The URL can be used to link to this page

Home My WebLink About2005-Building (sprinkler system) e OSHKOSH ON THE WATER Job Address 2550 S WASHBURN ST CITY OF OSHKOSH No 116946 BUILDING PERMIT - APPLICATION AND RECORD Owner RICHARD KOHLHOFF Create Date 10/25/2005 Desi9ner Contractor AHERN FIRE PROTECTION Cate90ry 232 - Alteration Stores & Customer Service Plan P7-55-0B05 Type . Building 0 Sign 0 Canopy 0 Fence 0 Raze Zoning Class of Const: 2B Size Unfinished/Basement ~Sq.Ft. ~Sq.Ft. Rooms Height 0 Ft. 0 Projection Finished/Living Bedrooms Stories Canopies Garage ~Sq.Ft. Baths 0 Signs Foundation . Poured Concrete 0 Floating Slab 0 Concrete Block 0 Post 0 Pier 0 Treated Wood 0 Other Occupancy Permit Required Flood Plain No Height Permit Not Required Park Dedication Not Required II Dwelling Units ~ II Structures ~ Use/Nature Comm/ Installation of Automatic Fire Sprinkler System as per pians. ofWork Plumbing Contractor HVAC Contractor Electric Contractor $32.000.00 Plan Approval $0.00 Permit Fee Paid $160.00 Park Dedication $0.00 Fees: Valuation Issued By: Date 10/25/2005 Final/O.P. 00/00/0000 0 penmitVoided Parcelld II In the performance of this work I agree to perfonm all work pursuant to rules governing the described construction. While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perfonm the work described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement holder(s) and to secure any necessary approvals before starting such activity. Signature Date Address 201 Morris Court AgenUOWner Fond du Lac Wi 54936 - 0000 Telephone Number 920-921-9020 To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may continue if the inspection is not performed within two business days from the time the project is ready. ~ Ahern Fire Protection A division of J- F. Ahern Go. 201 Mocris Court, P.O. Bo, 1316. Food du Lao. WI 54936-1316 TEL (920) 921-9020 . FAX (920) 921-B666 . www.ahemfire.oom Wiscoosio . Illioois . Missouri' Nebraska' Iowa RECEIVED JAN 1 3 2006 DEPARTMENT OF COMMUNITY DEVELOPMENT January 12, 2006 Building Inspector -- Brian Noe City of Oshkosh 215 Church Avenue -- PO Box 1130 Oshkosh, WI 54901 T -920/236-5051 F-920/236-1130 RE: FIRE PROTECTION SYSTEM INSTALLATION COLUMBIA RETAIL ....j¡;;.~,u"....~\f~ no OSHKOSH. WISCONSIN 54904 AHERN FIRE PROTECTION CONTRACT No. 490379 Dear Brian: Enclosed is a copy of the Contractor's Material and Test Certificates covering the ahove-referenced Fire Protection System Installation for your files. Very truly yours, AHERN FIRE PROTECTION A division of 1. F. Ahem Co. Lll!} Ô~ JeffR. Batterman Service Superintendent JRB/ksj LCITYOI-12-û6.DOC An Equal opportunity Employer AHERN FIRE PROTECTION Contracto~~_Mat~rialancl.Test Certificate for Aboveground Piping PROCEDURE Upon complelien of work, inspection and tests shall be made by the contracto(s representative and witnessed by an owne(s representative. All defects $ball be corr<>cted and system left in ""Mce before contraejor's "",,",nnel finally leave Ihe job. A certificate $ball be filled out and signed by both repreoentatives. Copies shall be p~ for approving authorities, own"', and contractor. 11 is understood the owne(s representative's signature in noway prejudices any claim against conbactorforfaulty material, poor workmanship, or failure to comply- approving authoritv's '~uirements or local ordinances. PROPER1Y NAME Columbia Retail AFP Contract II: 490379 I DATE: October 26, 2005 PROPER1Y ADDRESS Washburn & Highway 44 Oshkosh, WI 54904 ACCEPTED BY APPROVING AUTHORITIES (NAMES) 1. Oshkosh Fire Department (Battalion Chief - Stu Schrottky) 2. City of Oshkosh (Building Inspector -- Brian Noe) 3. 4. ADDRESS Plans 1. 101 Court Street - Oshkosh, WI 54901 2. 215 Church Avenue - PO Box 1130 - Oshkosh, WI 54901 3. 4. ., INSTALLATION CONFORMS TO ACCEPTED PLANS ¡~ES DNO EQUIPMENT USED IS APPROVED YES DNO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION It!YES DNO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? INSTRUCTIONS IF NO, EXPLAIN HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: IlemNo-'s2.3win 1. SYSTEM COMPONENTS INSTRUCTION ~:ES DNO be foowa"'ed by AfP 2. CARE AND MAINTENANCE INSTRUCTIONS YES DNO stoloseouttime. 