HomeMy WebLinkAboutCertificate of Occupancy
CITY HALL
Inspection Services Div
215 Church Avenue
PO Box 1130
Oshkosh WI
54903-1130
City of Oshkosh
ON THE WATER
Approved:
Issued:
11/05/2007
11/08/2007
River Valley One LLC
222 Ohio St
Oshkosh WI 54902
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby issued for the Tenant Space Alterations for
Sports Clips Hair Salon located at 540 S Koeller St as described in Building
Permit #126765.
This building shall be used for business only and is located in the C-2 Planned
Development District.
LIMITATIONS:
Maximum number of persons: 12
Certificate of Occupancy shall be required prior to occupancy, should additional
building(s) be erected, or should any buildings mentioned above be altered or
moved. The use of land, or buildings, shall not be changed until a Certificate of
Occupancy is issued for that occupancy. All conditions noted above must be
complied with in order for this certificate to be valid.
K ),~ wLt.~
Building Systems Inspector
cc: Delsman Construction
Building Permit Work Card
Job Address 500-550 S KOELLER ST Permit Number 0126765 Create Date 9/13/2007
Owner RIVER VALLEY ONE LLC Contractor DELSMAN CONSTRUCTION SERVICES LLC
Category 223 - Alteration Offices, Banks, Professional Plan Z5-2083-0807
Occupany Permit Required Flood Plain No Height Permit Not Required Class of Const:
Use/Nature ~40 S Koeller St/1200 sq. ft. Tenant space build out for "Sport Clips Hair Cuts", as per approved plans
of Work
HV AC Contr Plumbing Contr
Electric Contr
Inspections:
Date 10/4/2007 Type Rough In Inspector Nicole Krahn
REQUEST LINE / WILL BE READY FOR AN INSPECTION ON THE INTERIOR PARTITIONS
approved
DatelTime requested: 10/2/2007 07:52 AM Notice Type:
Access: ICODE IS #0328
Requested By: DELSMAN CONSTRUCTION SERVICES LLC - Joe
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Ready DatelTime: 10/4/2007 00:00 PM
Phone Number: (920) 901-4682
- - - - - - -- - - - - -- - - - - - - - - - - - -- - - - - - -- - - - - - - - - - -- - - - - - - -- - - - - --- - - - - -- - - - - - -- - - - - - - - - - - - -- - - - - - - - - -- - - - - - -- - - - - - - - - - - - - -- - - - - - - - - - - - - - - - -- - - - - - - -- - - - - - -- - - - - --- - - - - - - - - - --- - - - - - --
Date 10/31/2007 Type Final Inspector John Zarate
Request line / Joe wants to be there. Joe will have the address posted. There was a mix up with the post office.
approved wlcond.
DatelTime requested: 10/29/2007 01 :05 PM Notice Type: Ready DatelTime: 10/2912007 01 :05 PM
Access: ICode 0328
Requested By: DELSMAN CONSTRUCTION SERVICES LLC - Joe Phone Number: 920-901-4682
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - --- - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - --- - - - - - - - --
Date 11/7/2007 Type~~' Inspector Nicole Krahn:''SJij)Poved,J,
'<>;'Ot,,,'''''<l:''~.~'''''i#i;~''' ~:~:'""~"'~1::<:~
~ddress is posted and the compliance statements have been received.
DatelTime requested: 11/7/2007
Access: I
Requested By:
o Reinspect Fee 0 Fee Waived
08:24 AM
Notice Type:
Ready DatelTime: 11/7/2007 08:24 AM
Phone Number:
- - - -- - - - - - -- - - - - - -- - - - - --- - - - - -- - - - - - - --- - - - - - - -- - - - - - - - - - - - - - -- - - - - - -- - - - - - - - - - - - -- - - - - - -- -- - - - - - - -- - - - - - - - - - - - --- - - - - - - - - -- - - - - - - - - - - - --- - - - - -- - - - - - -- - - - - - -- - - - - - - - - -- - - - - --
D Reinspect Fee Paid
Page 1 of 1
Electric Permit Work Card
Job Address 500-550 S KOELLER ST Permit Number 126829
Create Date 9/18/2007
Owner RIVER VALLEY ONE LLC Contractor ENDEAVOR ELECTRIC
Service :. New 0 ChangeO Temp 0 ~J Type .~verhead~_Qu~nderground 0 N~~_j
Volts 120/208 Circuits 22 Luminaires 43
--
Amps ~~~ Switches __~ Receptacles _~~.
Use/Nature f3 - Commercial-Addition/Remodels 540'SKOELLERST7BUTCDOO'(TENANTSPACE FO-R"SPORT-CCH5s-RAIR:--l
of Work CUTS" i
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Value _ _u_____~_~,~Qg:QQ
Inspections:
Date 10/23/2007
._-~~
r;\1I of the'Wewere installed
I
I
Type ~~v Ceill~____ Inspector Kevin Benn~ru.___.____._u_.u._._
__ not approved
_mm m--m----l
_ .__..__.._______.___u_._____._.._.. __._._.________...J
i_
Date/Time requested: 1.0/23/2007 _ 08:1.Q..A_fI.!!__ Notice Type: FC Ready Date/Time:
Access:
10/23/2007 08: 1 0 AM
Requested by: ENDEAVOR ELECTRIC Dick ____~u
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
. n~~~~. ~'Oi26/200-~ _hm T;~~!b'tm. u m_.' hn.. hl~~'~~~~~;_' Ad~~'K~;~~~' nn. h u... m.' m. -... -.. .m.. '~~~r~~~~' n........
