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Home My WebLink About Project Closed 10/19/07 Job Address 500 S OAKWOOD RD Building Permit Work Card Permit Number 0120273 Create Date 6/27/2006 Owner MERCY MEDICAL CENTER OSH INC --~.,---_.__..~-,._. Contractor CR MEYER Category 222:,Il,lt~~Cltl<l.l!t;ospJ!a~_~Jr:1~titutiof1~ ____ ____ Plan U1-63-0606 Occupany Permit 13E!9~J!:"~~___ Flood Plain No Height Permit 1':(ol.R~gu!r.Elcl Class of Const: 2A Use/Natu re :Oftlce7Suile115iTnTerIor-remodelas-per-f-fFSApprovaTProjec( it. 4567-6766 - gr;:lnted 6-n June 16:2666. of Work i i i i HV AC Contr I ________J Plumbing Contr Electric Contr Inspections: Date!()!~?~?9.91_ ______ Type ____________ Inspector Allyl!.l2.<ln_nJ1<l..!!.______________ ro'''pe",,,,,,,,,,,",,,,,. -FILED CLOSED- -- ---------.. ----. - --- --- -------- --l ,_____ ______-.J Notice Type: Ready Date/Time: ______.___ Phone Number: Page 1 of 1 Job Address 500 S OAKWOOD RD Building Permit Work Card Permit Number 0120127 Create Date 6/19/2006 Owner MERCY MEDICAL CENTER OSH INC Contractor CR MEYER Category 220 - Alteration Hospitals & Institutions Plan Occupany Permit Required Flood Plain Height Permit ________ Class of Const: ~ ____________ ___d____~______ __~__________________________u _ _________ Use/Nature effice / Suite 115/ Demolition in preparation for remodel. * No work to commence beyond demolition until required permit is of Work secured. i ---"-'\ i ! HV AC Contr , I i I _____J Plumbing Contr Electric Contr Inspections: Date Type Inspector r----------- I i Date/Time requested: Access: l==-___ Requested By: o Reinspect Fee 0 Fee Waived Notice Type: I _________________________________--1 Phone Number: o Reinspect Fee Paid ~ _ _ -. _ _ _ -- _ ~ _ -- ~ ~_.- -- _ _ -- -- -- -.-. _ -- _ ----- _ _ ----- _ ------ _ ------ _ --.- _ ------ _ -- --- ----- ------ _ -.-- _ ----- _ ----- - ----. ----- - ----- - ------ -- ~- - - ---- _.- --- - -. - ~ - ~ --- - - .--- - ----- - - ~ Page 1 of 1 l' DIVISION OF DISABILITY AND ELDER SERVICES Jim Doyle Governor SOUTHEASTERN REGIONAL OFFICE MILWAUKEE WI 53203-1606 Helene Nelson Secretary State of Wisconsin Department of Health and Family Services Telephone: 414-227-5000 FAX: 414-227-4139 dhfs.wisconsin.gov June 16, 2006 . Peter R. Lecompte C. R. Meyer and Sons Company 895 W. 20th Avenue Oshkosh, WI 54902 RE: Suite 115 Alteration Plans - Mercy Medical Center-MOB 1376 sq ft; B Occupancy, 2000 LSC New 500 S. Oakwood Road Oshkosh, WI 54904 HFS Project: 4567-6766 Dear Mr. Lecompte: Final alteration plans that were received in the Department of Health and Family Services on June 5, 2006 have been stamped CONDITIONALLY APPROVED on June 16, 2006. These plans were reviewed for conformance to the 2002 Wisconsin Commercial Building Code, Chapters Comm 61 - 65. The plans have NOT been reviewed for conformance to the Plumbing Code (Chapters Comm 81-87), the Elevator Code (Chapter Comm 18) and any other Commercial code not specifically mentioned. Additionally, these plans and specifications have been reviewed for compliance with the 2000 edition of the Life Safety Code NFPA 101 where it applies. 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. Approval of these construction plans does not constitute approval of the facility for a specific Medicaid reimbursement rate. For further assistance with billing rate questions, contact Russeli Pederson, Chief, Hospital Fee for Services Section, at (608) 266-1720. This conditional approval does not constitute a guarantee of endorsement that the plans and specifications are free of design defects or omission; 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 DepartmenW~~_f!1I'~d lED to a determination that the systems, as detailed in the submittal, adequately ft~E I V above-referenced code reqUIrements. Wisconsin.golt' JUN 2 1 2006 DEPARTMENT OF COMMUNITY DEVELOPMENT Peter Lecompte M~rcy-Oakwood Medical Center-MOB Suite 115, Oshkosh l- '~/ Tb-e, owner, as defined in Chapter 101.0l(10),Wi~consin statutes, is responsible for complitJlcewilliall coderequirement~,Tl1e 9'Wer shall notify the department and local offic.i~ls beforetakingp?ssession of the newly constructed building. The building will be insPeCted duntigandafter construction, at which time additional code implications can be identified by the~epartment. A written response to following items of conditional approval is required. 