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Home My WebLink About010-941-15-1101-LUP-1998-357 � � . � Application for Land Use Permit o o L_ County of Sawyer 7 � PO Box 668 -Hayward WI 54843 715/634-8288 � � The undersigned hereby makes application for a Land Use Permit and agrees that all work shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance 1 and the laws and regulations of the State of Wisconsin. PRINT—USE BLACK INK OR PENCIL � � Medical Services, Inc. � d/b/a Hayward Area Memorial Hospital e. �-�' � ' 9 Heme FCM Corporation � � Owner Builder o Route #3, Box 3999 5555 �dana Road � 4Q Mailing Address Mailing Address � v Hayward, WI 54843 Madison, WI 53719 � City,State,Zip City,State,Zip �715) 634-8911 (608) 273-1069 Daytime Phone Daytime Phone Building Land Use ( )New ( )Filling ZoneDistrict x-1 rd� f�'� (�Addition ( )Dredging ( )Alteration ( )Grading Lot Size ( )Moving On ( ) � � � ( ) Acres 640 +- � c � Primary Structure Accessory Building Addirion � � ( )Dwelling ( )Garage-attached/detached ( )Deck � � ( )Year round ( ) #of car stalls ( )Porch o ( )Seasonal ( )Storage Building ( )Enclosed ( )Frame built on site ( )Screenhouse ( )Living room ( )Modular/manufactured ( )Greenhouse ( )Kitchen � ( )Mobile/manufactured ( )Other ( )Bedroom �. � ( )Other primary structure ( ) ( )Relocate/enlarge `? �� Medical Office Buildir�g� ( )#ofnew ` ' O Z Type of Construction � ( )Frame ( )Log ( )Pole/metal ( )Block ( )Concrete a � � (X�Other Structural Steel frame, masonry exterior � b Constmction Cost$ 1 400 000 � � .� �-l�� Vol 97 Pg y(nD of Deed Certified Soil Test# . � CSM Vol Pg Sanitary Perntit# C��—�(� � Plat Envelope �r: z I � Condo Vol Pg Yeaz Installed � c Aff of ex septic V P Owner When Installed: � � �aORH � � Application for Land Use Permit - Page 2 � Describe Construction: List dimensions of each structure, story, addition, or alteration. , #1. Approx #2. #3. #4. Size 130 ft. wide ft. wide ft. wide ft. wide 14o ft. long ft. long ft. long ft. long Floor azea � 7,50o sq. ft. sq. ft. sq. ft. sq. ft. Hgt from gade � 4 � +' to peak ft. hgt. ft. hgt. ft. hgt. Stories 1 stories stories stories # of bedrooms None ' rear lot line or watedine of lake/river 1n the box sketch in: Location and size of all existing and proposed structures. PLEASE REFER TO ATTACHED S ITE PLAN SHEETS 1 AND 2 . Location of septic system. Indicate distance to: Waterline Road - See plan Sheets Lot lines SepticSystem - See approved dr infield Distance beriveen structures. des i g . Indicate North. Fire Number: - � . Signature of Owner LEE R. GORUD , CONTRACTOR AS AGENT FOR MEDICAL SERVICES , INC . ------- centerline of road------- Issue Date July 15 , 1998 Expire Date July 15 , 1999 Office Comments: C�L/..G�c��/�l� Signature of Zoning Administrator x �� r�G �� . o � 0 7 0 �� I \ i' � � � o v � � �� — � , � � a� � cv, ,--�� l � -, \ — ^J � G \ � � , � � � � �� I �` s e �,. , \ , � , � � � �� G . � C� �1 � �G� r _ a v' ��'/ � 8 I � � � '� � �_, .:�� , ' � i �N . �� DIVISION OF SUPPORTIVE LIVING • Tommy G.Thompson Governor BUREAU OF QUALITY ASSURANCE State of Wisconsin 1 WEST WILSON STREET Joe Leean P.O.BOX 3os Secretary Department of Health and Family Services MADISON WI 53701-0309 July 7, 1998 Michael Jeffers FCM Corporation ' ,.--�`� 5555 Odana Road , s� Madison WI 53719 ��' RE: 68-72 Medical Ciinic Addition Hayward Area Memorial Hospital Hayward WI Dear Mr. Jeffers: Final plans and specifications received May 15, 1998, and mechanical received June 19, 1998, have been stamped CONDITIONALLY APPROVED based upon review for conformance to the current edition of the Wisconsin Administrative Building and Heating, Ventilating and Air Conditioning Code, chapters ILHR 50-64 and 69. The plans have NOT been reviewed for conformance to the Plumbing Code (chs. ILHR 81-86), the Elevator Code (ch. ILHR 18) and any other ILHR code not specifically mentioned. Additionally, these plans and specifications have been reviewed for compliance with Wisconsin Administrative Code HSS 124 Hospitals, Medicare (Title XVIII) and Medicaid (Title XIX) regulations including the applicable NFPA 101 (1991) Life Safety Code. Subject to local regulations, construction may proceed, except for those conditions listed below. The necessary corrections shall be made before construction begins. Any deviation from or additions to the plans made subsequent to this review is specifically not approved. The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, and hospital as defined by Wisconsin Administrative Code HSS 124.02(6), is responsible for compliance with all code requirements. The owner shall notify the department and local officials before taking possession of the building. The building will be inspected during and after construction. 