be combined to one.
NOTE: All mechanical equipment, ground or building mounted must be screened from view
of any street or residential property.
Signage will be discussed on separate page attached to this review sheet. Revisions and/or
additional information required.
Review Fee: $200.00
o Approved
lID Approved w/Conditions
o Denied
DHold
Reviewed by: David Buck
Review Date: 5/4/07
COPY: Planning
Please contact the Zoning Administrator at 920.236.5062 if you have any questions.
REVIEW AUTHORITY
As per Section 30-5 Enforcemem of the City Zoning Ordinance; the Director of Community Development. or designee. must approve all plans, except the following: (1) Alterations or interior
work when the use is conforming and when no change in use is proposed. (2) Maintenance items, e.g. siding, windows, etc.. when the use is confonning and when no change is proposed:
1:\Plmlll'ing\Z()niug Admllllslra!iol1\Zoning Compliance ChL'Ck Li~ts\2007\Mny\24f)O S Wil:'ihburn . Kwik Trip.doc
pplicant Engineering
.~ ~i~9;;iQ
Safety and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601-1831
TbD #: (608)264-8717
www.commerce.wi.gov/sb/
www.wisconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
June 30, 2006
CUST ill No. 268341
ATTN: Buildings & Structures Inspector
TIM LARSON
LARSON ARCHITECT S C
300 N SECOND ST
LA CROSSE WI 54601
MUNICIPAL CLERK
CITY OF OSHKOSH
PO BOX 1130
OSHKOSH WI 54903
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/30/2008
SITE:
Kwik Trip Stores #457
Washburn St / Ush 41/ Sth 44
City of Oshkosh, 54901
FOR:
Facility: 674300 KWIK TRIP STORES #457 STORE
WASHBURN ST / USH 41 / STH 44
OSHKOSH 54901
Object 1;ype: Building ICC Regulated Object ill No.: 1084662
Major Occupancy: Mercantile; Type VB Combustible Unprotected class of construction; New plan; 6,160 project sqft;
Unsprinklered; Occupancy: B Business, M Mercantile; Component(s) submitted with this transaction: HV AC ICC
Object Type: HV AC ICC System .. R.egUlated Object ill No.: 1084663
Smoke detection system; 6,160 sq ft Area Heated
Facility: 674301 KWIK TRIP STORES #457 CAR WASH
WASHBURN ST / USH 41 / STH 44
OSHKOSH 54901
Object Type: Building ICC Regulated Object ill No.: 1084665
Major Occupancy: Business; Type VB Combustible Unprotected class of construction; New plan; 2,805 project sq ft;
Unsprinklered; Occupancy: B Business; Component(s) submitted with this transaction: HV AC ICC
Object Type: HV AC ICC System Regulated Object ill No.: 1084666
2,805 sq ft Area Heated
The submittal described above has been reviewed for conformance with applicable Wisconsin
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner E D
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requiremen
The following conditions shall be met during construction or installation and prior to occupancy or use: JUL 1 2 2006
Key Items DEPARTMENT OF
· IBC 2603.7 -Verify that the ~-door freezer complies with this section, or that it has been t~QMM~~!Td\{nt\EVELOPMENT
with a current Wisconsin BuildingProducts Evaluation.
· IMC 606 - Provide a duct smoke detection system in the return air duct of AHU-1. The smoke detection system
shall shut down the air distribution system upon activation. Smoke detectors shall be connected to a fIre alarm
system (where fIre alarms are otherwise required). The activation of a smoke detector shall activate a visible
and audible supervisory signal at a constantly attended location unless exceptions are met. The detectors shall
be located in the return duct.
TIM LARSON
Page 2
6/30/2006
1":,-' I
"
Submit
· Comm 61.30(3) - TIlls approval does not include the canopy structures shown on the plans. The canopy
structures shall be submitted for review and approval prior to construction.
· Comm61.30 (3) - Submit, prior to installation, one (1) set of properly signed and sealed precast concrete plans,
a completed SB-118 application form including this transaction number and signed by the building designer, and
$100 submittal fee to Safety & Buildings, P.O. Box 7162, Madison, WI 53707-7162. Note as per Comm
2.31(1)(d)6. the fee for a structural component erected prior to plan submittal may be an additional $200.
