HomeMy WebLinkAboutCertificate of Occupancy ReportBuilding Permit Work Card
Adtlress 3550 MOSER ST Permit Number 010ffi21 Crea�e Date 5/21/04
�er BANNER PACKAGIN , MC Contractor CR MEVER
gory 291 -Alte�ation IndusMal
�. � Builtling !� Sign. _ � Canopy � Fence _ � Raze J Plan L9-40-0504
^8 Class of Const: __ Size � Value $200,000.00
iishetl/Basemen� 0 Sq. Finiahed/Living 0 Sq. FL GaroBe 0 Sq. Ft.
Ft.
ns 0 Betlrooms 0 Baths 0 � Pmjection '�.
es � ._ Height 0 FL Canopies 0 Signs 0
itlatlan � pouretl Concrete � Floating Slab � Pier � ONer
� Concrete Block � P�� � Treatetl Wood
cupany Peemil Requiretl Plood Plain Xeipht Permit
rk Dedication M Dwelling Units 0 M Structures 0
e/Nature 'IFaclory% Intetla alterations ta relocate Cure Room anC expantl p25s room. �- -� � -
Work
Plumbing Conir
ConN
inspecnons:
Date ?/23/OS Type Final Inspactor Allyn Dannhoff approvetl
�JOCONCERNSNOTED B&H � - — - -- � �� �— � -� - — -
Date/Timerequastetl: NoticeType: PhoneNUmber:
Access:
ReadyOale/fime: Reques�etlBy:
� Reinspect Fee � Fee Waivatl ❑ Reinspect Fee Paitl
HVAC Permit Work Card
Job Addrass 3550 MOSER ST Pertnit Number 108981 Create Date O6/29J2006
�'�e/ BANNER PACKAGtNG INC Contreclor GARTMAN MECHANICAL SERVICES
CateBOry 5�0-Intl.SCOmm-HeatingBVenGlating Plan
Fuel � Gas Oil ElecOic Solar Solitl ] Value 54,900.00
System Q New _ _ ❑ RePlace .. _� ❑ Olher . .�
ForcetlAir ✓ Ratlian� ,_ Steam A/C � ��Vent
Eleciric Hot Water Suppl. Con, Bumer
ChimneyType Ch'mneyA Chimnay8 DirectVent NolApplicable �
HeatLOSS AsApproveE Existing NotApplirable � Value 0
BTURate AsPerPlan Vanable ONer � Value 2@60mbN _
UselNature ilnsfallRatlianUinhareAheatforwnngroom. PracesseQUiDment.
ot Work
I
Date �/23/OS Typa Final Irepeclor Allyn OanMOft approvetl
NOCONCERNSN07Eb�B&H
DatelTimerequestetl: NoticeType: PhoneNUmber:
Access:
Reatly Date/Time: Requestetl By:
� Reinspect Fee � Fee Waivetl ❑ ReinspeIX Fee Paitl
__"___"""' ___'""'_' __""' _"_'_""__'"_'"_"__' _"'""'"_"_'"'"' ___'"'"' __ ___"'"""_"_"
BUILDINGS, HVAC, COMPLIANCE STATEMENT SBD-9720
This form is required�to 6e submitted by the supervising professional (architect, engineer, HVAC designer or electrical
designer) observi8g construction of projects within buildings with total areas 50,000 cubic feet or greater and bleachers
'COmm 50.10/Comm 67.50). Failure lo submit this form may result in pe�alties as specifietl in Comm 5026(Comm 6� 23
and/orlocal ordinances.
General Instructions: Prior to Ne initial ocwpancy of new buildings or additions and ihe final occupancy o(
altered existing buildings, submit this completed and signed fortn to:
• The municipal building i�spectio� office and
• Safety and Buildings, 10541N Ranch Road Hayward, Wi. 54843
Note: If the review was done by the municipality, the compliance statement goes onty to the municipal buildfng
inspector. A copy is not needed by Safety & Buildings � _
Persona� infortnatian you provide may be used for secondary purposes jPrivacy Law, s. t504 (1){m)�.
1. PROJECT INFORMATION: Please fll in the following with informa[ion from your plan approval letter.
TransactionlDNumber llOiiO�
Site Number 5849 3 �+
Site location (number & slreep �$�-✓ �i� MoSt'aA- ST�
�City ❑ ViUage � ❑ Townof OSN1�oSH Ca�ntyof W�NN�S'�SILf4o
2. PURPOSE OF THIS STATEMENT: (Check Box A, B, C, or D to indicate purpose antl complete any other .
applicable boxes antl information. Attach atlditional pages if necessary.) .
Check those which apply: � Building Object ID #°T� �O� vS ❑ HVAC Object ID #
❑ Lighting Object ID #
� Partial Gompletion LV N LN ypOM �'
Descnption of Portion Cam�
c� `n3L�
A} �8 Staiement of SubstaMial Compliance � �
To Ihe bes� of my knowledge, belief, and based on onsite observation, consWCtion of ihe following building and/or HVAC
' irems applicable to lhis pmjeG have been completed in substan�ial compliance with Ihe approaed plans antl
specificatid"ns.
❑ BUILDINGILICaHTINGI7EM5
1. SWCtu21 system incluaing submitlal an0 erection ol all building components
(irusses, precast me�al0uiltling.etc.) '
2 Fire pmtection system5 (spnnklers, alarms, smoke tlelectors) tlesigneq Installetl,
antl tes[eE �including fo�wartl flow on paG flow devices) by appra0�alely
registeretl pmfessionals
3. Shak anG sGimay enclosure
4. Exits including exi� an0 diredional lights �
5. Fire-resisOve consWCtion, endosure o� �azards, fire walls, laheietl �oars, dass
ot consW ctio4 fire stopped penetra�ons
6. Sani�ation system (�oile�s, sinks, tlnnking facilioes)
]. Bamer-hee inGUtling Gomm 18 elevalors antl Iitls
B. Energy envelope repuiremenls
9. NI condi0ons of Ouiltling plan appmval antl appliwble vanances
Tha following itams are not in compliance and must be addressed: _
B) O Statemsnt of Noncompliance
Due to the following listed violations, this project is not ready Por occupancy:
10. Extenor IlgpUng & wnlml requirements
i t. Interior lignting 8 coniml requireme��s
12. All condilions of lig�ting plan aOPmval
an0 applica�le vanances
p NYAGITEMS
1. HVAC system in�uoing final test
2. All cpndilion5 of HVAC plan apP��al antl
apqiraple vanances
C) ❑ Suparvisiog Professional Withdrawn From Project (Use A or B above b Inaicate projecl status as of this tlate.)
D) ❑ Project Abandoned
3. SUPERVISING PROFESSIONAI SIGNATURE FOR:
� Bu��ding ❑ HVAC ❑ Lighting �'� � C.D�vtP'� D le 8��+�°S
Name (please print or type�
Phonenumber�,;5•iiSoCustomerlD# R�I�IbGJ'�/ Signature �
SBD-9]10 (ROIR003) .
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