HomeMy WebLinkAboutBuilding Compliance Statement - 6/10/1997
Compliance Statement
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 (ILHR 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 ad ~ brad the final
occupancy of altered existing buildings, submit this completed and signed rr~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 DILHR or municipal project label, ortype or prjntthen~forr~abon.)
E ~' ` ~ ~
Owner Information Prolect`t~ni~ormation ~ .~ "'~~ ~ ,~,
Name Bui ing Occupancy apter s 8 Use ~-4~ } P "t -
~s :~ ,_
ha ter 54 Office
CE)NlPLIAhICE ~TATEI~IEhl7 LAE~EL Tenant Name i anv
Cs~FTCE
LAWGkIARIi UFtLIMITED
DEF Al~TI++11EElsIT t~ I;EiIE
344 i~ELLER RD
ki~l'~ ~~~1'I
93-14-4156-E
A444~14~~1
E Name an Registration N
PARTPIER~HIP ITT
James E. Larson
Name an Registration Num er o t
2. PURPOSE OF THIS STATE
^ Building and HVAC
r7 Partial Completion
iuntling Su
A-442
-877
t ,~
93079
Project ,~
(Check Box A B, or G to indicate pur ose and complete any other applicable
boxes and information. Attach addiptional pages if necessary.)
~ildingOnly ^HVACOnIy
r~.rc Description of Portion Completed
TAo thebest of mtem Wnt~o fS ~uband based! CO sf1'lplbarl ation, construction of the following building erid/or HVA2 items applipbleto
this project have been completed m substantial compliance with the approved plans and specifiations.
p~UILDING ITEMS p HVAC 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 {teitets, 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:
B) ^ Statement of Noncompliance
Due to the following listed violations, this project is not ready for occupancy:
,, ,. „
C) ^ Supervising Professional Withdrawn From Project Date Withdrawn
(Use A or B above to indicate project sta#us as of this date.)
. ...
_... _ . .
D) ^ Abandoned
ExKi11ATURES:
~•~~ 4 y I
300 Koeller Ro
® City ^ Village. ^ Town of Oshkosh
County of
Winnebago
HVAC system including final test
(ILHR 64.53)
2. All conditions of HVAC plan approval
and. applicable variances
rsuuaing supervising
SBD-9720 (R.Ot/94)