· Comm 61.30(3) - Submit, prior to installation, one (1) set of properly signed and sealed roof truss plans, a
completed SB-118 application form including this transaction number and signed by the building designer, and
$100 submittal fee to Safety & Buildipgs, P.O. Box 7162, Madison WI 53707-7162. Note as per Comm
2.31(1)(d)6. the fee for a structural component erected prior to plan submittal may be an additional $200.
Reminders
· IBC 1l01.2/ANSI A1l7.1-308.2& 3 - Mechanical system controls shali 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 floor space allows
a parallel approach.
· This review does not include approval or registration for the installation of Boilers and Pressure Vessels
indicated on this plan. The installation of any Boiler or Pressure V essel shall be registered with the Department
by the installer before the system is placed in operation as prescribed by COMM 41.41. Registration shall be in
writing on Form SBD-63 14. This form, and additional information, may be obtained via telephone at 608-266-
1818 or via the Internet at http://www.commerce.state.wi.us/SB/SB-DivForms.htrnl#Boilers
· Comm 61.30(3) - TIlls review does not include lighting. Comm 63.0001. Prior to installation, lighting plans and
calculations shall be prepared in compliance with the code and properly signed and sealed. The plans shall be
available at the job site as requested by the Department representative or local official.
· Comm 61.36(1)(a) & (b) - This approval will expire 2 years after the date of this letter if the building shell is
not closed in within those 2 years. Also, this approval will expire 3 years after the date of this letter if the work
covered by this approval is not completed and the building ready for occupancy within those 3 years.
A copy of the approved plans, specifIcations and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. Ifplan index sheets
were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to
plans that correspond with the copy on fIle with the Department. All permits required by the state or the local
municipality shall be obtained prior to commencement of construction/installation/operation. If this construction
project will disturb one or more acres ofland, an Erosion Control Notice ofIntent (NOl) shall be fIled with the
department 14 days prior to any earth disturbing activities.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
John P Pearse
Building Plan Reviewer , Integrated Services
(608)789-7852, M - F, 7:45 a.rn. -4:30 p.m.
john. pearse@wisconsin.gov
Fee Required $ 800.00
Fee Received $. 800.00
Balance Due $ 0.00
cc: Peter R Ochs, State Building Inspector, (920) 948-3500, Friday, 7:45 a.m. - 4:30 p.rn.
Brad Fry, Kwik Trip Inc
Robert Stone, JDR Engineering Inc
Jon P Wolf, Boiler Inspector, (920) 723-0032
LEWIS BAUER
Page 2
8/10/2006
;;.
municipality shall be obtained prior to commencement of construction/installation! operation. If this construction
project will disturb one or more acres ofland, an Erosion Control Notice of Intent (NO!) shall be filed with the
department 14 days prior to any earth disturbing activities.
In granting this approval the Division of Safety & Buildings 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 tliis review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead. (
Fee Required $
Fee Received $
Balance Due . $
610.00
610.00
0.00
~CL) ~
Warren Douglas Erler
Plan Reviewer, Integrated Services
(608)789-4690, Mon - Fri; 7:45 am - 4:30 pm
doug.erler@wisconsin.gov
WiS,MARJ:<:Qde:1648
cc: Peter R Ochs, State Building Inspector, (920) 948-3500 , Friday, 7:45 A.M. - 4:30 P.M.
