HomeMy WebLinkAbout2007-Certificate of Occupancy
City of Oshkosh
ON THE WATER
Approved:
Issued:
10/19/2007
10/19/2007
BFO Factory Shoppes LLC
6250 N River Rd 10400
Des Plaines IL 60018
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby issued for the interior alterations for DEB, tenant
space D210, located at 3001$ Washburn St as described in Building Permit
#126611.
This space shall be used for retail business and is located in the M-3 General
Industrial District.
LIMITATIONS:
Maximum number of persons: 264
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 no ve must be
complied with in order for this certificate to be vaJid.
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cc: Parsons General Contracting
Building Permit Work Card
Job Address 3001 S WASHBURN ST Permit Number 0126611
Create Date 9/5/2007
Owner BFO FACTORY SHOP PES LLC
Contractor PARSONS GENERAL CONTRACTING
Plan 22-2054-0807
Category 232 - Alteration Stores & Customer Service
Occupany Permit Required Flood Plain Height Permit ____.___. Class of Const:
Use/Nature D210 / DEB /Interior alterations to remove various walls and finish surfaces, 'combine spaces 210-230 Tnto-one tenanrspace- and I
of Wo.' 1.I,h. 9000 'flol,1. __ _____.1
HV AC Contr
Plumbing Contr
Electric Contr
Inspections:
Date ~!.1~~?2_~ Type ~~.!!!..__ Inspector AllynDann.~S'!f.___
iR-EQUEsrCfNE I READY FOR A RO.UGH .INSPECTION ---------.----------~-----------
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l._______
no time
Date/Time requested: 9/17/2007
Access: r-
Requested By: JACK
o Reinspect Fee 0 Fee Waived
01 :44 PM
Notice Type:
Ready Date/Time: 9/19/2007 00:00
--===~=--=--=-.J
Phone Number: (281) 639-4099_.____._._
o Reinspect Fee Paid
Date .1..0/19/?2.9l.. .~_ Type ~h In Inspector ~l.':!.P~~~!f.._
IReqi:iesifine"/ Above ceiling inspection. Discussed adding directional exit sign near rear exit access.
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approved
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Date/Time requested: 10/8/2007 08:43 AM
Access:
Requested By: PARSONS GENERAL CONTRACTING - Jack
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Notice Type:
Ready DatelTime: 10/10/2007: AM
Phone Number: 281-639-4099
Date 10/12/2007
r"'''1 II., I s.. FeN.
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Date/Time requested:
Access:
Requested By: PARSONS GENERAL CONI_f3AC.TING ~. Jac~____.___ Phone Number: ?81-639-4~______
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Type Final Inspector Allyn Dannhoff
Bottled water dispenser will be provided. OK when compliance statements are received.
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10/12/2007 10:18 AM
Notice Type:
Ready Date/Time: 10/15/2007: .AM
Date 10/19/2007 _ __ Type
Inspector Allyn Dann.hoff
approved
[ComplianceStatements received.
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u____~_~~___J
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Date/Time requested:
Access: C'
Requested By:
o Reinspect Fee 0 Fee Waived
Notice Type:
Ready DatelTime:
'---=-===::J
Phone Number:
o Reinspect Fee Paid
Page 1 of 1
Electric Permit Work Card
Job Address 3001 S WASHBURN ST Permit Number 126667 Create Date 9/10/2007
Owner BFO FACTORY SHOPPES LLC
Service ~ . Change 0 Temp. 0 N/A
Volts 120/208 Circuits
Contractor T RUCK ELECTRIC INC
----,----
I Type 0 Overhead . Underground 0 N/A
Luminaires
J
Value
Amps__~ Switches Receptacles
Use/Nature 6-43 - Commercial-Addition/Remodels 0210/ DEB /Interior alterations to combine spaces 210-230 into one ten-antspace'l
of Work and finish. 9000 sf total. To include a service change from 3 meters to 1 meter, new luminaires and associated circuits,
_pt,de, eto . J
$19,000.00
Inspections:
Date 99/18/_2_00~ Type !3_()Ug~___ Inspector ~~v!~~enner.._____________________ approved w/cond.
