HomeMy WebLinkAboutPlumbing 65-1003-P
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OJHKOJH
City of Oshkosh
Inspection Services
215 Church Ave., PO Box 1130
Oshkosh, WI 54902-1130
(920) 236-5049 (920) 236-5106 FAX
ON THE WATER
October 8, 2003
Fox Valley Excavating
441 Forest View Rd
Oshkosh, WI 54904
Ref: Plumbing Plan Approval:
Gary H. Decker,(4-Unit Condo sewer & water)
3200-3206 Issac Ln., Oshkosh, WI
3210-3216 Issac Ln.
Plan 10# File-65-1003-P
Dear Sirs,
Examination of the plumbing plans and specifications for this project has been completed. In
accord with Chapter 145, Wisconsin Statute, and COMM 81 through 85, Wisconsin
Administrative Code, the plumbing plans and specifications are approved contingent upon
compliance with the stipulation(s) noted below.
1. Storm sewer is without calculation and assumed to serve as discharge receptor
of sump pump for foundation drain only.
In the event installation of this plumbing system has not commenced within two years from this
date, this approval shall become void. A new application accompanied by full examination
fees shall be filed and an updated approval received before work may commence.
In granting this approval, the City of Oshkosh or its representative does not hold itself liable for
any defects in plans or specifications, plan omissions, examination oversight, construction or
any damage that may result in or after installation. The City of Oshkosh reserves the right to
order changes or additions should conditions arise making this necessary.
It shall be necessary for the installing plumber to obtain a plumbing permit from the City of
Oshkosh before proceeding with actual installation of this plumbing system or any of its parts.
Respectfully,
Richard Wood,
Plumbing Inspector
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OJHKOJH
ON THE W^TER
APPLICATION FOR REVIEW
-Complete all pages-
GENERAL PLUMBING
Inspection Services (920-236-5049) PO Box 1130 Oshkosh WI 54902-H:30 '
NOTE: Personal information you provide may be used for secondary
purposes [Privacy Law s. 15.04(1)(m). Slats.)
1. PlumbinQ Submittal
check all that applv
A) ()('Outside work ONLY
B) Contains one or more:
( ) Cross Connection Control
Assembly
( ) Catch Basin/Oil interceptor
( ) Grease Interceptor
( ) Chemical Waste System
( ) Sanitary Dump Station
C) Total Number of Fixtures in
ProjecUBuilding
( ) 1-30 () 201-250
( ) 31-50 () 251-300
( ) 51-100 ( ) 301-350
( ) 101-150 ( ) 351-400
( ) 151-200 ( ) 401-500
( ) More than 500 fixtures-
Total number_
D) ( ) Project is ApartmenU
Condo only
E) ( ) Project contains identical
Buildings. Number of
identical buildings _
F) ( ) Structure is greater than
3 stories in height.
G) ( ) Manufactured Home
Community and/or Campground
( ) Less than 50 sites for sewer
( ) Less than 50 sites for water .
( ) More than 50 sites for sewer
( ) More than 50 sites for water
5'1
W'
Fax or Intemet
... go3,
Make checks a ble to Ci of Oshkosh, Attach check here
THIS FORM IS VALID ONLY FROM 01/01/2001 to 06/30/2002
Complete for confirmed appointments*:
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Transaction 10:
2. Type(s) of Submittal:
{)o(Storm/Clear Water Drain and Vent
~ Water Supply System
()q,Sanitary Drain and Vent
( ) New () Alteration
( ) Addition ( ) Petition
( ) Revision to Previously App. Plan
Plan No. Revised
( ) Multiple Buildings
Number of Buildings
( ) Health Care Facility
Complete last page of this form for
multiple buildings or cross connection
assemblies
3. Project Information - Fill in all known Information.
Project/Site Name r tln:1 COf,'l./o In ;t1H1
Number & Street: '?20fJj '320l., 32.0 'I'; g 21J&
Legal Description: P ..,..,.., '~r c J, 5 S "i
County W,' ^ ()<) City ( ) Village ( ) Town of
Tenant name or buil mg designation: Example: West Mall/Jim's Shoes, Bldg #1
LG[M~
I Zip Code
()sAJu) It tv.. , 5' ()
Utilize the check boxes when designer, owner or requesting party Is the
Company Name
Address
City
Slate
Zip+4 (9 digits)
Phone Number (area code)
Fax or Internet
^itf:/(f!F~t-:gf;:,Z1<;f~;. ;~.j~)~<~~,i,::.:,',~, ~,~:{:.:'$r~~~Vij.~'"~~~~~_':~" _"t,; ':'
Customer Number
First Name
Last Name
Customer Numbe
Co
Company Name
Address
State
Zip+4 (9 digits)
City
State
Zip+4 (9 digits)
Phone Number (area code)
Fax or Intemet
Check others if applicable
( ) Payer Other
Total amount due, Review code 7657
$
Complete information requested where applicable.