3. NFPA 25 YES DNO LOCATION OF SUPPLIES BUILDINGS SYSTEM Entire MAKE MODEL YEAR OF K- QUANTITY TEMPERATURE MANUFACTURE FACTOR RATIOO Vikino Micromatic VK2OO Uoriaht3l4' Bronze 2005 8.0 245 286 Dea. Vikin Microfast OR VK3O2 Pendent 2005 5.6 4 155 Vikino M"..romatic VK116 2005 5.6 1 200 Dea. SPRINKLERS Vikino Micromatic VK2OO U rooze 2005 8.0 1 200 Dea. PIPE AND TYPE OF PIPE Liahtwall Nan Threadable' Thinwall Threadable' Black' Galvanized FITTINGS TYPE OF FITTINGS Grooved' Threaded' Welded Outlets FLOW ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST CONNECTION TYPE I MAKE MODEL MIN. SEC. Water Flow Detector I Svstem Sensor I WFD I /...-/:4- N/A I I I EXPLAIN ANY ALARM PROBLEMS: ALARM DEVICES LOW AIR ALARM DEVICE ALARM OPERATED 1YPE I MAKE I MODEL PRESSURE PROPERLY -N/A I I SETTING PSI I YES NO I EXPLAIN ANY ALARM PROBLEMS: Ahem Fire Protection CENTRAL MONITORING ' LOCATlON(S) SIGNALS RECEiVED ALARM SERVICE lYPE OR PRESSURE NAME OF REMOTE WATERFLOW SWITCH LOW-AIR OTHER SERVICE DETECTOR FLOW SUPERVISORY SUPERVISING LOCATION(S): STATION (ON-SITE) ßA:s e !"'. e..v ~ >\: REMOTE REMOTE NAME OF SERVICE: MONITORING ~ ~fZ\!)fI.\\--;I CN! ALARM SERVICE IS' SIGNALING (OFF-SITE) PHONE: OTHER: LOCATION(S): EXPLAIN ANY ALARM SIGNALING PROBLEMS: DRY VALVE Q.O.D. I MAKE MODEL I SERIAL NO. MAKE I MODEL SERIAL NO. I I I I TIME To. TRIP WATER TRIP POINT AIR TIME WATER ALARM THROUGH TEST PRESSURE AIR PRESSURE PRESSURE REACHED TEST OPERATED CONNECTlo.N'" OUTLET '2 PROPERLY DR IPE MIN. SEC. PSI PSI PSI MIN. SEC. YES NO WITHOUT I I I 0..0.0. WITH I I I 0.0..0. IF NO, EXPLAIN: \ I OPERATION: 0 PNEUMATIC 0 ELECTRIC 0 HYDRAULIC PIPING SUPERVISED DYES DNO I DETECTING MEDIA SUPERVISED DYES DNO DOES VALVE OPERATE FROM THE MANUAL TRIP, REMOTE, OR BOTH CONTROL STATIONS DYES DNO IS THERE AN ACCESSIBLE FACILIlY IN EACH IF NO, EXPLAIN D U E& CIRCUIT FOR TESTING PR TION DYES DNO V VES DOES EACH CIRCUIT DOES EACH CIRCUIT MAXIMUM TIME TO OPERATE SUPERVISION OPERATE VALVE RELEASE OPERATE RELEASE MAKE MODEL LOSS ALARM YES I NO YES NO MIN. SEC. I LOCATION & MAKE & MODEL SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE FLOOR (FLOWING) ~ l~iET I O~pT~~T I~i~; I O~:~~T FLOW RE ING PSI PSI PSI PSI (GPM\ V ST I I . . MEASURED FROM TIME INSPECTORS TEST CONNECTION IS o.PENEO. , NFPA 13 o.NLY REQUIRES THE 5O-SECONO LIMITATIo.N IN SPECJFICSECTIONS. 2 TEST DESCRIPTION TESTS BLANK TESTING GASKETS WELDING Ahem Fire Protection HYDROSTATIC, Hydrostalic tesls shall be made at not less than 200 psi (13.6 ham) for two houm or SO psi (3.4 bars) ahovestatic pressure in excess 01 1SO psi (10.2 ham) lor two hòúm. Differential dl)'1>ipe valve clappem shall ha left open during test'" prevent damage. All ahoveground piping leakage shall be stopped. PNEUMAT Establish40-psi (2.7 bars) airpressura and measure drop, which shall not exceed 1-1/2 psi (0.1 bars) in 24houm. Test presser ~at normal water level and air pressure and measura air pressura drop, whichshallnotaxcaed 1-1/2 psi (0.1 ham) in 24 houm. ALL P NG HYDROSTATICALLY TESTED AT . PSI L-Bar) for _HRS. IF NO, STATE REASON PI INGPNEUMATICALLYTESTED DYES ONO EQUIPMENT OPERATES PROPERLY DYES ONO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OR SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED F R TESTING SYSTEMS OR STOPPING LEAKS? YES ONO DRAIN READING OF GAUGE LOCATEOflEARWATER RESIDUAL PRESSURE WITH VALVE IN TEST TEST SUPPLY TEST CONNECTION:JLL PSI L--Bar) CONNECTION OPEN WIDE: .f2.£.... PSI LBar) UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISER OTHER EXPLAIN FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COpy OF THE CONTRACTOR'S MATERIAL AND TEST CERTIFICATE FOR UNDERGROUND PIPING. rtYES 0 NO FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING 0 YES 'ÍfJ NO IF POWDER-DRIVEN FASTENERS ARE USED IN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? OYESONO NUMBER USED 0 WELDED PIPING LOCATIONS YES ONO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS B2.1? DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS B2.1? DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO ENSURE THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? SIGNATURES FOR PROPERTY OWNER (SIGNED) TITLE .q:.MA,v 3 IF NO, EXPLAIN ¡vIA NUMBER REMOVED ~ rdYES ONO pYES ONO ~YES ONO YES ONO IF NO, EXPLAIN I Iíi DATE DATE 1'2 ~:l O~ .