~;~~~f~f;~~~:s Rh~~~: ~~:r~o ~~e~G~~~~r;i~~~~i~a~r~:~~:~ is to-~-e-;e~:::~:o~:~:~::a~I~:-~:~i~:~~~~-:bO:.-~:~i:::~--l
rith Tom Ruck on site.
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Date/Time requested: Q.~H/~007 g~53 P~ Notice Type:
Access:
Ready Date/Time: 09/17/2007 12:53 PM
Requested by: T RUCK ELECTRIC INC - Tom Ruck
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number:
Date 10/10/2007 Type Abv Ceiling Inspector Kevin Benner not approved
REQUEST LtNE I READYFOR A ROUGH tNSPECTION 10110107 AFTER LUNCH - ----. i
~e"ewed with tom R,ole ENT 10 ple"m, Se"", the ty-wl", ,"pport, fo' the .,;,'og method, 10 the grid, EM Lt, 10 the "" "" to be 00
[he local lighting circuit. . .
Date/Time requested: 10/09/2007 01 :2..8 PM_Notice Type:
Access:
Ready Date/Time:
10/10/200700:00 PM
Requested by: TRUCK ELECTRIC INC - Tom Ruck__
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: (920) 410-1~_n______
Date 10/10/2007 Type Reinspect Inspector ~n Benner _ approved w/cond.
~bV Clg IField Request \ The corrections above the ceiling in the store area were not complete-but they were still working on-ilw-fienllefCl
he site. the violations in the rear were substantially complete but the emergeny lighting was not relocated toto local lighting circuit. ENT I
! as removed. The E.C. stated that he would now be installing speaker wiring. Some boxes still need covers. I approved to have ceiling tile!
~tart to be installed where the electrician is complete with his work. '
------ -.-.,..---.._________..________._..___._.____.________~.____.___._..____...___~.._____.--1
Date/Time requested: l(){!Ql200Z._1.:I.:QO_~_~__ Notice Type: Ready Date/Time: !9!_1.9~_90T 0_9_:Q()._f'tIt1
Access:
Requested by: T RUCK EL~CIRICI_~ To~_______
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 410-1979
Date 1 0/15/~ Type Final
'REOUESfTTNE/-READY FOR A FINAL INSPECTION
'**EITHER LATE AM OR EARLY PM"
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Inspector Kevin Benner
_ not approved
-___~J
Date/Time requested: 10/12/2007 04:~~ Notice Type: FC Ready Date/Time:
Access:
10/15/2007 00:00
Requested by: TRUCK ELECTRIC!!'!c:c..Tom Ruck_
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: (920) 410-~_______
Electric Permit Work Card
Job Address 3001 S WASHBURN ST Permit Number 126667
Create Date 9/10/2007
Owner BFO FACTORY SHOP PES LLC Contractor T RUCK ELECTRIC INC
-----~--~--~-------_.._--- -_....__.._-_._-_..~-_._--_._-_.._-_..~~_._--,._----~
Service R--N~--- .-ct;----OT----ON/A ---I TOO h d . U d dON/A .
l~_~~___ an~~~I11P__ J ype _____~r_Ela_________n ergr~~____~~____ ____J
Volts 120/208 Circuits Luminaires
Amps _~ Switches Receptacles __
Use/Nature 643 - Commercial-Addition/Remodels 0210/ DEB I Interior alterations to combine spaces 210-230 into one tenant space*
of Work and finish. 9000 sf total. To include a service change from 3 meters to 1 meter, new luminaires and associated circuits,
receptacles etc.
