HomeMy WebLinkAbout2007-Certificate of Occupancy
CITY HALL
Inspection Services Div
215 Church Avenue
PO Box 1130
~ ~~:~,h,~
OfHKOfH
ON THE WATER
City of Oshkosh
Approved: 11/19/2007
Issued: 11/20/2007
Wyldewood Village Apartments LLC
2990 Universal St Suite A
Oshkosh WI 54904
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby issued for the new 16-unit apartment building located at
120 Wyldewood Dr, Oshkosh WI as described in Building Permit Number #121196.
This building is to be used only as a multi-family residence and is located in the R-3
Multiple Dwelling District.
LIMITATIONS:
Maximum number of persons and/or living units: One family per dwelling unit
CONDITIONS:
1) Final grading must be done in accordance with the approved subdivision
drainage plan. This plan is on file in the public works office, 3rd floor of City Hall.
2) Erosion control measures must be maintained until the lawn is established.
Note: Final grade must be a minimum of 6" below all siding.
NOTE:
1) Copies of inspection results are available upon request in room 205, City Hall
2) Future permits may berequired for additional work to your property.
A new Certificate of Occupancy shall be required prior to occupancy, should additional
building(s) be erected, or should any buildings mentioned above be altered or moved.
The use of land, or buildings, shall not be changed until a Certificate of Occupancy is
issued for that occupancy. All conditions noted above must be complied with in order
for this certificate to be valid.
. ("'err, L~
Ul ~('lt9 .. )
Building Systems Inspector
cc: Midwest General Contractors Inc
,: -
Building Permit Work Card
Job Address 120 WYLDEWOOD DR Permit Number 0121196
Create Date 8/22/2006
Owner ~IDVVE:ST C3._E!'I~RA~g()NTJ3Ac:T5>RS_____ Contractor MIDWEST GENERAL CONTRACTORS INC
Category!~_Q..: New Multi-Family
Plan U8-84-0806
Occupany Permit Required Flood Plain No Height Permit ~~_~ Class of Const: ~
Use/Nature C-OMM/16 unit multifamily building, non-sprinklered. 8 units on the first floor and 8 on the second. ]
of Work
----------------~-- - - ----------
HVAC Contr BREWER HEATING
Electric Contr CUMINGS ELECTRIC INC
Plumbing Contr WATTERS PLUMBING
Inspections:
Date ~~191?Q.0.?_ .....:...__ Type ~_____ Inspector ~r~__~__ not approved
iRE-QiJE~ffUNE 1 WILL BE READY FOR A FINAL INSPECTION 1) The parking lot is requiredto be paved and marked to meet
'accessibility requirements.
1_....... ........___._
---l
i
Date/Time requested: ~Q22'__~~ Notice Type: Ready Date/Time: ~!1~~Q9?'_ 00:00_____
Access: ~_~E:ASE CALL JAY Y'JITHMIDWEST HE CAN G~:Cy'ouJI.f~}.ilS=~9~C~III5II()_ BEI~.r~E:_S.If\JI~==~~=~-:~~ _-~~~J
Requested By: MIDWEST GEN~~L CONTRACTORS Lt!c:_=J~L__m_______ Phone Number: ~?Q.L~_~O=?13.7_8_ __.
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
;~~~~--i~i~~--------------- -----~;~-~::~:fi5~;-:-~=---;~~~~~~~-;--~~;~-~~---c--~~~::-~~-~~-~~=~----~-~:-~::::~B~il~;;~ -~"~~-
;
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______________________..1
Date/Time requested: 11/14/2007 01 :36 PM Notice Type:
Access: C---
Requested By:
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Ready Date/Time: 11/14/2007 Q!:_~~_
-------------------l
_ ________________~________________""_.________--.J
Phone Number:
Page 2 of2
Jl
Building Permit Work Card
Job Address 120 WYLDEWOOD DR Permit Number 0121196
Create Date 8/22/2006
Owner MIDWEST GENERAL CONTRACTORS
Contractor MIDWEST GENERAL CONTRACTORS INC
Category!30 - New Multi-Family
Plan U8-84-0806
Occupany Permit Required Flood Plain ~ Height Permit ~~~ Class of Const:
Use/Nature tOMM116 unit multifamily building, non-sprinklered. 8 units on the first floor and 8 on the second.