rEQUEST LINE / READY FOR A FINAL INSPECTION
(The sign will not be wired, it has not arrived yet and may not before the store opens)
Phone Number:
L
m_ ... ..~
Date/Time requested: )0/25/2007. 01:57 PM___ Notice Type:
Access: Front door lock box code is #0328
Ready Date/Time: 10/26/200700:00 PM
Requested by: !=_NDE~VOR.!.~~c;_"!:~~~Qi~~___ Phone Number: (920)7?~-1<400
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
- - - - - - - - - - - - ~ - - - - - - - - - - - - - - - . - - . - - - - - - - - - - - - - - - - - - - - - - - - - - -. - - - - - - - - - - - - - - - . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --
Electric Permit Work Card
Job Address 500-550 S KOELLER ST Permit Number 126829 Create Date 9/18/2007
Owner RIVER VALLEY ONE LLC Contractor ENDEAVOR ELECTRIC
----~
Service :e Ne~ 0 Change 0 Temp 0 N/A ] Type . Q",erhe~_~_O__Underground 0 N/A
Volts 120/208 Circuits 22 Luminaires 43
Ampsm____~QQ Switches ____~ Receptacles ______~
Use/Nature 643 - Commercial-Addition/Remodels 540-s-koELLER -ST"TSUILO- OUTTENANTSPACE FOR"SPCYRTCCfPSFiAIRl
of Wo,' CUTS. J
J
Value ________~~,.3SlQ:l?g
Inspections:
Date 09/25/2007 Type Underground Inspector Kevin Benner
r"""e"liiie I CO"1d yO" po"ibly do !hi, '"pedio" iod'Y, they WO"1d Ii'e to po", ooooreie iomorrow,
L-____
approved
Pie.., "" Dio' " E_"::O'__J
Date/Time requested: ~25/2QQZ.__ 07:3~ A~ Notice Type:
Access: Q.E~~__________n___________________ ____
Requested by: END~AVO-'3.E!-EC~~!Q.:_Dick__
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Ready Date/Time: 09/25/200710:02 AM
Phone Number: 920-729-1400
----------------------------------------------------------------------------------------------------------------------------------------.-----------------
Dafe 0~/25/~_ Type .LJ':l~9!Cl.~IlC!__ Inspector ~~"'ill_l3enn_e_~__~_____n_____ approved
r,eldRe<i'''' ' -_-----------------~-----------------------J---
L_______
Date/Time requested: 09/25/2_007_ 00:00 A~ Notice Type:
Access:
Ready Date/Time:
09/25/2007 00:00 AM
- ----- - - - -- - - - - - --.-- - - - -- ---- - -- --- - ---.-- - ----- - - -- ----- - ----- - .-- - - -- - -- - ---- - --- - - - ---~ - ~ ---- - - ~ -~ - ~ ----- - - - ~ ~ - - - -- - ~ - - - - - - ----- - ~ ~ -- - - ----~ - - - - -- - - ~ - --
Requested by:
o Reinspect Fee 0 Fee Wavied
Phone Number:
o Reinspect Fee Paid
Date ~~ Type Rough In Inspector Ke~in Benner ____________ approved
r:UEST~NE I READY FOR A ROUGH INSPECTiON (WlLlBEREA15V10104AFTERNOQNf .'-- - ._, ._-'-~===-'l
Date/Time requested: 10/03/?007 07:59 AM Notice Type: Ready Date/Time: 10/04/2007 00:00 PM
Access:
Requested by: ~N[)~~VOI3_~_'=-~<::_I~!~::.[)~~__
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: (920E?9-1~09____
- - - -- - - - - -- - - - - - ~ - - --- ~ ---- -- - - -- ~ -- - - - - - - - - - - - - - - - - - - -- - - ----- - - -- - - - -- - -- - - - - - - - - -- - - - - - ~ - - - - ~ - - - - - -- - - - - - - - --~- - - - - - - - - - - - -- - - ~ - - - - - - - - - - - - - - - - - - - - ~ - - - --
Date ~~~~ Type ~~",--~Jlit:l.!)_____~_ Inspector ~d.?m_~r:Cl':l_~t::____._ _________________ approved w/cond.
~equesfjTrie/ Paul will be there all day WedfOl24.CeilingtiIE;suwereputup~wHni-avethem-re-mov-ed for inspectio-n vVednesday,-
,2 straps to be added.
I
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L____~_n__
-.-.-.--.-..,
,
I
____________J
Date/Time requested: 1l?!23/2_007 _ 01:2~rvI_ Notice Type:
Access:
Ready Date/Time:
10/24/2007 :
-- - ~- - - - - - - - ----- - -- - - - - - - ------ - ------ - --~-- - ------ - ------ - --- -- - - - --- - ---- - - ----- - - - - - - ---- - -- - - -- - - - - - ~ ----- - - - - - - - -- -- - - - - - ~ - - ----- ~ - - - - - ---- - - - - - -- - - --
Requested by: ENDEAVOR._ELECTRIC - Paul
o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid
Phone Number: 209-2181
HVAC Permit Work Card
Job Address 500-550 S KOELLER ST Permit Number 126849 Create Date 09/19/2007
Owner RIVER VALLEY ONE LLC Contractor QUALITY MECHANICAL INC
Fuel 1.1'1 Gas I U Oil U Electric I U Solar U Solid I Value
System [!::] New 1 0 Replace I 0 Other
l!:J Forced Air U Radiant I U Steam I l!:J AlC I l!:J Vent
U Electric I U Hot Water I U Suppl. I U Con. Burner I
Chimney Type 0 Chimney A 0 Chimney B . Direct Vent 0 Not Applicable
Use/Nature 540 S Koeller / New HVAC system as per plan for the "Sport Cuts" tenant space.