Value ____...$1g,..Q00.OO
Inspections:
Date 10/16/2007 Type Re Final Inspector Kevin Benner approved w/cond.
rhe interior signage is to be listed per the FCN &the exterior signage was being installed at the time of this inspection -I
L ~_~
Date/Time requested: 10/16/2007 08:13 AM
Access: Meet Tom on site
Notice Type:
Ready Date/Time: 10/16/200709:00 AM
Requested by: T RUCK ELECTRIC INC
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Phone Number: 410-1979
HVAC Permit Work Card
Job Address 3001 S WASHBURN ST Permit Number 127201 Create Date 10/10/2007
--
Owner BFO FACTORY SHOP PES LLC Contractor CENTRAL HEATING SERVICE INC
Fuel Dg~s I U Oil I U ElectrlCl ~~~ U So~ Value __$3,790.00
System D. New J 0 Replace J 0._ Q~h_~~~~__~
[{) ForceaAlrl U Radiant -J []Sle~= O-NC---i o Vent- _J
U Electric I U Hot Water J U Suppl. = 0 Con. Burner I
Chimney Type 0 Chimney A 0 Chimney B 0 Direct Vent . Not Applicable-.-J
Use/Nature ID210 /Install registers and smoke detectors per plan.
of Work
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Inspections:
Date ~.2{~?!?QOZ_ Type ~___ Inspector Ally~ Dannho.!!__~____n______
[See-FeN.-OK whe-" compliance i:itatements~are provlded:--------------------------------------- ------------- -------1
l_____n_________~________________________._________ ____________________________________________________oo_____.1
DatelTime requested:
Access: [--oo
Requested By:
o Reinspect Fee 0 Fee Waived
Notice Type:
Ready Date/Time:
----- ---_..__.~-
---.------___---;--._1
Phone Number:
o Reinspect Fee Paid
Date ~_0/19!?.2Qz... Type Final
romp,""re S""me,', rere"ed.
Date/Time requested:
Access: I
Requested By: Phone Number: ~__
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
_ M _ _ _ _ _ _ _ _ _ _ _ _ _ M _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ _ _ _ _ _ ~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ ~ _ __ _ _ ~ _ _ _ _ ~ _ _ _ __ _ _ _ _ _ _. _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Inspector Ally~ Dannhoff._
approved
Notice Type:
Ready Date/Time:
__________-..-J
Job Address 3001 S WASHBURN ST
Owner BFO FACTORY SHOPPES LLC
Category 440 - Industrial-Interior
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature
of Work
Plumbing Permit Work Card
Permit Number 126677
Contractor E C MERRILL INC
Plan
Create Date 09/11/2007
Value
__~__ $7,9~~gO
Shower Water Softner Wait. St. Shamp Sink Coffee Maker
Floor Drain 2 Local Waste Ice Chest FlrlWst Sink Int Grease Trap
2 Lndry Tray Clothes Wshr Exam Sink Catch Basin Ext Grease Trap
2 Disposal Bidet Sculry Sink Wash Ftn RPZ Valve
Dishwasher Beer Tap Hand Sink Urinal Eye Wash Statn
Sump Pump Lab Sink Plaster Sink Standp Rec Wtr Sewer Mtrs
Classrm Sink Sterilizer Surgeons Sink Ice Maker Deduct Meters
Breakrm Sink Dip Well F Prep Sink Gar Drain Wtr Usage Mtrs
Ejector/Grind Drink Ftn Serv Sink Soda Disp
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[5210{DEB StoreY / I ntenor alteratlons"tO comI:iTne- spaces216~230Intoonte-nanfspace-:------------------------ --- ----------------1
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Sanitary Sewer
Conn.Type
Storm Sewer
Water Service
Size
Material
Type
#
Inspections for Work Card 94078
Date 911~?QQ?__~_ Type !::!':l.~~I]~~______ Inspector F>_a_ul__':I!'.~lf___ ___~____
~ork -not complete at inspection. ..______~.~_._m_u_.._._._____.,_~____^_______,_.__,
not approved
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Date/Time requested: 9/12/200708:24 AM Notice Type: Telephone Number:
Access: [=~--
Ready Date/Time: 9/12/2007 08:24 AM Requested By: E C M!=RRILL INC ____~_______~~
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
I
_____~.._______.__.J
Date 9/12/2007 Type Underground
Inspector Paul Wolf
approved
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Date/Time requested:
Access:
9/13/200701:11 PM
Notice Type:
Telephone Number:
Ready Date/Time: 9/12/2001. 01 :11 PM_ Requested By: !=~M_E~f3-'--L'_=_!~_c::________________________
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Date 9/18/2007 Type Rough In
Inspector .f:c3.ul Wolf
approved
Date/Time requested: 9/18/200712:14 PM Notice Type: Telephone Number: __________________________
Access: C-- ---------- ------- ----~-===~=-------I
Ready Date/Time: 9/18/2007 12:14 PM Requested By: E C MERRILL INC
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Date 10/12/2007 Type Final
Inspector Allyn Dannh~____________ approved
!Request line
.__._.,.i
Date/Time requested:
Access:
Ready Date/Time: .1 0/11/2QQ} 07:_52 AM_ Requested By: ~.QlJI!=RRI_,-=-L INC .::l~_____
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
10/11/200~07:52 AM
Notice Type:
Telephone Number:
235-3600
~^-.-~-~--..--'~-~~~
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CORRECTION NOTICE I FIELD INSPECTION REPORT ~
JOB WCATION: -So<> / :" :...= ~i" r,:! )).210
CONTRACTOR: R f'-'s, K. .