of Work
--- ---------1
HVAC Contr BREWER HEATING
Plumbing Contr WATTERS PLUMBING
Electric Contr CUMINGS ELECTRIC INC
Inspections:
Date 9/20!.~ Type Footings Inspector ~_'Sr:~__________ approved w/cond.
IF axed Request / Ready for a footing inspection 9-20-06 between 1 :00-2:06 Partial Approval. Some of the footings were already p-oureJd
I,
1
l____._ ______________ _____________~______
Date/Time requested: 9/19/2006 04:45 PM Notice Type: Ready Date/Time: 9/20/2006 02:00 PM
Access: 1----- ----__~__====__=~==~=~======:J
Requested By: John Skotzke Concrete Construction Inc Phone Number: (920) 2~1-1667____________
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Date ~7~~ Type Foundation Backfill Inspector Nicole Krahn
[a'tl"~Pla"a ,," afta, ;"pem;o"____ _ .. ..... .... ... ... .... .._
Date/Time requested: ~~Z!.~___ Q!~~ Notice Type: Ready Date/Time: ~~~O~_ QL~~_,L\JIII_
Access:
approved
~~J
Requested By: !VIIDWEST ~ENERAL Co.r-.J.TRACTO~I.!:J.<2.:_~~<:!~~
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Phone Number: 920-410-0864
Date 6/18!?207 _ _:..._ Type Roug~_______ Inspector ~icoJ.~IS~J:1r1.___________ _____ not approved
~) MoldTspresenton the drywall seperatlon between a few of the units~-The drywafirequrres-rePlacemenT'---~--------------HH-1
~) Repair the notched top plates where the exhaust pipes have been run through 3) Repair the drywall where the plumbing pipes are in
~he center of the wall system between units. The drywall needs to be continuous.
14) Drywall is to be installed in the mechanical room prior to running water lines. Firestopping the holes is req.
L i_J
Date/Time requested: 6/14/2007_ 02:20 PM Notice Type: Ready Date/Time: 6/18/2007
._---------~-----_.
Access: 1---
Requested By: iyIlDWEST GENERAL CONTRACTORS _INc:____________ Phone Number: .J.ay - 4?9=-5il.?~_
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
---=:=-=====
Date 6/27/2007 Type Insulation
Request line Drywall was already installed.
Inspector Nicole Krahn
not approved
-------------1
__.__._____~_.__.___~_.____~_________.__._J
Date/Time requested: 6/20/2007 11 :09 AM Notice Type:
Access: I
Requested By: IYIIDWEST QENERAL CON!RA.c~TORS_I_ti~n_____
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Ready Date/Time: 6/2J.!200?.... ~~_~____
_===- i --====-==-:=~=~=__=~=:-J
Phone Number: J~_Q 4~0~~_82~_
Page 1 of2
Electric Permit Work Card
Job Address 120 WYLDEWOOD DR Permit Number 124735 Create Date 8/22/2006
Owner MIDWEST GENERAL CONTRACTORS Contractor CUMINGS ELECTRIC INC
Service . New 0 ChangeO Temp 0 NIA I Type 0 Overhead . Underground 0 NIA
Volts 120/240 Circuits Luminaires 240
Amps 800 Switches 160 Receptacles 320
UselNature 630 - Residential-New Multi-Family Service COMM/16 unit multifamily building, non-sprinklered. 8 units on the first floor
of Work nd 8 on the second.
