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Home My WebLink About0042866-Building r. f,' ~~ lr ~ CITY OF OSHKOSH PERMIT - APPLICATION AND RECORD :2 '3/ N!!-42866 i' ~\ ~.. TYPE: BLDG~ HTG 0 ELEC 0 PLBG 0 SIGN 0 ZONING02- FLOOD PLAIN HEIGHT - - - - - - - - - - - - - - - - - - ~ ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - OWNER ~~o .so 'Koeller- kJ tYl 0 r--k. UI-t} / Mr'hcf ~tn-j/Ft e ~/1.f')::> I PLAN NO. ilL - 05:~/'t:1 ADDRESS ~ DESIGNER USE/NATURE OF WORK S{H r ;ita II 4Jj, ',j.,'f2 />'L - "uDt-- ko<-hc", "'-- ~4-.jr'e,~ A)oI-P ; be fl BUILDING CONTRACTOR .".-i SiZ~(H'-~ Sq. Ft. !j:..gOO # Rooms Foundation >~ u--eef/ rfhO.:St- Ail[t II Class of Const. # Stories G2 / Height /{p ~. ;J it Occupancy Permit HEATING CONTRACTOR C/e4~1 Heat 0 AlC 0 Vent 0 Fuel/System Heat Loss BTU'S ELECTRIC CONTRACTOR _ ~f.Y fo Jr- Electric Servo New 0 Change 0 Temp 0 Type _ Volts _ Amps_ Fixtures Switches Receptacles Circuits PLUMBING CONTRACTOR 'D 'r::- I/o PC. ~~ C1.. _BT _WH _ Disp _ WSoft _ CBasin _Lav _Sh _DW _DF _San. Sewer _WC _FDr _SP _Ur _ Storm Sewer _Sink _ L Tub _ Eject __SS _ Water Other ISSUED BY Fee Paid $ Date /' s130J Park Dedication $ Final/O.P. In the performance of this work I agree to perform all work pursuant to rules governing the described construction. S1GNATURE~ LJ U };;;;NER ADDRESS 67 t ( b~1\.l l 1 IZlJ. Ii I Z-q / '14 DATE Z-~I ,- 8> '='317 TELEPHONe # .~ /' PERMIT w<!28re, III (.. ;. riG hi- GENERAL NTRACTOR ,,~ -OS--/r"7 MASON. CONTRACTOR Width of lot 4.1 o .... ... o .c ~. 0, CD Q I , -- -. , :\ " ;; r..- I" , , , Ji\ , ZONE Front of lot .~~~ ~ o\<.-~ fECkI~. l?1b 4P MJULING ADDRESS ,;' -J Compliance Statement :3 <!:OSo ~e/~~-'- This form is required to be submitted by the architect, engineer, or HVAC desi9ner (supervising professional) observing construction of projects within buildings.with total v~lum~s exceedang 50,00.0 cubic f~et and c~n~tru.ction of antennas~ towers and bleachers (ILHR 50.1 0). Failure to submltthls form may result an penalties as specified an ILHR 50.26 and/or local ordinances. Genera.llnstructions: 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 and also to DILHR, Safety and Buildings, P.O. Box 7969, Madison, WI 53707 Personally identifiable information may be used for other purposes. 1. PROJECT INFORMATION: (Use the DllHR or municipal project label, or type or print the information.) Owner Information Project Information Bui ing Occupancy C apter s & Use 54 etail Name H E R E Unlimited Partnership II street L A B E L City gJ City County 0 of Oshkosh 2. PURPOSE OF THIS STATEMENT: (Check Box Ai-B, or Cto indicate purpose and comp'lete any other applicable ., b.oxes and imormation. Attach additional pages If necessary.) o Building and HVAC , Building Only 0 HVAC Only o Partial Completion Description of Portion Completed A) r.a. tt'atement of Substantial Compliance To the best of my knowledge, belief, and based on Onsite observation, construction ofthe following buildi....g a....d/or HVAC itemupplicable to this project have been completed in substantial compliance with the approved plans and specifitations. .,b. ....rUING 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 and installed by appropriately registered professionals 3. Exits including exit and directional lights 4. Shaft and stairway enclosures S. Fire-resistive 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: o HVACITEMS 1. HVAC system including final test (llHR 64.53) 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 