Water Supply System
Total Number of Fixtures
System Components
(check all that apply)
( ) Water Service
( ) Water Distribution System
( ) Private Water Main
6. Regulated Object Type Details
Sanitary Drain and Vent System
Total Number of Fixtures
Number of:
Grease Interceptors
Garage Catch Basins
Oil Interceptors
Car Wash Interceptors
Sanitary Dump Stations
System Components
(check all that apply)
( ) Building Sewer
( ) Interior Drain and Vent Piping
( ) Private Interceptor Main Sewer
Storm & Clear Water Drain and Vent System
Total Number of Fixtures
Number of:
Catch Basins
Area Drain Inlets
Roof Drains
Controlled Flow Roof Drain? (
) Yes ( ) No
System Components
(check all that apply)
( ) Building Sewer
( ) Interior Drain and Vent Piping
( ) Private Interceptor Main Sewer
Note: Complete last page of this form for Cross Connection Control Assemblies
7. Calculation of Fees Required. Check appropriate box and make fee computation.
.; .......,. ......;;:::;,';:1{..,;'...
Item pe~~rip.tion:::',j'" . ....; <.....
(;:>.co) Sanitary Building Sewer Only (no drain & vent)
( ) Sanitary Drain & Vent, with or wlo Sanitary Building Sewer
( ) Sanitary Private Interceptor Main Sewer
('f.. ) Building Water Service Only (no water distribution system)
( ) Water Distribution System with or w/o Water Service
( ) Private Water Main
!~ Building Storm and Clear Water Drain System
( ) Storm Private Interceptor Main Sewer
( ) Reduced Pressure Principle Backflow Preventer
( ) Reduced Pressure Detector Backflow Preventer
( ) Back Siphonage Backflow Vacuum Breaker
( ) Pressure Vacuum Breaker
( ) Grease Interceptor "(See Note Below)
( ) Chemical Waste System '(See Note Below)
( ) Garage Catch Basin" (See Note Below)
( ) Oil Interceptor ' (See Note Below)
( ) Car Wash Interceptor' (See Note Below)
( ) Sanitary Dump Station. ' (See Note Below)
( ) Petition for Variance inCluded (Attach Form SBD-9890)
( ) Revision to previously ~pproved plans
( ) Experimental Plumbing System
( ) Altemate Plumbing System
Manufactured Home' . " -" ,'\". ;;".':'1"::' ,.,.1". '). . ,
CommunityiRecreational Vetii~le Park","): Required Fee
1.25 Sites
26-50 Sites
$300.00
$350.00
FelfC()mput~tiollS(~g,4J>,!e~ J()[ili~tcill@ph
without C1pbNW~hj:'J'11;ltJi~{;~j;lI;;riI\:,u:,;;n;r)1';;:;~" .. .;:;:,
Sum of Sanitary Sewer Diameters...:~.-'nches x $25.00
Sum of Sanitary Sewer Diameters.._lnches x $40.00. or
for multiple sewer connections serving a single building the
fee mav be calculated per Comm 2.64 (3)(a)
Sum of Largest Diameters... _Inches x $25.00
Sum of Water Service Diameters..,~lnches x $25.00
Sum of Water Service Diameters.._lnches x $40.00, or
for multiple water service connections serving a single
buildinG the fee may be calculated Der Comm 2.64 13l(bl
Sum of Water Main Diameters..._lnches x $25.00
Sum of Storm Sewer Diameters...-!i.lnches x $10.00, or
for multiple sewer discharge points for a single site the fee
may be calculated per Comm 2.64 (3)(C)
Sum of Largest Diameters... Inches x $10.00
Require~:~
Fee'
I tJ6 .t;O
37. ro
'1b.l(j
Number of Assemblies......_ x $125.00
Number of Assemblies ....._ x $125.00
Number of Assemblies ....._ x $125.00
Number of Assemblies ....._ x $125.00
Number of Grease Interceptors... _x $70.00
Number of Chemical Waste Systems... x $70.00
Number of Garage Catch Basins..._x $70:00
Number of Oillnterceptors..._x $70.00
Number of Car Wash Interceptors... x $70.00
Number of Sanitary Dump Stations... x $70.00
Number of Petitions included... x $225.00
$75.00 Required
Number of Experimental Plumbing Systems... x $500.00
Number of Alternate Plumbing Systems... x $400.00
Manufa'Ctured HOITI~,:+;:;'.j.,;':'1'~;'~~W(\Yo,"(L&,,;; Re,quiied '.'
CommunitV/RecireationaiV~~I;JEf~~~k;);' . Fee.' .. .,' .
51-125 Sites $400.00
Greater than 125 $500.00
.
: .
" NOTE' No additional fees are required if submitted with sanitary drain and vent system.
[
Priority reviews are double the above fees. Prior approval from a section chief is required for a priority review. If
approval is granted the priority will be reviewed within 5 days of receipt.
Enter Total Fee (Minimum $60.00) here and at bottom of front page [/77 " S- 0
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