Value
$35,000.00
Inspections:
Date 09/06/2007 Type Final Inspector Kevin Benner
REQUEST LINE / READY FOR A FINAL INSPECTION
not approved
DatelTime requested: 09/06/2007 07:24 AM
Access:
Requested by: CUMINGS ELECTRIC INC - Jan Phone Number:
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
- - - - -- ---- - - ---- -- -- ----- - - - ---- - --- ---- - - -- ---- - - - ------- -- - -- --- --- ---- - - - ---- - - - ---- -- - - ----- - - - - ---- - --- ---- -------- ---- - - - ---- -- -- - -- - - - - ---- - - - - ---- --
Date 10/23/2007 Type Re Final Inspector Kevin Benner not approved
Notice Type: FC Ready DatelTime: 09/06/2007 07:24 AM
Demand from the Building Inspector
10/25/07 AM Called the General Contractor to discuss the violations and the inspection confusion with this property and 140 Wyldewood.
OatelTime requested: 10/23/2007 00:00 AM
Access:
Requested by: Phone Number:
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
------------------------------------------------------------------------------------------------------------------------------------------------------------
Date 11/01/2007 Type Re Final Inspector Kevin Benner approved
Notice Type:
Ready OatelTime: 10/23/200700:00 AM
DatelTime requested: 11/01/2007 10:04 AM
Access:
Notice Type:
Ready OatelTime: 11/01/2007 10:04 AM
Requested by: CUMINGS ELECTRIC INC
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Phone Number: 920-858-9828 Wes
-------------------------------------------------------------------------.-----------------------------------------------------------------------------------
Electric Permit Work Card
~
Job Address 120 WYLDEWOOD DR Permit Number 124735 Create Date 8/22/2006
Owner MIDWEST GENERAL CONTRACTORS Contractor CUMINGS ELECTRIC INC
Service [eNew 0 Change 0 Temp 0 NIA I Type 0 Overhead . Underground 0 NIA
Volts 120/240 Circuits Luminaires 240
Value
$35,000.00
Amps 800 Switches 160 Receptacles 320
Use/Nature 630 - Residential-New Multi-Family Service COMM/16 unit multifamily building, non-sprinklered. 8 units on the first floor
of Work and 8 on the second.
Inspections:
Date
Type Underground
Inspector Kevin Benner
DatelTime requested:
Access:
Requested by: Phone Number:
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
- - ~ - --- - - - - --- -- -- - -- - --- -- ------ - -- -- ---- - - - ------- - ---- - - - ------ - - ------ - - ------ - -- ---- - - - ---- - - ---- - - - ---- - -- - ---- - - - - - ---- - - -- - -- --- - ----- -- ---- - - ---- --
Date 06/14/2007 Type Rough In Inspector Kevin Benner
I"EQUEST LINE / Not ""dy
00:00 00
Notice Type:
Ready DatelTime:
00:00 00
Date/Time requested: 06/14/2007 07:50 AM
Access:
Requested by: CUMINGS ELECTRIC INC - Jan Phone Number:
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
--- - - ----- - - - ----- - - - - ---- -- - - - ---- - - - -- -- - - - - ---- - - - ---- -- - - ---- - - - - --- --- - - - ---- - - - ---- -- - ----- - - - ---- - - ---- - - - - - ---- - - - --- -- - - - ---- - - - ---- - - ----- - - ---- --
Date 06/14/2007 Type Re Rough In Inspector Kevin Benner approved
Notice Type:
Ready DatelTime: 06/14/200700:00 PM
DatelTime requested: 06/14/2007 11 :30 AM
Access:
Requested by: CUMINGS ELECTRIC INC Jim
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Notice Type:
Ready Date/Time: 06/14/200702:30 PM
Phone Number:
------------------------------------------------------------------------------------------------------------------------------------------------------------
Date 06/14/2007
IF"<ed to wes 6/15107
Date/Time requested: 06/14/2007 02:30 PM
Type Service
Inspector Kevin Benner
approved
Notice Type:
Ready Date/Time: 06/14/200700:00 PM
Access:
---- -- - - - - - - - - - - - --- - - - - - - - ---- - - - ----- - ------ - - - ---- - - ---- - - - - - ---- - - - - ----- -- - ----- -- ---- - ------ - - - ---- - - - ---- - - - - ---- - - - - ---- - - - ---- - - - ----- -- ---- -------
Requested by:
o Reinspect Fee 0 Fee Wavied
Phone Number:
D Reinspect Fee Paid
Job Address 120 WYLDEWOOD DR
HVAC Permit Work Card
Permit Number
123185
Create Date 08/22/2006
Owner MIDWEST GENERAL CONTRACTORS Contractor BREWER HEATING
.._--~---
Fuel L?I:Gas I U Oil I U Electric I ~Iar ~ U~olid..J Value $48,600.00
System 0.. New I [lBeplace llither--.J
U For_ced Airj U Radiant _J U Steam I [[ AlC __---.J U Ven.!.._--.--J
[[Electric -I ~6t Water .J ~ep.!:.-===:J D~~
Chimney Type a~l]lmney A -----0 Ch~~_________._Q!~E:lct V'~~_~==~===Q_~~-=Jl:PPlli:~PJ~~~:=J
Use/Nature ICOMM716unit multifamily building, non-sprinklerecC 8 unitsonThe-iTrsHfi:lc)j--ana-Son-thesecond:----------n
of Work !