, Bryan Novy, Kwik Trip Inc (Plans Mailed To)
King Manufacturing Corp
Wanen Baley, SteelKing Construction
, ,/
"""'-/I commerce.wi.gov
~!!E9o~!Jen
Safety and Buildings
4003 N KINNEY COULEE RO
LA CROSSE WI 54601-1831
TOO #: (608) 264-8777
www.commerce.wi.gov/sb/
www.wisconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
August 10,2006
CUST ill No. 271657
A1TN: Buildings & Structures Inspector
LEWIS BAUER
BAUER ENGINEERING CO
1037 S GEORGETOWN TERRACE
BEAVER DAM WI 53916
BUILDING INSPECTION
CITY OF OSHKOSH
POB 1130
OSHKOSH WI' 54902
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/10/2008
SITE:
Kwik Trip Stores #457
Washburn St / Ush 41/ Sth 44
City of Oshkosh, 54901
FOR:
Facility: 674898 KWIK TRIP STORES #457 GAS CANOPY
WASHBURN ST / USH 41 / STH 44
OSHKOSH 54901
RECEIVED
Object Type: Canopy, Free Standing Regulated Object ill No.: 1089901
AUG 1 4 2006
DEPARTMENT OF
COMMUNITY DEVELOPMENT
Facility: 674899 KWIK TRIP STORES #457 DIESEL CANOPY
WASHBURN ST / USH 41 / STH 44
OSHKOSH 54901
Object Type: Canopy, Free Standing Regulated Object ill No.: 1089902
The submittal described above has been reviewed for conformance with applicableWiscorisin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. TheoWIler, as defmed in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. ,:
The following conditions shall be met during construction or installation and prior to occupant;' ~r use:
Also Address
· IRe 3105.3 Column-supported canopies that are used for weather protection only may meet this section.
Provide canopies which are constructed of a rigid framework with an approved covering that is flame-resistant
(NFPA 701) or has a flame spread not greater than 25 when tested per ASTM E 84. Canopies over occupied
areas are considered part of the building proper and' shall meet the general class of construction and opening
limits.
. Comm 61.36(1)(a) & (b) This approval will expire 2 years after the date of this letter if the building shell is not
closed in within those 2 years. Also, this approval will expire 3 years after the date of this letter if the work
covered by this approval is not completed and the building ready for occupancy within those 3 years.
A ~opy of the approved plans, specificatio~sand this letter shall be on~site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. If plan index sheets
were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to
plans that correspond with the copy on file with the Department. All permits required by the state or the local
b:
'::
'~'.'C 0 mmer Ce,oWi:.9,OV
'. ISCOnsln
.... . . . . n~ellartR,1~.,t of. ~ommer~~n .
Safety and Buildings
4003 N KINNEY COULEE RO
LACROSSE WI 54601-1g31 n
TOO #: (608) 264-8777
www.commerce.wi.gov/sb/
www.wisconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
February 16, 2007
CUST ID No. 240539
BRAD FRY
KWIK TRIP INC
1626 OAK AVE SOUTH
PO BOX 2107
LA CROSSE WI 54602-2107
ATTN.' Buildings & Structures Inspector
BUILDING INSPECTION
CITY OF OSHKOSH
POB 1130
OSHKOSH WI 54902
REGISTRATION OF COMMERCIAL BUILDING
SITE
EROSION CONTROL NOTICE OF INTENT
SITE:
Kwik Trip Stores #457
2400 S Washburn
City of Oshkosh, 54901
FOR:
Object Type: Soil Erosion Control Regulated Object ID No.: 1118871
Anticipated end date: 10/30/2007; Anticipated start date: 04/01/2007; 4.2 Acres disturbed area
This letter acknowledges receipt of a Notice of Intent with our agency.
By virtue of the owner's signature on the application form, he/she has indicated that an erosion
control plan and a long-term stormwater management plan meeting the requirements set forth in
NR 216.46 and 216.47, respectively have been developed and will be implemented.
Please note:
1. That earth disturbing activities shall not begin before 14 days after we received the signed
Notice oflntent application to our agency.
2. That this approval has not included any review by the Department of Commerce of the
required erosion control plan required general stormwater management plan or any plumbing
~
KWIK TRIP INC
Page 2
2/16/2007
plan for this project. Plan submittal may be required for any stormwater piping system on the
premises and any stormwater infiltration or reuse systems per s. Comm 82.20. These may be
submitted separately or as part of the general plumbing plan submittal.
3. That there may be erosion control inspections conducted by the Department of Commerce
during the construction ofthis project.
4. The owner shall retain the above mentioned erosion control and stormwater management
plans on the construction site and make them available to state and/or local inspectors as
requested.
5. That plan review and/or inspections by the local municipality and/ or DNR may be required by
local permitting ordinances or DNR rules.
6. The owner shall file a Notice of Termination with our department when the site has been
stabilized per NR 216.55.
