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Home My WebLink About0118514-Building e OSHKOSH ON THE WATER Job Address 2700 W 9TH AVE CITY OF OSHKOSH No 118514 BUILDING PERMIT. APPLICATION AND RECORD Owner MERCY MEDICAL CENTER OSH INC Create Date 03/14/2006 Designer HGA Contractor CR MEYER Category 219 - Addition Hospitals & Institutions Plan S2-25-0306 Type . Building C-1PD 0 Sign 0 Canopy 0 Fence 0 Raze Class of Const: 2B Rooms 0 Height 0 Ft. Bedrooms Stories 1 Baths 0 0 Pier 0 Other 0 Treated Wood Size Zoning Unfinished/Basement ~Sq.Ft. 23500 Sq. Ft. 0 Projection I Canopies 0 Finished/Living Garage ~Sq.Ft. Signs Foundation . Poured Concrete 0 Floating Slab 0 Concrete Block 0 Post Occupancy Permit Required Flood Plain No Height Permit Not Required Park Dedication Not Required # Dwelling Units 0 # Structures ~ Use/Nature R:ancer Center Addition and Remodel as per plans approved by DHFS 12-19-05. of Work HVAC Contractor Plumbing Contractor Electric Contractor Fees: Valuation ,903.00 Plan Approval $0.00 Permit Fee Paid $3,733.00 Park Dedication $0.00 Issued By: Date 03/14/2006 Final/D.P. 00/00/0000 0 Permit Voided I Parcelld # 0613670000 In the performance of this work I agree to perform 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 perform 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 see ecessary approv before starong such activity. 3~ 14--ò{ç Date Signature Address 895 W 20TH AVE Agent/Owner OSHKOSH WI 54902 - 0000 Telephone Number 920-235-3350 x219 To schedule inspections please call the Inspec1ion 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. Jim Doyle Governor DIVISION DF DISABILITY AND ELDER SERVICES BUREAU OF QUALITY ASSURANCE 2917 INTERNATIONAL LANE, SUITE 300 MADISON WI 53704 Helene Nelson Secretary State of Wisconsin Department of Health and Family Se . 608-243-2024 : 808-243-2045 isconsin.gov June 6th, 2005 JUN 2- 1 2005 Of HGA Architects Attn. Scott Zube and Cherie K. Claussen, AIA 135 West Wells Street Milwaukee, WI. 53202 RE: Project # - 3961-5841 Building Addition and Alterations Mercy Oakwood - MOB Business "B" Occupancy 24,380 sq.ft. 500 £elilh Oak.wuud A,~. Zìoc:n.~ q~ ~e' Oshkosh, WI. 54914 Dear Mr. Zube and Ms. Claussen, Final Building, HV AC and Lighting Addition and Alteration plans that were received in the Department of Health & Family Services on June 6th, 2005 have been stamped CONDITIONALLY APPROVED these plans were reviewed based conformance with the current edition of the Wisconsin Administrative Building and Heating, Ventilating and Air Conditioning Code (Chapters Comm 61-65). The plans have NOT been reviewed for conformance to the Plumbing Code (Chapters Comm 81-86), the Elevator Code (Chapter Comm 18) and any other Commerce code not specifically mentioned. Additionally, these plans and specifications have been reviewed for compliance with Medicare (Title XVIII-Fed) and Medicaid (Title XIX-State) regulations including the applicable NFPA 1O12000Life Safety Codes 101 Edition. This conditional approval does not constitute a guarantee or endorsement that the plans and specifications are free of design defects or omissions; or that the systems submitted will be installed in conformity with the plans, or that the systems will operate acceptably even if installed in conformity with the plans, calculations, and specifications. The Department approval is limited to a determination that the systems, as detailed in the submittal, adequately conform with the above-referenced code requirements. This conditional approval is only for the physical environment referenced in the above codes and does not serve as certification nor licensure as a hospital per HFS 124 or State Statute Chapter 50. Approval of these construction plans do not constitute approval of the facility for a specific Medicaid reimbursement rate. For further assistance with billing rate questions, contact Russell Pederson, Chief, Hospital Fee for Services Section, at (608) 266-1720. Wisconsin.gov June 15, 2005 Page 2 . 