of Work
$12,935.00
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Inspections:
Date 10/31/2007 Typ~'Ffrf~
~""'~~''''"~"
Inspector John Zarate
~prO'\1ed ~
~:::t:'E:~'''E;:c'';?'',:;",'~
DatelTime requested: 11/01/200707:53 AM
Access: I
Requested By:
o Reinspect Fee 0 Fee Waived
Notice Type:
Ready DatelTime: 11/01/2007 07:53 AM
Phone Number:
o Reinspect Fee Paid
- - - - - - - -- - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - -- - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - -- - - - - - - - - - - - - - - - - - -- - - - -- - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - --
Job Address 500-550 S KOELLER ST
Owner RIVER VALLEY ONE LLC
Category
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
440 - Industrial-Interior
Shower
Floor Drain
1 Lndry Tray
1 Disposal
Dishwasher
Sump Pump
Classrm Sink
Breakrm Sink
Plumbing Permit Work Card
Permit Number 126945
_._---~-~---
Create Date 09/25/2007
Contractor
BENO PLUMBING
Plan ZZ2-272-0907-i'___ Value __,_____g9_~Q.9Q
Water Softner Wait. St. Shamp Sink 4 Coffee Maker
Local Waste Ice Chest FlrlWst Sink Int Grease Trap
Clothes Wshr Exam Sink Catch Basin Ext Grease Trap
Bidet Sculry Sink Wash Ftn RPZ Valve
Beer Tap Hand Sink Urinal Eye Wash Statn
Lab Sink Plaster Sink Standp Rec Wtr Sewer Mtrs
Sterilizer Surgeons Sink Ice Maker Deduct Meters
Dip Well F Prep Sink Gar Drain Wtr Usage Mtrs
Drink Ftn Serv Sink Soda Disp
Roof Drain Ejector/Grind
Misc.
Fixtures
Use/Nature \REM0I5LE-TENNANTSPACI'T540)TOR"SPORTS-ClIPS"S-ALON:
of Work
Sanitary Sewer
Storm Sewer
Water Service
Size
Material
Type
#
Conn.Type
Inspections for Work Card 94395
Date 9/25/~99I~__ Type !:J~.9!~~~--- Inspector ~c;~_'{\I~~~_________________n_ approved w/cond.
C-Oi1tractor musT relocaIe-local waste connection for waterheclterT&PreJieffrom-fiOor-selService sink tofloo-r-(frain-per-COMM82~33(8)(d)4-ContraCtor-Sh-aij~
jhave available at rough-in inspection a copy of the approved plumbing plan on-site. I
L-_-~-
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Date/Time requested: 9/25/200701 :23 PM
Access: [~~:----
Ready Date/Time: 9/25/2007 02:00 PM Requested By:
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
Notice Type:
Telephone Number:
,
J
_ M.. _ _ _ ~ M _ _ _ _.. _ - - - - - - - - - - - - -. - - - - - - - - - - - - - - - - - - - - -. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Date 10/3/2007 Type Rough In
Inspector ~~~_'!Vo~______________ approved w/cond.
~ent over requirements of deck mounted VB for shampoo sinks with plumber in order to preventquestions on finallnspediOi1~--
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Date/Time requested: 10/2/200703:11 PM Notice Type: Telephone Number: ~?20)~!~_:~~~~_____ ----- ---
Access: [=-~=~ -----=--==------~======~=:=-~=-==:~
Ready Date/Time: 10/~20~7_ 03:~~ Requested By: I3J::~2'='!:l!fI!I~t:'lQ:_B~a~I3~~_u~________
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
- - ~~~~-~-O/2-5/2QQ;~--~~~~~~--~~~~~~~-~~~~~~~~~ --P~~~I-~~_;f~-----~--~-~--~-~ ---~-~_~--~ -~~~:~~- ----- - - -- - - ------- - -- ----- ----- -- - -- ---- - - - --
__._.__________m____.__.~__._.__._______'____.___ .-..---.----.-------...------.-.-.-----
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Date/Time requested: 1 0/26/200~01 :34 PM
Access: I_~__H~_~~___
L__..__
Notice Type:
Telephone Number:
_____.~___J
- - - - -. - - ~ -- - ---- - ~.. .-- --- - - -. ---- - ~ ----- ~ ------ - ------ ~ ----- ~ - ----- -. --- - -_.-- - - - --. - --~ -- ------ -----. --- - ~ -- --- - ~ ---- -. - -~. - -- - - -. -- -- - ------ - ---- - -~ -- --- - ~~ - - -- ~~. - - - - ~ --- - ~ ----~. - - -- ~ - - - -- ~...-
Ready Date/Time: 10/25/200~ 01 :34 PM Requested By: BEN~PLUMBIf'J.<.'___
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
fDisregard,flrl-afapproved 10/25/07.
Inspector Paul Wolf
Date
Type Final
l
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u___________J
Date/Time requested:
Access:
10/31/200~09:04 AM
Notice Type:
Telephone Number:
(~_?gl3} 1:?93~
- - ~ - - - _.- -- - - -.. - -- - - - - ~. - --.. - - - - -.. - - ----- - ~ - ---- - - -- - - - - - .-- - ~ - --. -. - ---~ - - - - - ~ - -_.- - - - ~ -- - - -~ - - - - - ~~- - - ~ ~ - - - --~- - - ~ - - - - ~ ~ - - - - -- - - -- ~ --- - -. - --- -.. - ~ - - - -~.. -.. ~. - - - -. -. --- ~. - ---- - -~ *- - -. ~ - - - - -~ * --
Ready Date/Time: 19'~1/20Q} 9-~04 ATvl_ Requested By: B~~9HF'~l!fI!I-(3ING: D~~~~~~_ --------
o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid
'"
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OJHKQfH
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
September 7, 2007
Stephen Gries
Gries Architectural Group Inc.
