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Home My WebLink AboutCertificate 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: 12/05/2007 12/06/2007 Bradley Operating Ltd Partnership 131 Dartmouth St Boston MA 02116 CERTIFICATE OF OCCUPANCY An Occupancy Permit is hereby issued for Papa Murphy's Pizza located at 220 W Murdock, Oshkosh WI as described in Building Permit #127654. This building shall be used for Retail Business and is located in the C-2 General Commercial Planned Development Overlay District. LIMITATIONS: Maximum number of persons: 22 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 v cc: R J Albright Inc Papa Murphy's Building Permit Work Card Job Address 210-240 W MURDOCK AVE Permit Number 0127654 Create Date 10/25/2007 Owner BRADLEY OPERATING LTD PARTNERSHIP Contractor R J ALBRIGHT INC. Category ?_~q_-:Ji~'N Stores & Customer Service Plan 28-2169-1007 Occupany Permit Required _ Flood Plain Height Permit Class of Const: Use/Nature220WMurdock I Papa Murphy's 71nIerior 8:ij'eraBo"il.s-fornew"ienanf-"--"'-'---'-'. ~ --"-.--..-- ~-'-----"^"-----'--"--'------"'--~-"~ of Work i 1 I -_____J HV AC Contr Plumbing Contr Electric Contr Inspections: Date 12/4/2007 --_._-~ re"", Ii", 1_____ Date/Time requested: 11/30/2007 03:21 PM ["-_d' _ _ Access: i~ey above s~ore front door Requested By: ~ J ALBRIGHT INC. - Scott o Reinspect Fee 0 Fee Waived 0 Reinspect Fee Paid TYP~:J Inspector AIlY"-I2.~nnhofL ~.>;'~,~",,:4'_"'~-.~.", "approved o:;j. .0 ~.__..!!i 1~.~_'_~... ' I I I I ___.._.___.__",_1 Notice Type: Ready Date/Time: 11/30/200703:21 PM ----~ _____---.1 Phone Number: 376-0248 - - - - - - - -. - - - - - - - - - - - - - - - - - -- - -. - - - - - - - - - - - - - -. - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - -- - - - - - - - - - - - - - - - -- - - - - - -- -. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - - - - ~ ~ -- Page 1 of 1 Building Permit Work Card Job Address 210-240 W MURDOCK AVE Permit Number 0127227 Create Date 10/11/2007 Owner I?B,II._DLEY OPERATING LTD PAHTNE~SHIP Contractor R J~LBRI~I:L~~C~_________________ Category 232 ~ Altera~~r1. Store~ ~us~mer _~rv~~_____ _ ____________ Plan Occupany Permitl'!~~equired Flood Plain Height Permit_________ ___ Class of Const: Use/Nature ~20 WMurdock/PapaKilLirphys-Tfnstall eastaemisin~iwaITal1cri-estro6m_ - - ______d_ -- _d__ of Work I I HVAC Contr Plumbing Contr Electric Contr Inspections: Date _!Q/211~QQ?_ _:__ Type Rough In Inspector AII~_n_g_an~~~ff_~_______ ___ approved r~EQUESfTfNETREADY FORA ROUGH INSPECTION---------~ ------------ - ------ -- ----------------------------1 L"~___"__ "____~"~ Date/Time requested: 10/19/2007 09:08 AM Notice Type: Access: [LOCKBOX CODE IS #1650 Requested By: R J ALBRIGHT INC. - Scott Showers o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Ready Date/Time: 10/19/200709:08 AM _ __.___,~,_.___.._..__J Phone Number: (920) 23J~~~_________ Page 1 of 1 ~ Electric Permit Work Card Jo!?,Address 210-240 W MURDOCK AVE Permit Number 127394 Create Date 10/22/2007 Owner BRADLEY OPERATING L TD PARTNERSHIP Contractor VAN OFFEREN ELECTRIC LLC Service b New 0 Change 0 Temp . N/A I Type 0 Overhead 0 Underground . N/A Volts Circuits 15 Luminaires 14 Amps Switches 6 Receptacles 20 ,,,,,W""-,,, " ~~ jJ ~\," '\ . " 'J-0 Value $9,400.00 Use/Nature of Work 343 - Commercial-Addition/Remodels Space 220 (Papa Murphy's) /INSTALL 14 2X4 TROFFERS