to indicate project status as of this date.) Date Withdrawn D) 0 Abandoned A TURES: ~ '.tOj~ Date I HVAC Supefvising Professional Date Building Supervising Professional 5BD.9720 (R. 01/94) Compliance Statement This form is required to be submitted by the architect, engineer, or HVAC desi~ner (supervising professional) observing construction of projects within buildings with total volumes exceedmg 50,000 cubic feet and construction of antennas, towers and bleachers (ILHR 50.10). Failure to submit this form may result in penalties as specified in ILHR 50.26 and/or local ordinances. Generallnstructions: P~io.r to th~ i~itial occup'ancy of new buildings.or ad~Jt@;Pifa.~'h. J.,i.t~~,fJnal occupancy of altered eXlstmg bulldmgs, submit this completed and slgnecfiform tQ,;. ~:; ~\~ t",' The municipal building inspection office and also to ......" DILHR, Safety and Buildings, P.O. Box 7969, Madison, WI 53707 rES 9 1935 Personally identifiable information may be used for other purposes. 1. PROJECT INFORMATION: (Use the DILHR or municipal project label, or type or pri,Q;t.~~~fNfar'm:~ri,~ni?)' Owner Information projec\,jAfbV~~I<frY -." L A B E L H E R E Building Project # HVAC Project # o Building and HVAC o Partial Completion \ l e Description of Portion Completed A) . Statement ()fSubstantial 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 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 and installed by appropriately registered professionals 3. Exits including exit and directional lights . 4. Shaft and stairway enclosures 5. Fire-resistive 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: . HVAC ITEMS 1. HVAC system including final test (ILHR 64.53) 2. All conditions of HVAC plan approval and applicable variances B) 0 Statement of Noncompliance Due to thefollbwing listed violatibns,this prOject is not' ready for occupancy: ./( ,OJ,.'_' :':(;,) ~C) o Supervising Professional Withdrawn From Project (Use A or B above to indicate project status as of this date.) D) 0 Abandoned 3. SIGNATURES: Building Supervising Professional $BD-9720 (R. 01/94) Date Date Withdrawn -FE~-qS; Date . OSHKOSH.' FO~EDEJ:SARTMENT Fire Prevention Division 101 Cou rt Street Oshkosh, Wisconsin 54901 T elephorie236-5240/5241 RETURN. TO FlfU;DEPT~ OWNER NAME . .-- t . d#d.-OPt1.-I/-CTIL. (UJ,J DZr.::rCZAJ {lJJ1~~.:;;f!!--U?3../j OWNER AD. DRESS. ." .'. r-":\........ :.... ".' ~\1. '.4t! :-." ""GENERAl '90 Ii' ;,/ 0 ",., t\~-'~ .,."" ." .;;II ""t.. Off! \~'<l\w.t';"),"~d~"" ...... ..... ........ SPECIAL ClJ$,~f 11- '" - ST:TE.,..,~ti ACCEPTANCE TEST . ....... .. . . ... . .... t,: C. Q \':1'0 COMPLAINT ZIP TB;EPRONE. 0\') . REINSPECTION dl:Jt.,,-" 70 - FINAL DEP I\Rf;' , ~:l::5t gt ~Jlt~~T {-.\'SP.RINKLER;F\F!d:rEt-rl0N"'~~ - DISTRICT # vV j~ '~~RTIAl 0 RT. SEQUENCE # DOMESTIC Y \f N 0 COMPANY o!:L ~ tL 1 2 3&) . INSPECTOR t; /ZE6- ?,j/<.p-1- o o o '0 o ~ y: Non. Compo BLI1G:m.- OUTSIDE STORAGE ."",. 1. 0 Acctiss driveslfire lanes clear/posted 2. 0 Addresses posted 3. 0 Accumulation .of waste 4. 0 ProtectiOrim gas equip. 5. 0 Rre hydrants clear 6. 0 Outside stora!)e 30' from bldg. 7. 0 Outside stora!)e orderly 8. 0 Exit discharge clear 9. 0 Fire dept. connection valves clear and secure - caPs; covers, chains in place o o 12. '0 INTERIOR -EXITS, PASSAGEWAYS; UFE SAFETY. . 13.. 