1. What is the occupant load in the Waiting 1lI405? COMM 61.31(2)(e) 2. What are the supply and return/exhaust air flow rates in the Chapel? COMM 61.3 1 (2)(e) 3. Is there a visual, or visual and audible alarm in the Waiting Room? Documents listed in DDE 2494, those that are applicable, shall be submitted to this office prior to the final inspection for this remodeling project. Copy ofthe DDE-2495 compliance statement submitted to the Department of Health and Family Services or letter of completion from the architect, engineer or designer. U~til such documentation is received and approved, no staff, or patient, or visitor is ~llowed in the remodeled area. ',.',., ,.., ',,-: __..:. ,..:."" ':,' ,-u;'s,:'-,>:~',_."':''-.\ /, ':f.6ur ~~ts.ofappfoved plans arere~~~it()you.. ....... 'i":('::'l,": If you have any further questions, please contact meat Ganesh Shrestha, P.E. Health Services Section Bureau of Quality Assurance cc: - City of Oshkosh Building Inspector, 215 Church Avenue Oshkosh, WI 54901 Tom Laabs, Project Coordinator Affinity Health System, 500 S. Oakwood Road, Oshkosh, WI 54904 2 H:\Data\shresgl\Hospitals\Mercy Med Ctr-ESRD, Oshkosh\Remodeling Plans-Suite 115 Appr June 16, 2006.doc June 29, 2006 Safety and Buildings 141 NW BARSTOW ST FL 4TH W' -'~'._"'-'- WAUKESHA WI 53188-3789 f I r'i) ~ ((~ ry.';::,fl ~jj;i:,,::, -,rmt,., :--!,' TOO #: (608) 2.64-8777 ", I 1 r-'~'::.:..l:~::..:::.....~ if:;" , ':,.'" .oommen,e.,",.,?,,',bI II ... L -""11 i I www.wlsconsln.gov llr1u JUL - :t 2006 'U l! J Jim Doyle, Governor I . I ~..J Ifnary P. Burke, Secretary CITY C'LER' l..,,:.I , _.K'S OFFl'''"''r.: --~~"""'.._""'""-....... \""-.- . _..............w.......---..~ .,- "./I commerce.wi.gov ~i!~!'c!!n CUST ID No. 916133 DAVID ODEGARD AFFILIATED ENGINEERS INC 5802 RESEARCH PARK BLVD PO BOX 44991 MADISON WI 53719 . ATTN: Plumbing Inspector MUNICIPAL CLERK CITY OF OSHKOSH PO BOX 1130 OSHKOSH WI 54903-1130 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: ,06/29/2008 SITE: Mercy Medical Center 500 S Oakwood Dr City of Oshkosh, 54904-7944 FOR: Facility: 664839 CANCER CENTER ADDITION AND REMODEL 500 S OAKWOOD DR OSHKOSH 54904 Identification NUIi:lbers Transaction ID No. 1280014 Site In No. 666890 Please refer to both identiIicafion numbers, above, in all carres 'ondence with the a enc . Object Type: Plumbing System, Building Specific Regulated Object ID No.: 1022514 Revision; Hospital, Nursing Home, or Ambulatory Surgical Center; Plan Type: Addition-Alteration; 2 Interior Fixtures Object Type: Cross Connection Control Device, Health Care Regulated Object ID No.: 1081346 Revision; Device is Serving: HUMIDIFIER; Device Type: Reduced Pressure Preventer; Location on Property: Room GK680 North Wall; Manufacturer: WATTS; Model: 909; 3/4" Valve Size Object Type: Cross Connection Control Device, Health Care Regulated Object ID No.: 1083925 Revision; Device is Serving: After cooler; Device Type: Reduced Pressure Preventer; Location on Property: Room GK680 North wall; Manufacturer: WATTS; Model: 909; 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 defmed 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: Key Items 1. _ 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 unde,r any circumstance. 2. RP, PVB, or SVB's shall not be by-passed. Except for repair, they shall not be made inoperative or removed without departmental approval. 3. It is the responsibility of the owner to make sure the device is tested and that the test report forms (SBD- 9927) is sent to the Safety and Buildings Divisiori 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. ... DAVID ODEGARD Page 2 6/29/2006 4. 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 of tags 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. All permits 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 component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, t V {J~i4/l~ Chet Kintop General Plumbing Plan Reviewer, Integrated Services (262) 548-8634, Fax: (262) 548-8614 , Monday - Friday 07:30 To 4:00 chet.kintop@wisconsin.gov Fee Required $ Fee Received $ Balance Due $ 250.00 250.00 0.00 cc: James E Zickert, Plumbing Consultant, (920) 948-7336 Gary Kusnierz, Affmity Health Systems Cherie Claussen, Hammel Green & Abrahamson Architects & Engineers Gary Kusnierz, Affinity Health Systems .J