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Building Permit Work Card Job Address 865 S WESTHAVEN DR Permit Number 0129298 Create Date 3/28/2008 Owner FISS & BILLS POKLASNY FUNERAL HOME Contractor KEYSTONE DESIGN BUILD INC Category 221 -New Offices, Banks, Professional Plan B9-2318-0408 Occupany Permit Required Flood Plain _ Height Permit Class of Const: 5bibc Use/Nature New Funeral Home / 8000 sq building. of Work HVAC Contr Electric Contr BEEZ ELECTRIC INC Plumbing Contr D.R. HANSEN PLBG. Inspections: Date 10/14/2008 Type Final Inspector Nicole Krahn not approved REQUEST LINE/READY FOR A FINAL INSPECTION -TIM WOULD LIKE TO BE PRESENT Date/Time requested: 10/13/2008 01:00 PM Notice Type: FC Ready Date/Time: 10!13/2008 01:00 PM Access: Requested By: KEYSTONE DESIGN BUILD INC -Tim Miller Phone Number: 0 Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid ------------------------------------- --------------------------------------------------- Date 11!3/2008 Type Re Final Inspector Nicole Krahn approved Datemme requested: 11/5/2008 09:13 AM Notice Type: Ready Date/Time: 11/5/2008 09:13 AM Access: Requested By: Phone Number: Reinspect Fee ~ Fee Waived ^ Reinspect Fee Paid Page 3 of 3 Building Permit Work Card Job Address 865 S WESTHAVEN DR Permit Number 0129298 Create Date 3/28/2008 Owner FISS & BILLS POKLASNY FUNERAL HOME Contractor KEYSTONE DESIGN BUILD INC Category 221 -New Offices, Banks, Professional Occupany Permit Required Flood Piain Height Permit _ Use/Nature ew Funeral Home / 8000 sq building. of Work HVAC Contr Electric Contr BEEZ ELECTRIC INC Plan B9-2318-0408 Class of Const: 5bibc Plumbing Contr D.R. HANSEN PLBG. Inspections: Date 7/17/2008 Type Rough In Inspector Nicole Krahn not approved tequest line /Would like inspection so they can start Dosing up. There 7:00 to 5:00 daily Preliminary inspection. Mechanicals were not stalled. Firestop submittals are required for penetrations through the 1 hr rated wall. Emergency ilium. plans required. Builder will call or an inspection when everything is ready. Date/Time requested: 7/14/2008 10:46 AM Notice Type: Ready Date/Time: 7/14/2008 Access: Requested By: No name given Phone Number: 320-761-6537 Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid yP 9 Pe - -- --------------------------------------------------------not approved Date 7/28/2008 T e Rou h In Ins ctor Nicole Krahn tequest line. Wants to insulate Tuesday, July 29 morning. Ready for pre inspection on Monday, July 28 morning. Date/Time requested: 7/24/2008 11:12 AM Notice Type: FC Ready Date/Time: 7/28/2008 AM Access: Requested By: Keystone Design Phone Number: 320-761-6537 Reinspect Fee ~ Fee Waived ^ Reinspect Fee Paid ---------------------- ------------------------------------------------------------------ Date 7/30/2008 Type Re Rough In Inspector Nicole Krahn not approved tequest line Need fire stop submittals. Datemme requested: 7/28/2008 04:06 PM Notice Type: Ready Date/Time: 7/29/2008 PM Access: Requested By: KEYSTONE DESIGN BUILD INC Phone Number: 320-761-6537 Q Reinspect Fee ~ Fee Waived ^ Reinspect Fee Paid Date 8/1/2008 Type Insulation Inspector Nicole Krahn tequest line 1) Provide a fire stop for the b-vent at the ceiling line to maintain the 1" clearance to c !) I also could not verify the fire stops through the 1 hr wall due to the vapor barrier being installed. approved w/cond. Datemme requested: 7/28/2008 04:06 PM Notice Type: FC Ready Date/Time: 8/1/2008 Access: Requested By: KEYSTONE DESIGN BUILD INC Phone Number: 320.761-6537 Reinspect Fee ~ Fee Waived ^ Reinspect Fee Paid Page 2 of 3 Building Permit Work Card Job Address 865 S WESTHAVEN DR Permit Number 0129298 Create Date 3/28/2008 Owner FISS & BILLS POKLASNY FUNERAL HOME Contractor KEYSTONE DESIGN BUILD INC Category 221 -New Offices, Banks, Professional Plan 69-2318-0408 Occupany Permit Required Flood Plain Height Permit Class of Const: ~ti,~~ Use/Nature New Funeral Home / 8000 sq building. of Work HVAC Contr ,Electric Contr BEEZ ELECTRIC INC Plumbing Contr D.R. HANSEN PLBG. Inspections: Date 4/21/2008 AM Type Footings Inspector Allyn Dannhoff approved ~ax request. No forms started, not concerns noted with soil. OK to pour when ready. Date/Time requested: 4!18/2008 04:49 PM Notice Type: Ready Date/Time: 4/21/2008 03:00 PM Access: Requested By: JOHN SKOTZKE CONCRETE CONST Phone Number: 231-1667 Q Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date 4/22/2008 Type Footings Inspector Allyn Dannhoff no time Date/Time requested: 4/21/2008 03:30 PM Notice Type: Ready DatelTime: 4/22/2008 02:30 PM Access: Requested By: JOHN SKOTZKE CONCRETE CONST Phone Number: 231-1667 Q Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date 5/1/2008 Type Foundation Backfiil Inspector Allyn Dannhoff no time Date~me requested: 4/30/2008 01:03 PM Notice Type: Ready DatelTime: 4/30/2008 01:03 PM Access: Requested By: KEYSTONE DESIGN BUILD INC Phone Number: (320) 761-6537 Q Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date 5/7/2008 AM Type Footings Inspector Allyn Dannhoff a pproved w/cond. Date/Time requested: 5/6/2008 04:21 PM Notice Type: Ready Date/Time: 5/7/2008 10:30 AM Access: Requested By: JOHN SKOTZKE CONCRETE CONST Phone Number: 231-1667 Q Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid Page 1 of 3 Electric Permit Work Card Job Address 865 S WESTHAVEN DR Permit Number 129953 Create Date 4/7/2008 Owner FISS & BILLS POKLASNY FUNERAL HOME Contractor BEEZ ELECTRIC INC Service New Q Change Q Temp Q N/A Type Q Overhead ~ Underground Q N/A Volts Circuits 40 Luminaires 70 Value $35,000.00 Amps 400 Switches 40 Receptacles 120 Use/Nature 2 -Commercial-New Building Wiring FUNERAL HOME /WIRE NEW 8000 sq building. "debt acct of Work Inspections: Date 07/24/2008 Type Rough In Inspector Kevin Benner app~`ovdd w/cond. ;EQUEST LINE /READY FOR A ROUGH ELECTRICAL INSPECTION replace emergency wiring methods with MC of raceway reviewed with AJ . > > < DatelTime requested: 07/23/2008: 01:06 PM Notice Type: - Ready DateTme: 07/23/2408.01?06;PM ~~ , , _ t Access: ANDREW WOULD LIKE TO BE PRESENT Requested by: BEEZ ELECTRIC INC -Andrew Johnson Phone Number: (920) 379-5603 / 231-6655 Q Reinspect Fee Q Fee Wavied ^ Reinspect Fee Paid ---- ----------------------------------------------------------------------------pp ------------ Date 10/13!2008 Type Final Inspector Kevin Benner not a roved equest line /Andrew wants to be there for inspection.See field notes that were Reviewed wtih Andrew Date/Time requested: 10/08/2008 10:06 AM Notice Type: Ready DatelTime: 10/13/2008 Access: Requested by: BEEZ ELECTRIC INC -Andrew Phone Number: 379-5603 Q Reinspect Fee Q Fee Wavied ^ Reinspect Fee Paid ------------------------ -------------- Date 10/30/2008 Type Re Final Inspector Adam Krause approved ;EQUEST LINE /READY FOR A FINAL REINSPECTION Date/Time requested: 10/29/2008 06:59 AM Notice Type: Ready DateTme: 10/29/2008 06:59 AM Access: AJ WOULD LIKE TO BE PRESENT Requested by: BEEZ ELECTRIC INC - AJ Phone Number: (920) 379-5603 / 231-6655 Q Reinspect Fee Q Fee Wavied ^ Reinspect Fee Paid Electric Permit Work Card Job Address 865 S WESTHAVEN DR Permit Number 129953 Create Date 4/7/2008 Owner FISS & BILLS POKLASNY FUNERAL HOME Contractor BEEZ ELECTRIC INC Service New Q ChangeQ Temp Q N!A Type Q Overhead ~ Underground Q N/A Volts Circuits 40 Luminaires 70 Amps 400 Switches 40 Receptacles 120 Value $35,000.00 Use/Nature 2 -Commercial-New Building Wiring FUNERAL HOME /WIRE NEW 8000 sq building. **debt acct of Work Inspections: Date 06/06/2008 Type Underground Inspector Kevin Benner not approved ite Lighting rencher wa's broken. Per Rob, come back in later this AM Date~me requested: 06/06!2008 08:01' AM . Notice Types - .'Ready Datemme: 06/06/2008 09AO AM Access- Requested by: BEEZ ELECTRIC INC Phone Number: 379-5601 Rob Q Reinspect Fee Q Fee Wavied ^ Reinspect Fee Paid -------------- -----------------------------pp ------------ Date 06/06/2008 Type Underground Inspector Kevin Benner not a roved 0 one on site, trencher in pieces Date/Time requested: 06/06/2008 00:00 AM Notice Type: Ready Date/Time: 06/06/2008 00:00 AM Access: Requested by: Phone Number: 379-5601 Rob Q Reinspect Fee Q Fee Wavied ^ Reinspect Fee Paid Date 06/06/2005 Type Underground Inspector Kevin Benner ------------------------ _approved w/cond. ell Phone Request' ubstantially complete, approx. 30 " BFG Date/Time requested: 06/06/2008 00:00 PM Notice Type: Ready Datemme: 06/06/2008 00:00 PM Access• Requested by: BEEZ ELECTRIC INC Phone Number: 379-5601 Rob Q Reinspect Fee Q Fee Wavied ^ Reinspect Fee Paid ------------------------------------------------------------------- ------- Date 07!08/2008 Type Consultation Inspector Kevin Benner approved w/cond. ny time before Friday ttic fan disconnect location, firestopping, MUA exhaust fan wiring. Date~me requested: 07/16/2008 09:26 AM Access: Requested by: BEEZ ELECTRIC INC Notice Type: Ready Date/Time: 07/16/2008 09:26 AM Phone Number: 379-5603 AJ Q Reinspect Fee Q Fee Wavied ^ Reinspect Fee Paid Electric Permit Work Card Job Address 865 S WESTHAVEN DR Permit Number 129953 Create Date 4/7/2008 Owner FISS & BILLS POKLASNY FUNERAL HOME Contractor BEEZ ELECTRIC INC Service New 0 Change ~ Temp ~ N/A Type ~ Overhead ~ Underground ~ N/A Volts Circuits 40 Luminaires 70 Amps 400 Switches 40 Receptacles 120 Value $35,000.00 Use/Nature 2 -Commercial-New Building Wiring FUNERAL HOME /WIRE NEW 8000 sq building. **debt acct of Work Inspections: Date 05/14/2008 Type Underground Inspector Kevin Benner approved w/cond. wilding interior only. pproved with the condition the installation is done correctly. II backfilling was done at the time of inspection which was conducted 14 minutes after the field request for inspection was made. Date/Time requested: 05/14/2008 02:30 PM Access: Notice Type: Ready Date/Time: 05/14/2008 02:30 PM Requested by: BEEZ ELECTRIC INC Phone Number: 379-5601 Rob Reinspect Fee ~ Fee Wavied ^ Reinspect Fee Paid Date 06/03/2008 Type Service Inspector Kevin Benner not approved equest line o access because of the weather proofing for the service. ailed AJ to make arragements for a re-inspection Date/Time requested: 06/02/2008 11:38 AM Notice Type: Ready Date/Time: 06/02/2008 11:38 AM Access: Requested by: BEEZ ELECTRIC INC -Rob Phone Number: 379-5603 AJ Reinspect Fee ~ Fee Wavied ^ Reinspect Fee Paid -------------- ------------------------ Date 06/04/2008 Type Re Service Inspector Kevin Benner approved i KAIC MCB axed to WPS 6/4/8 Datemme requested: 06/03/2008 02:21 PM Notice Type: Ready Date/Time: 06/04/2008 00:00 AM Access: Call AJ to within 20 min of inspection Requested by: BEEZ ELECTRIC INC Phone Number: 379-5603 AJ 0 Reinspect Fee ~ Fee Wavied ^ Reinspect Fee Paid Date 06/04/2008 Type Consultation Inspector Kevin Benner rounding and bonding of the UFFER system, grounding electrode & supplemental systems. DateTme requested: 06/04/2008 12:56 PM Notice Type: Ready Datemme: 06/04/2008 00:00 AM Access: Requested by: BEEZ ELECTRIC INC Phone Number: 379-5603 AJ Reinspect Fee ~ Fee Wavied ^ Reinspect Fee Paid HVAC Permit Work Card Job Address 865 S WESTHAVEN DR Permit Number 131807 Create Date. 07/16/2008. Owner POKLASNY INC Contractor CENTRAL HEATING SERVICE INC Fuel / Gas Oil Electric Solar Solid Value $51,200.00 System ^/ New ~ ^ Replace ~ ^ Other / Forced Air Radiant Steam A1C Vent Electric ^- Hot Water Suppl. Con. Bumer Chimney Type Chimney A Chimney B Direct Vent Not Applicable Use/Nature ~COMM/ Funeral home/ Late PermiU Installation of heating and a/c. of Work mspect~ons: Date 7/30/2008 Type Rough In Inspector .Nicole Krahn approved Date/Time requested: 07/30/2008 .09:00 AM Notice Type: Ready Date/Time• 07/30/2008 09:00 AM Access: Requested By: Phone Number: Q Reinspect Fee ~ Fee Waived ^ Reinspect Fee Paid Date 10/14/2008 