0 DoiJrs- locked, E>iOCke<Ui1(jperatiVe, swing wrong direction Corridors, passageways, obstructed, improperly maintained Stair&:tQwers, obstructed, defective, improperly maintained DOorsdel!ices - panic hardware, fusible links, defective, inadequate Exit pasSageways - inadequately lighted EXit lights - to be lighted at all times !:xit signs - markings, inadequate/improper size. Exits - inadequate,' insufficient number Signs - not posted - inadequate Prohibited hardwa~ - slide bolts, key locks etc. 23. 0 Eme(gency ugfitii'gProyided 24. 0 Emergency Ughting Operational 25. 0 Interior - other 26. 0 Life safety - other 152 0 Battery Back-up GENERAL HAZARDS . .27. O. HaZardous accumulation rubbish, debris; waste materials to be removed. o$tock - merchandise improperly stored to retard spread of fire 29. 0 Interior finishes - decorations - tents, remove or flameproOf . . 30. 0 Storage/Stock too high; 24" from ceiling 31. 0 Ventilating systems to be cleaned, repaired, installed . 3:1. 0 ^ Aisles, cross aisles to be inilirifainedfUlI width at all times Combustible Iinf ariddLlsttobe removed from equipment, walls, beams, floor, disposed of in proper manner 34. 0 Vacant Building - secure all openings until such time as the building is made safe or taken down and removed Heating sysiems maintenance/cleaning Heat producing device clearance Improper- prohibited heating device General hazards - other Handrails 16. 0 17. 0 18. 0 19. 0 20. 0 21. 0 22: 0 33. 0 o o 35. 0 36. 0 37. 0 38. 0 39. 0 40: 0 ELECTRICAL 41.. 0 Wiring-switchesc.plugsdefeclive, to be replaced Wiring - improper and temporary, unsafe practice Extension cords/muni oullet devices Proper clearances:maintained . Bre<1ker locks/indentification . Other . - Blanks on electrical panel NFPA # o.:L v ZJ Non- Compo Non- Compo FIREWALLs~DOORS;CURTAIN . WALLS, PARTITIONS & CEILINGS 48. 0 Fire wall penetrations 49. 0 Ceiling tiles missing 50. 0 .fire doors inoperative 51. 0 Fire doors propped open 52. 0 Fire door closer 53. 0 Fire door hardware 54. 0 Signage where needed 55. 0 Fuse links damaged/painted missing 56. 0 Coqrdinalors/astragals 57. 0 Rre dampers 58. 0 Rre damper access 59. 0 . Unprotected openings 60. 0 Corridor integrity 61. 0 Proper opening Prot 62. 0 Rre walls, doors - other 63. 0 Walls, partitions, ceilings - other SPECIAL PFlOCESSESIHAzARDS/ EQUIPMENT/OTHER 64. 0 Culling and welding equip. 65. 0 Cylinder storage 66. 0 cylinder restraint 67. 0 Ventilation 68. 0 Manifold systems 69. 0 No-Smoking posted 70. 0 71. 0 72. 0 73. 0 DIPTANKS 74. 0 Cover-operational 75. 0 Valves-operational 76. 0 Controls-operational 77. 0 Overflow/drain 78. 0 Protection 79. 0 location/Separation 80. 0 .. 81: 0 SPRAY PRINTING:- 82. 0 Booth/Ahi81R6om loCation . 83. 0 Ventilation . '. 64. 0 PrOtection- 85. 0 Explosion proof wiring 86. 0 Adjacent storage 87. 0 - DUcls/fans/discharges 88. 0 Maint/cleaning 89. 0 Ignition devices 90. 0 Posted/Signs 91.. 0 92. 0 FLAMMABLE L1QUIDS-GASES-'. SOLIDS-EXPLOSIVES 93. 0 Not properly stored handled -processed 94. 0 Excessive amounts on premises 95. 0 Dip tanks, spray booth not properly separated or const. 96. 0 Materials not stored to retard spread of ~re .97. 0 Storage rooms-premises not properiy marked! maintained FLAMMABLE lIQlJIDS-GASES~ SOUDS-EXPLOSIVES 98. 0 Storage-prohibited except in fire resistive room oroutsidebldg. 99. 0 Tank location not in'accord with applicable standards 100. 0 Existing above ground tanks storage to be properly maintained, diked, marked, and located 101. 0 Above ground tanks prohibited 102. 0 Valves-dispensing equipment to be approved type-maintained in good order 103. 0 Electric wiring and appliances to be U.L type 104. 