HomeMy WebLinkAbout0150957-Building (Bar/Cooler addition) /�GpNNtO
BUILDINGS, HVAC, COMPLIANCE STATEMENT SBD-9720 I ���
This form is required to be submitted by the supervising professianal (architect, engineer, NVAC designer or ele T
designer) observing construction of projects within buiidings with total areas 50,000 cubic feet or greater and bleachers
(Comm 61.40). Failure to submit fhis form may result in penaities as specified in Comm 61.23 andlor locaf ordinances.
This form must be submitted prior to the plan approval expiration date or another submittal may be required.
General lnstructions: Prior to the initial accupancy of new buildir►gs or additions and the final occupancy of
aitered existing buildings, submit this completed and signed form to:
•The municipa! builcling inspection office {refer to the pian approval tetter for agency address�and
• Safety and Buildings, 1 Q541 N Ranch Road Hayward, Wl. 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� Buifdings.
Personai information you provide may be used for secondary purposes[Privacy Law, s. 15.04 (1xm)].
1. PRfJJECT INFORMATION: Please fill in the following with information from your plan approval letter.
Transaction ID Number 2078408 Project Name Ttte Bar
Site Numbe� 530177
Site Iocation (number 8 street) 825 N.Washburn
X City f� Village D Town of Oshkosh County of Winnebago
2. PURPOSE OF THIS STATEMENT: (Check Box A, B, C,or D to i�dicate purpose and comptete any oiher
applicable boxes and information. Attach additional pages if necessary.)
Check those which apply: X 8uifding Ob}ect ID# 1368432 ❑ HVAC Object!D#
D Lighting Objecf ID#
❑ Partial Completion
Description of Portion Completed
A} X Statement ot'Substantial Compliance
To the best of my knowledge, belief, and based on onsite observation, construction of the fallowing building and/or
HVAC items applicable to this pro}ect have been completed in substantial compliance with the approved plans and
specifications.
X BUILD{NG/LIGNTING ITEMS
t. Struciural system includirtg submittal and erection af al1 building components 1 Q. E�cteriw Iighting&control requirements
(trusses,precast,meta)buikling,etc.} 11. Intetior Gghting&c:ontrat requkemertts
2. Fire protection systems(spnnklers,alartns,smoke detectors)desigrted,installed, 12. AA conditia�s o(tighting plan approval
and tested(ncluding fornard fbw on bacic flow devices)try appropr'rately registered and applicable variances
professionals
3. Shaft and stairway enclasure
4. Exits including exit and directional lights
5. Fire�re�ive construclion,e�closure oI hazaards,frre v+ral[s,tabeled doors,class of D HVAC!'TEMS
construction,flre stopped penetrations
6. Sanitation system(toilets,sinlcs,drinking facEtifies} 1. HVAC system includisg fina!test
7. Barrier-free indud'asg Comm 18 elevators and lifts 2. All conditions of HVAC plan approval and
8. Energy ernebpe requirements apptkabie variances
9. Ap conditions of building plan approval and applicabie variances
The following ltems are not in compliance and must be addressed:
B) ❑ Statement af Noncompliance
Due to the following lisied violations,this project is not ready for occupancy:
C) ❑ Supetvisillg PtofessiO�al Withdr'aW(t From PPOjeCt {Use A or B above to indicate project status as of this dateJ
D) � Project Abandoned
3. SUPERVlSING PROFESSIONAL SIGNATURE FOR:
X Building ❑ HVAC C3 L'ghting KeiM S. S t1 1 r Date 4� I y' ~ ��
Name(please print ortype) t � n ° `� ,
Phone number 92Q-5742657 Customer ID# 65�453 Sigrrature ' � �