FOR WHITE BOX, IIVIRE NEW LIGHTING, ROUGH IN AND FINISH POWER FOR REQUIRED OUTLETS Inspections: Date 10/25/2007 r'" <>est It"' Date/Time requested: 1 0/24/2007 11 :35 AM Notice Type: FC Ready DatelTime: 10/24/2007 11 :35 AM Access: Key pad code #1650 Requested by: VAN OFFEREN ELECTRIC LLC - Rob Phone Number: 428-4160 o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid Type Rough In Inspector Kevin Benner not approved Date 10/30/2007 Type Re Rough In Inspector Kevin Benner approved REQUEST LINE / READY FOR A ROUGH REINSPECTION *PLEASE CALL CONTRACTOR WHEN INSPECTION IS COMPLETED** DatelTime requested: 10/29/2007 06:47 AM Notice Type: Access: key pad on door is #1650 Requested by: VAN OFFEREN ELECTRIC LLC - Rob o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid Ready DatelTime: 10/29/200706:47 AM Phone Number: Date 11/0212007 Type Rough In Inspector Adam Krause not approved REQUEST LINE / READY FOR A ROUGH INSPECTION *CALL CONTRACTOR WHEN THE INSPECTION IS COMPLETE**No access; what lock box? Date/Time requested: 11/01/2007 10:14 AM Access: LOCK BOX CODE IS #1650 Requested by: VAN OFFEREN ELECTRIC LLC - Rob o Reinspect Fee 0 Fee Wavied 0 Reinspect Fee Paid Notice Type: Ready Date/Time: 11/01/200703:00 PM Phone Number: (920) 428-4160 Date 11/06/2007 Type Re Rough In Inspector Kevin Benner approved ) Date/Time requested: 11/05/2007 00:00 PM Access: Requested by: o Reinspect Fee 0 Fee Wavied Notice Type: Ready DatelTime: 11/01/2007 03:00 PM Phone Number: o Reinspect Fee Paid . Electric Permit Work Card Jo~ Address 210-240 W MURDOCK AVE Permit Number 127394 Create Date 10/22/2007 ~~Eit' .... ;y ~-., U) ~.,,\~ Switches 6 Receptacles 20 Value $9,400.00.~~ \,\~J 643 - Commercial-Addition/Remodels Space 220 (Papa Murphy's) I INSTALL 14 2X4 TROFFERS FOR WHITE BOX;--" WIRE NEW LIGHTING, ROUGH IN AND FINISH POWER FOR REQUIRED OUTLETS Contractor VAN OFFEREN ELECTRIC LLC I Type 0 Overhead 0 Underground. N/A Luminaires 14 Owner BRADLEY OPERATING LTD PARTNERSHIP Service b New 0 ChangeO Temp . N/A Volts Circuits 15 Amps Use/Nature of Work Inspections: Date 11128/2007 Type Abv Ceiling Inspector Kevin Benner approved w/cond. REQUEST LINE I READY FOR AN ABOVE CEILING INSPECTION WOULD LIKE INSPECTION TODAY IF POSSIBLE 11/28/07 IcL2 Wiring suport. Reviewed with the electrician on site. DatelTime requested: 11/28/2007 07:08 AM Access: Notice Type: Ready DatelTime: 11/28/2007 07:08 AM Requested by: VAN OFFEREN ELECTRIC LLC - Rob o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Phone Number: (920) 428-4160 - - -- - - ---- - - ----- - - -- ---- - - - --- - - ---- - ------------ - - - ---- - - - ---- - ------- -- --- - - - ---- - -- ---- - ---- -- ----- - ----- -- - ---- - - - --- - - ----- - - ---- - ---- ----- - - - ---- - --- Date 12/04/2007 roo'es, "00 Date/Time requested: 12/03/2007 11 :38 AM Access: Type Final Inspector Kevin Benner not approved Notice Type: FC Ready DatelTime: 12/03/2007 11 :38 AM Requested by: VAN OFFEREN ELECTRIC LLC - Rob o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Phone Number: 920-428-4160 -- -- - -- - - - - ---- -- - - --- - - - - - -- - - ---- - - - --- - - ---- - ------- - - - ---- - - - ---- - - ---- - - - ---- - - --- - - - ---- - - - ---- - - ---- - - - --------- -- - ---- - ---- - - ------ ---- ----- - - - ----- Date 12/05/2007 Type Re Final Inspector Kevin Benner approved w/cond. I he panel schedule is to be