--~--.""1
i
i
Inspections:
Date ?!18/?()g7__ Type Rough In Inspector Nicole Krahn___n not approved
A)Firestopsa-re required for the 4" exhaust piping throughlhe toppjafes.---------------------n----~
~) Information is required to be submitted for the exhaust systems for the bathrooms. (I contacted Brewer Heating regarding this I
~~:ti~~~~~~:~~i~~:he plans showing seperateexhaust fans for the bathrooms in place of the :2 central eXhaus:its w:~_:~_:_I~~__1
Date/Time requested: 06/19/200707:07 AM Notice Type: E.<:;~ Rea~r_~ate~im~_ 06/1~~Q9L 0~9L:_='=~~=.~=.=..~~____
Access: I
Requested By:
o Reinspect Fee 0 Fee Waived
Phone Number:
D Reinspect Fee Paid
L=
Typ~a1U!J$".~
~~i:":;;i~"P"~".,'''''''''''-~:!:~,
Inspector Nicole Krahn
approved
Date 9/19/2007
. ..-l
__ _____________________----.J
09/20/2007 08:00 AM
Date/Time requested:
Access:
09/20/2007 08:00 AM
Notice Type: _________ Ready
Requested By:______m_n______________n__________ Phone Number:
_ _9_ _~_~~~~_~~~~ _~.~~_ .9. _~~~_ ~~!~_~~_ _ _ _ _ _ q _ _~_~~~~_~~~~ _~_~~_ ~~i_~ _ _ _ _ _ _ _ _ _ _ _. _ _. _ _ _. m. _. _ _.. _ _. _ _. _ _ _. _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ u _ _ __ _ _ _. _ _ _ _ _ _ _ _ _. _ _._
Plumbing Permit Work Card
Permit Number ~.?~_8,!~______
Contractor WATTERS PLUMBING
Create Date 08/22/2006
Job Address 120 WYLDEWOOD DR
----~-~------,--~~---_.__._._~~- .~-----------
Owner MIDWEST GENERAL CONTRACTORS
Category 440 - Industrial-Interior
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Misc.
Fixtures
Use/Nature
of Work
Plan
Value
. ___ $51, 1_16.()O
16
Shower Water Softner Wait. St. Shamp Sink Coffee Maker
Floor Drain 17 Local Waste Ice Chest Flr/Wst Sink Int Grease Trap
Lndry Tray Clothes Wshr 16 Exam Sink Catch Basin Ext Grease Trap
Disposal 16 Bidet Sculry Sink Wash Ftn RPZ Valve
Dishwasher 16 Beer Tap Hand Sink Urinal Eye Wash Statn
Sump Pump Lab Sink Plaster Sink Standp Rec 16 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
Hose bibs
16
16
16
16
4
ICOMM/16 unit multifamily building, non-sprinklered. 8 units on the first floor and 8 qn the second.
