HomeMy WebLinkAbout2007-Plumbing Plan Approval (conditional 1366511)
MAR 0 5 2007
Safety and Buildings
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February 19, 2007
CUST ID No. 2~Q431
ATTN.' Plumbing Inspector
JULIAN DOMINIAK
LUBENOW GOBSTER DOM1NIAK& ASSOC
. 5600 W BROWN DEER RD STE 205
MILWAUKEE WI 53223 .
MUNICIPAL CLERK
CITY OF OSHKOSH'
PO BOX 1130
OSfII{OSH WI 54903-1130
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 02/19/2009
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Transaction ID No. 1366511
Site IDNo. 714935
. SITE:
Renaissance Surgery Center of Oshkosh
2400 Witzel Ave
City of Oshkosh, 54904
FOR:
Object Type: Plumbing System, Building Specific Regulated Object ID No.: 1117738
Hospital, Nursing Home, or Ambulatory Surgical'Center; Plan Type:. New
Object Type: Cross Connection Control Device, Health Care RegUlated Object ID No.: 1117739
Device is Serving: MEDICAL WASTE PUMP. SAF- T PUMP; Device Type: Reduced Pressure Preventer; Location on
Property: RMA116 W WALL; Manufacturer: WATTS; Model: 009; V' Valve Size
. Object Type: Cross Connection Control Device, Health ~are Regulated Object ID No.: 1117740 .
Device is Serving: MEDICAL WASTE PUMP SAF- T PUMP; Device Type: Reduced Pressure Preventer; Location on
PropertY: RMA125 WEST WALL; Manufacturer: WATTS; Model: 009; 1" Valve Size
The submittal described aboye has been reviewed for colifon:Dance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The sub111ittalhas been CONDITIONALLY APPROVED.,The owner, as defined in
chapter.1 0 1.0 1 (1 0), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person:' mayeng~ge in or work at plumbIng in the state unless licensed to do so by the Department per
s.145.06, stats.
. The' follownig conditions shall be met during construction or installation and prior to occupancy or use:
Key Item(s) .
. Comm 82.40(3)( d)3. The installation of each RP, RP detector, PVB and SVB shall display a department
assigned identification number.
. _ The backflow preventer sPall 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.
. -RP, PVB, or SVB's shall not be by-passed. Except for repair, they shall not be made inoperative or removed
without departmental approval.
Also Address
JUUAN DOMINIAK.
Page 2
2/19/2007
.
- Iris the respOnstji~ ~~ sure ilie d-';ce is tested and that ilie 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.
- 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.
.
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. Allpermits
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 tIlls review
shall relieve the designer of the responsibility for designing a safe building, structure, or component
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead. .
snu, .
DamclL~\~
Plbg , Integrated Services "
(608)266-8075 , Monday-friday 7:00 AM-3:45 pm
dan.kraft@wisconsin.gov
Fee Required $
Fee Received $
Balance Due $
250.00
250:00
0.00
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cc: James E Zickert, Plumbing Consultant, (920) 948-7336
David JanSsen, Fox Valley Plastic Surgery Sc
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