re-written or typed so it is clearly identified. The E.C. stated that it would be corrected by Thursday 12/6/7. Reviewed with Rob. \ Rob V. called 12/7/7 8:04 AM and he stated the panel schedule will be installed this AM. DatelTime requested: 12/05/2007 07:14 AM Access: Notice Type: Ready Date/Time: 12/05/2007 11 :00 AM Requested by: VAN OFFEREN ELECTRIC LLC o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid Phone Number: 428-4160 Rob . ------ '-,-., ~ , ./' ~ CORRECTION NOTICE / FIELD INSPECTION REPORT '30 ~ City of Oshkosh I~ 1spection Services Division . A 5 Church Avenue, PO Box 1130 ~()shkosh, WI 54903-1130 Phone: (920) 236-5050 Fax (920) 236-5084 JOB LOCATION: CONTRACTOR: PROJECT TO BE INSPECTED: Q.. TYPE OF INSPECTION: K'I\a \ t:leL.-b-'tL- l.~C' 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 ofthis notice and return it to the Inspection Services Division by the Compliance Date of conE INSPECTION RESULTS fJ h 5' Print Name Company Signature: Date HVAC Permit Work Card Job Address 210-240 W MURDOCK AVE Permit Number -'---~.'--------------- Owner B ~J\J?!-~'(gl'E RA TI f\!_~J:.T~~A_RTf\!~R~1j CO ntractor CE NT~J\I,.IjI::_J\:r1 ~gJ3J,:_RY1C;E:_I~_g____ Fuel 0g:~~~~_J U_ o1f_~=:J Dn~~~tr0J U_~~Ta!-:_:! [JSO-i1~-=-1 Value __ t2.,400,9Q System D__r-Jew _J 0 Ref?!i:lcE3_____________J D.--2!.hE3~ I 0"_~I:~t3.cl~~lr _J [I~~~~r1.'--_=] U~ie~n1::__-=.=J D~~_-=:=:=-=:j D-\ient:=~~~--J O~Ele~~~c..~_~ [f!!?f~ater-:=J O-S~p~L__:=_=J D-Con~~-u=~n_~=~i Chimney Type DchTrlli1eY-A~---OChimneyB----_--_=:D~1.~~C~~==.~~~~~~=:=J ~:~~~:"~ [M (220 - P'P' M"~hi') I INSTAll REGIS~RS. GRILLS ~D EXHAUST FANS "'he,' #23m 127908 Create Date 11/20/2007 Inspections: Date 12/4/2007 Type'''Firrcirr<Jl- ;0'~;';';':;i""'- .,_. '~ Inspector Allyn Dannhoff ~vea -__ _, ----~--~---~----- E:~~~.._._~.,~>.:!::r."1,,,^,; r-- I I L_ _______ Date/Time requested: Access: [~: Requested By: o Reinspect Fee 0 Fee Waived -------------------~ Notice Type: Ready Date/Time: ------ -~:_=-==----] Phone Number: --- o Reinspect Fee Paid -- - - - --.. - - -. -- - - - - - ---. - - - - - ----- - ------ - ------ - - ~--- - - ---,-- - ------ - - ---- - - - - -- - - - - - - ------. - - - - - -- -- - - ~-~ -- ~ ~ ~-- ~ -~ ~ ~ - ---- -- - ~ - ~- ~ ~--~ -- ~ - --- - ~--- - ~ ~ ~ ~ ~.- ~ ~~ -- - ~- ~~ ~ ~ ~ - ~. -. Plumbing Permit Work Card Permit Number !?2~~_____ Contractor D.R. HANSEN PLBG. ----..----.--- Plan FL-285-1107-P $1 ,5~Q:Q0 Job Address 210-240 W MURDOCK AVE Owner BRADLEY OPERATING LTD PARTNERSHI Category 440 - Industrial-Interior Bathtu b Whirlpool Lavatory Toilet Res. Sink Bar Sink Water Heater Site Drain Roof Drain Misc. Fixtures Use/Nature of Work Create Date 11/02/2007 Value Shower Water Softner Wait. St. Shamp Sink Coffee Maker Floor Drain Local Waste Ice Chest FlrlWst Sink Int Grease Trap Lndry Tray Clothes Wshr Exam Sink Catch Basin Ext Grease Trap 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/G rind Drink Ftn Serv Sink Soda Disp r'iif '0"'" ,<e'" 'o',coe,IOC,oc "'""''''''''';; P",-"o",hy'iTe"", '"'' #220.-----------. L_ Sanitary Sewer Conn.Type Storm Sewer Water Service Size Material Type # Inspections for Work Card 95126 Date 11/2/2007 Type Underground Inspector Paul Wolf approved w/cond. Work-nofcompTetedattlme of inspection. Review needs to be completed for-lnstiiTftobe approve~-------------- ---.- ~--'--'-.