500 N Commercial Street
Neenah, WI 54956
Andy Dumke
River Valley One LLC
222 Ohio St
Oshkosh, VVI54902
Site: Plan Number: Z5-2083-0807
Sport Clips - Haircuts
540 S Koeller St
Oshkosh WI 54902
For:
Description: Tenant space Build Out
Object Type: Building only
Class of Construction: VB - 1280 Sq Ft.; sprinklered
Occupancy: B: Business Office ",on-separated use A-2,B, Muses
Maximum No of Occupants:.".."".
'r~;':~~.2:M~":
The submittal described above has been reviewed for conformance with applicable VVisconsin Administrative Codes and
VVisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in Chapter
101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements
Key Item(s) I Conditions:
. mc 901.2 Fire protection systems shall be installed, repaired, operated and maintained in accordance with this code
and the international fire code. Construction of new walls may require the addition and or relocation of sprinkler
heads to maintain required coverage, and not obstruct spray patterns of.fire sprinklers.
. Comm 61.30(3) I IMC 507.2 This plan review does not include heating, ventilation, or air conditioning.
HV AC plans are required to be submitted and approved prior to installation ofHV AC equipment. Be aware that
mc 1004.3.2.4 contains additional restriction for air movement in corridors
. Comm 80 This plan review does not include plumbing. Contact plumbing inspector, Paul VV olf (920) 236-5052
for additional information on potential issues with shampoo sinks.
. 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
. 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).
l:\lnBpcctionsWhm Revicw\C)i11!llcrd<l! Pbn Review 2007\Z5.208}.0807 540 S Koelki' St B1dg On1y.doe
Page 1 of2
...:
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SUBMIT:
· Com 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 of the approved plans, specifications, and this letter shall be on-site during construction. All permits are required to
be obtained prior to commencement of work.
In granting this approval the City of Oshkosh Inspection Services Department reserves the right to require changes or
additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the number listed below or the address on this letterhead.
~
~
Building Systems Consultant
(920) 236-5051 Monday- Friday 7:30 A.M. to 8:30 A.M and 12:30 A.M to 1:30 P.M.
bnoe@ci.oshkosh.wi.us
cc: Property file
Fee Required
Fee Received
Balance Due
l:\illspections\Plan Rcvicw\C)llHl1Crcia] Plan Ri'vicw 2007\Z5-20i;.3-0g07 54U S KocHel' St Bkig Only.doc
$
$
$
Page 2 of2
320.00
320.00
0.00
~
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
September 19, 2007
Thomas Lenz
Quality Mechanical Inc
P.O. Box 162
1701-A E Elm Dr
Little Chute, WI 54140-0162
Andy Dumke
River Val1ey One
222 Ohio St.
Oshkosh, WI 54902
Site: Plan Number: Z5-2083-0807-H
Sport Clips
540 S Koeller St.
Oshkosh WI 54902
For:
Description: HV AC System for new tenant space
Object Type: HV AC .
Class of Construction: VB -1280 Sq. Ft.; sprinklered
Occupancy: B: Business Office non-separated use A-2, B, Muses
Maximum No of Occupants: 12
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) I Conditions:
. IMC 302.1 The building or structure shall not be weakened by the installation of mechanical systems.
Verify that existing structure is capable of supporting the additional weight of the proposed roof top
equipment.
. Comm 61.31(4) Revisions to approved plans. All proposed revisions and modifications which involve
rules under this code and which are made to construction documents that have previously been granted
approval by the department or its authorized representative, shall be submitted to the office that granted the
approval. All revisions and modifications to plans shall be approved in writing by the department or its
authorized representative prior to the work involved in the revision or modification being carried out. A
revision or modification to a plan, drawing or specification shall be signed and sealed in accordance with
Comm 61.31(1).
SUBMIT:
. IECC 503.3.3.7 [Comm 63.0503(2)(1)] Balancing and documentation of the HV AC system shall conform
to the !MC. Balancing report required to be submitted prior to final occupancy being allowed.
. 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.
hTn,pediuns\Plan Revit'w\Commel't'ial P!;m R<:vit'w 200T.Z5-2083-08()7..11 540 S .Kodkr St HVAC Only.ill'"
Page 1 of2
A copy of the approved plans, specifications, and this letter shall be on-site during construction. All permits are required to
be obtained prior to commencement of work. .
In granting this approval the City of Oshkosh Inspection Services Department reserves the right to require changes or
additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the number listed below or the address on this letterhead.
~
Brian N oe
Building Systems Consultant
(920) 236-5051 Monday-Friday 7:30 A.M. to 8:30 A.M and 12:30 A.M to 1:30 P.M.
bnoe@cLoshlcosh.wi.us
cc: Property file
Fee Required $
Fee Received $
Balance Due $
230.00
230.00
0.00
V'In$f1",cii.ms\Plan R.;view'.('ommen:ial P!,m Review 2007\Z5-2083-0807-H 54!) S KiJdkr St nVAC Only.doc
Page 2 of2
11/01/2007 THU 10:37 FAX
~002/002
BUILDINGS, HV AC, COMPLIANCE STATEMENT SBD-9720
This form is required to be submitted by the supervising professional (architect, engineer, HVAC designer or electrical
designer) observing construction of projects within buildings with total areas 50,000 cubic feet or greater and bleachers
(Comm 50.1 O/Comm 61.50). Failure to submit this form may result in penalties as specified In Comm 50.26/Comm 61.23
and/or tocal ordinances. This form must be submitted prior to the plan approval expiration date or another submittal may
be required.