I
I
J
Sanitary Sewer
Storm Sewer
Water Service
Size
Material
Type
#
Conn.Type
~
Inspections for Work Card 88132
Date 1 0/5!~9Q.6___ Type Undergroun~__ Inspector ~~ Wolf..___~
approved
iReqUestLineTRecidy-tor a undergroud inspection-----
i
._---_._~----~.__._------'-_.._----,._._._-_..--_._---
,
Date/Time requested: 10/5/2006 11 :13 AM Notice Type: Telephone Number: ~920) .7}~=~_2.~_u_u.______u_ .._
Access: [~-=-_ ______________:~===----------=_==~.~
Ready Date/Time: 1Q~/20.9_?g:00 P~_ Requested By: '.II{,L\-n:~~S_J:'_l.UJIII_l3l!'l.Q_-_~~~__ mu___
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
_ ~ _ _ _ _ _ ~ _ _ _ ~ ~_ _ _ _ _ _. _ _ _ _ ~ _ ~ _... _ _ _ _ __ _. _. _ _ _ _ _ __ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ _ __ _ _ _. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.. _. _ _ _ _ _ _ _ _ _ ~ _ M _ _ _ _ _ _ _ __. _ _ _ _ _ _ - _ _ - - - - - - -. - ~. - - - - - - - - - -. - - --... - - - - - - - - - - - - - - - - - -.. - - - - - - - - - - - - - -. - - -.. -. --
Date 1/30/2007
Type Rouat'_~~_n_______ Inspector '3_i<:_h VY!LO_~__ ..____ _________ _ ___ approved
[Fax requesC-*****2-27-2007 Wrong-address- this Inspection was-for1TOVllykJewooa:*****----------------------
Date/Time requested: .!'~~.QZ~~__ Notice Type: Telephone Number: ~?2.:!}3-~g5___ ________
Access: [::==- -------===--==:----~-----__- I ___=======-:u~=:~~----=-=--==-=
Ready Date/Time: 1/29/2001'. 10:.90 ~~ Requested By: WATTERS PLUMBING - Jamie
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid ------ --------- ---------,--------------
_________________w____________________________________-----------------------------------------------------------------------------------------------------------------------------------------------
Date 5/24/2007
Type Rough In
Inspector Paul Wolf
approved
iFax-request-----
------------ -----------.---------- -I
I
I
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I
- ..____.___.__~.__.~ - .. .__. n._____j
Date/Time requested:
Access:
5/22/2007 09:27 AM
Notice Type:
Telephone Number: 920-733-8125
Ready Date/Time: 5/??/~0_0? ~J.:O.Q..lI.rv1___ Requested By: WATTERS PLUMBING - Jamie
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
- - ~~~~-ii~~!20_qi~- -i~~~=--~:=~-i~~.~~~~~~ n~~-~;i~~~~~~~~:~~~-_-~- ----- -- - ---- --------. -::.~~- - - -- ---
!Fax-.req.uesf-.-.".-.--------. .------~...-----~~----~------
'--------~----------l
I
I
_ ..--j
Date/Time requested: 11/14/200~01 :58 PM
Access: 511 Jay 420-5878
Ready Date/Time: 11/14/~~ 01:58 PM Requested By: ~A-n:EB_S_PLUII,'\.!?INQu______ ______
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Notice Type:
Telephone Number:
920-733-8125
--------------------------------------------------------------------------------
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ ~ - - - - - - - --
~
CORRECTION NOTICE I FIELD1NSPECTION REPORT
JOB LOCATION: \~O \ I. ")'f\d~~~
CONTRACTOR: 0.. IJ....<Y"\,", ~ 5> S~, L-
PROJECT TO BE INSPECTED:~~ ",^,u. \~;-~'^'"
TYPE OF INSPECTION: ~,-(\OL\ 'E..\~-b"'" t '-
~
City of Oshkosh
~\spection Services Division
15 Church Avenue, PO Box 1130
Oshkosh, VVI54903-1130
Phone: (920) 236-5050
Fax (920) 236-5084
Violations must be corrected and approved vvithin 30 days unless otherwise noted. Call for re-inspections prior to concealment
and/or occupancy. Upon completing the corrections, the ovvner/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
ttlllM#COI):E INSPECTION
Print Name
Company
Signature:
Date
This form is required to be submitted by the supsrvising professional (architect, engineer. HVAC designer or electrical
designer) observing construction of projects within buildings with total areas exceeding 50.000 cubic feet and construction
F antennas. lowers, and bleachers (llHR 50.10). Failure to submit this form may result in penal~es as specified in
...HR 50.26 andfor local ordinances.