Inquiries concerning this correspondence may be made to Brian Ferris at (608)785-9335, or at the
address on this letterhead. Please refer to the Transaction ID No. referred to in the regarding
line when making an inquiry or submitting additional information.
Sincerely,
Karla Arenz
License/Permit Prog Associate, Integrated Services
(608)785-9308, Mon, Wed, Thurs, Fri 10 am - 3 pm
karla.arenz@wisonsin.gov
cc: Peter R Ochs, State Building Inspector, (920) 948-3500, Friday, 7:45 A.M. - 4:30 P.M.
Bob Mueller
~ JUIHOc2D07( WED) 08, 31
::: ~
c
[]
D
LARSON ARCHITECT
(FAX)508 73d 5599
P. 001/002
C LARSON.
J:lARCHITECT
Date:J~ t.@tD1
Re: KT -.. 4ca1
~~~r\IW\
1924 Nakomis Avenue .
I:a Crosse, WI 54603 .
To: 1-l\0t....6 t;.R~I-TJ~'" c..rt'f ~f O~\'t~tt-1.~Z~~j
~Oe- ~\ ~\tS ~~ ~1.0-..'~~.~~8
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~ ~ ~FON \ltA(;(.." .
Copy:
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..~
Phone: 608-784-6808
1924 NAKOMIS AVENUE, LA CROSSE, WI 54603
FAJ{: 608-784-6599
J.UtJ-20-"2007(WED) 08: 31 LARSON ARCHITECT
(FAX)608 78d 6599
P.002/002
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D LARSON
DARCHITECT
LARSON ARCHITECT
(FAX)608 784 6599
P.001/OOl
Date: Me:: 10 I Q,7
Re: KWlK lRlP ~~
~M{Ncb.(~~
1924 Nakomis A venue
La Crosse, WI 54603
To: Cf\t of !?5~t-\
etJ\L.,p'~(Q l~fec-TtON
j~Je:a~ ~~~
FAX: ~U) ..~"!t6 -~o&r
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1924 NAKOMIS A VENUE. U\ CR.OSSE. WI 54603 Phone: 60S~784-6808
FAX: 608-784-6599
;::/
7-:,4
Drainage Grading and Erosion Control Plan Approval
Page 1 ofl
Dannhoff, Allyn J.
From: Nowicki, Laura E.
Sent: Wednesday, May 09, 20072:25 PM
To: Dannhoff, Allyn J.; Noe, Brian; Muehrer, Todd M.
Cc: Rabe, James E.
Subject: 2400 S. Washburn St-Kwik Trip Drainage Grading and Erosion ControlplaJ;1 Approval
May 9, 2007
Leah Berlin
Kwik Trip, Inc.
P.O. Box 2107
1626 Oak Street
La Crosse, WI 54602-2107
RE: Drainage, Grading and Erosion Control Plan Approval (2400 S. Washburn St.)
Dear Ms. Berlin:
This letter is to inform you that the Drainage Grading and Erosion Control Plan (dated May 2, 2007), which you
submitted on behalf of Kwik Trip, Inc., has been reviewed and approved. An encroachment agreement is required
for the landscaping and irrigation taking place on site. The City of Oshkosh will draft and forward this agreement
for your signature.
If you have any further questions regarding this project, please do not hesitate to contact us.
Sincerely,
James Rabe, P.E.
Civil Engineer II
cc: David Patek, P.E., Director of Public Works
Steve Gohde, P.E., Assistant Director of Public Works
Laura Nowicki, Civil Engineer I
Allyn Dannhoff, Director ofInspection Services (via email)
Brian Noe, Building Systems Inspector (via email)
Todd Muehrer, Zoning Administrator / Associate Planner
File
5/9/2007
Kwik Trip~ Inc.
1626 OakStreet.. P.O. Box 2107
La Crosse; WI 5460i;!,ol2t01
PhonE!; (60~} 7$1 "a9~.Fax; (6()~} l$Hi~$()
"TO serve our customers and community more effeciively ihananyone.elsebytMatlng oor
cu$/omers, ao-worl<ersaoo suppYers as we. personally; would Ijke lobe tteited..