General Instructions: Prior to the initial occupancy of new buildings or additions and the final occupancy of
altered existing buildings, submit this completed and signed form to:
. The municipal building inspection office.e.n.Q
. Safety and Buildings, 10541N Ranch Road Hayward, Wi. 54843
Note: If the review was done by the municipality, the compliance statement goes only to the municipal building
inspector. A copy is not needed by Safety & Buildings.
Personal information you provide may be used for secondary purposes [privacy Law, s. 15.04 (1 )(m)].
1. PROJECT INFORMATION: Please fill in the following with information from your plan approval letter.
Transaction 10 Number 2'5 "'~f?/~....tJ~1
Site Number v ~-
Site location (number & street) ,~/2/' lj//~[//$&N1J !Jf~ :J#1"u--#J'5r:
;K City 0 Village 0 Town of tJ!I;lpiH' County of ~/~~)P/?tl!J
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; )(auilding Object 10 # ~/~ ~ HVAC Object 10 #
o Lighting Object 10 #
o Partial Completion
Description of Portion Completed
A) ;( Statement of Substantial Compliance
To the best of my knowledge, belief, and based on onslte 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.
)!{.BUILDING/LlGHTING ITEMS
1. Structural system including submittal and erection of all building components
(trusses, precast, metal building. etc.)
2. Fire protection systems (sprinklers, alanns, smoke detectors) designed,
installed, and tested (including fOIWard flow on back flow devices) .by
appropriately registered professionals
3. Shaft and stai/way enclosure
4. Exits including exll and directional lights
5. Fire-resisllve construction. enclosure of hazards, fire walls, labeled doors, class 0 HVAC ITEMS
of construction, lire stopped penetrations
6. Sanitation system (toUets, sinks, drinking facilities)
7. Banier-free including Comm 18 elevators and lifts
8. Energy envelope reqUirements
9. All condllions of building plan approval and applicable variances
The fOllowing Items are not In compliance and must be addressed:
10. Exterior lighting & control requirements
11. Interior lighting & control requirements
12. AU conditions of lighting plan approval
and appliceble variances
1. HVAC system including final test
2. All conditions of HVAC plan approval and
applicable varlancas
B) 0 Statement of Noncompliance
Due to the followlng 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 date.)
D) CJ Project Abandoned
3. SUPERVISING PROFESSIONAL SI~ATU FOR:
)( Building 0 HVAC 0 Lighting ?h ~ IdV' ~
Na please pn tor typl1)
Phone number f;'~?U~41~ Customer ID # ~cM+ Signature
SBD-9720 (R.02/2004)
BUILDINGS, HVAC, COMPLIANCE STATEMENT SBD-9720
This form is required to be submitted by the supervising professional (architect, engineer, HVAC designer or electrical
designer) observing construction of projects within buildings with total areas 50,000 cubic feet oeater and bleachers
(Comm 50.10/Comm 61.50). Failure to submit this form may result in penalties as specified in m 50.26/Comm 61.23
and/or local ordinances. This form must be submitted prior to the plan approval expiration date submittal may
be required. ...
General Instructions: Prior to the initial occupancy of new buildings or additions and the fina~'PCY of
altered existing buildings, submit this completed and signed form to:
. The municipal building inspection office 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 ID Number Z5-2083-0807-H
Site Number
Site location (number& street) 540 S Koeller Sf (Sports Clips)
~ City 0 Village 0 Town of Oshkos County of Winnebago
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 10 # ~ HVAC Object ID #
o Lighting Object 10 #
o Partial Completion
,Description of Portion Completed
A) jgJ
Statement of Substantial Compliance '.
To the best of my knowledge, belief, and based on onsite observation, construction of the following building and/or HVAC
items applicable to this project have been completed in substantial compliance with the approved plans and
specifications.
o BUILDING/LIGHTING ITEMS
1. Structural system including submittal and erection of all building components
(trusses, 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 IRI HVAC ITEMS
of construction. fire stopped penetrations
6. Sanitation system (toilets, sinks, drinking facilities)
7. Barrier-free including Comm 18 elevators and lifts
8. Energy enveiope requirements
9. All conditions of building plan approval and applicable variances
10. Exterior lighting & control requirements
11. Interior lighting & control requirements
12. All conditions of lighting plan approval
and applicable variances
1. HVAC system including final test
2. .AII conditions of HVAC plan approval and
npp!icable variances
The following items are not in compliance and must be addressed:
B) 0 Statement of Noncompliance
Due to the following listed violations, this project is not ready for occupancy:
C) 0 Supervising Professional Withdrawn From Project (Use A or B above to indicate project status as of this date.)
D) 0 Project Abandoned
3. SUPERVISING PROFESSIONAL SIGNATURE FOR: . .
:h::'::beC~9:~~:87_~2~:h;;~;c::;:~~~~~7
~
SflD-9720 (R.02i2004)
NOV 02 2007
DEPARTMENT OF
COMMUNITY DEVELOPMENT
INSPECTION SERVICES DIVISION
~ 11/01/2007 2.: 48
9208531485
DELSMAN CON5TRUCTION
PAGE 01
DELSMAN CONSTRUCTION SERVIces, LLC
13432 Rame.ker Rd, Ree.dsville, WI 54230
Phone 920-863-1484 - Fox 920-863..1486
Date
Facsimile Cover Page
11/~/41
{I <7
This transmission consists of () pages, including the cover page.
~1 ~'8v-- · .
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From: :fbG
To:
Message: ~ C tf'7l f,~ S~
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rtf 76 I
~~~J--
11/01/2007 20:489208631486
-_. v..... -.J~: ....01..1 A. >.I; ...lJ /:"""'......