Type Final Inspector Nicole Krahn not approved ivac plans were changed without state approval. The furnace in the mech. room does not have the required clearances. Date/Time requested: 10/15/2008 07:28 AM Notice Type: FC Ready Datemme: 10/15/2008 07:28 AM Access: Requested By: Phone Number: Reinspect Fee ~ Fee Waived ^ Reinspect Fee Paid - ------------ Date 11/3/2008 Type Reinspect Inspector Nicole Krahn approved Date/Time requested: 11/05/2008 09:15 AM Notice Type: Ready Datemme: 11/05/2008 09:15 AM Access: Requested By. Phone Number: Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid Job Address 865 S WESTHAVEN DR Owner FISS & BILLS POKLASNY FUNERAL HOME Category 440 -Industrial-Interior Bathtub Shower Water So Whirlpool Floor Drain 6 Local Wa Lavatory 3 Lndry Tray Clothes W Toilet 3 Disposal Bidet Res. Sink Dishwasher Beer Tap Bar Sink Sump Pump Lab Sink Water Heater 2 Classrm Sink Sterilizer Site Drain Breakrm Sink 1 Dip Wel Roof Drain Ejector/Grind Drink F Misc. 2 Flushing rim sink Fixtures Use/Nature New Funeral Home / 8000 sq building. ""C of Work Plumbing Permit Work Card Pennit Number 129433 Contractor D.R. HANSEcN PLBG. Plan ZZ8-301-0408P ner Wait. St. Shamp Sink te Ice Chest Flr/Wst Sink shr Exam Sink 2 Catch Basin Sculry Sink Wash Ftn Hand Sink Urinal 3 Plaster Sink Standp Rec Surgeons Sink Ice Maker F Prep Sink Gar Drain 1 Serv Sink 1 ft s Soda Disp to Size Material Type # Conn.Type Sanitary Sewer 6 Plastic Lateral 1 New Storm Sewer Water Service 6 Plastic Lateral 1 New Create Date 04/07/2008 Value $35,000.00 Coffee Maker Int Grease Trap Ext Grease Trap RPZ Valve 1 1 Eye Wash Statn 1 Wtr Sewer Mtrs ,Deduct Meters Wtr Usage Mtrs Inspections for Work Card 96963 Date 7/28/2008 Type Rough In Inspector Paut Wolf not approved Nail plates required and test required on above ground piping. DatelTime requested: 7/25/200812:23 PM Notice Type: FC Telephone Number: Access: Ready DateTme: 7/25/2008 12:23 PM Requested By: D.R. HANSEN PLBG. Q Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid Date 10/10/2008 Type Final Inspector Paul Wolf ..not approved st line /Would like inspection towards the end of the dayCross connection at morgue table equipment. ASSE 1001 VB requires 6" highest point of hose height. RPZ valve requires test and registration. DatelTime requested: 10/10/200!08:08 AM Notice Type: FC Telephone Number: 420-6149 Access: Ready DateTme: 10/10/200! PM Requested By: D.R. HANSEN PLBG. -Steve Q Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date 10/13/2008 Type Re Final Inspector Paul Wolf approved RPZ valve removed and corrections completed on work station faucet vacuum breaker per direction given by Tom Braun from Dept. of Comm. DateTme requested: 10/13/200!12:49 PM Notice Type: Telephone Number: Access: Ready DateTme: 10/13/2001 12:49 PM Requested By: D.R. HANSEN PLBG. Q Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Inspections for Work Card 96963 Date 4/21/2008 Type Sewer/Water Inspector Paul Wolf approved w/cond. ater completed at time of inspection and sanitary sewer started. DateTme requested: 4/21/2008 02:29 PM Notice Type: Telephone Number: Access: Ready Date/Time: 4/21/2008 02:29 PM Requested By: D.R. HANSEN PLBG. Q Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid Date 4/22/2008 Type Sewer Inspector Paul Wolf approved w/cond. ork complete at time of inspection. Went over tracer wire requirements with Dave and Mark. Date/Time requested: 4/22/2008 08:19 AM Notice Type: Telephone Number: Access: Ready Date/Time: 4/22/2008 08:19 AM Requested By: D.R. HANSEN PLBG. Q Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid - ----- -------------------------------------------------------------------------------------------------------------------- Date 5/9/2008 Type Underground Inspector Paul Wolf approved UG. Datemme requested: 5/9/2008 08:37 AM Notice Type: Telephone Number: Access: Ready Date/Time: 5/9/2008 08:37 AM Requested By: D.R. HANSEN PLBG. Q Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Date 5/12/2008 Type Underground Inspector Paul Wolf approved DateTme requested: 5/12/2008 09:09 AM Notice Type: Telephone Number: Access: Ready Date/Time: 5/12/2008 09:09 AM Requested By: D.R. HANSEN PLBG. Q Reinspect Fee Q Fee Waived ^ Reinspect Fee Paid B~:ILT~~Nt':fi, H~AC,~3~M+IPI.I,A-~+~ ST'AT~M~I'~CT S;~il!-~72~ This bard iS na~dred ka b~ fay f he euper~ieirt~ ¢r45~3sic~rtr~i i~tc=hlbfs~t. ertpN>tf}er, 9~lVANG de6ir tx dee47nar} obearvirtly eor~abaldton dt pra}erls wMkiin twiAdings rat fatal 3 tiP,t]Qp Ctat11G feet ot• greater and t?bepdi~er## ~Gtatnm 8t_A4S}. T (g sa~tmil finis tam ray rer~tA in penat6~ea is ifiad ~i C;ornm 6t3$ ardtcr focal otcisran~. 'Khat from rra-gt tie aubmiNad prior to the P~ ap(xawal expitetia~r dada cx ~rralFMf *ubmigat rnry tte mired. 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P+hane raantWr«~6~7~ 1~+Worttnt lp ~ .~'"' l~Ilk,l~-,_..~' $H~47.'~! i$tllTt2dlt, 58n-axa~:ta.acrwda, 10127!2048 11:31 FAX 820 X99 4336 TSI CQII SALES\EMG ~ CENTRAL NT& ~ 442!002 6ui~ln~, NVAC Compliance Statement BBD-972 't'his forrn is required to be nut mitl~d bl+ the aupotvidetp prvfes riorai (architect. erlginoer, HVAC designer or ekCfricai designer) obwrving oor~ttuctl ~n of projects vNiflln v++ h total arena eulosedirp 50.000 cubic feet cr greater ~ bleax~rs (Comm 80. iQlComl n 81.e~}. FaYura to ~6lns 1Na lam may recruit in panatties sa allecifiad in Comm 50.28/Gomm 81.23 aMlor lot ~1 ard6tanoes. f~@nerdi h1~tnlCtl~le: F rior taD the UtNlal cY of I ~lN buNdings or additions and tl1e final. otxupaul~j- of altered exir3ting bulkfings. sv trrrl~thirr taompiel~ed and signrr~t f+omt to: • The municipal buidin~ rlspec~t oi~ics ~ • 5at'etyand Butdit~, t+kS4iN Ranch Road, Hayward, W184843 Paisa-at b you provide n ay ba usad far aoewrsdary P~P~ [l'~Y t.aw. s.1d.04 (lxrraj. 7, PROJECT WFORIiAATiC N: Please tip;n fhe fo~nring i+iittc infarmabun fran y~orer plan approve letter. Traatsadion ~ Number 18Q~ Site Number 73441_._ Sibs loca8on (nwnber 8 atre ~) 9oetU llw~nren Dti+ro ® City ^ Vilape ^ Town Of ~ Oshicoeh County of Ylftnrlebeoo 2. PURPOSE OF THiS aTj TEMLNT: {Check Boot A, td. f.:, or Q faD indicate purpose acrd t~mpiete any other ~plicabie boxes and loft rnnatbn, Attach >iddilonai pLst es if necessary). Check those which apply ^ 8c,iidirP Abject loll ~ HVAC Object ~ 1~_. ^ l,.ighting Ot>~t Etc, ~ Partial Completion . DescripNgn d Portio:t Compte/ i Iy ©StettetrldrK of tsu#>atatttial troKlt~~ To Ma beet d my kn• edsd9s~ ~lirf. erMf based an ansils a~s.rvaion. conalrucfian of Mss fae+fiwing b~citd ender NVAC Msms appecabre b lhls pro! xt have been oorripie>ad b subeta+i:0 eanpAerae ~ e+e apprayed plans and etrewY~tior+e. ^ liU1L.DINS;iA.1~lI TM~I~fi n'EMS 1. Sbualutal ayslert ink au4r~it+el and araofan d ~1 6urid.>a oon+pa+anEs ~ ass, Preeaef. rnslal txr/dn0. edo-} 2. Firo pnaaotletr *1 eWrrr (ePn~dars. alainre, amoks ds`! dorx) deaipnad, Inahk ~ and tealed toward flow ~: n back lbw devtoe.a br ~+ ray PMadst+danak. 3. Shaft and sbfrwr y enelooue 4. RtdEs hekdn fi as k and dlnellgeat rphls S. F~SiaisM ooA abi+oe4tr. analoerge d ha~xerido. firs.w. rile, iabaiwl downs, pees d a nsinrofon. fire aAopped penatrNtana lf. Sarlla9orr syalw++{toNis, ahkv.dAnkp"rYfaditlea) 7. BanNr-free ineka infi Cantu 18 ebvafArs and N[ig 8. ernraiope nquirarnartts 9. Hr oardtlona d i utdnB P~+ apprarai and applicable ~+ariar '~1M 1foADwirlp NMr1i ac a twt In oorrrpltaetw and cowl 5a addrtwed: B} ^ ~,pnsent 04r NC novrnplian~ Due 1o ffa foMotnkg lisle 1 vl~atiorra,l!>b project k not read+ for oacupanalr. 10. Euisricr 8 oon6d rsqui.rnnts 11. hriariar 1glrOnp ~ oonftol ~ 12. A/ wrdlllons of il~Mns phn a~pprovai and applioal~le varlarrosa p wv~ !collie 1. rtvac syslerrs inc~rrg 5nar lest 2. AI candilior-s of Fl1//1C plan approval and appliea6is variances Cy ^ Snpenris&iq Pro tressional Mhthdr0wn Ftnrn N roject {wrs a ar B above 1o irk pn~t anus as of e~ date.) D} !7 Pr+ged A6antiol,rd S. SUPEatQ PRQFES~310>~IAL SIC~IATURE FOR: ^ 0 riv..c ^ ~ieh~a Phone tE ~ 4Yli~t 1100 Cuetoirer IOfi 1 Q19'i! i3 81Qnaesa aalau~eaci`~ ,, Tim Miller From: Marc Kelash [marckLc.~' keystonedb.com] Sent: Friday, October 17, 2008 1:03 PM To: 'Tim Miller' Subject: FW: Poklasny-Piss & Bills Funeral Home From: Lon Negen [mailto:LON@NEGENARCHITECTS.COM] Sent: Friday, October 17, 2008 12:11 PM To: marck@keystonedb.com Subject: Poklasny-Piss & Bills Funeral Home Mark, I have researched the accessible sink and pocket door hardware issue for this project. These items are note required to be accessible. Lon Negen, AIA-Principal Negen Architects, Inc. 22517 178th Avenue, Suite 200 Cold Spring, MN 56320 Tebphone: 320.685.3304 Fax: 320.685.4038 Page 1 of 1 Krahn, Nicole R. From: Dannhoff, Allyn J. Sent: Tuesday, October 28, 2008 8:24 AM To: 'Gary Biesinger' Cc: Krahn, Nicole R. Subject: RE: Funeral Home Egress.pdf Nicole copied you on an answer to your inquiry. Apparently the Architect is working with the GC in identifying the exit paths. He had conversation with Nicole and was supposed to be addressing this issue. (Which is the appropriate process, meaning the Supervising Professional (arch/engineer) should be laying out/identifying the exit paths requiring illumination as well as reviewing. the emergency illumination plans for compliance with the performance requirements before it is installed.) Thanks. Allyn From: Gary Biesinger [mailto:garybiesinger@beezelectric.com] Sent: Monday, October 27, 2008 12:29 PM To: Dannhoff, Allyn J. Cc: marck@keystonedb.com Subject: FW: Funeral Home Egress.pdf Importance: High Hi Allyn, We are working with Nicole on the egress path of lighting for the Poklasny Funeral Home. The way I understand it Nicole would like values on the entire rooms in the Chapel Area. Could you possibly get together with Nicole and define a path of egress for us to illuminate as the customer is trying to get occupancy of this building and is waiting on an approved drawing. Thanks for the help, Gary Gary Biesinger President Beez Electric, Inc. Ph: 920-231-6655 Fx: 920-231-7255 This email is intended for the use of the addressee(s) only and may contain privileged, confrdential, or proprietary information that is exempt from disclosure under law. Ifyou have received this message in error, please inform us promptly by reply email, them delete this email and destroy any printed copy. Thank you. 10/31/2008 Page 1 of 1 Krahn, Nicole R. From: Lon Negen [Ion@negenarchitects.com) Sent: Tuesday, October 28, 2008 10:40 AM To: Krahn, Nicole R. Cc: marck@keystonedb.com Subject: Poklasny-Piss & Bills Funeral Home Nicole, I am responding to concerns that you have brought to my attention dtuing our telephone conversation October 26. 1. The garage is not required to have 2 exits because the occupant load does tiot require it. I am told that 2 exit signs have been installed in the garage @ the exterior door & door leading into hallway 116. I am OK with the exit sign @ the exterior door, but have given direction to the contractor to remove the exit sign leading into the hallway room 116 because it is not part of exiting system. 2. Room 116 does not require an emergency light because its occupant load does not require it and is not part of the exiting system. 3. Doors that are not part of an exiting system are not required to be locked (door 115). 