General Instructions: Prier 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 and
. Safety and Buildings, P.O. Box 7162, Madison. WI 53707-7162
Peroonal information you provide may be u..d for secondary pUl'p05es {Privacy Law. s. ~S.04 (1)(m)J.
1. PROJECT INFORMATION: Please fill in the following with information from your plen approval letter.
Transaction 10 Number I 340 I~ 7
SijeNumb.r ?/(!5/$6 \ '1"0 WIllJ; v.u>cJ-
Site location (number & street) . Wrz~ : II 1/) d d
crrC'tty CJ Village CJ Town 0.1 0.5ti14'S"~ County of ttI N*hAt:4c
2. PURPOSE OF THIS STATEMENT: (Check Box A. B. C. or 0 to indieate purpose and complete any ether
applicable boxes and information. Attach additional pages If necessary.) ,
Check those Which apply: 0 SulldingObject 10 #. ~AC Object ID # / (oto ~ S
C l.ighting Object 10 #
a Partial Completion
/ Description of Portion Complete<!
A) rf Stat.ment of Substantial Compliance
To tht best of my knowledge. belief, and based on onsite O~$ervatjQn. construction of the follClwing building and/or HVAC
itertfs applicable to this ~rojeCl have been completed in sutlstantial compliance with the approved plans and
specifications.
o SUILDING ITEMS
1. Stl'\.letural system including submittal and ereeticlI'l of all building
components (truS$es. precast. metal building, 8IC.'
2. Fire protection systems (sprinklers. alarms. smoke detectors) designed.
installed, and tested (including forward flow on back flow devices) by
appropriately registered professionals
3. Shalt and stairNaY enclosure
4. ElCitll including exit an!! directicnallights
S. Firlll-re$lstlvc construction, enclosure of llnards. fire walls, labeled
doors. clan of construction
6. Sanitation system (toilets. sinkS. drinking facilities)
7. 8arrier-free induding Comm HI elevators and lifts
8. ILHR 63 energy envelope
9_ All ccnditions of building plan approval and applicable variances
The following Items are not in compll8m::e and must be addressed:
u HVAC ITEMS
1. HVAC system inducing final test
('LH~ 64.53)
2. All ~:mditlons of HVAC plan approval and
applicable vlilrjanc~~
o r.IGHTING lTEMS
1. l!xterlor ligllting & control reQuireme~ts
2.. Interior li9hting & control requIrements
3. All conditions of lighting plin approval and
applicable lIariancas .
B) a Statement of Noncompliance
. Due to the following listed violations. this project is not ready for oceupen<;y:
C) C Supervising Professional Withdrawn From Project (Use A or B above to indicate prQlec. stalus 8S of this date.)
D) [J Project Abandoned
J. SUPERVJSJNG PRgFESSIONAL SIGNAT~ F~R:/
Ll Building t!"HVAC 0 L.ighting UUt5i 0 -ey-("~
Name (plea:ie print or tyC)e)
Pl\cne number f:,;.d --74; Customer 10 #- ~ 8'';; 9/1
Signature
SBD-972G (R.OSJ98l
Jrs- /
Z/Z d
17617Z9Z170Z6
<< OZS9817LOZ6
L1 !PIn
!,(;14~ ~
r
Cl3M3Cl8
TOTAL P.01
ZO:OO L O-ZO-OOOZ
Builc:l~ings, HV AC Compliance Statement SBD-972Q
This form is required to be Sl:lbmitted by the supervising professional (architect, engineer, HV AC designer or electrical
designer) observingc-onstructior'l of projects Within buildings with total areas exceeding 50,OOOctibicfeeforijreater and
bleachers (Comm 50..10/Corrfrn61.50);Failure t6'submit thisforrnmay result in penalties as spedfiedin Cornm
50.26/Comm 61.23ant:llor localotdinances: ,.:,..' ..