0 Misuse of materialssubjeCtt6 fire and injury to personnel 105. 0 Cabinets required 106. 0 Cabinet/room ventilation 107. 0 Safety GarIs 108. 0 Bonding and grounding 109. 0 Proper postirig/No smoking 110. 0 Explosion wiring where needed 111. 0 Storage room suppression 112. 0 Haz. mat. M.S.D.S. 113. 0 Haz..mat. list/update 114. 0 SecondillY. containment 115. 0 Waste product dispoSal 116, 0 Waste rag storage/disposal 117. 0 Other 118. 0 Proper Cabinetl.D. SERVICE STATIONS 119. 0 U/G taDk fill pipes 120. 0 U/G tank spill proto 121. 0 Dispensers/posting 122. 0 Hoses-piping'nozzles 123. 0 Impact valves 124. 0 Fire suppression 125. 0 Emergency controls 126. 0 Breakers identified 127. 0 Station maint./rags/ miscellaneous 128..0 SUPPRESSION SYS]'I:MS/ALARMS 129. 0 Suppression/standpipe - MAII\ITENANCE 130. 0 Suppression/standpipe - REPAIR 131. 0 Sprinkler system, DESIGN/DENSITY INADEQUATE FOR HAZARD '. Sprinkler system -OBSTRUCTiON Valve identification Valve - SECURITY/MONITORING Alarm system maintenance/repair Suppression system monitoring required Alarm system tests Smoke-.he?t detection:fire alarm system(s) inoperative. To be repaired Smoke and heat'detection Storage top high Fire extinguisher mounting Fire extinguisher location Fire extinguisher 1.0. Fire extinguisher adequate ~ > Rre extinguisher service date I TI (3 h Suppression/alarm system - other pf!.. pi V 132. 0 133. 0 134. 0 135. 0 1'36. 0 137. 0 138. 0 139. 140. 141. 142. 143. 144. 14!i 146. 0 OTHER 147. 0 148. 0 149. 0 150. 0 o o o o o o ~ Kitchen suppression system Kitchen suppression service.date Hood'.fi~ers Fusible links removed Misc, Violations Ust Below 0 Premises and equipmElIltin good order~no visible hazards observed this date SECTI01\i101.14 OF: THE WISCONSIN STATUES CONSTITUTES EVERY RRECHIEF. A DEPLrIY OF THE WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN [lELATlONS, AND REQUIRES HIM OR HIS APPOINTED INSPECTORS TO MAKE INSPECTIONS FOR THE PURPOSE OF ASCERTAINING AND CAUSING TO BE CORRECTED ANY CONDITIONS UABLE TO CAlISE FIRE, OR ANY VIOLATION OF ANY LAW OR ORDINANCE RELATING TORRE HAZARD OR PREVENTION OF FIFiES. .. ........ . '.. . . THE FOLLOWING ORDERS ARE ISSUED FOR THE CORRECTION OFVIOLATlONITEIVlS CHECKED AsOVE. THESE ITEMS SI-IALLBECOMPLIEDwITH FORTHWITH. WAflNING: FIRE OR INJURY RESULTING FROM FAILURE OR PELAYTO COMPLY WITH THIS NOTICE WILL BE ATTRIBUTED. TO. NEGLEGENCEON THE PART OF THE RESPONSIBLE PARTY OR PARTIES. (AN APPUCATlON FOR APPEAL MUST BESOMBI1TED TO THE FIRECHIEJ=wiTHIN 24 HOURS OF THIS REPORT) . , .. . .NOT'ICE THIS BUILDING 'SHALL NOT BE OCCUPIED UNTIL FINAL INSPECTIONS HAVE BEEN MADE AND THIS CARD SIGNED BY THE FOLLO.WING INSPECTORS 5~cf,< r~ SECTION 7-32 CERTIFICATE OF OCCUPANCY TO BE ISSUED (A) NO BUILDING OR PART THEREOF SHALL BE OCCUPIED UNTIL SUCH CERTIFICATE HAS BEEN ISSUED. NOR SHALL ANY BUILDING BE OCCUPIED IN ANY MANNER WHICH CONFLICTS WITH THE CONDITIONS PUT FORTH IN THE CERTIFICATE OF OCCUPANCY. PRESENT THIS CARD FOR OCCUPANCY PERMIT TO. Code Enforcement Division Room 205, City Hall Oshkosh, Wisconsin 54901 -x BUILDING.. ~ij;~,,~LECTRICA ~ ,:~~,{u, E A T.IN.. .. . ~' ",:\", ' ~~ PLUMBING INSPECTIONS MAY BE ARRANGED BY CALLING 236-5050. "' 1 DATE ~oJ.s- I - I {I DA TE"IP.lJ/7~ -fl. DA.TEIIJt1!;1j- DATE 151)73- f FIRE 236"-5241 I. DATE NOT APPLICABLE TO 1 AND 2 FAMILY DWELLINGS IT ARIAN 236-5030 -DATE Iy for Businesses that Require a Permit from the City Health Department. SEALER DATE Only for Buslriesses where Scales, Pumps or Scanning Registers are used.