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Home My WebLink About0127711-Plumbing (RPZ valves) , . e CITY OF OSHKOSH No 127711 OSHKOSH PLUMBING PERMIT - APPLICATION AND RECORD ON THE WATER Job Address 500 S OAKWOOD RD Owner MERCY MEDICAL CENTER OSH INC Create Date 11/06/2007 Contractor BASSETT MECHANICAL Category 440 - Industrial-Interior Plan Coffee Maker Int Grease Trap Ext Grease Trap RPZ Valve Eye Wash Statn Wtr Sewer Mtrs Deduct Meters Wtr Usage Mtrs Bathtub Whirlpool Lavatory Toilet Res. Sink Bar Sink Water Heater Site Drain Roof Drain Misc. Fixtures Use/Nature Install RPZ valves in Decon Room 1E005 and site drain serving ultrasonic washer per State Plan Approval #'s 1464306 and 1477465. RP of Work valves shall be tested before being put into service. Check #221634 Valuation Issued By Shower Water Softner Wait. St. Shamp Sink Floor Drain Local Waste Ice Chest FlrlWst Sink Lndry Tray Clothes Wshr Exam Sink Catch Basin Disposal Bidet Sculry Sink Wash Ftn Dishwasher Beer Tap Hand Sink Urinal Sump Pump Lab Sink Plaster Sink Standp Rec Classrm Sink Sterilizer Surgeons Sink Ice Maker Breakrm Sink Dip Well F Prep Sink Gar Drain Ejector/Grind Drink Ftn Serv Sink Soda Disp 0 Size # Conn. Type 2 Material Type Parcelld # 0613660000 Date 11/07/2007 Sanitary Sewer Storm Sewer Water Service $2,200.00 $0.00 $25.00 0 Permit Voided I Plan Approval Permit Fees In the performance of this work, I agree to perform all work pursuant to rules governing the described construction. 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. Signature Address PO BOX 7000 Agent/Owner KAUKAUNA WI 54130 - 7000 Telephone Number 800-236-2502==920- Date To schedule inspections please call the Inspection Request line at 236-5128 noting the Address, Permit Number, Type of 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. City of Oshkosh Inspection Services Division POBox 1130 Oshkosh, VV154903-1130 Phone: (920) 236-5050 Fax: (920) 236-5084 RECEIVE~ NOV 062007 ~ DEPARTMENT OF ~KOJH COMMUNITY DEVELOPM ON THE WATER Plumbing Permit A~iWtOi1'ICES DIVISION I hereby apply for a permit to do and install the following plumbing on the premises hereinafter described, the work to conform to the VVisconsin State Plumbing Code, in the performance of which all parties hereto agree to and are bound by said statutes. . Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128, Oshkosh VVI 54903-1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the normal permit fee, which ever is greater. OR If vou are a contractor particivating in the Permit Fee Account Svstem and have adeauate funds. check here if vou want this processed throuf!h vour account n t ** Advisory - For applicable projects, an Electrical Installation Verification (EIV) form, signed by the Electrical Contractor or Homeowner (for installations allowed to be performed by the homeowner) must be submitted with the permit application. Applications submitted without an EIV when such is required, will not be processed for Permit Issuance and will be returned for completion. Job Address 500 S. Oakwood Ave. Value (Including labor and materials) $2,200.00 Date U/2/07 Owner Affinity Health DSingle Family DDuplex Contractor DMulti-Family Bassett Mechanical DRentalDCommercial @Industrial Number of Fixtures: Bathtub Disposal Drink Ftn Catch Basin Whirlpool Dishwasher Wait. St. Wash Ftn Lavatory Sump Pump Ice Chest Urinal Toilet Ejector/Grind Exam Sink Gar Drain Res. Sink Water Softner Sculry Sink Soda Disp Bar Sink Local Waste Hand Sink Coffee Maker Water Heater Clothes Wshr F Prep Sink Comm. Ice Maker o Gas 0 Elect C PwrVnt Bidet Serv Sink Site Drain / Shower Beer Tap Int Grease Trap Roof Drain Floor Drain Classrm Sink Ext Grease Trap Standp Rec Lndry Tray Surgeons Sink R.P.Z. Valve 2 Eye Wash Stn Lab Sink Breakrm Sink Shamp Sink Wtr Sewer Mtrs Plaster Sink Dip Well Flr/Wst Sink Deduct Meters Sterilizer Hose Bibs Wtr Usage Mtrs Misc. Fixtures ;-.<,....