HomeMy WebLinkAboutBuilding Compliance Statement
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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 designer (supervising professional)
observing construction of projects within buildings with total volumes exceeding 50,000 cubic feet and construction
of antennas, towers and bleachers (lLHR 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 occuJ?ancy of new buildings or &'a,tt~:A'S,and the final
occupancy of altered existing buildings, submit this completed ancfsigned'forii~:J~(f,:;"
The municipal building inspection office and also to""'"
DILHR, Safety and Buildings, P.O. Box 7969, Madison, WI 53707 '7 I t::"
Personally identifiable information may be used for other purposes. . lj ~. iJ 7995
1. PROJECT INFORMATION: (Use the DILHR or municipal project label, ortypel;}~pri~I't}(.Ji.(1focmation.)
"'Ii jffl,~ ;i.'f, Ii ," <$ ~ ; J;/~' {:'{:_
Owner Information PrOject 'iifol!,".~j~n/;'
17.", ~
SUI Ing Occupancy apter s & Use - v
Cha ter 54 Retail
Tenant Name i any
J-K Fabrics & Crafts
su~a~n9 Location num r street
~ ~ Koeller Road
III
H
E
R
E
street
P!J City
County 0
D Village
DTown of
Oshkosh
Building Project #
94068
HVAC Project #
2. PURPOSE OF THIS STATEMENT: (Check Box.A~B, or C; to indicate purp<<?seand comp'lete any other applicable
boxes and InTormatlon. Attach additional pages If necessary.)
o Building and HVAC ~....blJlg Only 0 HVAC Only
o Partial Completion
_ ~ Description of Portion Completed .
A) ~atement 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 proje ave been completed in substantial compliance with the approved plans and specifications. .
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:
o HVACITEMS
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 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
~~TU~~
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Building Supervising Professional
SBD-9720 (R. 01194)
-s. t!:j t-
Date
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HVAC Supervising Professional
Date