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Home My WebLink About0126320-Storage Tank (generator) e OSHKOSH ON THE WATER Job Address 490 N CAMPBELL RD CITY OF OSHKOSH No 126320 STORAGE TANK PERMIT - APPLICATION AND RECORD Owner WIS PUBLIC SERVICE CORP Category 280 -INSTALL STORAGE TANKS Create Date 8/14/2007 Contractor U.S. PETROLEUM & EQUIPMENT Tank Type . Metal o Fiberglass Service . Install o Remove Contents ~ Petroleum D Kerosene Tank Size 145 Tanks D Solvent D Liquid Petroleum . Above Ground 0 Underground D Natural Gas D Other Use/Nature Install 1- 145 Diesel storage tank for generator. of Work Permit Fee Paid $160.00 Date 8/17/2007 D Permit Voided I Parcelld # 1608710200 In the performance of this work I agree to perform all work pursuant to rules governing the described construction. Signature Date Agent/Owner Address 558 CARTER COURT KIMBERLY WI 54136 - 0 Telephone Number 920-730-4240 . 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. 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 secure any necessary approvals before starting such activity. Address of Job Si te FLAMMABLE AND COMBUSTIBLE MATERIAL STORAGE TANK REVIEW CHECKLIST R~. 4 ~ 0 C ~Ai'\, 'P \o~ \\ ---r-\ Il'I\ -€ _ t A)&c (\ e-r ~\o \ i:..- Ll. S. V~\-el.'l,^,,- ~aC, p " \ . Contractor Address ~-"X ~'7\~r L-ou,r-t- ~ \ ifY'. i?\ \. 'i i \.,.J I:. .'1 L\ \ ""3 lc> \.C\?.D) 17-,5-~;L~1 Owner Contractor Contractor Phone Install Tanks ~- Underground Remove Tanks____ Above Ground ~ Number and Size of Tanks 0- r \~ \'-\:'S~~ \1,,, _~ e",~ \ ."'\ ~ .~",,\.pr";:\. {:"' J ~V~~P \ ( ~i.-\b List Materials Stored Tank Composition (Check the proper Fiberglass____ Steel ~. Proposed Start Date . ~'~\Ol Cost Of Job ~\~() Categories) Fiberglass Coated Steel____ .J..i--: -7~ 3 2..,1"2..../ cO $\~D- Permit Fees to be Collected Review Approved For Permit Issuance Y/ N_ Conditions of Approval: NOTE: THIS IS NOT A PERMIT. THIS FORM MUST BE PRESENTED TO THE INSPECTORS IN ROOM 205, CITY HALL, BETWEEN THE HOURS OF 8 - 9 A.M. OR 1 - 2 P.M. TO OBTAIN THE REQUIRED PERMITS. PERMITS SHALL BE OBTAINED PRIOR TO COMMENCING ANY ACTI~ICATED ON.THIS FORM. Signature of ReVieWingOffiC~. !QA Date 't,\\~ \ 0, COPVORTANK 1 01 Court Street Oshkosh, Wisconsin 54901 920/236-5240 City of Oshkosh Fire Department ~ OfHKOfH ON THE WATER August 9, 2007 US Petroleum Equipment 558 Carter Court Kimberly, WI 54136 RE: CONDITIONAL APPROVAL CONDITIONAL APPROVAL EXPIRES: August 9, 2009 APPROVAL NUMBER: 2007-6 SITE: Time Warner Cable Hub #7 490 Campbell Road FOR: Installation of (1) 145 Gallon Aboveground Storage Tank (sub-tank for generator). Your plan has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. This plan has been "CONDITIONALLY APPROVED". The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. This tank system shall be installed in accordance with the Conditionally Approved plans. Any change in the initial installation, which deviates from the original conditionally approved plans, shall be submitted for review as a revision. The on-site inspector shall be notified prior to, and shall review any proposed changes, prior to such changes, to ensure compliance with applicable standards. NOTES: 1. COMM 10 notification shall be sent to me prior to any installation procedures being initiated. 2. Your City of Oshkosh Permit Fee needs to be paid per the instructions at the bottom of our UST/AST Permit Checklist. The permit may then be picked up at the same location prior to the commencement of any work. A copy of the conditionally approved plans, specifications, Installation Permit, and this letter shall be on-site during the installation construction and available for review by authorized representatives of the Department. The required City of Oshkosh installation permit shall be obtained and on-site at the time of commencement of installation. Sincerely, ~ John F. Holland-L.P.O. Fire Prevention Bureau Oshkosh Fire Department 101 Court Street Oshkosh, VVI 54901 (920) 236-5249 j holland@ci.oshkosh.wi.us ". FLAMMABLE I COMBUSTIBLE Environmental & Regulatory Services Division \Yisconsin LIQUID TANKS ~~;",;:,. "':'~~I,"m Pro'"'''''' T '"" DoparfmentofCommerce INSTALLATION APPLICATION Madison, WI 53707-7837 INSTRUCTIONS: Fill in ALL applicable data. Failure to complete the form entirely may cause additional (608) 267-9795 (608) 266-8981 delay. Submit this form with five sets of plans which include details and data as required by Comm 10.10, along with the required fees made payable to: Department of Commerce at the address in the upper right corner of this page. Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)]. OWNER INFORMATION PROJECT INFORMATION CONTRACTOR INFORMATION Customer 10#: 688092 Site 10#: Facility 10#: Customer 10#: 240928 Name Facility Name Contractor Name Time Warner Cable Hub #7 US Petroleum Equipment Com~any Name Site Address Number and Street ime Warner Cable 490 Campbell Road 558 Carter Ct Number and Street ljJCity o Village o Town of: City, State, Zip Code 1001 W Kennedy Ave Oshkosh Kimberly WI 54136 City, State, Zip Code County Contact Person Customer 10#: Kimberly WI 54136 Winnebago Todd BroeckeJ Telephone Number Fax Number Fire Dept. Providing Fire Coverage FDID# Telephone Number Fax Number ( ) ( ) Oshkosh 7003 (920 ) 735-8287 (920 ) 739-0741 iii Install tank(s) 0 Install automated fueling device: o Install piping 0 Key control system o New install self service 0 Card control system o Revise a Ian 0 Code control s stem TANK SYSTEM OCCUPANCY: II; -+ Olf Vehicle Fueling:. D Attended 0 o Retail Fuel Sales 0 Bulk Plant Storage 0 Residential 0 Utility It! Backu Generator 0 Mercantile/Commercial 0 Industrial 0 Agricultural TANK CONSTRUCTION: II; -+ Tank Type: 0 Single wall ~ Double wall It! Bare Steel 0 Cathodically Protected & Coated Steel (Check one: A. 0 Galvanic or B. 0 Impressed Current) o Coated Steel 0 Fiberglass 0 Steel - Fiberglass Reinforced Plastic Composite o Lined - Date: 0 Other s ecl : TANK SPECIFICATIONS: (each tank) Itl Aboveground 0 Underground Manufacturer: Tank Listing: Dimensions: Capacity: On an UL 142 5.89'x3.34' 145 o System upgrade: o Spill protection o Overfill protection o Leak detection Unattended o Terminal Storage 0 School o Government 0 Other (s ecify): o Corrosion system upgrade: o Line tanks o Impressed current o Galvanic o Tribal Nation Burial depth: Contents: Diesel WI RegUlated Object No. (if applicable): Overfill Protection: III Yes 0 No Make/Model: visual oauoe Spill Containment: III Yes 0 No Make/Model: oauoe adi to fill Tank leak detection method: Automatic tank gauging Vapor monitoring 0 Groundwater monitoring (Primary method) 0 Inventory control and tightness testing iii Interstitial monitoring 0 Aboveground / visual monitoring o Manual tank gauging (only for tanks of 1,000 gallons or less) 0 Statistical Inventory Reconciliation (SIR) PIPING CONSTRUCTION: II; -+ 0 Underground III Aboveground Pipe Type: ~ Single wall 0 Double wall OBare Steel 0 Cathodically Protected & Coated Steel - Check one: 0 Galvanic or B. 0 Impressed Current o Coated Steel 0 Fiber lass ~ Flexible. . S & R lines Piping System Type: 0 Pressurized piping with - A. 0 auto shutoff; B. 0 alarm or C. 0 flow restrictor iii Suctio " . k 0 Suction i ing with check valve at um and ins ectable Make/Model: Piping leak detection method: used if pressurized or check valve at tank: 0 Vapor monitoring 0 Interstitial monitoring o Groundwater monitorin 0 Tightness testin 0 Electronic line monitor Itl Not re uired Vapor Recovery: OStage I CARB#: 0 Stage II CARB#: Stage II Operational: 0 Yes 0 No o Fiber lass 0 Flexible 0 Other s eei Aggregate Tank CapaCity: 145 gallons Number of tanks: Fee: (Fee table on reverse side) Plan Examination Install Inspection Subtotal a) TanklPipe System Installation $ 60 (7636) $ 100 (8253) $ 160.00 b) Addition OR Upgrade for corrosion protection $ (7636) $ (8253) $ c) Conversion to Key - Card - Code - pas For conversion of existing only: Submit ERS-6294 pas form to LPO. Submittal fees listed on form. d) Addition OR Upgrade for leak detection For add/upgrade of existing only: Submit ERS-9 LD POS form to Commerce. Submittal fees listed on form. e) Interior Lining ofTanks $ (7636) $ (8253) $ f) Addition OR Upgrade of Stage II Vapor Recovery $ (7636) $ (8253) $ g) REVISION Previous Approved Plan #________ $ (7636) $ h) GROUNDWATER SURCHARGE $100 (WI Stat. 101.14(5)) (Required for items: a, b, e and f) $ (7637) TOTAL FEE: $ 160.00 I certify by signature that provisions of the current Flammable and Combustible Liquids Code, 40 < ~~:~:Z'~ (ONR), 1m,' o"otn~':;/ ;;;; b, S19MW" ~ <ial, ERS-9 (R. 03107)