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, is responsible for compliance with all code requirements. The owner shall notify the Department and local officials before taking possession of the building. The bni1ding will be inspected during and after construction, at which time additional code implications can be identified by the Department. . The facility will be inspected during and after construc1ion by an engineer of this Department to ensure compliance with NFPA 101 Chapter 38 Federal Regulations. COMM 61.33 Evidence of Plan Approval. The architect, professional engineer, designer, builder or owner shall keep one set of plans bearing the appropriate stamp of approval at the building site. . Item #1- Review egress from Infusion Area. Common path of travel is exceeded in space GK665. (NFPA LSC 101 sec. 38.2.5.3.). . Item #2- Sprinkler' plan addition and modifications shall be submitted for review before installation. perNFPA 13, . Item #3- Review oxygen room requirements per NFPA 99. The oxygen storage room should be one-hour rated. NFPA 99. . Item #4- Passage doors GK585 and GK61O cannot be locked in exit egress passage (NFPA LSC 101 - 38.2.5,). . Item #5- Review air-changes in Infusion Space Areas. Reference IMC code. . The below listed documentation shall be submitted to this office prior to the final inspection for this minor remodeling project. Documentation -Local plumbing inspection report. -Local electrical report. -Local building inspection approval or copy of occupancy permit. -Provide documentation sprinkler system installation and test report, and certification that the system is fully operative (Use NFPA 13). Jim Doyle Governor OIVISION OF DISABILITY ANO ELDER SERVICES BUREAU OF QUALITY ASSURANCE 2917 INTERNATIONAL LANE, SUITE 300 MADISON WI 53704 Helene Nelson Secretary State of Wisconsin Department of Health and Family Services Telephone: 808-243-2024 FAX: 608-243-2045 dhfs.wisconsin.gov December 19th, 2005 HGA Architects Attn. Scott Zube and Cherie K. Claussen, AIA 135 West Wells Street Milwaukee, WI. 53202 RE: Project # - 3961-5841R Building Addition and Alterations Mercy Oakwood - MOB Business "B" Occupancy 24,380 sq.ft.-Total; 3,700 sq.ft.-New see s""tJ, Odk.wuud Ave. Oshkosh, WI. 54914 "Z-7ø<:> ...." '*'" -- Dear Mr. Zube and Ms. Claussen, Final Revised Building, HV AC and Lighting Addition and Alteration plans that were received in the Department of Health & Family Services on December 19th, 2005 have been stamped CONDITIONALLY APPROVED these plans were reviewed based conformance with the current edition of the Wisconsin Administrative Building and Heating, Ventilating and Air Conditioning Code (Chapters Comm 61-65). The plans have NOT been reviewed for conformance to the Plumbing Code (Chapters Comm 81-86), the Elevator Code (Chapter Comm 18) and any other Commerce code not specifically mentioned. Additionally, these plans and specifications have been reviewed for compliance with Medicare (Title XVill-Fed) and Medicaid (Title XIX-State) regulations including the applicable NFP A 101 2000 Life Safety Codes 101 Edition. This conditional approval does not constitute a guarantee or endorsement that the plans and specifications are free of design defects or omissions; or that the systems submitted will be installed in conformity with the plans, or that the systems will operate acceptably even if installed in conformity with the plans, calculations, and specifications. The Department approval is limited to a determination that the systems, as detailed in the submittal, adequately conform with the above-referenced code requirements. This conditional approval is only for the physical environment referenced in the above codes and does not serve as certification nor licensure as a hospital per HFS 124 or State Statute Chapter 50, Approval of these construction plans do not constitute approval of the facility for a specific Medicaid reimbursement rate, For further assistance with billing rate questions, contact Russell Pederson, Chief, Hospital Fee for Services Section, at (608) 266-1720. Wi$consin.gov December 19, 2005 Page 2 