4. I accept the photometric plan presented by the contractor. I am confident that the plan as submitted will provide adequate lighting in case of an emergency. Please contact me if you have further questions. Lon Negen, AIA-Principal Negen Architects, Inc. 22517 178th Avenue, Suite 200 Cold Spring, MN 56320 Telephone: 320.685.3304 Fax: 320.685.4039 10/31 /2008 Page 1 of 2 Krahn, Nicole R. From: Lon Negen [Ion@negenarchitects.com] Sent: Tuesday, October 28, 2008 1:14 PM To: Krahn, Nicole R. Cc: marck@keystonedb.com Subject: Re: Poklasny-Piss & Bills Funeral Home Nicole, The contractor will be adding 2 emergency fixture on both sides of the operable wall toward the west end of the room. This will provide more that adequate lighting for the exit paths, I am sure. The hall 116 is not intended to be used by the public, it is not part of the e~citing.system. The required exit doors have been signed accordingly. It is not necessary to lock those doors by code, but I understand that the door 115 has been provided with a lock for function. let me know if there are any other issues I need to address. On Oct 28, 2008, at 12:23 PM, Krahn, Nicole R. wrote: Lon, I would just like to make sure I completely understand the below a-mail. Yesterday during our conversation you stated that you thought all four aisle ways in the two chapel areas should have emergency lighting due to the fact that there is no fixed seating in this area. You stated that you were going to have the photometric plan revised to include this. I have not received a revised plan. Have you changed your mind or has the photometrics plan been redone to include this? Secondly, I thought we discussed the fact that no exit light would be required in room 116 provided there was locking hardware on both door 115 and 112c to prevent the public from entering those areas. I agree as stated below that emergency illumination would not be required. Please let me know if I was mistaken. Also you stated that the offices pocket doors do not need accessible hardware. Let me know if you have any questions. Thanks in advance for your response. Nicole Krahn City of Oshkosh Inspection Services Division 920-236-5036 From: Lon Negen fmailto:IonCa~negenarchitects.com] Sent: Tuesday, October 28, 2008 10:40 AM To: Krahn, Nicole R. Cc: marckCc~keystonedb.com Subject: Poklasny-Piss & Bills Funeral Home Nicole, I am responding to concerns that you have brought to my attention during our telephone 10/31/2008 Page 2 of 2 conversation October 26. 1. The garage is not required to have 2 exits because the occupant load does not require it. I am told that 2 exit signs have been installed in the garage @ the exterior door & door leading into hallway 116. I am OK with the exit sign @ the exterior door, but have given direction to the contractor to remove the exit sign leading into the hallway room 116 because it is not part of exiting system. 2. Room 116 does not require an emergency light because its occupant load does not require it and is not part of the exiting system. 3. Doors that are not part of an exiting system are not required to be locked (door 115). 4. I accept the photometric plan presented by the contractor. I am confident that the ` ` plan as submitted will provide adequate lighting in case of an emergency. Please contact me if you have further questions. Lon Negen, AIA-Principal Negen Architects, Inc. 22517 178th Avenue, Suite 200 Cold Spring, MN 56320 Telephone: 320.685.3304 Fax: 320.685.4039 Lon Negen, AIA-Principal Negen Architects, Inc. 22517 178th Avenue, Suite 200 Cold Spring, MN 56320 Telephone: 320.685.3304 Fax: 320.685.4039 10/31/2008 Page 1 of 3 Krahn, Nicole R. From: Gary Biesinger [garybiesinger@beezelectric.com] Sent: Tuesday, October 28, 2008 1:56 PM To: Krahn, Nicole R. Cc: marck@keystonedb.com Subject: RE: Poklasny-Piss ~ Bills Funeral Home Attachments: Funeral Home Egress 2.pdf Nicole, Could you please review the updated egress path of lighting and let me know if it is OK. In the Chapel,areas will be rows of chairs only allowing easi: and west movement to egress path as Allyyn and I ; discussed.. If you should need the chairs shown on the print please let me know. Thank you, Gary Gary Biesinger President Beez Electric, Inc. Ph: 920-231-6655 Fx: 920-231-7255 This email is intended for the use of the addressee(s) only and may contain privileged, confidential, or proprietary information that is exempt from disclosure under law. Ifyou have received this message in error, please inform us promptly by reply email, then delete this email and destroy any printed copy. Thank you. From: Krahn, Nicole R. [mailto:nkrahn@ci.oshkosh.wi.us] Sent: Tuesday, October 28, 2008 1:28 PM To: Gary Biesinger Subject: FW: Poklasny-Piss & Bills Funeral Home Gary, This is the response I just received from the architect. He's stating that you're adding additional fixtures to address the operable wall area. Has the photometric plan been revised or were these fixtures noted on the original plan? Thanks for your help. Nicole Krahn From: Lon Negen [mailto:lon@negenarchitects.com] Sent: Tuesday, October 28, 2008 1:14 PM To: Krahn, Nicole R. Cc: marck@keystonedb.com Subject: Re: Poklasny-Piss & Bills Funeral Home Nicole, The contractor will be adding 2 emergency fixture on both sides of the operable wall toward the west end of the room. This will provide more that adequate lighting for the exit paths, I am sure. 10/31 /2008 Page 2 of 3 The hall 116 is not intended to be used by the public, it is not part of the exiting system. The required exit doors have been signed accordingly. It is not necessary to lock those doors by code, but I understand that the door 115 has been provided with a lock for function. let me know if there are any other issues I need to address. On Oct 28, 2008, at 12:23 PM, Krahn, Nicole R. wrote: Lon, I would just like to make sure I completely understand the below a-mail. Yesterday during our conversation you stated that you thought all four aisle ways in the two chapel.areas should have emergency lighting due to the fact that there is no fixed seating in this area. You stated that you were going to have the photometric plan revised to include`this. I have not received a revised' plan. `Have you chariged your mind or has the.photometrics plan been redone to include this? Secondly, I thought we discussed the fact that no exit light would be required in room 116 provided there was locking hardware on both door 115 and 112c to prevent the public from entering those areas. I agree as stated below that emergency illumination would not be required. Please let me know if I was mistaken. Also you stated that the offices pocket doors do not need accessible hardware. Let me know if you have any questions. Thanks in advance for your response. Nicole Krahn City of Oshkosh Inspection Services Division 920-236-5036 From: Lon Negen fmailto:Ion@negenarchitects.com] Sent: Tuesday, October 28, 2008 10:40 AM To: Krahn, Nicole R. Cc: marck ke sy tonedb.com Subject: Poklasny-Piss & Bills Funeral Home Nicole, I am responding to concerns that you have brought to my attention during our telephone conversation October 26. 1. The garage is not required to have 2 exits because the occupant load does not require it. I am told that 2 exit signs have been installed in the garage @ the exterior door & door leading into hallway 116. I am OK with the exit sign @ the exterior door, but have given direction to the contractor to remove the exit sign leading into the hallway room 116 because it is not part of exiting system. 2. Room 116 does not require an emergency light because its occupant load does not require it and is not part of the exiting system. 3. Doors that are not part of an exiting system are not required to be locked (door 115). 4. I accept the photometric plan presented by the contractor. I am confident that the plan as 10/31/2008 Page 3 of 3 submitted will provide adequate lighting in case of an emergency. Please contact me if you have further questions. Lon Negen, AIA-Principal Negen Architects, Inc. 22517 178th Avenue, Suite 200 Cold Spring, MN 56320 Telephone: 320.685.3304 Fax: 320.685.4039 Lon,Negen, AIA-Principal Negen Architects,, lnc. _; 22517,178th,Avenue, Suite 200. , " "Cold Spring, MN 56320` ~'~ Telephone: 320.685.3304 Fax: 320.685.4039 r. 10/31/2008 Page 1 of 3 Krahn, Nicole R. From: Gary Biesinger [garybiesinger@beezelectric.com] Sent: Tuesday, October 28, 2008 2:12 PM To: Krahn, Nicole R. Cc: marck@keystonedb.com Subject: RE: Poklasny-Piss & Bills Funeral Home Nicole, We will be there 1St thing in the morning working on the egress lighting. Could you please keep the inspection time of 1:30 in your schedule? We.should be completed with the project by then. Gary Gary Biesinger President Beez Electric, Inc. Ph: 920-231-6655 Fx: 920-231-7255 This email is intended for the use of the addressee(s) onl7~ and Wray contain privileged, confidential, or proprietary information that is exempt from disclosure under law. Ifyou have received this message in error, please inform us promptly fiy reply email, then delete this email and destroy any printed copy. Thank you. From: Krahn, Nicole R. [mailto:nkrahn@ci.oshkosh.wi.us] Sent: Tuesday, October 28, 2008 1:58 PM To: Gary Biesinger Subject: RE: Poklasny-Piss & Bills Funeral Home Gary, It looks good to me. Let me know when you're ready for a re-inspection. Thanks! Nicole From: Gary Biesinger [mailto:garybiesinger@beezelectric.com] Sent: Tuesday, October 28, 2008 1:56 PM To: Krahn, Nicole R. Ce: marck@keystonedb.com Subject: RE: Poklasny-Piss & Bills Funeral Home Nicole, Could you please review the updated egress path of lighting and let me know if it is OK. In the Chapel areas will be rows of chairs only allowing east and west movement to egress path as Allyyn and I discussed. If you should need the chairs shown on the print please let me know. Thank you, Gary 10/31/2008 Page 2 of 3 Gary Biesinger President Beez Electric, Inc. Ph: 920-231-6655 Fx: 920-231-7255 This email is intended for the use of the addressee(s) only and may contain privileged confidential, or proprietary information that is exempt from disclosure under law. Ifyou have received this message in error, please inform us promptly by reply email, then delete this email and destroy any printed copy. Thank you. From: Krahn, Nicole R. [mailto:nkrahn@ci.oshkosh.wi.us] Sent: Tuesday, October 28, 2008 1:28 PM To: Gary Biesinger Subject: FW: Poklasny-Piss & Bills Funeral Home .Gary, - This.is the response I just received from -the architect. He's stating that you're adding additional: fixturesao address the operable wall area. Has the photometric plan been revised or were these fixtures noted on the original plan? Thanks for your help. Nicole Krahn From: Lon Negen [mailto:lon@negenarchitects.com] Sent: Tuesday, October 28, 2008 1:14 PM To: Krahn, Nicole R. Cc: marck@keystonedb.com Subject: Re: Poklasny-Piss & Bills Funeral Home Nicole, The contractor will be adding 2 emergency fixture on both sides of the operable wall toward the west end of the room. This will provide more that adequate lighting for the exit paths, I am sure. The hall 116 is not intended to be used by the public, it is not part of the exiting system. The required exit doors have been signed accordingly. It is not necessary to lock those doors by code, but I understand that the door 115 has been provided with a lock for function. let me know if there are any other issues I need to address. On Oct 28, 2008, at 12:23 PM, Krahn, Nicole R. wrote: Lon, I would just like to make sure I completely understand the below a-mail. Yesterday during our conversation you stated that you thought all four aisle ways in the two chapel areas should have emergency lighting due to the fact that there is no fixed seating in this area. You stated that you were going to have the photometric plan revised to include this. I have not received a revised plan. Have you changed your mind or has the photometrics plan been redone to include this? Secondly, I thought we discussed the fact that no exit light would be required in room 116 provided there was locking hardware on both door 115 and 112c to prevent the public from entering those areas. I agree as stated below that emergency illumination would not be required. Please let me know if I was mistaken. Also you stated that the offices pocket doors do not need accessible hardware. 