DELSMAN CONSTRUCTION
PAGE 02
~C02/J02
BUILDINGS, NV AC, CQMfLIANCE STATEMENT SBD-9720
This form is required to be submlt1ed by the supervising professional (architect, engineer, HVACcleslgner()(elecfrical
designer) obsEllVing construc1ion of projects within buildIngs with total areas 50,000 cubic feelorgr9ater andb(eaeher~
(Comm 50.1 OIComm 6' .50). Failure to submit this form may resuk in penalties 8S speclfled inCornm 50.26/Comm 61.23
anolor loclill ordinl!lnoea. This form must be subml~d prlortoth.at plan approvel explratlon date or anottler submittal may
be required
Genere"nS1ructfonfS: Prior to the initial occupancy of new buildings or additions and the finel occupancy of
altered existing buildings, submit this compl$ted and signed form to:
· The municipal building inspection office i!lil
. Safety and Buildings, 10541N Ranch Road Hayward, WI. 54843
Note: If the reVfew was done by too municipalltyl the compliance statement goes only to the munioipDI building
inspector. A copy is not needed by Safety & Buildings.
Personal information yo\..' provide mey be uslld for !!1eeondary purposell {Privaoy Law, s. 16 :)4 (1 )(m)j.
1. PROJECT INfORMATION: Pleue fill l1"lll18 following with Informelio:"l frerr: t'our pIe" appro~alletter.
TransC\CticnlD Nwmber r2:5 ... ~?J...~$.P..~
Site Numbe~ .~ ~
Site location Invmber& strQe(}~~,s;//,M'~ ~ft? 0J1;J,t.~.5r
;;r City 0 Village 0 Townof ~.7~~'H' County of "JJuA!#~
2. PURPOSe OF THIS STATEMENT: (Check. Box A. 8, C, or 0 to indicate purpose end complete snyother
applicable boxes and Informatiol1. Attactl addltlor.at pagelllf neoe~ary.~
Check thO$8 which apply; )(aulldil'lQ Object ID It- ~~ ~ HVAC Object ID #
o hightiog Object ID '# ~._
o Panial Completion _
Oeacri~lion of PonIon Completfld
A) ;;( Statement of Substantial Compliance
To the best of my KnOWledpe, belief, end baseD on en$lt& ~lV.llon, construction of tne followinEl building and/or HV AC
Items applicable to this project h~V9 b88!\ eQmpleted jr. substantlat eompllanee with the l'lppro\l&d Illa~'. end
speolficaUona.
~ ElUll.OINGIlIGHnNG rrEMS
i. SI.P\J~..Jt.. oll$Mm lMludlng $ub"lllbll ."'d ertlction of al! building componllnlS
(1...."lIltS, P~COlll. mete I bl.lll.:llng eto.)
2. Fire proloecllon "':-,swmlll (aprlnkllll'i, ilfal"l1C CPTlGKCl dttt010r$) dBs/9flSd,
InOllllhtc. .nd lasted (l"tllUdlng fOlWard ftowon back new ClaIl1CoIl5\) by
'-llpropfletely regIRl."" PNro8aioFlBls
3. 9hBI111nd Iltaltway .neID.llre
4 E~ts: Including exll .nd c:tlr1lCltlOnlllllgl1la
5. FillM'0s!sUV1I constn.lclloll, inclosure of halama. lire \W'ls, lit/tlea door&, elMS 0 HVAC ITIMS
of COIlst!""etiOll, II/'i1lllQpped pefle"'d,om
S Ser~/lfl'ion syslern (loU.ls. sino. drlni(jnl? lacllltles)
'7. Serri.r'li1lo lnilll,.ldlf'lQ Comm HI .I,vtllors and Ufla
8. Energy en~opl!l rsQull'8lTl,nl!;
<). All condlllol'll Q~ bulldlnQ pllln lI;:lprovaland spp:lc;eble vel1llnce$
The follo~lng Item. ant not In compll.n~a and m,,~t be aadf'e8l18d: .___
10. e:lCIerlor lightlng &. contro! fSqU!,,*lI'Ilflts
11. Il\terior lighting & t:Onlllll fliQulrerneme
i:!, AU c;ondlft~nB ~f lighting plein ,pprovII'
.rId ,j)plIClll~' lI~e"
'. I'f\lAC Gyltetn motudln" finlllllelll
Z. All oonclltlOl's of HVAC pUlrl tpprOVllI flr,d
appl!oablft IIManees
B) 0 St.tement of Noncompliance
Due 10 tho fotowlnQ lilted v!oletiooo. th,,, proJect" not rGlldy tor OCQu~AI'lC)':
C) CJ Su.,.rvltlng Profe..lonal Withdrawn From Projtlct (U,e A or e Iil~ve to Indloel$ project .status II' of thl~ dll..!
Dl 0 Project Ab.ndoned
3. SUPERVISING PROFESSIONAl.. SIGNATU
)i( Blllldlng 0 HVAC C Lighting 'IF J!;1
N, " pl.... P or ~)
P~Qno nl;mber ~..z4-l$ CU6lt)",e~ fD # ~?fh::'1St:?-'f .
. 0&7 __LL_\. 0 4: -~
&...~~ ~~ ~J==, .:
SFlII.Q710 IR,Ci2120<}4
~ 10/30/2007 19:28
921218531485
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DELSMAN CONSTRUCTION
PAGE ell
NEW TAB of
GREEN BAY, INC.
978 Lakeview Drive
Green Bay, WI 54313
leI: (920)-434-0840
Fax: (920)-434-0240
TEST, ADJUST AND BALANCE
REPORT
OCTOBER, 2007
PROJECT SPORTS CLIP
-_.~--------~ ~
OSHKOSH, WISCONSIN
ARCHITECT
ENGINEER
TOM LENZ
KAUKAUNA WISCONSIN
CONTRACTOR
QUALITY MECHANICAL. INC.