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, 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, at which time additional code implications can be identified by the Department. The facility will be inspected during and after construction by an engineer of this Department to ensure compliance with NFPA 101 Chapter 38 Federal Regulations. COMM 61.33 Evidence of Plan Approval. The architect, professional engineer, designer, builder or owner shall keep one set of plans bearing the appropriate stamp of approval at the building site. Item #1- Sprinkler plan addition and modifications shall be submitted for review before installation. perNFPA 13. . Item #2- Passage doors GK585 and GK6l 0 cannot be locked in exit egress passage ( NFP A LSC 101-38.2.5.). . The below listed documentation shall be submitted to this office prior to the final inspection for this minor remodeling project. Documentation -Local plumbing inspection report. -Local electrical report. -Local building inspection approval or copy of occupancy permit. -Provide documentation sprinkler system installation and test report, and certification that the system is fully operative (Use NFPA 13). - Provide Information on Medical Gases certification and Testing per NFP A 99. -Provide documentation that the heating and ventilation systems have been rough balanced and are fully operative, final balancing report to follow or provide final balancing report (Comm 64.53) -Provide certification that all fire and smoke dampers have been field tested and provide a description of where they were installed in accordance with NFP A 90A. -Provide documentation of electrical performance criteria and testing per NFP A 99, Chapter 7. December 19, 2005 Page 3 -Provide copy of manufacturer's carpet specification test report from the testing laboratory. -Letter from installer certifYing that carpet that is installed is the same as that tested. -Documentation of wall and ceiling finishes as to flamespread characacterists. . Three copies of the revised approved plan covers were previously returned. If you have any further questions, please contact me at (608) 243-2037. cc: - City of Oshkosh Building Inspection Dept. - Tom Laabs, Project Coordinator c/o Mercy Hospita1- Oshkosh - Affiliated Engineers - Attn. Scott Moll, PE. 5802 Research Park Boulevard, Madison, WI. 53719 - c.R. Meyer & Sons - 895 West 20th Street, Oshkosh, WI. 54903 HSSMOBPLN3-1-o5 CITY OF OSHKOSH - DEPT. OF COMMUNITY DEVELOPMENT SITE PLAN REVIEW - ZONING Location of Property: 500 S Oakwood Road 2....,00 '-' ~ ~ Date Received: 2/14/06 Applicant Name: CRMever Phone: 920-235-3350 Fax: Applicant Address: 895 W 20th Ave City: Oshkosh State: JYL Zip: 54903 Owner: Mercv Med. Center Oshkosh Parcel Number(s):06-1367 & 06-1366 Zoning: C-1PD Type of Construction: Cancer Center - Addition and landscaping Compliance Checklist Yse I.et-WiàIh ~ bet-Area ~ Aift"'F! Height From Setback Com8r giEle Setback lRterior giEle getback Rear getback BælE1iag .^.rea Access ReguJati8R' ParbRg St""ElarEis LeadiRg StaRdards ViGieR Clear""ce Tr""'. YarEi St""Elards SereeffiRg LaR<IGeapi<>g bighâRg Signage Mechanical Screening Var-'C'JP'PD CeRditieRS Gthef Comments/Conditions 1. This review does not include signage. 2. Any new, replaced or relocated mechanical equipment proposed with this project must be screened ITom view of any residential property or public right-of-way. """ZONING REVIEW FEE NOT COLLECTED PRIOR TO REVIEW*"" **Only one site/landscape plan-forwarded to BN with approval sheet** Review Fee: $100.00 (Disturbed area < 10 000 so 1\= $1001> 10,000 sq 1\= $200.00 Signage = $25 Floodplain = $75) 0 Approved IXIApproved w/Conditions 0 Denied 0 Hold Reviewed by: David Buck Review Date: 2/17/06 Please contact the Zoning Administrator at 920.236.5062 if you have any questions. REVIEW AUTHORITY A,p"S~""30-5Eof"."~"tofth'ŒyZ"iogO,'dio"",th' Di"ct"ofCo_oi,yDmlopmo""""~igo".=",ppco","pl=.",,p"h'fo"owio" (I)A""""""iol""" "tkwhoot"'",'i'",'f'nnio",dwhoo""",,'io",'i'pcopo,,' (2)M.oIoo""it_",'idiog,wiOdow"o",whootho,"i,",ofo<u'¡o,oodwhOOO?'h"g,"PCOPO'" "",~"¡".