HomeMy WebLinkAboutFax (compliance statement) - 12/14/2010 SOti' °N Wd6Z:l OIOZ 171 ' °a4 anvil pni°ad
CHET
WESENBERG
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ARCHITECT, LLC
FAX TRANSMITTAL
December 14, 2010
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To: City of Oshkosh Inspections Dept.
Attn: Kevin Ciabatti
Fax:: 920 - 236 -5084
From: Chet Wesenberg
Pages: 2
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RE: 1399 South Park Avenue- Droves Sunroom
To Whom it May Concern:
I am the supervising professional for the above mentioned project. I have
inspected the project and find it to be in conformance with the prevailing •
building codes. Attached you will find a Compliance Statement SBD -9720 for
your 'records.
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Thanks
or
Chef Wesenberg
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3205 CASEY TRAIL
• OSHKOSH, WISCONSIN 54904
TELE! 020.220.4900
PAX: 020.220.4910
CELLPHONE: 920.410,6200
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SOti 'cl WdH:l OLE 'tit '30 awl J Paniaaad
BUILDINGS, HVAC, COMPLIANCE STATEMENT SBD -9720
This form is required to be submitted by the supervising professional (architect, engineer, HVAC designer or electrical
designer) observing construction of projects within buildings with total areas 50,000 cubic feet or greater and bleachers
(Comm 61.40). Failure to submit this form may result in penalties as specified in Comm 61.23 and /or local ordinances.
This form must be submitted prior to the plan approval expiration date or another submittal may be required.
General Instructions: Prior to the initial occupancy of new buildings or additions and the final occupancy of
altered existing buildings, submit this completed and signed form to:
• The municipal building inspection office (refer to the plan approval letter for agency address) and
• Safety and Buildings, 10541 N Ranch Road Hayward, WI. 54843
Note: If the review was done by the municipality, the compliance statement goes only to the municipal building
inspector. A copy is not needed by Safety & Buildings.
Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)].
1. PROJECT INFORMATION: Please fill In the following with information from your plan approval letter.
Transaction ID Number /V( , ?/ Z - D P Project Name 1 / frr ,( 4.c447 rdP4._
Site Number : •
Site location (number & street) /jiff .5 1% 4/ 1/1/ lgr,
X City Q Village CI Town of Q�1 4 County of V//17/Jel
2. PURPOSEIOF THIS STATEMENT: (Check Box A, B, C. or D to indicate purpose and co i
e any other
applicable boxes and information. Attach additional pages if necessary.)
Check those which apply: 1Building Object ID # ❑ HVAC Object ID #
/❑ Lighting Object ID #
❑ Partial C',ompletion
Description of Portion Completed
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A) Statement of Substantial Compliance
To the best of my knowledge, belief, and based on onsite observation, construction of the following building and /or HVAC
items applicable to this project have been completed in substantial compliance with the approved plans and specifications.
❑ BUILDING/LIGHTING ITEMS
1. Structural system including submittal and erection of all building components 10. Exterior lighting & control requirements
(trusses, precast, metal building, etc.) 11. Interior lighting & control requirements
2. Fire protection systems (sprinklers, alarms, smoke detectors) designed, installed, 12. All Conditions Of lighting plan approval
and tested (Including forward flow on back flow devices) by appropriately and applicable variances
registered professionals
3. Shaft and stairway endosure
4. Exits including exit and directional Tights •
5. Fire- resistive construction, enclosure of hazards, fire walls, labeled doors, lass 0 HVAC ITEMS
of construction, fire stopped penetrations
6. Sanitation system (toilets, Sinks, drinking facilities) 1. HVAC system including final test
7. Barrier -free including Comm 18 elevators and lifts 2. All conditions of HVAC plan approval and
8. Energy envelope requirements applicable variances
9. All Condition of building plan approval and applicable variances
The following items are not in compliance and must be addressed:
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B) ❑ Statement of Noncompliance
Due to the following listed violations, this project is not ready for occupancy:
C) ❑ Supervising Professional Withdrawn From Protect (use A ore above to Indicate project status as of this date.)
D) 1=1 Project Abandoned
3. SU V1SING PROFESSIONAL SI TU FO
Building 17 HVAC 0 Lighting G� .c�yf /90 0
Name (please pent or V ✓�/
Phone number f0130 t .10 Customer ID # 9701 1 i Signature l ate
l ( „44. > .
SBD -9720 (R.07/2008) ,
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SBD -9720 (8.02/2004)