10/31/2008 Page 3 of 3 Let me know if you have any questions. Thanks in advance for your response. Nicole Krahn City of Oshkosh Inspection Services Division 920-236-5036 From: Lon Negen [mailto:lon@negenarchitectscom] Sent: Tuesday, October 28, 2008 10:40 AM To: Krahn, Nicole R. Cc: marck@keystonedb.com Subject: Poklasny-Piss & Bills Funeral Home x , . . .,~ 'Nicole, , ~ ..: . I am responding to concerns that you have brought to my attention during our telephone conversation October 26. 1. The garage is not required to have 2 exits because the occupant load does not require it. I am told that 2 exit signs have been installed in the garage @ the exterior door & door leading into hallway 116. I am OK with the exit sign @ the exterior door, but have given direction to the contractor to remove the exit sign leading into the hallway room 116 because it is not part of exiting system. 2. Room 116 does not require an emergency light because its occupant load does not require it and is not part of the exiting system. 3. Doors that are not part of an exiting system are not required to be locked (door 115). 4. I accept the photometric plan presented by the contractor. I am confident that the plan as submitted will provide adequate lighting in case of an emergency. Please contact me if you have further questions. Lon Negen, AIA-Principal Negen Architects, Inc. 22517 178th Avenue, Suite 200 Cold Spring, MN 56320 Telephone: 320.685.3304 Fax: 320.685.4039 Lon Negen, AIA-Principal Negen Architects, Inc. 22517 178th Avenue, Suite 200 Cold Spring, MN 56320 Telephone: 320.685.3304 Fax: 320.685.4039 10/31/2008 Page 1 of 1 Krahn, Nicole R. From: Marc Kelash [marck@keystonedb.com] Sent: Tuesday, October 28, 2008 3:17 PM To: Krahn, Nicole R. Cc: 'Gary Biesinger ; 'Tim Miller' Subject: RE: Poklasny-Piss & Bills Funeral Home Nicole, That will work fine for us Tim should have the reports on site, they are suppose to be doing the balance report later today/ or morning and he will have them for you, and the remaining field inspection report is complete ready for re-inspection. 'Thank you for working with us. ~ ~ . Marc From: Krahn, Nicole R. [mailto:nkrahn@ci.oshkosh.wi.us] Sent: Tuesday, October 28, 2008 2:33 PM To: marck@keystonedb.com Cc: Gary Biesinger Subject: RE: Poklasny-Piss & Bills Funeral Home Mark, I'm planning on doing a re-inspection for the funeral home tomorrow afternoon. The electrician hopefully will be done installing the emergency illumination at that time. I'm still waiting on the Building Compliance Statement and the Hvac Balancing Report. Will these be given to me tomorrow at the time of inspection? Thanks for your help. Nicole Krahn 10/31 /2008 Page 1 of 1 Krahn, Nicole R. From: Marc Kelash [marck@keystonedb.com] Sent: Tuesday, October 28, 2008 3:57 PM To: Krahn, Nicole R. Cc: 'Gary Biesinger ; 'Tim Miller' Subject: RE: Poklasny-Piss & Bills Funeral Home Nicole, That will work fine for us Tim should have the: reports on site, they are suppose to be doing the balance report later today/ or morning and he will have them for you, and the remaining field inspection report is complete ready for re-inspection. Thank you for working with us. - Marc From: Krahn, Nicole R. [mailto:nkrahn@ci.oshkosh.wi.us] Sent: Tuesday, October 28, 2008 2:33 PM To: marck@keystonedb.com Cc: Gary Biesinger Subject: RE: Poklasny-Piss & Bills Funeral Home Mark, I'm planning on doing a re-inspection for the funeral home tomorrow afternoon. The electrician hopefully will be done installing the emergency illumination at that time. I'm still waiting on the Building Compliance Statement and the Hvac Balancing Report. Will these be given to me tomorrow at the time of inspection? Thanks for your help. Nicole Krahn 10/31/2008 Page 1 of 1 Krahn, Nicole R. From: Marc Kelash [marck@keystonedb.com] Sent: Wednesday, October 29, 2008 3:22 PM To: Krahn, Nicole R. Cc: Tim Miller' Subject: Poklasny Fiss and Bills Attachments: compliance for poklasny.jpg Nicole, Please find the compliance statement (SBD-9720) from the architect as requested in the field inspection report. l ~ ., understand we are waiting for the final electrical approval and once this is complete, you will be able ,to foraivard < ~ . . the certificate of occupancy to me so the owners can start to use the building. Thank-you.fer your: time..: ~: , . ,~. >-,, ^ ~, z , . ; Marc Kelash Keystone Design Build, Inc. President of Operations/Owner 22517 178th Ave. Suite 210 Cold Spring MN 56320 320.685.8054 office 320.685.8853 fax 320.761.8062 cell marck@keystonedb.com 10/31/2008 Page 1 of 2 Krahn, Nicole R. From: Marc Kelash [marck@keystonedb.com] Sent: Friday, October 31, 2008 8:42 AM To: Krahn, Nicole R. Subject: RE: Poklasny Fiss and Bills Nicole, Thank you for your help with the inspections, I will let the Poklasny's know the outcome. My daughter was born on Halloween 17 years ago so I get to celebrate twice on Halloween Again thanks ' Marc From: Krahn, Nicole R. [mailto:nkrahn@ci.oshkosh.wi.us] { :. ~ -: ~ <~ 7r Sent: Friday, October 31, 2008 8:31 AM ~ < .~, °. To: Marc Kelash - Subject: RE: Poklasny Fiss and Bills Mark, The electrical did pass. An occupancy permit will be issued but it probably will not be sent out until Monday or Tuesday of next week. Please let the owner's know that they can occupy the building and the occupancy permit is on it's way. Thanks! Have a Happy Halloween! Nicole Krahn From: Marc Kelash [mailto:marck@keystonedb.com] Sent: Friday, October 31, 2008 8:12 AM To: Krahn, Nicole R. Subject: FW: Poklasny Fiss and Bills From: Marc Kelash [mailto:marck@keystonedb.com] Sent: Wednesday, October 29, 2008 3:22 PM To: 'Krahn, Nicole R.' Cc: Tim Miller' Subject: Poklasny Fiss and Bills Nicole, Please find the compliance statement (SBD-9720) from the architect as requested in the field inspection report. I understand we are waiting for the final electrical approval and once this is complete, you will be able to forward the certificate of occupancy to me so the owners can start to use the building. Thank you for your time. Marc Kelash Keystone Design Build, Inc. President of Operations/Owner 22517 178th Ave. Suite 210 Cold Spring MN 56320 10/31/2008 Page 2 of 2 320.685.8054 office 320.685.8853 fax 320.761.8062 cell marck@keystonedb.com 10/31/2008 Page 1 of 3 Krahn, Nicole R. From: Krahn, Nicole R. Sent: Tuesday, October 28, 2008 1:58 PM To: 'Gary Biesinger' Subject: RE: Poklasny-Piss & Bills Funeral Home Gary, It looks good to me. Let me know when you're ready for a re-inspection. Thanks! Nicole From: Gary Biesinger [mailto:garybiesinger@beezelectric.com] Sent: Tuesday, October 28, 2008 1:56 PM To: Krahn, Nicole R. Cc: marck@keystonedb.com Subject: RE: Poklasny-Piss & Bills Funeral Home Nicole, Could you please review the updated egress path of lighting and let me know if it is OK. In the Chapel areas will be rows of chairs only allowing east and west movement to egress path as Allyyn and I discussed. If you should need the chairs shown on the print please let me know. Thank you, Gary Gary Biesinger President Beez Electric, Inc. Ph: 920-231-6655 Fx: 920-231-7255 This email is intended for the use of the addressee(s) only and may contain privileged, confidential, or proprietary information that is exempt from disclosure under law. Ijyou have received this message in error, please inform us promptly by reply email, then delete this email and destroy any printed copy. Thank you. From: Krahn, Nicole R. [mailto:nkrahn@ci.oshkosh.wi.us] Sent: Tuesday, October 28, 2008 1:28 PM To: Gary Biesinger Subject: FW: Poklasny-Piss & Bills Funeral Home Gary, This is the response I just received from the architect. He's stating that you're adding additional fixtures to address the operable wall area. Has the photometric plan been revised or were these fixtures noted on the original plan? Thanks for your help. Nicole Krahn 10/31/2008 CORRECTION NOTICE /FIELD INSPECTION REPORT JOB LOCATION: ~ ~ 1~~s`rN~~ ©~- City of Oshkosh Inspection Services Division CONTRACTOR: K~ STS ~S \ IJriS ~U ~ ~ 215 Church Avenue, PO Box 1130 osnkosh, wt sa9o3-1130 PROJECT TO BE INSPECTED: ~1~t~c=~_ ~ Phone: (920) 236-5050 Fax (920) 236-5084 TYPE OF INSPECTION: CD1~aS l~~-?~?>r~ ~~~- ~ ~ 1''~-~~-- i 1~~'R`vt~1~ 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 of this notice and return it to the Inspection Services Division by the Compliance Date of TT~1l+I# CODE INSPECTION RESULTS '. ,.; ~`,~?jl'-'11T t'L~ ~ ~ S ~ C--~'L~ V U~C~ 5~--t'-`Z~-~~la'~ ~-4 ~~~~ L.1~'~-- ~.~l,-~'~ ~ ~ ~~C~~i~. k~i I~Z ASZ~ 1~z..,L~- A~'F'`Z.~,J~'LS ~ D~ `1 Z~ ~~~~ ~ `A ~ +~- 5 ~l.~r~ p--~Q ~ . (o t~r ~1~~iSS `I ~t,v`J,~.. Il-~. 2~ ,2~ 1'' C.~...`z-ya-3Z,~d.~~lfi~ 'Tfl ~~0vg~l ~L ~~. ~ ~ ~1~~.-~.7t- ~ ~..~ ~~~ t~'A~~t,'-ti.... IA~z-~ , ~-At.., A'l~ ~C'~~4Dyl`~`S 'i~Fl~~:l.~-l `1'11~i ~`1(,.a ~.- ~o ~ ~ ~rnC ~~~C.c-SS ~? ~ ~ ~~'~ ~~B-~tr~ ~. t t ~~ ~C:t-k.`-c`,.,~,T Ire SS~~3~~z. 15 ~R~~cA vn-- s;~be~~.-~ ~~~~. ACTION TAKEN: . . ^ Not Approved/ Insp. Report left on site ^ Not Approved/ Insp. Report given to ^ Mailed/Faxed Signed Inspection Services Division Date of Inspection Phone # ~ ~ hereby certify that the v4~ations listed on this NoticefReport have ~~~d 1 Print Name company Signature: Date CORRECTION NOTICE /FIELD INSPECTION REPORT JOB LOCATION: ~ ~~ ~ ~~~ F~"~~'~Z-l~ ~ e- City of Oshkosh Inspection Services Division 215 Church Avenue, PO Box 1130 Oshkosh, WI 54903-1 1 30 Phone: (920) 236-5050 Fax (920)236-5084 CONTRACTOR: PROJECT TO BE INSPECTED: TYPE OF INSPECTION: 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 of this notice and return it to the Inspection Services Division by the Compliance Date of I I'EM# 'CODE INSPECTION RESULTS :. ,, ~` '-~ ~~" Pr~~ M~411~ `c-e~. Imo} 5 ~ I./1~-- - iJ ~-~ ~-~1~.*`Z ~`c.~l IS ~c..~ ~ ~~~1 1T }-~~`c4~ -1l~z ~l ~' 1~~- t~~l~-l i 2`v~ . `~=c~-f ' ~C'.C~SS ~ fS t L.t t~,..I~ i - ACTIDN`TAKZCI~: ~~ ... ^ Not Appr ved/ Insp. Report left on site ~Q'~Jot Approved/ Insp. Report given to '~ `~ ~ Mailed/Faxed Signed i / ("_ 10 ((`~' ~~ Z~~ "1,~ Inspection Services Division Date of Inspection Phone # f I hereby certify that the v~o~atons .listed on this NoticefR.eDart hav~=~n ~+~r~>~ce~d. Print Name Company Signature: Date commerce.wi.gov ^ ^ ~scons~n Department of Commerce Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary February 28, 2008 CUST ID No. 1071208 JIM POKLANSY POKLANSY INC 130 CHURCH AVENUE OSHKOSH WI 54901 ATTN.• Inspector BUILDING INSPECTION CITY OF OSHKOSH POB 1130 OSHKOSH WI 54902 REGISTRATION OF COMMERCIAL BUILDING SITE EROSION CONTROL NOTICE OF INTENT PLAN SUMMARY APPROVAL SITE: Fiss & Bills Funeral Home 865 South Westhaven Drive City of Oshkosh, 54952 SE1/4, SW1/4, 521, T18N, R16E Subdivision: Lot 3 of Csm 1952 FOR: Object Type: Soil Erosion Control 02/28/08 ~ Identification Numbers ~ Transaction ID No. 1513400 Site ID No. 735017 Please refer to both identification numbers, above, in all correspondence with the agency. Regulated Object ID No.: 1173037 Code Applies Date: Anticipated end date: 08/31/2008; Anticipated start date: 05/01/2008; Calculation Method: Code Appendix Method; Description: Silt Fence and tracking pad will be placed before construction begins. Wet detention basin will act as temporary sediment basin during construction. Inlet protection will be placed at storm sewer inlets. Wet detention basin will meet post construction quality and quantity requirements. Site is exempt from infiltration.; Payment Method: INVOICE; 1.76 Acres disturbed area; Water Body: Sawyer Creek This letter acknowledges receipt of a Notice of Intent with our agency. This acknowledgement does not affect the authority of DNR to enforce chapters 281 and 283, Stats. and administrative rules under those chapters. By virtue of the submitter's self certification via our website, and the owner's signature on this form, he/she has indicated that erosion and sediment control plan and along-term stormwater management plan have been developed and will be implemented in accordance with the requirements set forth in Comm 60.13 Wis. Adm. Code. Please note: 1. That earth disturbing activities shall not begin on this site until 7 days after the owner signs this form (below). 