LITTLE CHUTE. WISCONSIN
--~---_._--_._-------_-....''''
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10/30/2007 19:28
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9208531485
DELSMAN CONSTRUCT ION
PAGE 02
',-- "AB' ,
f.,/X'<"/:/;, / -\ N'EW T of
f,~.~;,~~;""//';r'</ GRE'EN BAY INC
\",.,., /::;/j ........ L ,,'
",,/,r"''- ,. ,0',: -
:,./~<//~>~::<~
",,1 ,I I' ,~ " ..,
:<..:...~ '
CERTIFICA liON,
PROJECT SPORTS CLIP
ADDRESS OSHKOSH, WISCONSIN
.....-'-1.._-- .~----_.-
~-,_....--,._......._..~-..-----"
-.----...
THE DATA PRESENTED IN THIS REPORT IS AN EXACT RECO~D OF SYSiEM PERfORMANCE AND
WAS 08TAINED IN ACCORDAI'JCE \NiiH NEBS STANDARD PROCEDURES. ANYVARIANCES FRONt
DESIGN QUANTiTIES WHICH EXCEED NEBB TOLERANCES ARE NOTED THROUGHOUT THIS
REPORT
THE AIR DISTRIBUTION SYSTEMS HAVE BEEN TESTED AND BALANCED AND FINAL ADJUSTMENTS
~AVE BEEN f\l1ADE IN ACCORDANCE WITH NEBS "PROCEDURAL STANDARDS FOR TEST!NG .
ADJUSTING _ BALANCING OF ENVIRONMENTAL SYSTEMS. AND THE PROJECT SPECiFICATIONS.
NEBS CONTRACTOR NEW TAB of GREEN BAY, INC.
REG. NO
2949
CERTIFIED BY
Ke!1 Sikora
DATE OCTOBER. 2007
THE HYDRONIC DISTR!BUTION SYSTEMS HAVE BEEN TESTED AND BALANCED AND FINAL
ADJUSTMENTS HAVE BEEN MADE It~ ACCORDANCE WITH NEBB "PROCEDURAL STANDARDS FOR
TESTiNG _ ADJUST1NG - BALANCING OF ENVIRONMENTAL SYSTEMS" AND THE PROJECT
SPECIFICATIONS,
NEBS CONTRACTOR NEW TAB of GREEN BAY, INC,
~,__.___w_..,_
,.-.---.,,-.--..---.-----.;...---.
REG, NO
2949
CERTIFIED BY
Ken Sikora
DP.TE OCTOBER,2007
SUBMITTED AND CERTIFIED BY:
NEBS CONTRACTOR
NEW TAB of GREEN BAY, INC.
T AS SUPERVISOR
REG. NO. 2949
DATE OCTOBER,2007
Ken Sikora
Page ~ 0" ::
10/3012007 19: 28 9208631486 bELSMAN CONSTRUCTION
.: .,~:" ;..j-~7. ~!,!_ n',~~'. :"~\:,-; ",,~;~'1""".:,~ !.'~I::"jC':',J::".:..;.'" "I' ~ l-~""""'-~":-':-~"~'(' ./j..."t~ .."~'I ,:",
PAGE 03
";::';//00~r'\NEW TAB of
\~:.;~f:~::0:'IJ GREEN BAY INC.
.O'A"-;;;,l:/j;r- -...- '
,/,1/.(".,.,/
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Air Apparattjs
Test Report
MAKE SHEAVE FENNER
!SHEAVEDiAM.IBORE.-r:.~--~D59'I-5!iiI-~
~o BEL ~~KE!SIZi:.j--'-1 BRO~ING i A;;:;--
1 NO FIL Tf;RS!'fVPEISIZE 2 I TA 'i 6X2.5X2
[FAN BUSHING ~-- --.--- .-.----..
1---
I
I ~- =t-----l
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t I
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----. ..-'" "1--'" <tII"I-..... I
MAKE I FRAME J GE. ,./18Y
-~ ~_..- .--..------------...1
HF I R?M . i 1125 \
1------------:-- . ..__..-~....-
VOL TS,PHASE:HERTZ 208 ; 3 I 60 . l
F.L. AMPS f SF
52 i 1.15
MAKE SHEAVE \ POWER DR!VE ~
SHeAVE D1AM. i BORE 4": 5/8" I
,----.-.-" .-.---""..- ~
SHEAVE DisTANCE '" =,.
.-
~.~...----_.._--'- -.--.----,...--.-.-...-
SHEAVE OPER. OIAM 3 TURNS TO OPEN
iARRANGE~ENT!CL~SS
DISCHARGE
RTU /1
DOWN
2 B127.29
399
.\ 1573
l-
I
1
i
TEST DATA DE'SIGN I ACTUAL \
1 FAN D.SCH PRESS.(SP) ,4'
FAN SUCT. PRESS.(TP) I -.47
HEAT CO;L INLET SP I !
I
HEAT COIL OUTLET SP
HEATING CO:L~F - I
COOL COIL INLET SP
COOL COIL OUTLET SP
COOL. COIL ~p I
i
FILTER iNLET S.P~
FILTER OUTLET SP I __
! F!LTER,lF I
I TEST DATA DESIGN ACTUAL
I
,
r TOTAL CFM .~ 2000 + 1972
\--- .
