HomeMy WebLinkAboutE-mail (building compliance statement) - 02/02/2012 �, , Page 1 of 1 '
i
Noe, Brian
From: Dean Schulz [dean.s@ExcelEngineer.com]
Sent: Thursday, February 02, 2012 2:13 PM
To: 'Scott Schimmers (scott@rjalbright.com)'; Noe, Brian
Subject: Christian Community Child Care
Attachments: scanfront_20120202_141137.pdf
Brian,
Please find attached, the building compliance statement.
As far as the component submittal, I believe all are either submitted or will be submitted shortly.
Please let me know if you need anything further or have any questions.
Dean J.Schulz
Project Manager
���
_ .#y►
- r_
100 Camelot Drive
Fond du Lac,WI 54935
920.322.1675 direct
920.926.9801 fax
www.excelen�ineer.com
Always a better plan
2/2/2012
.
,
BUILDINGS, HVAC, C�MPLIANCE STATEMENT SBD-9720 1105780 :
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 approvat 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, 1Q541N 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 & Buildings.
Personal information you provide may be used for secondary purposes[Privacy�aw,s. 15.04(1)(mj].
1. PROJECT ENFORMATI4N: 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 indcate purpose and camplete any other
applicable boxes and informa#ion. Attach additional pages if necessary.)
Check those which apply: X Building �bject ID#1341058 HVAC Object ID#
Lighting Object ID#
❑ Partial Completion
Description of Portion Completed
A} ■ Statement of Substantial Compliance
To the best of my knowledge,belief,and based on onsite observation,construction of the following buitding and/or HVAC
items applicable to this project have been completed in substantial compliance with the approved plans and
specifications.
❑ BUILOINGILIGHTING ITEMS
1. Structural system including submittal and erection of all building components 10. Exterior lighting 8 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 forvvard flow on back flow devices)by and applicable variances
appropriately registered professionals
3. Shaft and stairway enclosure
4. Exits including exit and directional lights
5. Fire-resistive construction,enclosure of hazards,fire walls,labeled doors,class ❑ HVAC ITEMS
of construction,fire stopped peneUations '
6. Sanitation system(toilets,sinks,drinking facilities} 1. HVAC system including final test
7. Barrier-free including Comm 18 elevators and lifts 2. AI(conditions of HVAC plan approval and
8. Energy envelope requirements applicable variances
9. All conditions af building plan approval and applicable variances
The following items are not in compliance and must be addressed:
B) ❑ Statement of Noncomptiance
Due io the following listed violations,this project is not ready for occupancy:
C) ❑ Supervising Professional Withdrawn From Project {use A or�above to indicate Project status as ottnis dace.)
D) ❑ Project Abandoned
3. SUPERVISING PROFESSIONAL SIGNATURE FOR:
X Building HVAC Lighting Dean Schulz.RA Date Z Z �O
Name(please print or type)
Phone number 920-926-9800 Cust�mer ID�1261929 Signature_
SBD-9720(R.07/2408)
EB-@1-2@12 @9 :45 AM GENTRALHEATINGSER� 9202356670 P. @1
AIR MOVING EQUIPMENT TEST SHEET
SYSTEM -
E ui ent Location 1,,,, a — Q t�t "r'S f J�,� �
Area Served C'L SS IQ� U 1�1 S � d—
E ui ment Manufacturer : ( � /2
Nodel - � �
Serial Number � 1 1 C ��a
S ecified Actual S ecified Actual
Total CFM - Fan 9 S o q 9 �
Total CFM - Outlet S� � (D
R/a c�rt 5 (� 3 (o
0/A CFM '7 (Pj
ota tat c ressure + � --
Inlet Pressure
Dischar e Pressure
Fan RPM
Specified Actual Specif ied Actual
Motor Manufacturer
Motor HP BHP
Phase --
Doltage p 8 p
Amperage ;� �
Motor RPM � �
Hotor Service Factot
Starter Heater Elements
Motor Sheave � No Grooves
Faa Sheave S o. Gr
Belts .
Remarics
Received Time Feb, 1, 2012 9; 11AM No. 8176
FEB-01-2@12 09 :46 AM CENTRALHEATINGSERV 9202356670 P• 02
,� s r w G D y�Y � � � - � ��.�------ ---- - -- --_____
Proj ect _. � �" r T f�
Floor 4� --------
System
AIR DISTRIBUTION TEST SHEET
� � Test-FPM or CFM Final
� ! Ter�inal ' Design _
Terminal Room �-----� Factor �- �M CFM I,Test 1 Test 2 ;Test 3 ' FPM CFM
Number Number ; Type ! Size
----- � °' � n � 5-� ' �� _
___l--.--------!�--�—'t-��?�_ � ; s_� �g ��s_
� � a -- ��
_2 _ -----.----- - ', , � 4� `
-----�- ' � ; � ;�� � � �S�' i
y _ ' _ _ � ' '
;
:I.. --- ' r i j '' �' � i i
.._�-� 1 i � ; ; _
� � 1 I
' - - ---- --- --� ; a � � � ; � � ,
F_..__.�----;--- i '
; � 30
; � � ,
�- I j �i ±
�- � i , f i � ' 1�� `� �
� , I � � � �2.�� �
� ' 1 i
I �- � � � I I
.._'""-...�__"'"' � I I ' I 1
, _.'-'_" • 1
� � � i I`
I -I�- 1
_-_ _ i I
_�-..--�-� , ' j �:
� �--�._�-�'- � ' .