PROJECT TO BE INSPECTED: 7<-l' h I
TYPE OF INSPECTION: p'iAo./
.
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 si~ and date at the bottom of this notice
and return it to the Inspection Services Division by the Compliance Date of j r- .
conE INSPECTION JU:SULTS
t:I ~ /;4 .
~~e.
.~'
Print Name
Company
Signature:
Date
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OJHKOfH
City of Oshkosh
Division of Inspection Services
215 Church Avenue
PO Box 1130
Oshkosh WI 54903-1130
www.ci.oshkosh.wi.us
ON THE WATER
August 21, 2007
Coutland Morgan
Coutlan Morgan Architect
711 Fielder Rd
Arlington, TX 76012
Scott Fisher
Prime Retail
217 E Redwood St 20th Floor
Baltimore MD 21202
Site: Plan Number: Z2-2054-0807
DEB
3001 S Washburn St. Space D210-D230
Oshkosh WI 54904
For:
Description: Tenant space alterations
Object Type: Building & HV AC
Class of Construction: lIB - 9000 Sq Ft.; Sprinklered
Occupancy: M: Mercantile / Retail
Maximum No of Occupants: 264
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and
Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in Chapter
101.01(10), Wisconsin Statutes, is responsible for compliance 'with all code requirements
Key Item(s) / Conditions:
. IBC 711.3 Any penetrations of fire rated assemblies are required to be protected with a listed firestopping
system that matches the rating of the wall assembly being penetrated. Copies of the firestopping systems
are required to be provided at the time of inspection.
. IBC 901.2 Fire protection systems shall be installed, repaired, operate.d and maintained in accordance with
this code and the international fire code. Construction of new walls may require the addition and or
relocation of sprinkler heads to maintain required coverage, and not obstruct spray patterns offire
sprinklers
. IBC 906.1 / IFC 906.3 The maximum travel distance allowed to a fire extinguisher is 75 feet.
. IBC 1003.2.11 Means of egress illumination is required to be installed per this section. All paths of egress
are required to have adequate emergency lighting to meet the performance requirements ofIBC
1003.2.11.3. Existing means of egress emergency lighting is permitted to be maintained in compliance
with the code in effect at the time of construction. Any altered path of egress, or new path of egress,
and any new emergency lighting being installed is required to comply with current code requirements.
The relocated exterior doors require emergency light on the exterior side of doors.
RCI'ic\\'\,Cummcrcial Pl;m Rev!cw 20(l7\Z?'-2()54()~()7 "OO! S 'Nashburn St Bkg &. HV:\C.doc
Page 1 00
. IMC 602.2.1 Materials exposed within plenums. Except as required by Sections602:2.L1 through
602.2.1.4, materials exposed within plenums shall be noncombustible or shall have a flame spread index of
not more than 25 and a smoke-developed index of not more than 50 when tested in accordance with
ASTM E 84. Caution on materials and equipment - i.e. speakers security equipment being located
above ceiling within the plenum space.
. IMC 606.2.1 Smoke detectors shall be installed in return air systems with a design capaCity greater than
2000 cfm......