2. That this approval includes a plan summary review by the Department of Commerce of the required erosion control plan. No review has been made of the required general stormwater management plan or any plumbing plan for this project. JIM Page 2 2/28/2008 3. Plumbing plan submittal maybe required for any stormwater piping system on the premises or any stormwater infiltration or reuse systems per s. Comm 82.20. These may be submitted separately or as part of the general plumbing plan submittal. 4. That there maybe erosion and sediment control inspections and enforcement actions conducted by the Department of Commerce and authorized agents during and after the construction of this project. 5. The owner shall attach a copy of this signed form to above mentioned erosion control and stormwater management plans and retain the combined form and plans on the construction site and make them available to state and/or local inspectors as requested. 6. That plan review and/or inspections by the local municipality and/ or DNR may be required by local permitting ordinances or DNR rules. 7. The owner shall file a Notice of Termination with our department when the site has been stabilized per s. Comm 60.12. Upon receipt of the Notice of Termination, the owner shall assume full responsibility for the ongoing maintenance and operation of the post-construction stormwater management devices on the site as per Comm 60.13 Wis. Adm Code. As such, the site maybe subject to inspections and enforcement actions by Department of Commerce and authorized agents. 9. The erosion and sediment control measures and devices for the site must inspected by the owner /owner's agent as required in Comm 60.21 and maintained as per Comm 60.22: Comm 60.21 Monitoring. (1) The owner or owner's agent shall check the erosion and sediment control practices for maintenance needs at all the following intervals until the site is stabilized: (a) At least weekly. (b) Within 24 hours aRer a rainfall event of 0.5 inches or greater. A rainfall event shall be considered to be the total amount of rainfall recorded in any continuous 24 hour period. (c) At all intervals that are cited on the erosion and sediment control plan. (2) (a) The owner or owner's agent shall maintain a monitoring record when the land disturbing construction activity involves one or more acres. (b) The monitoring record under par. (a) shall contain at least the following information: 1. The condition of the erosion and sediment control practices at the intervals specified under sub. (1). 2. A description of the maintenance conducted to repair or replace erosion and sediment control practices. 10. Refer to Comm 60 for additional requirements. Technical inquiries concerning this correspondence may be made to Lennie (Robert) Kanter 608- 261-6541, email Robert.Kanter(cuwi.gov or at the address on this letterhead. Please refer to the Transaction ID No. referred to in the regarding line when making an inquiry or submitting additional information. Sincerely, Joanne Koch License/Permit Program Associate ,Integrated Services (608)264-7623 , 07:45 - 4:30 j oanne.koch@wisconsin.gov Fee Required $ 25.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Payment Submittal. WiSMART code: JIM Page 3 2/28/2008 cc: John R Anderson, State Building Inspector, (715) 823-2014 , Monday,7:45A.M.-4:30P.M. Tim Verhagen , Martenson & Eisele Inc Russ Karasch ,Keystone Design-build, Inc. By the signing of this letter, the owner certifies upon penalty of law: • That this document and related erosion and sediment control and stormwater management plans were prepared in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on his/her inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of his/her knowledge and belief, true, accurate, and complete. He/she is aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violation. • That the erosion and sediment control plan and post-construction stormwater management plan will be available at the project site for state or local inspection use. I am the owner of this property agree to the terms and responsibilities stated in this document. Signature• Date commerce.wi.gov i ^ ~scons~n Department of commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer. AL/1_ Secretary March 03, 2008 CUST ID No. 1069626 ATTN.• Buildings & Structures Building Inspector LON NEGEN NEGEN ARCHITECTS 22517 178TH AVENUE COLD SPRING MN 56320 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/03/2010 SITE: Poklansy Fiss & Bills Funeral Home South Westhaven Drive City of Oshkosh FOR: BUILDING INSPECTION CITY OF OSHKOSH POB 1130 OSHKOSH WI 54902 (Please forward a copy of this letter to the fire department conducting inspections of this project.) Identification Numbers Transaction ID No. 1505853 Site ID No. 734411 Please refer to both identification numbers, above, in all with the Object Type: Building ICC Regulated Object ID No.: 1170344 Code Applies Date: 02/05/08 Major Occupancy: Assembly; Type VB Combustible Unprotected class of construction; New plan; 7,918 project sq ft; Completely Sprinklered; Occupancy: A-3 Other Assembly Uses 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 defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. This review is based on bound set and additional information in bound set. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • IBC 907.2.1 - A manual fire alarm system shall be installed in accordance with NFPA 72 in Group A occupancies having an occupant load of 300 or more. Portions of Group E occupancies occupied for assembly purposes shall be provided with a fire alarm system as required for the Group E occupancy. • IBC 903.3.1.1 -Where the provisions of this code require that a building or portion thereof be equipped throughout with an automatic sprinkler system, sprinklers shall be installed throughout in accordance with NFPA 13 except as provided in Sections 903.3.1.1.1, 903.3.1.2 and 903.3.1.3. Also Address LON NEGEN Page 2 3/3/2008 • Comm 62.1101(2) Buildings and facilities shall be designed and constructed to be accessible in accordance with this code, with ICC/ANSI A117.1 and with the changes, additions, or omissions to the ICC/ANSI A117.1 requirements specified in subs. (3) to (5). Submit • Comm 61.30(3) -This review does not include heating, ventilating or air conditioning. The owner should be reminded that HVAC plans, calculations, and appropriate fees are required to be submitted for review and approval prior to installation. The submitted HVAC plans shall match the approved building plans. Note as per Comm 2.10 installation of HVAC without approved plans could result in double fees. • Comm 61.30(3) -Submit, prior to installation, one (1) set of properly signed and sealed truss plans, a completed SB-118 application form including this transaction number and signed by the building designer, and $100 submittal fee to Safety & Buildings, P.O. Box 7162, Madison WI 53707-7162. Note as per Comm 2.31(1)(d)6. the fee for a structural component erected prior to plan submittal may be an additional $200. Reminders IBC 1011.1 -Exits and exit access doors shall be marked by an approved exit sign readily visible from any direction of egress travel. Access to exits shall be marked by readily visible exit signs in cases where the exit or the path of egress travel is not immediately visible to the occupants. Exit sign placement shall be such that no point in an exit access comdor is more than 100 feet from the nearest visible exit sign. Address the need for 90 minute continued illumination in case of power loss. • Comm 61.36(1)(a) & (b) -This approval will expire 2 years after the date of this letter if the building shell is not closed in within those 2 years. Also, this approval will expire 3 years after the date of this letter if the work covered by this approval is not completed and the building ready for occupancy within those 3 years. • Comm 61.31(2)(b) - A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. Changes to the approved plan must be submitted for review and approval. Failure to properly attach the approval and index page to the plans that match the copy on file with Department may result in enforcement action under ss. 101.02 or 443.13, Statutes. • ICC/ANSI A117.1 Sec. 604.3.1 -Clear space around the water closet shall be a minimum of 60" from the side wall and a minimum of 56" from the back wall. No other fixtures or obstructions including lavatories and urinals shall overlap the clear floor space required for the water closet, except as permitted by Section 604.3.2. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. If plan index sheets were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. If this construction project will disturb one or more acres of land, an Erosion Control Notice of Intent (NOI) shall be filed with the department 7 days prior to any earth disturbing activities. You will need to either file the NOI and an erosion control plan summary on-line at LON NEGEN Page 3 3/3/2008 www.commerce.wi.gov/sb or submit a completed NOI form and either a plan summary or complete plan to us, with additional fees, or to the certified municipality. In granting this approval the Division of Safety & Buildings 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 maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fokruddin Khondaker Engineering Consultant Building Systems ,Integrated Services WiSMART code: 7648 (608)266-1930 , 7:45-4:30 M-f fokruddin.khondaker@wisconsin.gov Fee Required $ 730.00 Fee Received $ 730.00 Balance Due $ 0.00 cc: John R Anderson, State Building Inspector, (715) 823-2014 , Monday,7:45A.M.-4:30P.M. Keystone Design Build Inc Jim Poklasny, Plklasny Funeral Home Negan Architects Inc New Codes to be Effective: The Wisconsin Division of Safety & Buildings has adopted the 2006 International Code Council suite of building codes, including the International Existing Buildings Code, with an effective date of March 1, 2008. For further information, got to ~vww.commerce.~vi. Gov/SB/ commerce.wi.gov ^ ~sconsin Department of Commerce Jim Doyle, Governor Richard J. Leinenkus~el. Secretary October 23, 2008 CUST ID No, -101.1793 BRAD NOAH TEMPERATURE SYSTEMS INC 2200 S ASHLAND AVE PO BOX 12088 GREEN BAY WI 54307 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03!03/2010 SITE: Poklansy Fiss & Bills Funeral Home South Westhaven Drive City of Oshkosh Identification Numbers Transaction ID No. 1602990 Site ID No. 734411 Please refer to both identification numbers, abovc, in all correspondence Safety and Buildings PO BOX 7162 MADISON Wt 53707-7162 Contact Through Relay www. commerce.wi.gov/s W www.wisconsin.gov with the FOR: Facility: 689636 POKLANSY FISS & BILLS FUNERAL HOME SOUTH WESTHAVEN DRIVE Object Type: HVAC ICC System 02/05/08 Revision; 7,918 sq ft Area Heated Regulated Object ID No.: 1178763 Code Applies Date: 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 defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Only those object types listed above have been approved; other submittals such as plumbing and those listed below under Also Submit, maybe required. