HomeMy WebLinkAbout2007-Plumbing Plan Approval (conditional 1424752)
...../1 commerce.wi.gov
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Safety and Buildings
PO BOX 7162
MADISON WI 53707-7162
TOO #: (608) 264-8777
www.commerce.wi.gov/sb/
www.wisconsin.gov
Jim Doyle,. Governor .
Mary P. Burke, Secretary
August 07, 2007
CUST ill No. 269431
ATTN: Plumbing Inspector
JULIAN DOMINIAK
LUBENOW GOBSTER DOMINIAK & ASSOC
5600 W BROWN DEER RD STE 205 .
MILWAUKEE WI 53223
MUNICIPAL CLERK
CITY OF OSHKOSH
PO BOX 1130
OSHKOSH WI 54903-1130
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/07/2009
SITE:
Renaissance Surgery Center of Oshkosh
2400 Witzel Ave
City of Oshkosh, 54904
FOR:
Facility: 674203 RENAISSANCE SURGERY CENTER OF OSHKOSH
2400 WITZEL AVE
OSHKOSH 54904
Plan Type: New; 2 Interior Fixture(s)
AUG 0 9 2007
DEPARTfVlENTOF
COMMUNITY DEVELOPMENT
INSPECTION SERVICES DIVISION
Object Type: Cross Connection Control Device, Health Care (Tag #) > Regulated Object ill No.: 1144511
Device is Serving: STERILIZER; .'
Device Type: Reduced Pressure Preventer;
Location on Property: RM A123 E WALL N END;
Manufacturer: WATTS; Model: 009; 1-1/2" Valve Size
Object Type: Cross Connection Control Device, Health Care (Tag #) > Regulated Object ill No.: 1144512
Device is Serving: STERILIZER;
Device Type: Reduced Pressure Preventer;
Location on Property:RM A123E WALL N END;
Manufacturer: WATTS; Model: 009; 1/2" Valve Size
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 defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per
s.145.06, stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
.
ThecrosscoI1I!.ection control assemblies indicated in the above. Description box have been registered with the
Department.. Each device shall be tagged by the installing plumber as per Comm 82.40(3)(d) 3. Each
. device shall be tested and reported as per Corom 82.21(3). Contact Material Orders at 608-266-2780 for a
supply of tags.
(over) .