-l Date/Time requested: ~~~~~1~~~__ Notice Type: Telephone Number: Access: [--== _______ _ -~_=_=~~_~=[=~~~ -= : _ :=--==~-_:- -~-~-~ :-=~_~~ ~~= - ~n-~=:- _-_~:==:~ Ready Date/Time: ~Y2/~007 09::L5 A~_ Requested By: '2:!3.:Jj~~~I'J!'~_E3Q'_n_________________ o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid Date 12/4/2007 Type Final Inspector J=>_C1u~Wolf ______________ approved Date/Time requested: 12/5/200707:27 AM Notice Type: Telephone Number: _______ Access: C_=_=:_==-~===:==_~==-===_==~_==~=~=~ Ready Date/Time: 12/4/2007 07:27 A~ Requested By: DR I::fANSEN PLBG. o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid ~~-----~-.--'-I ~ ~ OJHKOJH 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 October 24, 2007 Kevin Salmon Michael J WilkusAIA 11487 Valley View Rd Eden Prairie MN 55344 Dunham Associates 50 So Smith St, Suite 180 Minneapolis, MN 55402 Joe Wight Bradley Operating Limited Partnership 11520 N port Washington Road Suite 202 Mequon, WI 53092 Phyllis Senn Papa Murphy's Pizza 5302 Wesrhall Ave Louisville, KY 40214 Site: Papa Murphy's Pizza 220 W Murdock Ave Oshkosh WI 54901 For: Description: Tenant space alterations Object Type: Building only Class of Construction: lIB - 1240 Sq Ft.; Occupancy: M: Mercantile f Retail Maximum No of Occupants: 22 Plan Number: Z8-2169-1007 Unsprinklered 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 defmed in Chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements Key Item(s) f Conditions: . IBC 906.1 /IFC 906.3 The maximum travel distance allowed to a fire extinguisher is 75 feet. . IBC 1209.1 Provide toilet room floors with smooth, hard, nonabsorbent surface extending minimum 6 inches up onto walls. Sheet A-l finish schedule indicates 4 inch base, please revise to 6 inches to comply with code. . COMM 62.1109 (12) Where counters are provided for sales or distribution of goods or services, at least one of each type provided shall be accessible. . COMM 2603.4.1.3 Walk-in coolers. In unsprinklered buildings, foam plastic having a thickness that does not exceed 4 inches (102 mm) and a maximum flame spread of 75 is permitted in walk-in coolers or freezer units where the aggregate floor area does not exceed 400 square feet (37 m2) and the foam plastic is covered by a metal facing not less than 0.032-inch-thick (0.81 mm) aluminum or corrosion-resistant steel having a minimum base metal thickness of 0.016 inch (0.41 mm). A thickness of up to 10 inches (254 mm) is permitted where protected by a thermal barrier. Verify compliance with these requirements as details on cooler specifications were not provided with plan submittal, this information shall be provided to field inspector. I:\Inspedions\Plan Revit'\v\Cummen:ial Pian Revkw 2007\Z8-21()9-] 007220 WMHrdo\;k A vt' Bldg Only.do\; Page 1 of2 . Comm 61.30(3) IIMC 507.2 This plan review does not include heating, ventilation, or air conditioning. IN AC plans are required to be submitted and approved prior to installation ofl-IVAC equipment. Be aware that mc 1004.3.2.4 contains additional restriction for air movement in corridors . 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). . 