12-1.1.4.5* Renovations,Alterations,and Modernizations. Renovations, alterations, and modernizations shall comply to the extent practical,with requirements for new construction in accordance with 1-4.6. Where renovations, a(terations or modernizations are done in a nonsprinklered facility,the automatic sprinkler requirements of Chapter 12 shall apply to the smoke compartment undergoing the renovation, alteration or modernization. However, in cases where the building is not protected throughout by an approved automatic sprinkler system, the requirements of 13-1.6 and 13-2.3.2 shall also apply. Exception No. 2 to 12-3.7.3 shall be permitted only where adjacent smoke compartments are protected throughout by an approved, supervised automatic sprinkler system in accordance with 12-3.5.2. Where minor renovations, alterations, modernizations, .�ichaelJeffers � July 7, 1998 �, Page 2 � . or repairs are done in a nonsprinklered facility,the requirements of 12-3.5.1 shall not apply,but,in such cases, the renovations,alterations,modernizations,or repairs shall not reduce life safety below that which cxisted before,nor below the requirements of Chapter 13 for nonsprinklered buildings. The smoke compartment undergoing the renovation needs to be protected throughou[by an approved sprinkler sys[em. A Life Safety Code diagram showing the smoke and fire barriers shall be provided. ILHR 69.06 Plan examination and department action.(1)All buildings. The accessibility requirements of[his chapter shall be presented as a part of the general plan submit[als as required under s.ILHR 5012(3)(b). The requirements of ss.ILHR 50.12,50.13 to 50.175,50.185(1)and 50.20 shall be complied with where applicable to the project. (2) ADDITIONS AND ALTERATIONS. Plans and specifications showing compliance with this chapter and the primary path of travel to the added or altered area shall be submitted to the department or its authorized representative for department action. All hazardous areas such as X-ray files,hospital records,storage rooms,soiled utility rooms,and business records,need to be enclosed with one-hour fire rated walls and class"C"fire door assemblies. NFPA 90 2-3.11.1 does not allow the corridor in health care facilities to be used as a portion of the air handling system. Four copies of the approved architectural and one copy of inechanical plans are being returned herewith. If you have any further questions,please contact me at(608)266-7577. Sincerely, �, � �" , • v�l —�iL' " � ��ti�_t�i�' D G,�-c� Leo Schlimgen,P.E. Health Services Section Bureau of Quality Assurance LS/jh 76761tr cc: -City of Hayward -Hayward Area Memorial Hospital } } ' 6.2 .6.1 .5. 1 C � `\ �-_�. � �--� 1 �� .7. 2 � lNDIAN .7.� ,s. � SCHOOL LA, �� , .io.2 ��, / � J �� ` .io.i .s. i � , � � \ - � ; .� �. � .�2.� C ►r2 C /' A � C ' I IAII' U - nnn CCCT Foim No.27�M—OUIT CLAIM DEEU Mlnnesola UN[orm ConveyenclnQ Blonka Q978) Miller�0avis Co.,Mlnneepolis Individual(s) to Individual(s) No delinquent ta�ces and transfer entered; Certificate o[ Resl E�tate Vulue ( ) tlled ( ) not requlred 2 219 4 g � Certlflcnte of Real Eatate Value No. � ' 19 Neqtile�'� C�itn, 1 . 6ewyU�i Cx��tf � 1 w�va.1 1or re«'�l Iho _L�da7 �1 _�-c . A D 19�_ at o'cloc� County Auditor � �,; �; „ � � _ . ,,�,i..� 1❑ v-i G� by d �;, �,�,�,�t;r,.,., s�� _�� Y� �( ��"� De ut �._.�� -`='-. r�,_"==�� P Y STATE DEED TAX DUE HEREON: $ 0 �� Date: January 14 , lg 91 (reserved for recording data) FOR VALUABLE CONSIDERATION, Donald F. McLaqan� a single erson , Grantor(§�, (marital s�atusl hereby convey(s) and quitclaim(s) to Kelly Theuner and Stefani Christenson real ro ert in Sawver , Grantee(s), P P Y County,�URi�S�B&�xdescribed as follows: Wisconsin _ � Lots 1 and 2 , Block 1 , Community Beach. � ��/ � �� .�, c�r. EY.,�MPT (if more space is needed,continue on backl together with all hereditaments and appurtenances belonging thereto. (,� , r , r , — Donald F. Mcl,agan � Aft;x Decd 't'ax Stamp HerF� STATE OF MINNESOTA l Olmsted j ss. COUNTY OF ) The foregoin instrument wae acknowl�dge�l before me this 1 4th dey of_,Tani�ary , 19�]_, bY Donal� F. McLagan, a singte person ___ , Grantor(s). I NOTARIAL STAMP OR SEAL(OR OTHEA TITLE OR RANK) i �1 ..,, � i �ay � —�Q•-'� �„�4� 9IGNATURE ON PERSON TAKING ACKNOWLEDGMENT �4�� r. � d �YI , Taa Sl¢[emenH tor tha reol peoDarty da�celbad !n thb Imtrument thoWd ,. • t �k' ��j:�C At�..�y�:��$ '�,. be�ent to (Include neme and oddcau o!Guntee): � � 4T.as6r8� Cikt4fµ� �I � a�r �.�-,�,�,,,�}� � � Donald F. McLagan � """� ""�""" •w�.M,.�, I 1204 Second Street NE � - -� ' Rochester MN 55906 � _. . ----. _ , �THIS INSTRUMENT WAS DRAFTED BY(NAME AND ADDRES9):' ! 0' Brien, Ehrick, Wolf, Deaner & Maus IAttorneys at Law I611 Marquette Bank Building P.O. Box 968 Rochester MN 55903 (507) 289-4041 �_.__ `�L 4 �3 � �u 3 9 '