~",i".^,mi"io,,~"""i".Cm"p"~""'m't."""obO"'OOSO"-'O""&t~"'.po.'m ~ S .¡::. u....- ." commerce.wl.gov ~ 1!£9 J~!lQ Safety and Buildings 141 NW BARSTOW ST FL4TH WAUKESHA WI 53188-3789 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 12,2005 COST ID No.916133 DAVID ODEGARD AFFILIATED ENGINEERS INC 5802 RESEARCH PARK BLVD PO BOX 44991 MADISON WI 53719 ATTN: Piumbing Inspector BUILDING INSPECTION CITY OF OSHKOSH POB 1130 OSHKOSH WI 54902 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/12/2007 SITE: Mercy Medical Center ~ see S O..i..Md Dr .).700 ",. l' Ao<' City of Oshkosh, 54904-7944 FOR: Facility: 664839 CANCER CENTER ADDITION AND REMODEL 500 S OAKWOOD DR OSHKOSH 54904 Identification Numbers Transaction In No. 1143960 Site In No. 666890 Please refer tQ both identification numbers, above, in aU côrreSuí:mdence with the at!enêv. Object Type: Plumbing Syst~m, Building Specific Regulated Object ID No.: 1022514 Plan Type: Addition-Alteration; 32 Interior Fixtures Object Type: Cross Connection Control Device, Health Care Regulated Object ID No.: 1022533 Device is Serving: FILM PROCESSOR; Device Type: Reduced Pressure Preventer; Location on Property: Room GK 440 South Wall; Manufacturer: WATTS; Model: 909QT; 3/4" Valve Size Object Type: Interior Sanitary Drain & Vent System Regulated Object ID No.: 1023707 Object Type: Interior Water Distribution System Regulated Object ID No.: 1023708 Object Type: Plumbing System, Site Specific Regulated Object ID No.: 1023709 Object Type: Interior Storm Drain System Regulated Object ID No.: 1023712 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defmed in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Items 1. Comm 82.36(8)(a) Sumps and (b) Pumps. The construction, installation, location, size ofsumps, and pump discharge piping shall meet the requirements of Ibis section. 2. Comm 82.40(4)(c)1.b. Control valves shall be installed in the supply piping to each water heater and water treatment device and in the fixture supply to each plumbing fixture, appliance and piece of equipment. 3. The backflow preventer shall be installed so that the relief valve outlet is protected by an approved air- gap. The drain from the relief valve must discharge to either a floor drain or an approved receptor. No part of the backflow preventer may be submerged under any circumstance. .. . 4, RP, PVB, or SVB's shall not be by-passed. Except for repair, they shall not be made ino~rative or removed witbout departmental approval. .~ , i9Q.. ..~~~ ,. ;\ " DAVID ODEGARD Page 2 7/12/2005 5. It is the responsibility of the owner to make sure tbe device is tested and that the test report forms (SBD- 9927) is sent to the Safety and Buildings Division upon completion of the test. A department-listed Backflow Prevention Device Tester shall perform the test. A list of testers is available from the department upon request. 6. A TEST SHALL BE CONDUCTED ON EACH RP ,PVB, OR SVB PRIOR TO IT BEING PUT INTO SERVICE, AND A MINIMUM OF ONCE A YEAR THEREAFTER. Reminders The. cross connection control assemblies indicated in the above Description box have been registered with the Department. Each Device shall be tagged as per Comm 82.40(3)(g)3. Each device shall be tested and reported as per Comm 82.21(3). Contact Material Orders at 608-266-2780 for a supply oftags or performance test forms. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors, If plan index sheets were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. All pennits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or componeut. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead, õÃdÞ; ~~ Fee Required $ 425.00 Fee Received $ 425.00 Balance Due $ 0,00 Chet Kintop General Plumbing Plan Reviewer, Integrated Services (262) 548-8634, Fax: (262) 548-8614, Monday - Friday 07:45 To 4:30 ckintop@commerce.state.wi.us cc: James E licker!, Plumbing Consultant, (920) 948-7336 Cherie Claussen, Hammel Green and Abrahamson Inc (Plans Mailed To) Gary Kusuierz, Affmity Health Systems J, :ff h,..'l ai !iJ