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • IECC 803.2.6 & 803.3.3.5/Comm 63.1031 Provide an economizer cycle for the cooling system unless the designer can demonstrate that one of the exceptions in the code can be met. • Comm 61.36(1)(a) & (b) -This approval will expire 2 years after the date of March 03, 2008 if the building shell is not closed in within those 2 years. Also, this approval will expire 3 years after the date of March 03, 2008 if the work covered by this approval is not completed and the building ready for occupancy within those 3 years. This revised approval is only for ATTN.• Buildings & Structures. Building Inspector BUILDING INSPECTION CITY OF OSHKOSH POB 1130. OSHKOSH WI 54902' ' ~ , ,, (Please forward a copy of this letter to the fire department conducting inspections of this project.) BRAD NOAH Page 2 10/23/2008 the works indicated in revised bound set, all other conditions of previous approval with Transaction ID number 1530185 would remain in effect. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. If plan index sheets were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. All permits required by the state or the local municipality shall be obtained prior`to_ commencement of construction/installation/operation. Any local requirements .shall be complied with. This plan has. not been generally reviewed for compliance with fire code requi>~ements,: including those for fire lanes and fire protection water supply, so contact the local .fire, department for further information. ~ . If this construction project will disturb one or more acres of land, an Erosion Control Notice of Intent (NOI) shall be filed with the department 7 days prior to any earth disturbing activities. You will need to either file the NOI and an erosion control plan summary on-line at www.commerce.wi.gov/sb or submit a completed NOI form and either a plan summary or complete plan to us, with additional fees, or to the certified municipality. In granting this approval, the Division of Safety & Buildings 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. The Division does not take responsibility for the design or construction of the reviewed items. Per s. Comm 61.40(4), projects for buildings of over 50,000 cubic feet total volume shall have supervising professionals who file compliance statements with this agency and the local code officials prior to occupancy of the project. The compliance statement form is available on our website, www.commerce.wi ov/sb under forms for commercial buildings. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fokruddin Khondaker Engineering Consultant Building Systems ,Integrated Services WiSMA.RT code:-7648 (608)266-1930 , 7:45-4:30 M-f fokruddin.khondaker@wisconsin. gov Fee Required $ 150.00 Fee Received $ 150.00 Balance Due $ 0.00 cc: John R Anderson, State Building Inspector, (715) 823-2014 , Monday,7:45A.M.-4:30P.M. Temperature Systems Inc Jim Poklasny, Plklasny Funeral Home 07/28/2008 13:26 9209548243 ,,he~rr~ ~~~ R'te~a~r~ IAA d1vls~oR of .~. F: Ahc~mt Go. sutx E. Ca~te~ Dry uMta - one wi w'i't ~.{eaa~2 • ~ixerlgles4•eaas • wwu.e~hemllraco~ w~oonsnn • nnd,o~ ~ Nfi.~vur~ • ~tertx~a~ke • ravra One Company, Many Services Plumbing • Pipe Fabrication • Water/Wastewater HVACR Fire Protection • Mechanical Service ~ IndustriallProcess Committed to Service excellence Whether as a prime contractor, subcontractor or joint venture partner, we have the experience and technical capabilities to provide constructive solutions to our customers' diverse needs. Call us for more information on how we can meet your service requirements. With Offices in: ~ Wisconsin e Illinois ~ Missouri p Nebraska e Iowa ATTENTION: COMPANY: FROM: RE: Nichol DATE: Oshkosh Building Department p,qx#: 920/2365084 David Dewhurst TEL #: Poklasny, Fiss 8~ Bills Funeral Home Nichol, Here is the fire stopping detail you asked my fitter about today. If you have any questions please feel free to contact me at: 920/907-5404 ddewhurst p~ahemfire.com Hard copy to be mailed? ^ Yes ^X No AHERN FIRE FAX PACE 01/02 Cover Sheet + 1 Page(s) Please contact us if there is a problem wlfh this transmission. ApD_Fax, 0322~5,do1 07/28/2008 13:26 9209548243 AHERN FIRE PAGE 02/02 N N N J z s o, J a M N ~ G m ~ ~ a+yi c F" ~ N = 4 O v Y ~ KL e~- S O W ~ F"" v ~ ~ ~ = o ~, V7 ~""' ~ ~ t ~- N ,~ d Or ~ (ti ~~ ~ ~.Tf. °~N ~ a~ N ~ ~ Nom... ~0 V)d N ~ oI ~ I ` p iJ1 O~ ~~ _ ~ ~ U G I ~ E ~ of ~~ E ao Q 7 = zooms-~ n ~ ~ ~ O ~ ( i O J m G~ U~ d N W t l~ . O 1 Q: .C.~9 fWf~11 ~ % .mod. `~ a ~ C '~ L1_ ~ V]~~~~~Gm ~W 5 ~ - ~ J~ E E-"m~ SQ o ~ ~ ~~.v•o~ c~ ~~ ~ ~ ?~~adz ~~ ,z x w L ~ ~ C~ d Vl :e r_ r N U ~- N r7 ~ W L:.1 ~ y 07/3/2008 14:04 9202317255 BEEZ ELECTRIC ~, ~~ ~~C C~~G~~~y DI~C~e Phone; 920-231-6655 • Fax: 920-231-7255 Email: customerservice@heezelectric.com PAGE 01 facsimile transmittal Attn: Nicole Fax: 920.2365484 From: Rob ]ones Date: 7/30/08 Re: Fire Stop ~ Poklasny-Fiss&Bills Pages 2 (including cover) ~ Urgent X For r~'view D Please comment Notes: Nicole Here is the info. On are firestop Regards, Rob Jones Project Manager ^ Please reply ^ Please recycle P.O. Box 2332 • Oshkosh, Wisconsin 54903-2332 F~ 07/30/2008 14:04 9202317255 BEEZ ELECTRIC ~,, , . ~ `" `,• System No. W-L-3001 September 07, 2004 (Formerly System Ho. 149) ~tiags - C~FTr (Sec Item ~l j' " ~ T Rapngs-= st4-t . - ana 1 rtr t see non q L Rating Ac Ambient -15 CFM/sq ft (See Item 3) L Rating At 40(1 F -less than 1 CFM/sq R (See Item 3) v PAGE 02 l . Wall Assembly -'l'hc I or;t hr fire•rntcd gypsum wnllboard/sn-d wall assembly shall be constructed of the materials and in the manner described in the individual U3(Nl or U400 Series Wnll or Partition Desigts in the []I. Fire Rcaiatanee Directory and shall include the following cnnstruclion fcalures: A. 3tuda -Wall framirtgt rosy consist pf either wood sludo nr steel channel studs. Wood studq to consist of nom 2 by 4 in. lumber spaced l6 ia. OC with nom: by 4 in. lumber end plates ettd t:rtrss bracer. Steel studK to be min 3-5/8 in, wide by 13/8 in. deep channels spaced max 24 in OC B. Cypsaro Board" - AJom 1IZ or 5!$ in. thick, d tl wide with sgttate or lapt:red edges, The gypstan wallboard type, thieknest, number pf 4tyers and sheet orietltation shall be as specified in the individual Wall or Partition Design. Diem of circular Through opening tp be 3/8 in. to 5/g in. larger than outside diem of cable or cable bundle. C. F'asteaers -When wl:~od stud Framing is employed gypsum wallboard layers attached to studs with cement coated nails na specified In the individual Wall or .Partition Design. When steel channel stud frnming is employed, gypsum wallboard attached to studs with Type; S self-drilling, self-tapl:~ing bugle-head Atccl screws as specified in the individual Wall or Partition Design. The hoary F Baling of the flrestop system kt equal to the hourly fire rating of the wall assembly in whkb it is installed. 2. Cables -Individual cable or max 1 in. diam cable bundle intttalled in thmugh opening wish an armular spttx of min A in, (point coamcq to tn;uc 314 in. Cable to be rigidly sl.lpported on lath sides of wall assembly. The followinD types and sizes of c;-bles may be used: A. M~ut 150 pair No. 24 ,~1WG copper conductor telephone cable with polyvinyl chloride (PVC) insulation and jacket materials. When max 25 pair U:lephoac cnbk is used, T Ratnng is 2 h>: Whco 50 to 150 pair tekphooe cable. need in 1 hr t7rc rated wall, T Rating is a/4 ht: q~hca 50 to 150 pair tcleph~ae cable is used in 2 hr fire rated wall, T Ratlag is t 6r. t3. Max No. 10 AWG m~:,ltiple copper conduetorTypc NT,t ("Romex")nonmetallic sheathed cable with PVC insulation andjneket materials, When Type KivF cabk Is used, max T Rating b 1.1R hr. C• Multiple fiber optical communication cable,jacketed with PVC and having a max outside diem of 5/8 in. When fiber optic cable i~ owed, maxi Rating is 2 hr D. Max IZ AWG Multi i:unductpr (max seven conductont) puwerlconlrol cahlc with crnswlinkcd polyethylene (`CLPF) Insulation and XLPE or PVC jacket materiels, When math coadutYOr powerkentrttl cable is aced, mac T Rating is L hr- E. Max fourconductcir ~~iith ground No. 2 AWG (or smallerl aluminum SER cables with polyvinyl chloridr in~utation and jacket materials. 3. Fill, VoM or Cavity Mater~iala" -Caulk Sealant nr Pu/ty -Caulk or pally Fill material inalallCd to completely fil l ~rtnular apses betwelm cable and gypsum wallboa~~d on both sides of wall and wtth a min l/4 io. diant bead of caulk or putty a{tplicd to perimeter o1'cable(s) at i4~ egress from each side of th,a wall. 3K CO~IpAN'l(, MP+ Stix putty, CP 25W81 caulk, FB-3(>nG WT sealant or Cable Wrap putty (Note; L Rncing;l apply only whop CP tSWB+~-ulk or FF3-3000 WT is used.) *Bcaring the l1t Clasgitic;tlion;~(ark this materiel war extracted and dratm by 3M fire Protection Prt:dteds fratn the 2007 edhlon of the Ul Fire Resistenco Oirenory. c©m re~IMlMI~I N C O v C d s a~ 0 s u- .` to O O O SEC.['~ON ,~-.A~ M -~ I System No. W-L-1049 - F Ratings - 1 and 2 Hr (See Item 16) T Rating - 0 Hr L Rating At Ambient -Less Than 1 CFM/sq ft ~ L Rating.At 400 F -Less Than_1__CFMLsq ft . _ ___ _ _ .,..,_ 1. Wall Assembly -The 1 or 2 hr fire-rated gypsum wallboard/stud wall assembly shall be constcuc4ec~w'` materials and in the manner described in the individual U300 or U400 Series Wall or Partition Design in;,, Fire Resistance Directory and shall include the following construction features: ;~;" `Wall A. Studs -Wall framing may consist of either wood studs or steel channel studs. Wood studs o co - many nom 2 by 4 in. (51 by 102 mm) lumber spaced 16 in. (406 mm) OC. Steel studs to be min 3-1/2 in:-,(~3 `and s wide and spaced max 24 in. (610 mm) OC. When steel studs are used and the diam of opening exce~ ` A• width of stud cavity, the opening shall be framed on all sides using lengths of steel stud installed be' ~ ~ nB` ~ the vertical studs and screw-attached to the steel studs at each end. The framed opening in the be 4 to 6 in. (102 to 152 mm) wider and 4 to 6 in. (102 to 152 mm) higher than the diam of the pen, ~ The I item such that, when the penetrating item is installed in the opening, a 2 to 3 in. (51 to 76 mm) clear ",insta present between the penetrating item and the framing on all four sides.. :~ ` ' ;T#~ro " B. Gypsum Board* - 5/8 in. (16 mm) thick, 4 ft (1.22 m) wide with square or tapered edges.. The: :::pipe, board type, thickness, number of layers, fastener type and sheet orientation shall be as specifie ` q o be individual 0300 or 0400 Series Design in the UL Fire Resistance Directory. Max diam of opening; timay I ~~. (660 mm) for steel stud walls. Max diam of opening is 14-112 in. (368 mm) for wood stud walls ~ I The hourly F Rating of the firestop system is equal to the hourly fire rating of the wall assembly ui.~ ~ is installed. ~ - i 2. Through Penetrant -One metallic pipe, conduit or tubing to be installed either concentrically or ecce~, - . ~ within the firestop system. Pipe, conduit or tubing may be installed at an angle not greater than.4~ dg9>•e; __i perpendicular. The annular space between pipe, conduit or tubing and periphery of opening shall be,ti; III, ~ (0 mm, point contact) to max 2 in. (51 mm). Pipe, conduit or tubing to be rigidly supported on both side Urfa assembly. The following types and sizes of metallic pipes, conduits or tubing maybe used: ~' terl A. Steel Pipe -Nom 24 in. (610 mm) diam (or smaller) Schedule 10 (or heavier) steel pipe. `,,.__ B. Iron Pipe -Nom 24 in. (610 mm) diam (or smaller) cast or ductile iron pipe. ~ C. Conduit -Nom 4 in. (102 mm) diam (or smaller) steel electrical metallic tubing, nom 6 in.