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. .MUN 30 This review does not include review for signage. Applications for and questions regaurding signage permits should be directed to Todd Muehrer - Associate Planner (920) 236-5062. . MUN 15 NOTE: Contact Anne Boyce - Health Services (920) 236-5029 for additional information as to Health code requirements. A copy of the approved plans, specifications, and this letter shall be on-site during construction. All pennits are required to be obtained prior to connnencement 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. nan e 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 $ 320.00 320.00 0.00 FInsp,,('jiul1S\Plan g"vit-w\Commen:ial Plan [{,'vi.,\\, 2007\Z8-2169-1 007220 'IV MurdOCK Ave Bldg Only.doc Page 2 of2 ,... ~ OJHKOJH ON THE WATER City of Oshkosh Division of Inspection Services 215 Church Avenue PO Box 1130 Oshkosh WI 54903-1130 www.ci.oshkosh.wi.us November 12, 2007 Dale H O'Connell PO Box 802 Green Bay WI 54305 Joe Wight Bradley Operating Limited Partnership 11520 N port Washington Road Suite 202 Mequon, WI 53092 Phyllis Senn Papa Murphy's Pizza 5302 Wesrhall Ave Louisville, KY 40214 Site: Papa Murphy's Pizza 220 W Murdock Ave Oshkosh WI 54901 For: Description: Tenant space alterations Object Type: HV AC only Class of Construction: fiB - 1240 Sq Ft.; Occupancy: M: Mercantile I Retail Maximum No of Occupants: 22 Plan Nnmber: ZS-2169-1007-H Unsprinklered 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 defmed in Chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements Key Item(s) I Conditions: . 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 Corom 61.31(1). . 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 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. \\OSHKOSH M ISFS\Dcpartmcnts'.!nspixt:01lo\Pl;;m Rcvicw\Comri1crcial Plan Review 2007"ZX-2169-1 007 -H 220 iN Murdock Ave H Vile Only.do(; Page 1 of2 Inquiries concerning this correspondence may be made to me at the number listed below or the address on this letterhead. ~ Bnan Noe 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 $ \\OSHKOSHM!SFS\Dcpanments\lnspcetiolls\Plan Revicw\Cornmcrcia1 Plan Review 2007'Zil-21 69-1 007 -H 220 W Murdock A V(: H V:\C Only,JoG Page 2 of2 230.00 230.00 0.00 BUILDINGS, BV 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 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 ID Number Project Name ~ MV~f't-\""(::; '~'_~i' Site Number Site location (number & street) 220 W W>>~ ~EN\1e- I ~rte ~ )(City 0 Village 0 Town of OSHV-OSri County of 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 pages if necessary.) Check those which apply: 0 Building Object ID # 0 HVAC Object ID # o Lighting Object ID # o Partial Completion Description of Portion Completed A) 0 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. D BUILDING/LIGHTING ITEMS 1. ~tRolgt,..~1 syvtilY\ ;n,..llIrling ellh....itlal gR~ 13r89tisfI er.;;.1I b...:Jd:,~ "'''''IIl..nJIIt:I~M (tnl~~A~. Pf89Q~t. mntfllli14i1~iA!I, 6t8.) 2. Eir.a pr9ts.tisA systeMS (8f)Aflldefe, sISJ;'lJY. Y"'?....O ~9t9.re) .saiA"ed, it.~L...II....~, AQd tBetefi (ifl8huUftlj fep.,veN ~8VJ 8" bash ~8n 88. iees) B~ Bp'Ir!,s. iat.l)l)I rqgiet~..~~ pl>'Qml&i8F1sl6 3 ~h,ft ;tRd etsifl..a) 1.~~6IeJare 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 Comm 18 elevators and lifts 8. ~1'I81'!1) 81'1.8181111 r8l!JIlII'llM8Rtl 9. All conditions of building plan approval and applicable variances The follOWing items are not in compliance and must be addressed: 10. IIiJOOA~r HShH"9 , ooRtrel F8ttt!Jirel,.'lll~ 11. Interior lighting & control requirements 12. All conditions of lighting plan approval and applicable variances o HVAC ITEMS 1. HVAC system including final test 2. All conditions of HVAC plan approval and applicable variances 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 k> indicate project status as of this date.) D) 0 Project Abandoned 3. Sl{PE~VISING PROFESSIONAL SIGNATURE FOR: )(Building 0 HVAC 0 Lighting L. \Ul Name (please print or type) Phone numberfJ';Z.Q41.