DATE:
May 7, 2007
TO:
City of Oshkosh - Building Inspections
FOR:
Building Permit Application Fee
Valuation
Store: $445,000
Plumbing $35,000
Electric $50,000
HV AC/Ref. $120,000
Carwash $400,000
Plumbing $35,000
Electric $40,000
HVAC $35,000
Gas Canopy $100,000
Electric $10,000
Diesel Canopy $100,000
Electric $10,000
Site Improvements $340,000
Total $1,720,000
Fee:
$148.00
$4050.00
$4,198.00 Paid
Total Fee:
Kwik TripTM Stores * Kwik StarTM Stores * Convenience Transportation™, LLC * Tobacco Outlet PIUSTM
Hearty Platter™ * Hearty Platter Cafe™ * Hot Spot™ * Hot Spot™ Plus
AWL"
TRIP
l'ijii
Kwik Trip, Inc.
1626 Oak Street. P.O. Box 2107
La Crosse, WI 54602-2107
Phone: (608) 781-8988 . Fax: (608) 781-8950
RECEIVED
DATE:
April 19, 2007
APR 24 ZQn7
'70 serve our customers and community more effectively than anyone else by treating our
customers, co-workers and suppliers as we, personal/y, would like to be treated. - DEPARTMENT OF
COMMUNITY DEVELOPMENT
INSPECTION SERVICES DIVISION
TO:
City of Oshkosh - Building Inspections
FOR:
Building Permit Application Fee
Valuation
Store:
Carwash
Gas Canopy:
Diesel Canopy
Total
Fee:
$148.00
$4050.00
$4,198.00
Total Fee:
..
Kwik TripTM Stores * Kwik Star™ Stores * Convenience Transportation™, LLC * Tobacco Outlet PIUS™
Hearty Platter™ * Hearty Platter Cafe ™ * Hot SpOFM * Hot SpOFM Plus
I From: JllR
Engineering
8082717048
08/18/2007 23:47
1f138 P.001/002
BUILDINGS, HV AC, COMPLIANCE STATEMENT SBD-9720
This form Is required to be submitted by the supervising professional (architect, engineer, HVAC designer or electrical
designer) observing constructlon of projects within buildings with total areas 50,000 cubic feet or greater and bleachers
(Comm 50.1 O/Comm 61 :50). Failure to submit this form may result in penalties as specified .in Comm50.26/COmm 61.23
and/or local ordinances. This form must be submitted prior to the plan approval expiration date or another submittal may
be required.
General Instructions: Prior to the initial occupancy of new buildings or additions and the final occupancy of
altered existing buildings, submit this completed and signed form to:
· The municipal building inspection office (refer to the plan approval letter for agency address and
· Safety and Buildings, 10541N Ranch Road Hayward, Wi. 54843
Note: If the review was done by the municipality, the compliance statement goes only to the municipal building
inspector. A copy is not needed by Safety & Buildings.
Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)J.
1. PROJECT INFORMATION: Please fill in the following with information from your plan approval letter.
Transaction 10 Number _~_"1~'> _ Project Name---I'~~_7L.J..e.....::....:o.~ILOS.H #:~S:1
Site Number , l ~ I b"
. Site location (number & street) _ W~f:uLJ..LSr ju~.$~~ ~4-
. City 0 Village )('Town of 05&-tl'.D~_____Countyof \k1"~INe...~(:rO
2. PURPOSE OF THIS STATEMENT: (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 ID # __--.:___ )(HVAC Object 10 # 7,'Oedk{P2
. 0 Lighting Object ID # ( 5~)
D Partial Completion _____.
Desaiption of Portion Completed
A) "kt' Statement of Substantial Complianee .
)'" 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.
[J BUILDINGILIGHTING ITEMS .
1. Structural system including submIttal and erection of all building components
(trusses, precast, 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
ofconslruclion, fire slopped penetrations
6. Sanitation system (toilets, sinks, drinking facilities)
7. Barrier-free including Comm 1 B elevators and lifts
6. Energy envelope requirements
9. All conditions of building plan approval and ap.l)lIcable variances
The following items are not in compliance and must be addressed:
10. Exterior lighting & control requirements
11. lnterior lighting & control requirements
12. All conditions of lighting plan approval
and applicable variances
X HVAC ITEMS
1. HVAC system including final test
2. All conditions of HVAC plan approval and
applicable variances
B) D Statement of Noneomplianee
Due to the following listed violations, this project is not ready for occupancy:
C) [J Supervising Professional Withdrawn From Project (Use A or B above to indicate project status as ofthls date.)