.' ;". '"' :--,(" .\~.
Generalln~ti"ct!Qn~:' ,; Pr\orJo the. initial occupancy of new buildings or additions and the final occupancy of
altered existing buildings, submitthis completed and signed form to:
. , ".. .:, ,',:';~ Tti~TP,Q!~i~~c~.~ira,in~)H:~p~G!!Pr)()tfiS~, 8fcld.., ~;; ..l;;'
....:'. "_,,,,~~~fetyanqeuildings,10541N Ranch Road, Hayward, WI 54843
Personal information 'you' provide ri-tc:iy be ~~edfc)r ~~~orld'a& purposes [Privacy Law, s_ 15.04 (1 )(m)].
1. PROJECT INFORMATION: Please fill. in thefoll6wing with information from your plan approval letter.
Transaction 10 Number i 259405
Site Number 711513
Site location (number & street) 120 WILDEWOOD 16 UNIT.BLDG. B
o City 0 Village 0 Town Of OSHKOSH County of WINNEBAGO
2. PURPOSE OF' THI~. ~T A TEMENT: (Check Box A,B, C, or Uto indicate purpose and complete any other
applicable boxes 'and information. Attach additional pages if necessary).
Check those which apply: 0 Building Object 10# 1041326 0 HVAC Object 10#
o Lighting Object 10#
o Parti~1 Completion
.'.,.; ',., De;s~riJlti~nof Porti~n Completed
Af0 Statement of substi:mti~~P.:~Tpliancc:: .~. . ,", ,. ' ":.:
To the best of my knowledge, belief, anql;>asecton Qnsiteob,servatlon,CQnstruction of the following building andlor HVAC
_ .,~' '_.> ,~"~,,~,,,~,~_',..r'-j' '~;, -;~,:,,";',... ;:,,"<~..,'J ",f",/:': <"-i")!"'~:J '..;~,1'
items applicable to this project have been completed in substantial compliance with the approved plans and specifications,
:::_n'L:~,j "";1~.~;~' ~~;"\""~i-,;.; .:~.,..,;.'.:,-... ~}q ~';~C;)'::':_::{ I .~/:
.. .-'",i' [~lB/,,!"L.DJ~<:;II;.IGHTIN.GlTEMS "., ,i<,',oe'
. . 1_'Structural syste~ includi~g submittal and erection of all building
components (trusses;.precast, metal building, etc.)
,2. Fire'protectiorrsystems (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 of construction, fire stopped penetrations
6. Sanitation system (toilets, sinks, drinking facilities)
7_ Barrier-free including Cornm 18 elevators and Iiffs
8_ Energy envelope requirements
9_ All conditions of building plan approval and applicable variances
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10. Exterior lighting & control requirements
11. Interior lighting & control requirements
.... .,' 1'2. AlIconditiOriSof lighting plan approval
and applicable variances
o HVAC ITEMS
1. HV AC 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:
B) 0 Statement of Noncompliance
Due to the following listed violations, this project is not ready for occupancy:
C) 0 Supervising Professional Withdrawn From Project (Use A or B above to indicate project status as of this date.)
D) 0 Project Abandoned
3. SUPERVISING PROFESSIONAL SIGNATURE FOR:
o Building 0 HVAC 0 Lighting DONALD HAANEN 9/12/2007
Name (please print or type)
Phone # (920) 497-5007 Customer 10# 649536 Signature
SBD-9720 (ROl/2003)