. IMe 606.4.1 The duct smoke detectors shall be connected to afire alarm system. The actuation of a
smoke detector shall activate a visible and audible supervisory signal at a constantly attended location.
. IMC 606.4.1 Exception 2. In occupancies not required to be equipped with a fire alarm system, actuation
of a smoke detector shall activate a visible and an audible signal in an approved location. Smoke detector
trouble conditions shall activate a visible or audible signal in an approved location and shall be identifies
as air duct detector trouble.
. Comm 61.31(4) Revisions to approved plans. All proposed revisions and modifications which involve
rules under this code and which are made to construction documents that have previously been granted
approval by the department or its authorized representative, shall be submitted to the office that granted the
approval. All revisions and modifications to plans shall be approved in writing by the department or its
authorized representative prior to the work involved in the revision or modification being carried out. A
revision or modification to a plan, drawing or specification shall be signed and sealed in accordance with
Comm 61.31(1).
. MUN 30 This review does not include review for signage. Applications for and questions regarding
signage permits should be directed to Todd Muehrer- Associate Planner (920) 236-5057
SUBMIT:
. IRC 1003.2.11 Means of egress illumination is required to be installed per this section. All paths of egress
through The Retail Display area are required to have adequate emergency lighting to meet the performance
requirements ofIBC 1003.2.11.3. Provide complete emergency lighting plan showing compliance with
these requirements prior to installation of emergency lighting system.
. Comm 61.30(3) This review does not include lighting. Comm 63.0001 Prior to installation, lighting
plans and calculations shall be prepared in compliance with the code. Please submit lighting work sheets.
. Comm 61.50 (4) Supervision. Prior to the initial occupancy of an alteration the supervising professional
shall file a compliance statement form SBD-9720 with this office.
A copy oftbe approved plans, specifications, and this letter shall be on-site during construction. All pennits are required to
be obtained prior to commencement of work.
\\OSHKOSHMISFS'j)cpartmetTls\!nSPc'dinns\Plilfl Rcyic\\"Cornmen:ial Phm Review 20()7\Z2-2()54-()~07 3')0! S Wnshburn St B\lg & HVACdoe
Page2of3
In granting this approvaIthe. City of Oshkosh Inspection Services Department reserves the right to require changes or
additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designerofthe responsibility for designirig a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the number listed below or the address on this letterhead.
nan oe
Building Systems Consultant
(920) 236-5051 Monday- Friday 7:30 A.M. to 8:30 AM and 12:30 A.M to 1:30 P.M.
bnoe@ci.oshkosh.wi.us
cc: Property file
Fee Required $
Fee Received $
Balance Due $
860.00
860.00
0.00
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Page 3 of3
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OJHKOfH
ON THE WATER
City of Oshkosh
Division of Inspection Services
215 Church Avenue
PO Box 1130
Oshkosh WI 54902-1130
Office 920-236-5050
Fax 920-236-5084 '
Temporary Occupancy Permit Application
Address for the Requested Temporary Occupancy Permit: :500 ( -S', tJa sll ~ t-i1 b 2:1 0
Occupancy or Use of Structure: /2, e f-a. (' l - D E J3
Building Permit Number: 1;C Ie:. t:, { I
Issue Date: /0/1 t:-/07
, I
Applicant Information
Name: affej( U~/
t:/ /() . ,
Company Name: 1/11'500 {len/ dd'f
Mailing Address: 3%/7 u4ee~:Vt7- Rd' k~#!5'le/' 011,'0 r'5/36
Phone Number: ?~- C;'5c(-- $~ c. Fax Number: ?'~.- ~&"I- /~ fi'&:f
As (check all that apply) the owner, ~the General Contractor, _the Building Permit
Applicant, _the agent for, the owner, I hereby request approval for a T7;rary Occupancy Permit
at the aforementioned address. Temporary Occupancy is requested from /. ~b 07 (date) through
f z/'io 7 (date.) I agree to abide by any Conditions of Approval. I understand that Final
Occ ancy Approval or a Temporary Occupancy Permit Extension must be secured by the Temporary
Occupancy Permit expiration date or I may be subject to Municipal Citation issuance for each day the
structure is occupied without the required Occupancy Permit.