. ..�._.___"..�.._�-
....�.._..'"_'_...__... � i I . � � ::
�
' ' � � � � I
I ..._'.__a- l - � .
__...-. �I � 1
i . , I i
� , ! � '
i � �
i ; ; �
I � , ; I j
_��~ �' J , 'i '
i t ! ' ; �
I- ; �
� � 1 I
�. - - I i ' , I
I � j � i
' i i l
1
l ! ± I �
i � � �
� � � i ; � �:
1- � I i I { �-,
` � I
�-�_"_ M
� 1 �
I._ _...-- � I .
Remarks
Received Time—Feb. 1. -2012 9: 11AM No� 8176
FEB-01-2012 09 :4fi AM CENTRALHEATINGSERV 9202356670 P. 03
Date ...� 3--,/_-�-'�--- -
� /
Page . ._...�.__..._.°f �__.-_ i.
� I�Q �sTi�9� cortrr . c � i� n � � r�� _ ---- :
Project Name ---------` ___ _ _
EXHAUST FAN DATA SHEET
- i
� _I --_._.._._._.__�--------�- ----
SYSTEM ' � , �""°^"
p _�?!'� �
Equipment Location /� � � �� ; _ __-1 1��_-.__-__---..--- ,
Area Served �y 'f � ' G �.�-L.-- �..
._--- -- --- --- i
-- --- - - .
�/ O �} /rl�
Equipment Manufacturer T._._IZ__ C��_�_ ---- __.. ' _ -�� � . . ;
__.._.---...__....--..__�_ -----__......_-'.--""-•-' I lJ � � . . ...
� � . .
Model ,.�_.,-�--__._-- 6 � y . _ �.._.. -... .
Serial Number � --� � � �
- -- -------._._._ .. __-_ .
-- - -•-•- ------ �
._---- _ -
� Specified � Actual � SQecified __ Actual
�
_ --- -_.
�_. ,___. , € ;
, � �_._�_ -
7 °�
..__•_ 7 S .--------------
; Total CFM - Fan ��.�..^.___,--7 -- -----... _.__ ___i _ _
..-- ----- � - -
� Total CFM - Outlet � 7 �.; _.._�._.7.5_-._-�-. 7___. __ ._..___ ._
t�.--
t_.� ' ; � �
� _. . ._�....--..
� Total Static Pressure* .-t.-_- -�---��---�-- i � -- �---��
-------_-.. _.�
, , � I
; Inlet Pressure � � - `
____.__. ,
' Discharge Pressure � _ � -__.-----�-�-- �------_�__`
`, !. -
, i �
; Fan RPM � i _ - - ... _.--------------..-=--_�_�._-
— �---
� � Specified ; Actual �__._SQecified ___ _,.___ Actual_
, -
- , �
Motor Manufacturer ! � --"^- - � �
Motor HP/BHP ; I �' ----------, -____------ :
, __
� -- � I f '
� � � ------ ...
Phase � - ------ -- ---- .---
--- , � � l � o ; i � � o . .l _ . � ;
' Voltage � _1_ _.. -----.._ _....___ _-_ _ --.- -- _ _ � c� .
_ _�-�----- �; � � _ _. _�
Amperage �__.-----_--� i._..------------------�----...___. ..---- '
. '. i
Motor RPM � � '
, , - -------------+—__-_.
___ --.-----+
_ ____- --- _
____ _- __. �_.__�-----._.____; �
Motor Service Factor ' __._.____ _.___.-----•._ __ ..-------_.__..._..._ __�
_____
_ ___ _.__ - 1 __.__�
Starter Heater Elements� — ---�
--____
---------- ----.
Motor Sheave & No. Groovesi I �'
--------___ _ --
I --�---___-_-----�------
-------.. _____..__.._
-- -
- - __._ --_-'•_-_------ �- �
Fan Sheave & No. Grooves , - ----------•- ---J---�-�--'-�"""'�--- '.
_..-- -----•--� - ------- - ;
� ______-.�.1_--�__.------•---------- ---.._..._..----
Belts �---i _�__._�__.-.---
*Not always required or applicable.
Remarks --.-„--.---- —
Recefved Time Feb. 1, 2012 9: 11AM No. 8176