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Compliance Statement
This form is required to be submitted by the architect. engineer. or HVAC d.si9Mf' (supervising ptOfessional)
observing construction of projects within buildings with total volumes exceeding 50.000 cubic feet and construction
of antennas, towers and bleachers (ILHR 50.1 0). ~ailure to submit this form may result in penalties as specified in
ILHR 50.26 and/or local ordinances. .
N~m.
, OF
. OPMENT
of C~l4 tL, G~ CJ
CJ Building and HVAC
CJ Pa",~J CompletIon
DescriPtion of PottlonCompleted
A) ~ Statement of Substantial Compliance . ..
To t~ of m, knowledge. belief. and Nsed on ons.!t!l ol!sel'latlon. construction of the follc'4Ofing building and/or HV",C items applicabl. to
thiS proJect h.". been completed in subsuntlai compliance WIth the apprOWd planulWi .pecmutlOM:"
o BUILDING 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.
fire extinguishers~
3. . Exiu including exit and directional lights
4. Shaft and stairway enclosures
5. Fire-resisti'le construction, enclosure of hazards, fire walls,
labeled doors. class of construction
6. Sanitation system (toilets. sinks. drinking facilities)
7. ILHR barrier free requirements
8. All conditions of building plan approval and applicable variances
The following items are not in compliance and'must be addressed:
)litVAC ITEMS .
1. HVAC system.including tinal test
(ILHR 64.53)
2. All conditions of HV AC plan approval
and applicable variances
B) 0 Statement of Noncompliance
Oue to the follOWing listed 'I1Olaaons. thIS proteCt IS not r.aclyfor occupancy:
C) 0 Supervising Professional Withdrawn From Project
(Use A or B above to .ndate I)tOI<<t status as of this dllte.)
Oate Withdrawn
0) 0 Abandoned
3. SIGNATURES:
BUilding Supervising Professional
S8~~720(R. 1219J)
,1- ~Sl~fJI1~
. HVAC Supervising Professional Date
Date