D) [J Project Abandoned
3. SUPERVISING PROFESSIONAL SIGNATURE FQR: J QJ~'
[J Building VHVAC [J L1ghting__~...9 ,r- C _ S'fbrlJE tL , Date ....tJl.__
/" Name (please print or type) /1
Phone number C<<::6,. Z17 - nm Customer ID # A OS 'Z. 04L_s,gnature - f.Z6 . . . .
SBD-9720 (R.04I2005)
U~"'-J '.olooV ,...~.u...,~vv-rJ
From:JDR Engineering
8082717048
08/18/2007 23:47
0138 P.002/002
. BUILDINGS, HVAC, COMPLIANCE STATEMENT SBD-9720
This form is required to be submitted by the supervising professional (architect, engineer, HVACdesigneror 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/Comrn 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. PROJECT INFORMATION: Please fill in the following with information from your plan approval letter.
Transaction 10 Number 1-zA 14 ~ S" Project Name__~ I ~ :oz..lE.=_O s..w ~~--~7
S~t N b l' 'S I 0 ...,
I e urn er -- L.!2~___L-_____ I J
Site location (nUmber&. street)_~'~~~_~~A1t._~~~~___ .'
[J City Cl Village )t Town oc.1lS>~~___county Of,--~..J.!!JJ.J~.AA..,~CL-____
2. PURPOSE OF THIS STATEMENT: (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: tJ Building Object to # _______ XHVAC Object 10 # _l..Q~~.~
tJ Lighting Object 10 # ---:-_______ (CAe ~~~t-:l)
[J Partial Completion _________ ____
Description of Portion Completed
A) "trlf Statement of Substantial Compliance .
r To the best of my knowledge, belief, and based on onsite observation, construction of the following building and/or HV AC
items applicable to this project have been completed in substantial compliance with the approved plans and specifications.
o BUILDING/LIGHTING ITEMS .
1. Structural system jncl~ding submittal and erection of all buildIng components
(trusses, precast, metal building, etc.)
2. Fire protection systems (sprinkleni, alarms. smoke detectoni) designed, installed,
and tested (including forward now on back now 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-freeincluding Comm 18 elevators and lifts
8. Energy envelope requirements
9. All conditions of building plan approval and applicable variances
10. Exterior lighting & control requirements
11. Interior lighting & control requirements
12. All conditions ofligbting plan approval
. and applicable variances
XHVACITEMS
1. HVAC 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: _
S) [J Statement of Noncompliance
Due to the following listed violations, ~is project is not ready for occupancy:
C) Cl Supervising Professional Withdrawn From Project (Use A or B above to indicate projact status as of this date.)
D) [J Project Abandoned
3. SUP::~~Nx~~E~S=. L~~~Om~>JE: J ~DMo~
Phone number ~.::trl:JJZl Customer ID # l3 Sz..q:j.J_slgnature
SBD-9720 (R.04I200S)
0.,11..........-'" ,~., \..........,.""',...vv-J
SEP-17-2007(MON) 10: 22
LARSON ARCHITECT
(FAX)608 784 6599
P.002/002
Buildings, HVAC, Lighting Compliance Statement
This form is required to be submitted by the supelV/sing professionsl (architect, engineer, HVAC designer or electrical
designer) observing construction af projects within buT/dings with total areas exceeding 50,000 cubic feet and construction
of antennas. towers, and bleachers (ILHR 50.10). Failure 10 submit this form may result in penalties as specified in
ILHR 50.26 and/or Jocal ordinances.