~dC/f' ~~e/
/ (Applicant Signature)
/0-- /t;-o 7
(date)
-------------------------------------------------------------------------------------------------------------------------------
Application StatusKAPproved
(Office Use Only)
Denied Expiration Date: 1C.~tf7Fee Collected /00-
Comments/Conditions of Approval: ltJeeof
~~eU4.t:~:5. '~v r2/~jk7
, I
E/~ ~. ;!uf1C C~;;~~e
Reviewing Inspector:
Date: /r~~~7
~I
~ 10/19/2007 12:18
7406811684
PARSONS CONTRACTING
PAGE 01
PARSONS GENERAL CONTRACTING
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,..........".."".,.........1""........"....,.,.,..........,. ..",..,.".
Dave Parsons
3817 Wheeling Road
Lancaster, Ohio 43130
Phone 740-654-3226
Cell 740-503..3606
Fax 740-681~1684
Send to: From:
City of Oshkosh, WI, Bnilding Dept. Dave Parsons
Attention: Date: lO~19-2007
Office Location: Office Location.:
Fax Number: 920-236-5084 Phon.e Number: 740-503..3606
1;1_ Urgent
l1{ Reply ASAP
'0 Please comment
ClPlcase review
~ For your information
Total pages, including cover: 3
Attacbed are Buildings, HV AC, Compliance Statements SBD-9720 (one each for Bllilding
Object and BV AC Obj~!)..foF-Deb"iSllo~IQ~~ roit is #126611. -
-- --- ~
P...... [ax. C.bO certlli<Ate ofoo"'pancy'o mo a' 748-681.1684. 'J
Than ks, --
Dave Parsons
10/16/2007 11:39
7406811684
PARSONS CONTRACTING
PAGE 02
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BUIL.DlNGS~HVAC, COMPLIANCESTATf..:v.I.ENT SBD.9720 .
ThJg fa,,,, III ~qui~ to b" cubmirktd by the I:upervl~dng profecslon::ll (atcM.c~ IlIngin.tr. HVAC ".Ignltor elaetrleal
designer) abltervlng construCtion of praject5 wit"l" bulfding. wIth totar areas 50,000 cubic f&et or jJt'fI8letand b~echel"!
(Com", 5O.101C0mm 51.SO). Falfure fl) slltlmlt In's form mlfy result In penaltles.s spocJfIer.f In Cornm tiO,2f(Comm 61.~3
and/or lo~ ordinancelll, Thla form my&t be $ubmillcd prior fa the plan apl)ro".' expirAtion date or eMottle.- .ubmiltl!ll may
be ~quired.
GeMr.J In.tn.u~t;ons: Prior to the initiol occupancy of new buildlng!l or adtfitioM and thoflnalo<<=upal""~,Y of
altenect existing buIlding" submit tl'als compleieCf anet lignect form to;
· Tfi. municipal buUdlng incpectron ofRc::e (refer to the plan apprDyal lel1er for agency IIddrDls.emI
· Safety and BUildings, 1~S"1N Ranch Read Hayward. Wf. 548a
NOle; lfthe rl!view was done by <<he municfpality. the c.ompllance statement goes onl,y to fhe mllnicipal blJJlding
Inspector. ^ copy Js not needed by Safety & Buitdlngs.
Personal informlllion you pl'C\lltfe rn8y bI! U!ed for St':CDnd8ry PUl'JlOSl!!1I [Prlvecy l.IW. s. 1$.04 (1,(rn)J.
1, PROJECT INFORMATfN: Please rrn in [he 'ai/awing \Vfth Information from yaur plan approval letter.
Tren_"", II) Numb.r ~~ -g&o1 Pn>jacI Nomo--.J:m · (~IJ( !1PN~ I
SIte Number :"_?PAcE:. .t( 2.10 - [?2:;O . - ,. .