~ m '~sconsin Department of Commerce P.U. I:!ox f3U"¿ Madison, WI 53707-7302 Fax: (608) 267-9723 TTY: (608) 264-8777 htlp J lwww.commerce.sIate.wi.us htlpJIwww.wisconsin.gov Personal infonmation you provide may be used for secondary purposes [Privacy Law, 5.1504 (1)(m)]. Please rint clearl in ballpoint pen. Additional information on back age. AFP #490379 Street Address Washburn & Highway 44 Double Check/DC Detector Performance Test ReQulated Object Number: - - - - - ~ - - OWNER INFORMATION OWner Name Columbia Retail Cfty Oshkosh, WI 54904 FACILITY INFORMATION State Zip Code OWner's Contact Person Telephone Number ( ) Facilfty Name Columbia Retail Cfty Oshkosh, WI 54904 Assembly Location Lower Level - South Wall Zip Code Street Address Washburn & Hi9hway 44 County Winnebago Size 4" Assembly Type Model 350ABGVIC 0 DC Detector Manufacturer Wilkins INITIAL TEST 1ST check ,,"Closed tight 0 Leaked 5 --~_t!'.t!~ 'i FINAL TEST 0 Closed tight Static 2"d check ~Closed tight 0 Leaked 'p'?!Q---_____n--_m?!!'!!~ d.O ;:'~I!?________._n_._.__._---_.__._--------------_.__.__.-._..n_- PSID 0 Closed tight Static PSID DETECTOR BYPASS ASSEMBLY INITIAL TEST 1ST check 2"d check 0 Closed tight 0 Closed tight 0 Leaked 0 Leaked Static PSID Static PSID ..- n_.____--. --------.____._n__.__.----.-.-.--.-.--------------------------.--------.----.--.------------ -----------.--.------------------------- DETECTOR BYPASS ASSEMBLY FINAL TEST 0 Closed tight 0 Closed tight Static PSID Static PSID ASSEMBLIES IN FIRE PROTECTION SYSTEMS Forward Flow Test Note: Include hose stream demand where applicable Designed flow rate ID..M.GPM Indicatina Control Valves RNo. one control valve open 'Is;¡ No. two control valve open Valve supervision: Part(s) Replaced/Comments Çlù.¡<!(.Å \- I'>I"{,\JI'~~L€ 11+ Actual flow rate ~IGì GPM /i'Tamperswitch 0 Locked '"?" rs1 I HEREBY CERTIFY THE TEST RESULTS ARE TRUE AND THE TEST WAS CONDUCTED BY ME PERSONALLY. Tester Signature ß\<f\t} \tJ ~II" cf ~/ß-~ Registration No. d-b I ;,} \) I Time of Day 1/: at (.::."-" Date ¡.).I.:J:J../~ç . . Tester Name (print) Phone No. " - OWNER INFORMATION The backflow preventer is a mechanical device designed to protect the potable water supply system from being cnntaminated. There is a physical cnnnection to equipment or water of either unknown or questionable quality, thereby requiring the installation of the backflow preventer. In order to ensure that this device is working as designed, it must be periodically tested. A test shall be conducted on each backflow preventer prior to it being put into service, after any repairs, and a minimum of once a year thereafter. It is the responsibility of the owner to make sure the device is tested. The test shall be perfonned by a department registered Cross Connection Control Device tester. OWNER'S CONTACT PERSON: The owner's contact person is the name of the person responsible for the backflow preventer maintenance and records. (Note: Please provide full name.) OLD VALVE REPLACEMENT INFORMATION . .. If thi~test i!; for a replacement valve, please include all infonnation for the replacement valve on thisfonn. The. . .' .- ...,. , máñur~êrñõ.;"serìål no.7size, and the assembly ty¡:ie of the "old" valve must included on the cnmment line of this form.' . t:' DOUBLE CHECK VALVES AND DOUBLE DETECTOR CHECK VALVES INSTALLED IN FIRE PROTECTION SYSTEMS l . I.:' A copy of this completed test must be attached to or located near the double check valve or double detector check valve. MINIMUM REQUIREMENTS FOR PASSING TEST DC and DC Detector . The first check must close tight, and have a minimum static 1 PSID. . The seCond check must close tight, and have a minimum static 1 PSID. Do not send a copy of this report to the Department of Commerce, Safety and Buildings Division. Copies of this report shall be distributed to the following: Owner and tester as indicated on the bottom of each page. l.. , '