! FAN SP - rsp . .88
t-.- i ,
---r~-
l~~N RPM -J-~ 1118
I EXTERNAL SP - ESF' i .25 .50
l---------...-,...--
I MoTO~ VOL. TS 208 212/214/213
[ I , ,
I MOTOR AMPS I ~,2
~~SiOS AIR CFM : t:;, -r- 400
i RETURN A: R CFM ! ':. ! '600
t-.----- .4._-.l---
IlvlA T:::( ~l:iO A X OA, T) - (~'.(-R t.. X RAT:
I MAT=( 20 0 X - 1... (80,0 X' I
I MAT'" - of SET@ - of
~---,._._--,._-_.
Remarks:
+
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TEST DATE
OCTOBeR 26. 2007
READINGS BY:
Mil<ie H..;!chi"1:)on
Page 3 01 8
10/30/2007 19: 28 9208531485 DELS~1AN CONSTRUCTION
"'. ';).l:..J~~'" ~~~~ :-,/: f'},.:~,): '~',:).~,J ..:,..c:l)"..:'" ~''''':'I:.:hq:l'':'',:~", ';,~ J.M~"J-;:-.'::';'" Ij~.l. J'~'::;.i .,J', · ,.
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TEST DATE'
PAGE 04
Air Outlet (Flow Hood)
Test Report
~'T'-NEW TAB of
_l_~GREEN BAY, INC.
:
l
I
~ I
I I
I
1 +
- ~
OCTOBER 26. 2007
READINGS 8y
tJiil.;~ H,J1(;I'" ',$0"
Page 4 or' 6
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'3208531485
DELSMAN CONSTRUCTION
PAGE 05
10/30/2007 1'3:28
tf\'.:,'" ,""\. .,' '.
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Y i .. A r\,' .' /;211 I ' ,.
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Fan
Test Report
PROJECT SPORTS CUP
L.QCATION OSHKOSH. WISCotlSIN
-~---,"--'~"---'l
-,----~---.'.T _._------...,..-.~-- ~AN.NO:-~"~---I---. FAN NO- i
FAN DATA .; FAN NO. H-1
!
LOCATION .J--,- C~~. i
- -1
-""'" i
i SERVICE I EXHAUST j
\MANUFACTlJRER \ _. ------
~
8ROAN
!MODELNO 1 L500 ~
t ~ERIA~!~_____.--_.--~-_.--.. -.-..--------- _.._~_._._--~._..,_.._--+_.__._,--------_..,_...,.\
~P'PE l CLASS EF'1 - - -----+------j
--- -...,--
MOTOR MAKE 1 STVl,E .~ ------BROAN;:-.-.. -~
l.._.~--,,-,,-~----...~ -.~.--_.,--, _' l.... ._~.__._~,w.,_...
--_...""----"" ..
~~ HPIRP~RA'~=- ----"""c~ _w -------,--i------.-~-------...-~-,-~
VOL TSIPHASE/HERTZ I ~ 15 : 1 160 I .
--- ...~.,-_._.--..---.~.~..----- --"1
~ r--.----'---".~---
. F.L:AMPsiS~ I -/1,0 i '
I I ----l
MTA. SHEAVE MAKE/MODEL DIRECT DRiVE;
MTR SHEAVE DIAMIBORE DIRECT ORNE:
FAN SHEAVE MAKE DIRECT DRIVE .__.~---+~------l
---- .
I!~ SHEAVE DIAM/BO~ DiRECT DRIVE;
--'-'---~==r==-~-'-----'- -,~~. ...~
: NO BELTS MA.KEISIZE DIRECT DR.-VE I I
-~--,.~,--_._..~-~..., ------'""--- .......-. --~----,--- ..-,...- ------.-.--...;.-
f s..EAVE DISTANCE I DIRECt DRIVE I t 1
8USHINGFlLTER- j ---~.---::1-~_--------1--------J
TEST DAT-. : DESI~ -.CTUAL DESIGN! -.Cru-.L I DE81GN i -.CTUAL
~!S} i 600 \ 469 1 \ i
i :~-~;;,~--- ----+ DI~~,~~"i.-1 - ~':~~: - ----+------+--+---1
'i-(iTALs:;;-~-t---:rn- ---.76-1------t--~---t--t-.~--..1
!VOl T~\GE~- -t-1j5- 120 -t----f-.--...---.--f-------- ----..-.-..'..1
l.-. _.. ...____._....__...__ _.__.____._.__J...._..._...:.....~.~.~_.~_~__.__.~-.~--..-~-.-~.... -- -.- - _1 -J- .
i AMPERAGE i' I 1.6 I .. ,- . -- "I -.---, I "--'-,.-'- --I
r' .._______..___,_-r.___.___-!-_,___..__-l-_".________ --.-.-.--~.-~,-.,--- ..-.+--.-.....--.--,1
i OuTSIDE P,iR OP~ L L_ .. I I -L i I
Remarks;
"
TEST DATE.
OCTOBER 26 ;2007
READlN~$ BY
Mike H_ltchl")s.~r'
-----.-.....--
Pagi2 5 oi f
10/30/2007 19:28
9208631486
DELSMAN CONSTRUCTION
PAGE 06
~;"..: :ll."~ i;' . :,';\ ~'~:'(': f..-:., ." ............) H,:,.'l,,:,.,...~..L ~ ~ ,,-.:< ~,~...-...I., ;'r..~~.:
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Test Report
~."
(/....;. /..' . "'.>~/ ./ 'l
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'~T.Y'PE
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\ AI~FLGW Cf\1 \ AI~FLOW CFM !
\
- I
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SVSTEMiUNIT
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TEST APPARA rGS
! FIN,I\L
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EF-1
PHOJECT SPORTS CUP
~
OUTLET MANUFACTURER
:
. ;OTAL I
150
350
138
138
1
'.~ OF l
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:;31
331
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OCTOBER 28, 2007
READINGS B"
MiKe HJIGhhson
TEST DATE:
Fage 6 (A e