Sire_. en....." A -l gC>OJ S ~ ~
· Ciiy CJ Villagg [] Town of ~ l':)t;'t-\ Knsc..\, ~C~~~f
2. PURPOSe 0'" THIS STATEMENT: {Check 90)( A, 9, C, or D to indicate purpose ami cc>mglete any other
Bpplll:able bcutes and Information. Attach 9dditionaI pagefl if necessary.)
Check tnose which apply: Cl BUilding t)bJecl ID , _ . HVAC Object I~. DuIq &It.\
C lIghtIng Object ID fI.
Q Partial Completion
Delc:ripticn Of F'Cll'lloll COmpletltd
A) C ShlltAem.nt of SUDstanUa. Campll""CM
To !hI!! blllSI 0' my Slnt:l~ecf5le, ber~e:1. anll based en Ollllllte observAtiOn, COrrslr\ll;tlon ar me ft)IIaWlng bulrtJing rJn~or HVAC
items ap~Iresbre to '''it Projeel "8~ be!!!l"I coPnpl.,ed In SLlbstanti.' eompli.,,~ with In. llIpproved plane and
apef;lIlcA(lon8.
J:l BlIflDINCIUGHTl/tIG ITEM$ .
1. Stf'lll:2Utar .Ylltft! inCluding sIoIb/'rimar ancJ lttlll:lIoJ\ af III bvlldl"g ta"'pOnentll
[trUitt'S, PI!!;II!, metJIl buIldIng. .'1:.)
2. FiJI: 1l1'Dtec:ti6., Cys.I.ms (a"inICIltr". alArms.. 81nDII!:I detector.) deafilled.
il'l8t.~!lf, 8\'Id 'utelt ClndudlIIJ faN,lAm flCHl 5" bacll: flow ~elm) by
8pp rep'III"~ ...,I511n1f JlfO~JCl"II"
:3. 9"." .nll stallWlllJ' enclOsuNt
... ElCfta II1c:llldlllg IIIfft .nlll d/ft!Cll4n.IIJsonts
5. F,....nlJlI~till. eClMlruelloll. '''cfOllUhl ""I'IlItAr$, fiM ~_.I.b~11!If doora.. ClllllS . WAe /TIMS
01 tDntlllll;1loll, "TO Itll~p.d ~"'ttrttlf)ll.
S. SIlIlIt.ltIcM I~~em (tolret~. 8Ink~, dffl7kln\7 'acl.sl'
7, s.rrler-r-rea'''l:ll.Idlll9 cc:J~ 73 "~IDIlI'l'llf lifts
S. Energy IlO"elOplt ~qu'rel'llenls
;, An GOndlticane aF DlIlIl1mg ~I*, .pprllv.llInlll .pplicab'1! vatl.'.lncu
The rolrowrnlllte"'. .", not iq campl/ance and tn~lt b. .dd.....ed:
,.,
10. ENrler 110"''''0 1& ~Mt'ol ftt!ultelm,....
11, In~tit)" JIQIlIil'lg ! ClIntrllil n:lIUirem.nta
,,2. All Ctll\dll rtlflt Dl' llghtfnll P"" '~prova,
.Md .P?'lcabl.. ".,J8nr::llS
t. HVAC .tllltl Inclu<llP'tll ,."., tell
2. All tlttl~iOl\. I)' MVAC pl,n .~fQn' 8nd
~llcabre nrilllncol
B) C Staf8mlftt 01 Nencompfi:lftCle
Due to Ole rLllI~lng ".kld vlAlltllllll, l~ If p~;I!r:1 ic nat rOI~ far ee~,,~~
=
C) C Supervlslng Prof...'ona' Willi drawn From ptN)j~c( (Us!! A ~r ! lbOve 10 '''1I1caM ptejl!tct -IMllt .a or 1hl1 data.,
D) 0 PI'DJoc.t Ablncfo"_a
, SUPE$RVISING PItOFESS'ONAL SrCNA TURE FOR;
e eu/Iftlg . ttVAC 0 Llghllng "'"' .
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iHn2r.llR.C4J20tJS.~
10/19/2007 12:18
7405811584
PARSONS CONTRACTING
PAGE 03
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