HomeMy WebLinkAboutBuilding Complaince Statement
Compliance Statement
Name
L Landmark Unlimited Partnershi
A Company Name
B
E
L
This form is required to be submitted by the architect, engineer, or HVAC desi9ner (supervising professional)
observing construction of projects within buildings with total volumes exceeding 50,000 cubic feet and (onstruction
of antennas, towers and bleachers (ILHR 50.10). Failure to submit this form may result in pe alties as specified in
ILHR 50.26 and/or local ordinances. . lk~-:: ,;:c:.;t; "-
General Instructions: P~io.r to th~ i~itial occup'ancy of new buildings.or ad I onS~n~]h. ,e,J....iQal
occupancy of altered eXlstmg bulldmgs, submit this completed and signed form td:" .1!\~,) /if t;l'
The municipal building inspection office and also to M.41) _ t,
DILHR, Safety and Buildings, P.O. Box 7969, Madison, WI 53707 . , ! I J jO ,..
Personally identifiable information may be used for other purposes. Cf) . I' lJiE/> .~, ,0) .... J 9::J
1. PROJECT INFORMATION: (Use the DILHR or municipal project label, or type or pri~~l~')Pl~~~!i??~
Owner Information Project Informatiort VI:; ,Or.
BUI jng Occupancy apters & Use
Chapter 54 Office
Tenant Name i any
u heran Brotherhood
BUI In Location num r & street
Koeller Road
~City o Village OTown of Oshkosh
III
H
E
R
E
street
31.$'
County 0
Building Project # 9 4 070
HVAC Project #
2. PURPOSE OFTHIS STATEMENT: (Check Box.A"B, or <; to indicate pur:P9se and comp'lete any other applicable
. .~ boxes and infOrmation. Attach additional pages If necessary.)
. 0 Building and HVAC fi'I'IDlding Only 0 HVAC Only
o Partial Completion
~ Description of Portion Completed
A) Lf Statement of Substantial Compliance
To the best of . knowledge. belief. and based on onsite observation. construction of the following building and/or HVAC items applicable to
this proje lIe been completed~in substantial compliance with the approved plans and specifications.
UILDING 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:
o HVAC ITEMS
1. HV AC system including final test
(ILHR 64.53)
2. All conditions of HV AC plan approval
and applicable variances
B)D 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
~TURE~
Building Supervising Professional
SBD-9720 (R. 01194)
"5- ~r-iHV CS .. P f . I
Date A upervlsmg ro esSlona
Date