-., Electric Contractor (for projects not requiring an EIV Form) Use / Nature of Work Size Material Type # Conn. Type Sanitary Sewer Storm Sewer VVater Service 07/07 ~1 ..), commerce.wi.gov ~i!~gn!J!! I Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov OCT 09 2007 DEPARTMENT OF COMf.TUI~ITY Dc'vcLuPlvitl\l1 INSPECITON SERVICES DIVISION Jim Doyle, Governor Mary P. Burke, Secretary October 04, 2007 CUST ID No. 904420 THOMAS EVERS BASSETT MECHANICAL 1215 HYLAND AVENUE PO BOX 7000 KAUKAUNA WI 54130 ATTN: Plumbing Inspector MUNICIPAL CLERK CITY OF OSHKOSH PO BOX 1130 OSHKOSH WI 54903-1130 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/04/2009 Identification Numbers . Transaction ID No. 1464306 Site ill No. 666890 Pl~ase refer. to h()th.i~el1tification .numbers1 aboye,in, li1l90rres ondellce whh the a . enc .. SITE: Mercy Medical Center 500 S Oakwood Dr City of Oshkosh, 54904-7944 ; Fire Dept ID: 7005 FOR: Facility: 644431 MERCY MEDICAL CENTER 500 S OAKWOOD DR OSHKOSH 54904 Tenant Name or Addn/Alt Description: Ultrasonic Washer from West Wall to East WallPlan Type: Addition-Alteration; Sanitary Diameter DFU: 3; 2 Interior Fixture(s); Water Diameter GPM: 3 Object Type: Interior Sanitary Drain & Vent System Regulated Object ID No.: 1152106 Object Type: Interior Water Distribution System Regulated Object ID No.: 1152107 . 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: . All notes and spec's listed on the plans. 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. .~.~. Page 2 THOMAS EVERS Sincerely, Fee Required $ Fee Received $ Balance Due $ Jt~~/yr~ Herman J Delfosse Plumbing Plan Reviewer 2 , Integrated Services (715)524-3630, Mon -thur 6:45 - 4:30 Fri 6:45-10:45 herman.delfosse@wisconsin.gov cc: James E Zickert, Plumbing Consultant, (920) 948-7336 Lisa Ebben, Bassett Mechanical Bassett Mechanical Gary Kusnierz, Affinity Health Systems 10/4/2007 80.00 80.00 0.00 .. j commerce.wi.gov ~i~.E.9n!!Q Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary November 01,2007 CUST ID No. 227294 THOMAS SCOTT EVERS BASSETT MECHANICAL 1215 HIGHLAND AVE PO BOX 7000 KAUKAUNA WI 54130-7000 ATTN: Plumbing Inspector MUNlCIP AL CLERK CITY OF OSHKOSH PO BOX 1130 OSHKOSH WI 54903-1130 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/01/2009 SITE: Mercy Medical Center 500 S Oakwood Dr City of Oshkosh, 54904-7944 ; Fire Dept ID: 7005 FOR: Facility: 644431 MERCY MEDICAL CENTER 500 S OAKWOOD DR OSHKOSH 54904 Plan Type: New REC NOV 0 5 2007 DEPARTMeNT OF . COMMUNITY DEVELOPMENT INSPECTION SERVICES DIVISION Object Type: Cross Connection Control Device, Health Care Regulated Object ID No.: 1158725 Device is Serving: PASS THROUGH WASHER NORTH; Device Type: Reduced Pressure Preventer; Location on Property: DECONTAMINATION lE005; Manufacturer: WATTS; Model: 009SS; 1/2" Valve Size Objec~ Type: Cross Connection Control Device, Health Care Regulated Object ill No.: 1158726 Device is Serving: PASS THROUGH WASHER SOUTH; Device Type: Reduced Pressure Preventer; Location on Property: DECONTAMINATION 1E005; Manufacturer: WATTS; Model: 009SS; 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: Key Item(s) . Comm 82.40(3)( d)3. The installation of eachRP, RP detector, PVB and SVB shall display a department assigned identification number. . - 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 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. . - 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 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. .r THOMAS SCOTT EVERS Page 2 111112007 . _ 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. 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, Fee Required $ Fee Received $ Balance Due $ 250.00 250.00 0.00 .~/P~ Herman J Delfosse Plumbing Plan Reviewer 2 , Integrated Services (715)524-3630, Mon -thur 6:45 - 4:30 Fri 6:45-10:45 herman.delfosse@wisconsin.gov cc: James E Zickert, Plumbing Consultant, (920) 948-7336 Thomas Laabs, Mercy Medical Center