HomeMy WebLinkAboutE-mail (partial compliance statement ) - 02/03/2012 . ' � Page 1 of 1 �
Noe, Brian f
From: Dean Schulz [dean.s@ExcelEngineer.com] '
Sent: Friday, February 03, 2012 2:14 PM
To: Noe, Brian; 'Scott Schimmers (scott@rjalbright.com)'
Subject: Christian Community Child Care
Attachments: scanfront_20120203_141255.pdf
Brian,
Attached is the partial compliance statement for the proposed building adition.
Dean J.Schulz
Project Manager
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100 Camelot Drive
Fond du Lac,WI 54935
920.322.1675 direct
920.926.9801 fax
www.excelen�ineer.com
Always a better plan
2/3/2012
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BUILDINGS, HVAC, COMPLIANCE STATEMENT SBD-9720 1105780
This form is required to be submitted by the supervising professional (architect, engineer, HVAC designer or electrical €
designerj 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 buifdings, 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, 10541N 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 2008540 Project Name Christian Communitv Child Care—Education K4(E)Addition
Site Number 769731
Site location(number&street) 3870 Jackson Street
X City Oshkosh County of Winnebaqo
2. PURPOSE OF THIS STATEMENT: {Check Box A, B, C, or D to indicate purpose and complete any other
applicable boxes and information. Attach additional pages if necsssary.)
Check those which apply: X Building Object ID#1341058 HVAC Object ID#
Li h 'ng Object ID#
�I Partial Completion � �,�a
Description of Portion Co eted
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.
❑ BUtLDINGII.IGHTING 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, 12. All conditions of lighting plan approval
installed,and tested(including forward flow on back flow devices)by and applicable variances
appropriately registered professionals
3. Shaft and stairvvay enclosure
4. Exits inGuding exit and directional lights
5. Fire-resistive construction,enclosure of hazards,fire walls,labeled doors,class O 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 HVAG plan approvaf and
8. Energy envelope requirements applicable variances
9. Atl conditions of building plan approval and applicable variances
The fol�owing items are not in compliance and must be addressed:
B� ❑ Statement of Noncompliance
Due to the following listed viotations,this project is not ready for occupancy:
C) ❑ Supervising Professional Withdrawn From Project (use A or B abo�e to�nd�cate Pro�ea stat�s as ot cnis date.�
D) ❑ Project Abandoned
3. SUPERVISING PROFESSIONAL SIGNATURE FOR:
X Building HVAC Lighting Dean Schulz.RA Date � � �� f
Name(please print or type) 1
Phone number 920-926-9800 Customer ID#261929 Signature_
SBD-9720(R.07/2008)
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