-{a., ~-- (or smaller) steel conduit or nom 1 in. (25 mm) diam (or smaller) flexible steel conduit. ng D. Copper Tubing -Nom 6 in. (152 mm) diam (or smaller) Type L (or heavier) copper tubing... E. Copper Pipe -Nom 6 in. (152 mm) diam (or smaller) Regular (or heavier) copper pipe. 3. Fill, Void or Cavity Material* -Sealant Min 5/8 in. (16 mm) thickness of fill material applied within a; flush with both surfaces of wall. At the point contact location between through penetrant and gypsum min 3/8 in. (10 mm) diam bead of fill material shall be applied at the gypsum board/through penetrant~i_. on both surfaces of wall SPECIFIED TECHNOLOGIES INC - SpecSeal 100, 101, 102 or 105 Sealant *Bearing the UL Classification Mark I III IIIIIIII II (IIIIIIIII III ~I~III I II I IIIII~IIIIII III II III Spec fled Te hnologies, Inc., So er~Ile,4NJ (800) 992-1180 o~~u` ~ ~ .- 736 W-L Systems Technical Service 1 Section A-A ~~~ ~ ~~~ ~ J A ~ ^ rA s ~p System No. W-L-2100 F Ratings -1 and 2 Hr (See Item 1) T Ratings - 0, 1/4 , 1 and 1-1/2 Hr (See Item 2) 1. WallAssembly -The 1 or 2 hr fire-rated gypsum wallboard/stud wall assembly shall be constructed of the materials.and irr described in the individual 0300 or 0400 Series Wall or Partition Design in the UL Fire Resistance Directory and shall following constiudion features: A. Studs -Wall framing may consist of either wood studs or steel diannel studs. Wood studs to consist of nom 2 by 4 iti: spaced 16 in. OC. Steel studs to be min 3-5/8 in. wide and spaced max 24 in. OC. - ~'° B. Gypsum Board* - 5/8 in. thick, 4 fl wide with square or tapered edges. The gypsum wallboard type, thidmess, number c fastener type and sheet orientation shall be as spedfied in the individual U300 or U400 Series Desrc~n in the UL Fre R Directory. Max diam of opening is 3-1/2 in. - The hourly F Rating of the firestop system. is equal to the hourly fire rating of the wall assembly in which it is installed. -~ 2. Nonmetallic Pipe -One nonmetallic pipe or tubing to be centered within the firestop system. Pipe or tubing th be rigidysup both sides of wall assembly. The following types of nonmetallic pipes or tubing maybe used: A. Polyeuhylene Pipe -Nom 1 in diam (or smaller) SDR 11 (or heavier) polybutylene (PB) pipe for use in dosed (process piping systems. A nom annular space of 1/4 in. is required within the firestop system. ~' B. Cross Linked Polyethylene (PEX) Tubing -Nom 1 in. diam (or smaller) SDR 9 PEX tuning for use in dosed (processa piping systems. A nom annular space of 1/4 in. is required wffhin the firestop system. C. Acrylonitrile Butadiene Styrene (ABS) Pipe -Nom 1-1/2 in. diam (or smaller) Sdiedule 40 cellular core ABS pipe ft dosed (process or supply) or vented (drain, waste or vent) piping systems. The annular space shall be min 1/4 in. ~ max'1: D. Polyvinryl Chloride (PVC) Pipe -Nom 2 in. diam (or smaller) Sdiedule 40 cellular or solid core PVC pipe for use in dosed I or supply) or vented (drain, waste or vent) piping systems. The annular space shall be min 0 in. (point contact) th max 1 in: E. Chlorinated Polyvinyl Chloride (CPVC) Pipe -Nom 2 in. diam (or smaller) SDR 17 CPVC pipe for use in dosed (pn supply) or vented (drain, waste or vent) piping systems. The annular space shall be min 0 in. (pant ) to max 1 in.,;" The hourly T Rating of the firestop system is dependent on the hourly fire rating of the wall assembly in which it is installed and~i through penetrant, as shown in the table beloHr. Rating of Wall Type of Through Penetrant T Rating, Hr _ 2 PB pipe 1-1/2 , 2 PEX tubing 1-12 _~ 2 PVC or CPVC pipe 1/4 2 ABS pipe 0 1 PB pipe 1 1 PEX tubing 1 n._a 1 PVC or CPVC pipe 1/4 1 ABS pipe 0 3. FII, Void or Cavity Material` -Sealant -Min 5/8 in. thickness of fill material applied within annulus, flush with both surface Additional fill material to be installed such that a min 1/4 in. thick crown is formed around the penetrating item.. SPECIFIED TECHNOLOGIES INC - SpecSeal 100,101,102,105,120 or 129 Sealant '`Bearing the UL Class cation Mark The h shorovr Thror annul ~PPk ~, II I IIIIIIII II IIIIIIIIIIIIIIIIIII I II I III IIIIII III I I III S ec fi d Te hnCo aesa ~ncR So edrv~l9e N Jo 800 r 992-1180~pUL ~o ~ "III P 9 ( ) 774 yy_L Technical Service 1-800-992-1180 wwwstiflrestop:ci-m Section A-A 201 Morris Court, P.O. Box 1316 ~. F. AHERN CO. Fond du Lac, WI 54936-1316 MECHANICAL ~t FIRE (920) 921-9020 p • (920) 921-8666 f PROTECTION CONTRACTORS WWW.jfahern.com Building Inspector -- Brian Noe City of Oshkosh 215 Church Avenue PO Box 1130 Oshkosh, WI 54901 T-920/236-5051 F-920/236-1130 RE: FIRE PROTECTION SYSTEM INSTALLATION POKLASNY-PISS & BILLS FUNERAL HOME H65 SOUTH WESTHAVEN DRIVE OSHKOSH, WISCONSIN 54904 AHERN FIRE PROTECTION CONTRACT NO.490743 Dear Brian: Enclosed is a copy of the Contractor's Material and Test Certificates covering the above-referenced Fire Protection System Installation for your files. Very truly yours, AHERN FIRE PROTECTION A division of J. F. Ahern Co. ~/~~~ Mark L. Jozefowski, Superintendent MLJ/ksj Enclosure Z:\FIltE\411DATA\490743U.CITY10-13-2008.DOC ' ~,~„ OCT 1 4 2008 DEF'i~RT1v~ENT ©E COMMUNl?Y `'EVE~OPMENT INSPECTIOiV SERVICES DIVISION Building the Midwest Since 1880 An Equal Opportunity Employer October 13, 2008 AHERN FIRE PROTECTION Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by the property owner or their authorized agent All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in noway prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authori 's re uirements or local ordinances. PROPERTY NAME Poklasn -Piss & Bills Funeral Home AFP Contract #: 490743 DATE: July 30, 2008 PROPERTY ADDRES South Westhaven Drive Oshkosh, WI -5F#J92 ~ 9 ~ i h~ ACCEPTED BY APPROVING AUTHORITIES (NAMES) t,~V 1. City of Oshkosh (Building Inspector -- Brian Noe) 2. Oshkosh Fire Department (Battalion Chief -- Stu Schrottky) 3. 4. ADDRESS Plans 1. 215 Church Avenue -- PO Box 1130 -- Oshkosh, WI 54901 2. 101 Court Street -- Oshkosh, WI 54901 3. 4. INSTALLATION CONFORMS TO ACCEPTED PLANS YES ^ NO EQUIPMENT USED IS APPROVED ES ^ NO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION ^ YES ^ NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? INSTRUCTIONS IF NO, EXPLAIN HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: Item No.'s 2 a 3 will 1. SYSTEM COMPONENTS INSTRUCTIONS YES ^ NO be forwarded by AFP at closeout time. 2 CARE AND MAINTENANCE INSTRUCTIONS - YES ^ NO 3. NFPA 25 YES ^ NO LOCATION OF SUPPLIES BUILDINGS SYSTEM Entire Buildin MAKE MODEL YEAR OF K- QUANTITY TEMPERATURE MANUFACTURE FACTOR RATING Vikin Microfast QR VK302 Pendent 1!2" White 2008 5.6 81 155 De . Vikin Microfast R VK302 Pendent 1/2" White 2008 5.6 9 286 De . Vikin Microfast QR VK300 Uri ht 1/2" Brass 2008 5.6 86 200 De . SPRINKLERS T co BB1 TY4180 Uri ht 3/4" Brass 2008 8.0 1s 200 De . PIPE AND TYPE OF PIPE __ Lightwall Non-Threadable: Thinwa ll Threadable FITTINGS TYPE OF FITTINGS Grooved; Threaded; Welded Outlets: Mechanical Tens FLOW ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST CONNECTION TYPE MAKE MODEL MINUTES SECONDS Water Flow Detector S stem Sensor WFD ~ N/A EXPLAIN ANY ALARM PROBLEMS: ALARM DEVICES LOW AIR ALARM DEVICE ALARM OPERATED TYPE MAKE MODEL PRESSURE SETTING PSI PROPERLY N/A YES NO EXPLAIN ANY ALARM PROBLEMS: OCT 1 4 2008 DEPARTMENT OF ~~ ~~-r.,~~~. - utvtLUPMENT INSPECTION SERVICES DIVISION Ahern Fire Protection CENTRAL MONITORING SIGNALS RECEIVED ALARM SERVICE LOCATION(S) TYPE OR NAME OF REMOTE WATERFLOW PRESSURE SWITCH LOW-AIR OTHER SERVICE DETECTOR FLOW SUPERVISORY SUPERVISING LOCATION(S): STATION (ON-SITE) REMOTE REMOTE NAME OF~,E`R. VICE: ~^ ° ntt s~~ ALARM MONITORING SERVICE j~2 SS -~ al SIGNALING (OFF-SITE) `~ PHONE: b OTHER: LOCATION(S): EXPLAIN ANY ALARM SIGNALING PROBLEMS: DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. DRY PIPE TIME TO TRIP WAT R TRIP POINT AIR TIME WATER ALARM OPERATING THROUGH TEST ' b PRES URE AIR PRE SSURE PRESSURE REACHED TEST b OPERATED TEST CONNECTION • OUTLET'• PROPERLY MIN. SEC. P I PSI PSI MIN. SEC. YES NO WITHOUT Q.O.D. WITH Q.O.D. IF NO, EXPLAIN: OPERATION: ^ PNEUMATIC ^ ELECTRIC ^ HYDRAULIC PIPING SUPERVISED ^ YES ^ NO DETECTING MEDIA SUPERVISED ^ YES ^ NO DOES VALVE OPERATE FROM THE MANUAL TRIP, REMOTE, OR BOTH CONTROL STATIONS? ^ YES ^ NO IS THERE ANA CESSIBLE FACILITY IN EACH IF NO, EXPLAIN DELUGE & CIRCUIT FORTS G? PREACTION ^ YES ^ NO VALVES DOES EACH CIRCUIT DOES EACH CIRCUIT MAXIMUM TIME TO OPERATE SUPERVISION OPERATE VALVE OPERATE RELEASE MAKE MODEL LOSS ALARM? RELEASE? YES NO YES NO MINUTES SECONDS LOCATION & MAKE MODEL SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE FLOOR (FLOWING) PRESSURE INLET OUTLET INLET OUTLET FLOW REDUCING VALVE TEST PSI PSI PSI PSI GPM 'MEASURED FROM TIME INSPECTORS TEST CONNECTION IS OPENED. ° NFPA 13 ONLY REQUIRES THE 60-SECOND LIMITATION IN SPECIFIC SECTIONS. r- Ahern Fire Protection HYDROSTATIC: Hydrostatic tests shall tie made at not less than 200 psi (13.6 bar) for two (2) hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for two (2) hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All TEST aboveground piping leakage shall be stopped. DESCRIPTION PNEUMATIC: Establish 40-psi (2.7 bar) air pressure and measure drop, which shall not exceed 1-1/2 psi (0.1 bar) in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1-1/2 psi (0.1 bar) in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT SI (_Bar) for HRS. IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED ^ YES ,~ NO EQUIPMENT OPERATES PROPERLY YES ^ NO dI S DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OR SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? :YES ^ NO DRAIN READING OF GAUGE LOCATEe NEAR WATER RESIDUAL PRESSURE WIT V LVE IN TEST : ~ TEST SUPPLY TEST CONNECTION: PSI Bar) PSI (_Bar) .CONNECTION OPEN WIDE TESTS UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISER(S) TO OTHER EXPLAIN BE FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE CONTRACTOR'S MATERIAL AND TEST CERTIFICATE FOR UNDERGROUND PIPING. ~ YES ^ NO FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING YES ^ NO IF POWDER-DRIVEN FASTENERS ARE USED IN CONCRETE, HAS IF NO, EXPLAIN REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? ^ YES ~NO ~~ ~/VS GG~ BLANK NUM ER USED LOCATIONS NUMBER REMOVED TESTING ~ ~~ GASKETS ELDED PIPING YES ^ NO IF YES... Do you certify as the sprinkler contractor that welding procedures used complied with the minimum requirements of AWS 62.1, ASME Section IX Welding and Brazing Qualifications, or other applicable ,~ YES ^ NO qualification standard as required by the AHJ? Do you certify that all welding was performed by welders or welding operators qualified in accordance ,~ YES ^ NO WELDING with the minimum requirements of AWS B2.1, ASME Section IX Welding and Brazing Qualifications, or other applicable qualification standard as required by the AHJ? Do you certify that the welding was conducted in compliance with a documented quality control procedure to ensure that (1) all discs are retrieved; (2) that openings in piping are smooth, that slag J~YES ^ NO and other welding residue are removed; (3) the internal diameters of piping are not penetrated; (4) completed welds are free from cracks, incomplete fusion, surface porosity greater than 1/16 inch diameter, undercut deeper than the lesser of 25% of the wall thickness or 1132 inch; and (5) completed circumferential butt weld reinforcement does not exceed 3/32 inch? CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL YES ^ NO (DISCS CUTOUTS (DISCS ARE RETRIEVED? HYDRAULIC NAMEPLATE ROVIDED IF NO, EXPLAIN DATA YES ^ NO NAMEPLATE REMARKS DATE LEFT IN'SERVICE WITH ALL CONTROL VALVES OPEN: -" i/ NAME OF SPRINKLER CONTRACTOR AHERN FIRE PROTECTION, 201 MORRIS COURT ~ FOND DU LAC, WI 54935 TESTS WITNESSED BY AUT ORI _ VING JURISDICTION (SIGNED) ~-~-~ TITLE D TE Q~ ~ n a SIGNATURES - U THE PROPER WNER OR THEIR AUTHORIZED AGENT (SI NED) TITLE TE FOR SPRI O i;~~.