General Instructions: Priorto the inlt/a/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 Sui/dings, P.O. Box 7.162, Madison, WI 53707-7162
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 \ '/..87 435" ~~~~c.6. ~'6~~ S~\.Cf
'. J ~~~~V\-" ~ \\\c.u.xJe; t::1-lCS' ~6~
Site Number 7' to l 07 'e61GJ'Q5\-\ ~ c\-CAR.""'~ Adlol.\) 8'1$ ~
Site location (number & street) 'Sl1t 4+ 1- \Y5it +\ f $.\PI\~t3~ ~ t. fCt<.OO~~~,t",:- ,
~ City 0 Village 0 Town' oJ 06"W-Dsl.t County of 1fJ1~~~O ~\1,ol
. ,
2. PURPOSE OF THIS STATEMENT: (Check Box A,' B. .c, or D to indIcate purpose and complete any other
applicable boxes and information. Attach additional p-ages if necessary.) ,
. r08"'1' .tbt..
Check lhose whIch apply: ta BUilding Object 10 # r 081- "s" ' 0 HVAC Object ro # ,
o Lighting Object 10 #
Cl . Partial CompleUon
. Description of Portion Completed
A) rZ Statement of SUbstantial Compliance
To the besl of my knowledge, belief, and based on onslle obse/'Va~on, construction of the following buildIng and/or HVAC,
items applicable to this project have been completed In substantial compliance with the approved plans and
. speclficaUons.
IX. BUILDING ITEMS .
1. Structural system Including submittal and erection of all building
componenls (trusses, precast, metal building, etc.)
2. Fire protection systems (sprinklers. alarms. smoke detectol'$) 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, lire walls, labeled
doors, class of construction
6. Sanitation system (toilets, sinks, drinking facilities)
7.Sarrier-free Includlng'Comm 16 elevators and lifts
B. ILHR 63 energy envelope
9. All conditions of building plan approval and applicable vaiian~ .
The following Items are not In compliance and must be addressed:
o HVAC ITEMS
. 1. HVAC system inclUding timal test
(rU-IR 64.53)
2. All conditIons of HVAC plan approval and
. applicable variances
o LIGHTING ITEMS
1. E;xterior Ughtlng & control requirements
2. Interior lighting & control requirements
3. All conditions of lighting plan approval and
applicable variances
B) 0 Statement of Noncompliance '
. Due 10 the following listed vIolations, this project is not ready for occupancy:
C) CJ SupervisIng Professional WIthdrawn From Project (Use A or B above to Indicate project status as of this dale.)
D) 0 Project Abandoned
3. SUPERVISING PROFESSIONAL SIGNATURE F R:
Pt Building 0 HVAC O' Lighting 1'1 60
Name {please print or Iype}
Phone numberbC8 '".84 ~u&tomer ID # 1.108 ~1-1_slgnature
. .., .
/
/
580.9720 (R..OS/98)
~r~p-IN;J(THU) 10,17
D
D
D
[I LARSON
DARCHITECT
1924 Nakomis Avenue
La Crosse, WI 54603
LARSON ARCHITECT
(FAX)508 784 5599
P. 001/002
Date: ~p.. P:,t 07
Re: KVJIK-rR\P
To: ~\CdB ~T\}j
g['/ 6r C)Sf1~*
FAX: '32..0-z..3b-~~t
,
CA@y STf<~Jc::,TuRe C6M.pl,~Hc..e s~-reJvt8N1-
Copy:
~
Phone: 608-784-6808
1924 NAKOMIS AVENUE, LA CROSSE. Wl54603
FAX: 608-784-6599
SEP-J3:;..2007( THU) 10: 17
LARSON ARCHITECT
(FAX)608 784 6599
P.002/002
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CORRECTION NOTICE / FIELD INSPECTION REPORT
JOB LOCATION: ~l\tr) '7) u..J~-t\eu:.AJ ~-;'l
CONTRACTOR: O,,~ (t'S'\.A)'!C..- ~~
PROJECTTOBEINSPECTED: Q.- S~~ 1~'S:.i\-
TYPE OF INSPECTION: ~ "-.>~ -fAb ) P- ~ "'
~
City of Oshkosh
Inspection Services Division
215 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
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
.. 'CODE INSPECTION RESULTS
I~\D~ ~~
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~
Affik~
-i}~\- ~ ti()
0, ) " }D"I
Date ofInspection
'fl Mailed/Faxed
qzo-- ~-~
Phone #
Print Name
Company
Signature:
Date