&'ll:ustomer 10 #CO~l cfLi \\.W,07 Iv 30 07 12:15p . Compliance Statement is form is required to be submitted by the supervising professional (architect, engineer, HV AC designer or electrical designer) observing construction of projects within buildings with total areas exceeding 50,000 cubic feet and construction of antennas, towers, and bleachers (ILH~ 50.10). Failure to submit this form may result in penalties as specified in ILHR 50.26 and/or local ordinances. 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 fonn to: . The municipal building inspection office iilld . Safety and Buildings, P.O. Box 7969, Madison, WI 53707-7969 p. 1 Personal infonnation you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)J. 1. PROJ:ECT INFORMATION: (Use the Safety and Buildings or municipal project label, or type or print the information. If label is used, no additional entry is needed on Part 1. O\vner Information Project Information Slale and Zip Code County of Name L A B E L Company Name Number and Slreet CilY D H E R E rlan or Reference Number Name & Reg. II of Super\' ising Pro f. for IJ Building 0 BV AC 0 lighling Name & Reg. II of Supervising Prof. for LJ Building l.. \ E \...L. 2. PURPOSE OF THIS STATEMENT: (Check Box A, S, C, or D to indicate purpose and complete any other applicable boxes and information. Attach additional pages if necessary.) Check those which apply: 0 Building 'f/J HV AC :J Partial Completion Descrirtion of Portion Completed A) [I Statement of Substantial Compliance To the best of my knowledge, belief, and bas..:d on onsile observation, construction of the following building and/or I.IV;\C ilems applicable to this project have been completed in substanti<ll compliance with the approved plans and specifications. o Lighting o DUILDING ITEMS 1. Structural system including submittal and erection orall building components (trusses, precast, metal building, ctc.) 2. Fire protection systems (sprinklers, alarms, smoke detectors) designed, installed, and tested (ineluding forward flow on back flow devices) by appropriately'registered professionals 3. Shaft and stairway enclosure 4. Exits including exit and directional lights . 5. rire-resistive construction, enclosure of hazards, fire walls, labeled doors, c1:\ss 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: '" I IV AC ITEMS ,e HV AC system including final test ([UIR 64.53) 2.. All conditions of BV AC plan approval and applicable variances o LIGHTING ITEMS I. Exterior lighting & control requirements 2. Interior lighting & control requirements 3. All conditions of lighting plan approval and and applicable variances B) 0 Statement of Noncompliance Due to the following listed violations, this project is not rcady for occupancy: o Building '$ BV AC 0 Lighting o Building 0 (IV AC 0 Lighting o Duilding 0 BV AC 0 Lighting SE3D-9720 (R.OI/97) or B above to indicate project status as of this date.) C) 0 Supervising Professional Withdrawn From Project D) 0 Project Abandoned 3. SUPERVISING PROFESSIONAL SIG~A Date ~c>-~o'-l-C\ Date Date