~NED) TITLE DATE i~ ~~ 7d ~,4'~rn•~~ ~-3~-~' ADDITIONAL EXPLANATIONS AND NOTES: ~_ Double ChecktlDC Detector /SCOIfS//I Perfomance Test Department of Commerce Regulated Object Number: Personal information you provide may be used for secondary purposes [Privacy Law, s.1504 (1)(m)]. OWNER INFORMATION Please print clearly in ballpoint pen. Additional information on back page. Owner Name Street Addres Safety and Buildings Division P.O. Box 7302 Madison, WI 53707-7302 Fax: (608) 267-9723 --TTY: (608) 264-8777 httpJlwww.commen:e.state.wi.us httpJ/ww~w./wisc~ons~in, jgoav city State Zip Code Owner's Contact Person Telephone Number ~,'f...,,.,... - - s~~. y Facility Na ` ~ Street Addres City ff State Zip Code County ~ S~~oSh wt p Assembly Location Manufacturer Model Serial Number Size Assembly Type ~,DC ^ DC Detector Initial Test 1'st check 2'nd check Closed tight ~ Closed tight ^ Leaked C, ^ Leaked Static 3 ~ T PSID Static ~~ © PSID Final Test ------------------------------- -- Closed tight Closed tight 2'nd check Static ~~ _PSID Static ~ s ~ PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST 1'st check 2'nd check ^ Closed tight ^ Closed tight ^ Leaked ^ Leaked RECFalr~ static PSID____Static______--PSID-----------(}~~~--4-28f18----- DETECTOR BYPASS ASSEMBLY FINAL TEST ^ Closed tight ^ Closed tight DEP,~F~"i`MC4l~a7~ OF COMMUNITY DEVELC7PMENT Static PSID Stdti~ ° PSID INSPECTION SERVICES DN ON ASSEMBLIES IN FIRE PROTECTION SYSTEMS Note: Include hose stream demand where applicable Forward Flow Test Designed flow rate ~~ GPM Actual flow rate GPM Indicating Control Valves ^ No. one control valve open ^ No. two control valve open Valve supervision• ~ Tamper Switch ^ Locked P~s) Replaced/Comments ~,,.~,.i5 n ~''-~ w ~ ~'e~ ~ v-~-lv~ s c. ~os~ I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Tester Name (print) .. ~ , r z~ Registartion No. ~ I Time of Day~_3~ ~~'t Tester Signature Phone No. Date ">~' SBD 0 4 N. 12/0 i ributed to the following: Owner and tester rptBlank_WlDoubleCheck_DC_Detector Date -"'_7` ~ Page _~^of ~ ~_ Project Name. r d K 1. /~S /~ l~ ~ ~ 5 S d" ~ t ~.. ~- 5 J !_____._ AIR MOVING EQUIPMENT TEST SHEET SYSTEM ~ .. Equipment Location ~ ~~ ~ ~ a ~ ~ ~ ~ 3----- ----w-- - - Area Served j_ ou ~J 4 ~"' L o B ~~ ~ i~ST ~ 9 ~-"'1 ! / b 11 ~ ) $ ~ 1_~~ ~~2_ Equi went Manufacturer 0~.-7 ~ /'7 p S t9 Q oR P S~ Model ~ i~ ~ ©~S' 0 ~` ~ ~o ~ °i ~'`7 ~~ © S ~ -- Serial Number .,~ l`! $ ~ ~ d0 ~ ~ 7 ~ s~ ~ S ecified Actual t S ecified Actual,.-__ Total CFM -Fan L? L~ ~ S ~ 1 -~ S ~ Total CFM -Outlet ~ O ~ 3 ~~ ~ ~ ~~~ ota tatic ressure ~ S ~ ~ ~ ~ s-p Inlet Pressure -- Dischar a Pressure --- Fan RPM Specified ~ Actual Specified Actual. Motor Manufacturer Motor HP BHP I 1 ~ ~ ------ Phase ~ Voltage Q p ) 1 ,~ 1 ~ ~ Amperage . ~" c~Nt-y l \7 • ~ , C~ _~ru_C~ Motor RPM Motor Service Factor Starter Heater Elements Motor Sheave ~ No Grooves Fan S heave & No. Grooves _ _ Belts _ Remarks Date ____,~_L ~ 7 ~ Page ~_of id~-- Project Name_ 1 0 K L'~ S/~~ ~)5'j d• f~l ~- 1-S `^ __ ._. AIR MOVING EQUIPMENT TEST SHEET SYSTEM ~"' Equipment Location 0 0 N') ) ~ ~• n +1 a ~ 1 ? Area Served ~ }~ ~}- ~ -z L -- ~ ~ o -~ i l j ~ ~ lz= L - t2 ~ ~ ~ L!~__ Equipment Manufacturer ~ 'T_ ~.'~- i`t }~ 5 / ~ rZ ~ l"Z s rA +2 Model 9 /`1 Pz ~ ~ ~ J"~ P Q ~ ~ h- 1 ~ Serial Number ~'fl~ ~ s ~ ~ 0' © .s ~ O ~° ~ S 4s ~ Specified Actual S ecified Actual____ Total CFM -Fan ~ 8 '~ ~ $~ ~ ~ ~ ~(9 © / ~~ S 5 Total CFM -Outlet D ~ ~ ~ ~ ~ E7 `~ ~ S R/A CFM j ~ © I l Ff 5~ ~~0 / ~ ota tatic ressure M 5- S ~ ~- Inlet Pressure Dischar a Pressure Fan RPM Specified ~ Actual Specified Actual Motor Manufacturer Motor HP BHP 1 1 _~ 1 ____-- Phase ~ voltage ~ j j v j t~ 0 Amperage ~ , ~ `~ Motor RPM - Motor Service Factor Starter Heater Elements Motor Sheave & No Grooves Fan S h eave & No . Grooves _ _ Belts Remarks. Date / ~ ~' b~ Page Hof Project e ~ ,•~r~?~ ~ 1,. ~' {j iV y - ~ ~ S S 'f' ~ ~ 2' ~- s -_------ ---- -------- -- AIR MOVING EQUIPMENT TEST SHEET S'SCSTEM _ ~~"" _ .._. _~ Equi atent Location ~ ~ ~ ~ 02 ~ _ __ _ d ©~ -«__. Area Served.- ~ G t= - ~~ d ~`.t t~ ~ ~l~ ~r? vl~`(- ~? a_1`_(- - E ui ment Manufacturer T f /? L /~J ~r L, ~ ~ ~ S T~ K Model F ~ S" ~ jV r? M ~ ~ ~ .~ ~ ~i_ 1 ~ __ - Serial Number D c' 7 ~ ~ ~ d ° ~' 3 s ~ a ~ ~~ ? $ ~ y ~ ified S e c Actual i S ecified _ !.Actual.. ___ Total CFM -Fan o ^~ ~ ~ ~ ~ `O ' ~~ D O ~ ~ ~ - Total CFM -Outlet j u ~ ~ L~ c1 _--__ R/A CFM ~ a ~ ~~ ~ _ 0/A CFM ~ G~ O -- ---r~_5~_~.______ __ ota tatic ressure ~- Inlet Pressure __._._____ Dischar a Pressure _ Fan RPM Specified Actual Specified Actual Motor Manufacturer Motor HP BHP F~Z~rT 1 n~~ L 1' lP c~ 0~1/~ L I - j .. __ Phase ~ --~-_ Voltage 1 ( ~ ~ ~ ~ / o Am era e F:-t ~ Motor RPM - Motor Service Factor Starter Heater Elements Motor Sheave & No Grooves Fan Sheave & No. Grooves Belts __ Remarks Date 1 ~ 3.~'~ `` Page y ~ ~~ - System ~ -' , Floor ~~ -.~_.__.__ AIR DISTRIBUTION TEST SHEET '.Terminal Room ~ Terminal ~ Design Test-FPM or CFM ~ Final i_ Number Number ~ Type 'Size ;Factor; FPM CFM 'Test I .Test 2:Test 3 FPM CFM ~ ~, ~5 ~ i ~1 ; fig ~ ~ ~ j p i ~~~` ~ ~ D fl, r + g~ ~ ~ ~ 111 ~ ~ O { I 1 s ~ .~ i i ~- ~ ~ ~ ~~ ~ S- ~ ~ ~ ! ~.' ~ ----- o < oo ' I < ~ ( f ~ ~ ~ f ~ j ' ~ ~- ' ~ r ~ ` ~ 4 I i f f l ~ < < f 1 ---- i I Remarks Date ~ ~~ ~-~ 7 ~C Page ~ i"' F . ~ ~-- Project _ ~ Q ~ ~ /~ S ~,%Y - T~ 1 S S ,F- ~ l L L S ----- u~---. ________-- System ~ -' ~. Floor ~6 `_.___. __ AIR DISTRIBUTION TEST SHEET Terminal Room Terminal !, Design Test-FPM or CFM Final Factor ~- Number Number Type !Size ~ FPM CFM ;Test 1 :.Test 2Test 3 `FPM CFM _ ~ € ~ ~ _------- i1~ ~~y ~t~I©~ is v - ~~- - - - -__ ~ .- ~-- 1 I l i~xl©: r~ v --- ~ t i x i~ ~" ' v ~ _____ ~ t ~ ~ ~7X ~ ~~- ' ' S"C3 ~ ;t t~ 6~ (a ' ~ ~ ~---~-~ - j ~ a, ~~ ~ ~ (p L7 1 0 ~ ~ ~ t 3~ ~ ~ l~~ _ . ~.,__". i f { - ~ ~ j ~ i ~ i ' -.- ' y 1 ` ~ { '~- ~ I ~ ----- i - f ~ j ~ i i 1 ~ { !1 f i ` i I f ~ 1 i 1 i [ ~~~ i ' i ~ ~ I i ~ 1 Remarks Date __~.~ ~~ Page (e ~` ~ - ;~ ~--- Project System ~~ '" ~ Floor 46 ~~______. AIR DISTRIBUTION TEST SKEET -- 'Terminal~ Room Number Number.. ----- ~ ~ ~' , Type !Size ~~.~-I ' IYX)ti ' Design Test-FPM or CFM Final Factor '; FPM CFM ±Test 1 Test Z ',Test 3 ~ FPM CFM a 3s' ~ X 1 1 ~ xt~{ . ~S' 3 v ,_ ~. ;'4uj i , 35'' 30 ! ~ i~ j ~ ~ ~ i ~~ ` ~ ~ ~ ± S 1) D ~~ ~ , ti i b `~ I ~~ ~ p~ ~ ~ ~ ~ I ~ t~~v~ ?!5~-~5 _ _~ . ___ _ r__ ____----_ 4 ~ i i I _j ~ i t---- 1 ~ ~ ~ ~ i ~ ~ jji I i S ~ 1 ~ ~ i i ~ + ~ ~ 1 ~ ~ { ~ ~ ~ ~ ~ I i i ~~_ _ i ~ i ' 1 Remarks Date ~ ~ ~ ~ ~~ Page ~ ~ ~ -I '~ Pro j ect ____-~--_ 0 X L- '~} S ~7~' r= / S 5 d`' (j I L L S System r `^ ~} Floor 46 ~___. __ AIR DISTRIBUTION TEST SHEET Terminal Room + Terminal ` Design Test-FPM or CFM i, Final Factor r Number Number i Type !Size ~ FPM CFM !Test 1 .Test 2;Test 3 FPM CFM > > a ' r y~~Y ~ s~ 3~ --- a ~ y,~ ~ 3 ~~ ~ , b5 ~ ._~ ~ ~ ' ` 10 ~ . s~' s ~ ~ ~ -- -----___-~- - ~ i ~ ~ ~ ; r 1 1 j i s _ __._ ____ i i } ' i I ~________€ ~ ; s ~- i N _ f i ~ t ~ ~ i i ~ 1 i ~~. i ~ ~ 1 ~ ~ ~ Remarks Date ~~ G~ Page ,_ ~'' G' i- /~-- - ~~jj o ~( ,~ ~1 S /y Y- 1` I S S d-- ~; 1 L L S -- -------_._.. Project _, 1' ------------- System ~ ~ Floor 4~ ~~~._._ AIR DISTRIBUTION TEST SHEET ,Terminal Room Number 'Number Terminal $ ~ Design Test-FPM or CFM ! Final '. Factor ~- Type !Size FPM CFM '.Test 1 'Test 2iTest 3 FPM CFM J ~~ ~~~I ~ ~ x ~~o ~ 15' - -- --- --- ~ i ~x ~ 3 0 ; 35~' } ~ I o ~i? o ~ ! ~ s ! R ' ~~~ ~ i ~ < ~ ~ 1 p j ~ ~ i ~ i i ~ i - j____-_.____ _._______~.___- ----~---- i -- f __-----~ } ~ 1 I ~ i I ! ~ ~ ~ } ~ j ~ I i ~ ~ f i-- ~ ~ ~ I f I ~ E ~ _ _ ~ 1 f { i 1 Remarks ___ __ Date __._/~(,~~ ~~~ Page . __~__-°f __~ ~. Project Name 4~ Z- h SNy - F t S S~~ 1 t- L S ______._.___-_____. EXHAUST FAN DATA SHEET t Location Area Served Equipment Manufacturer Model Serial Number ,~ :~ -- - _ _ i -------- _ Specified ____tT_ Actual Spcecified _ .____Actual _ Total CFM -Fan '. ~ _ _ ~ 7S 7~ ~ ~ - _- j ~ ~~~ ~ i ~ sue.- --... _.. __ _ Total CFM -Outlet ' _ _ 7....~_._.-_._- ~ i , ',Total Static Pressure* Inlet Pressure i !3 ~ . ~~' ' --j-- i ~ _.____,L~ _` J..~- t _.__~_ -------- _~..~____ -___._~ ____~ - --____-- _ _ _ _ _. Discharge Pressure ~ __ Fan RPM ~ ~ - _ . .._. __-_v~ r '; S ecified Actual :. Specified __;~_Actual__ - __ _ _ _. Motor Manufacturer ~ ~ ' __ __-.__.. _ Motor HP /BHP D ~~C Ac 1 `7 t11J L ~ G'j" I ON 1- ~ ~ ~Q !~'t" T_ lONt4 t ~; ~!} c"j'/ o*f IQ C .. Phase ( ~ i ~ f ~ _-~ _ ~ Voltage Amperage ~ ' r i ~ j ~ ---1 , ~ t---_--~-~--~-._ __ __ ~ --~ _~ -- - - _ _ _j ~ l` ___.~_.____._. _ _ _. _ __. _ .~ Motor RPM ~ i Motor Service Factor ___ __ _ - ~~ Starter Heater Elements -_._ ~ __._.. _- ,.~~_ _ i Motor Sheave & No. Groovesi ___ ~ ~ __ __ _ Fan Sheave & No. Grooves ~ ~~ _ ___^. Belts ~ J ~ --- ----- _^------------~ *Not always required or applicable. _ Remarks Date _... _~~ ~ ~.__-._ Page ._ ~ ~ _~of ~~_~. Project Name ~ 0 u L /4 S /~~ '" ~ ~ S S '~" ~~ ~" ~-.5 ~----------_____ __.______ EXHAUST FAN DATA SHEET Specified Actual _ . I o ~ __.~.___ _ _~_ I 4 _ -- _ SYSTEM ~' I=` ~ ".iZ ~ ~ N' ~ - ~ _ ~.- Equipment Location ~~"~ ~~? S ~ ~ p ~ __ ~1 ~ L O Ll /J ~ ~ _._._.._._.__._.. L ,_ _ Area Served ' jZ Q p ~ _, ©~ ~ ~ Q l~ 1-~ ! ' Equipment Manufacturer ' '~ ~ /y ~ 1 ~~ K Q /`} /1~ ' p ---__.. ~__ __ -_._ - -. Model i L ~.,~ a ~ Serial Number T~_____,_- __- , _ ----- .Total CFM -Fan .Total CFM -Outlet i~Total Static Press Inlet Pressure 'Discharge Pressure Fan RPM Motor Manufacturer ,Motor HP/BHP Phase Voltage ____ Amperage Motor RPM Motor Service Factor Starter Heater Elements Motor Sheave & No. Grooves Fan Sheave ~ No. Grooves BP_ItS Specified _ ___ Actual ---- _ -- __.- --- --- , ___._~_._ ~ ___fi.____,. _.___ -___.__ r Specified ~ Actual S ecified ____~ ctual__. __ _. , ',~-c~"l D.~tR-L ' f`~A`c 1 ! ~.tl~}L ~ ~IC A'~T t C~ ~4~--! ~-`1Z~c7-~ ,•v-~4~.. ---~-- , ; r i I ~___ ~ ~ -- 1 tt o ~ ~ _- t---1 ~ _~'_ _-- __~__ t _~ ~--- - -- _ a i ~,,._. .,..__..__ _~....___.~_~r..-..__. _. .. ._. _- _a i i t --- _____----------~ 4~ -___."~ -- - ~ , I *Not always required or applicable. Remarks _ Date V ~ g Page __ ~/ ~-°f __ ~•~ Project Name ~~ l~ ~- ~°~~~ ~ ~~5~ `~" ~ 1 L L S _ ____--~-- - EXHAUST FAN DATA SHEET Equipment Locstion. ' Area Served Equipment Manufacturer 'Model f --~ Serial Number Total CFM -Fan Total CFM -Outlet Total Static Pressure* +Inlet Pressure `Discharge Pressure Fan RPM r - ~t ~~ ~~~ ~ ~ !'1 _1 ~ ~ ~~ ~~~® ecified ~ ~____~_ ~ " s- - cF~~~'ri j{ p ~_ 3 ap Actual _,~ Specified _ ~_Actual_ _ _ _ - -- 3 po ~ 3 o ~ 5- - __ _._~.._._ i _ ~j i 1 i i Specified ~ Actual Motor Manufacturer ~~~~ _ Motor HP/BHP ~ F"~}-~'j'~ Phase ' 'Voltage _~~ ;Amperage Motor RPM Motor Service Factor Starter Heater Elements Motor Sheave & No. Grooved ' Fan Sheave & No. Grooves - Belts _ _ *Not always required or applicable. Remarks 'T t u~ ~_ i ~ _____? ~? _.__._~ ____ ~ ~ Date ~ ~ e~- pa_. _.___ Page AL±Z of __~_.__ Project Name ~ O~ C- /`t sn~~ - r 1 s s ~- a J L L s _--- __._-. EXHAUST FAN DATA SHEET SYSTEM ~ ~a ~ ~ ---~ ~ 1.= i ~v ~__--- Equipment Location V , , 1Q 3 ~1 (~ l Area Served '. ~ D /`~ f f ~ ~ - - -- Equipment Manufacturer ~ Q ~ f}' /-1 _.-- - -------- ~ _______________G u 1 ~ ~ ~_r oZ _~7 G- ~. Model __ _,.. -~_____~_~..__----_ _ ~_ - __ _ - _. Serial Number '--_ __~___._ . _ 1 1 ! y _ 3 0 3 ~' `f __-.-- - - --- Specified ~ Actua_l ~ S ecified Actual _ ~ '~- ~_____ _~__._~_ o____-_ __ _ Total CFM -Fan __.~ --- _ _ _ -' - -- _ _ ~ S -- ---- ----~ --- _-- -- ;Total CFM -Outlet 'Total Static Pressure* ;Inlet Pressure -~ 'Discharge Pressure Fan RPM Motor Manufacturer Motor HP/BHP Phase ' Voltage Amperage ' Motor RPM Motor Service Factor Starter Heater Elements /© .moo i ___---- _-_~. __ _ I , ___._____ _._ ~_ ___ __ ___ _- ------ i .- ecified t Actual S ecif i `. --_l l Motor Sheave & No. Grooves Fan Sheave & No. Grooves Belts __ *Not always required or applicable. Remarks _,_____ - ----~ ~ _ _ _. __ -.~_ _ i. _ 1-~---- _ _- i