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Home My WebLink About2008-Plumbing (alterations to rm #A116)OSHKOSH ON THE WATER Job Address 2400 WITZEL AVE Contractor OGDEN PLUMBING Bathtub Whirlpool Lavatory Toilet Res. Sink Bar Sink Water Heater Site Drain Roof Drain Misc. Fixtures Use/Nature of Work Shower Floor Drain Lndry Tray Disposal Dishwasher Sump Pump Classrm Sink Breakrm Sink Ejector/Grind Valuation issued By CITY OF OSHKOSH PLUMBING PERMIT -APPLICATION AND RECORD Water Softner Local Waste Clothes Wshr Bidet Beer Tap Lab Sink Sterilizer Dip Well Drink Ftn Owner WITZEL LOT 2 LLC No 133603 Create Date 09/29/2008 Category 440 -Industrial-Interior Plan Coffee Maker _ Int Grease Trap Ext Grease Trap _ RPZ Valve 2 Eye Wash Statn 1 Wtr Sewer Mtrs Deduct Meters Wtr Usage Mtrs Wait. St. _ Ice Chest _ Exam Sink _ Sculry Sink Hand Sink 1 Plaster Sink 1 Surgeons Sink F Prep Sink Serv Sink Shamp Sink _ FIrIVVst Sink Catch Basin _ Wash Ftn Urinal Standp Rec Ice Maker Gar Drain . Soda Disp ~,i; a- Date 10/21 /2008 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 Date Address PO BOX 689 Agent/Owner NEENAH WI 54957 - 0689 Telephone Number 725-8985 ~ o scneaule mspectlons 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. $2,700.00 Plan Approval $0.00 Permit Fees $35.00 ^ Permit Voided ~~ti~ ~.r ~,~ Safety and Buildings i ~~ 2331 SAN LUIS PL STE 150 . ov commerce.w g - "--~ ~ ~ GREEN BAY WI 54304 i sco n s i n °C T 2 0 2008 Contact Through Relay v~nnrw.commerce.wi.gov/sb/ Department of Commerce aC~_ ft r-~:~~~,iVT CAF COiv6M -~ ' www.wisconsin.gov +11~1~ ; ~FVELOpMENT IN5Pi=z; ? Jim Doyle, Governor , - ~~ ` `{~~I~`=~ ~IVISIhN Richard J. Leinenkugel, Secretary October 15, 2008 CUST ID No. 654744 DEREK J ANDERSON OGDEN PLUMBING PO BOX 689 NEENAH WI 54957 ATTN.• Plumbing Inspector MUNICIPAL CLERK CITY OF OSHKOSH PO BOX 1130 OSHKOSH WI 54903-1130 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/15/2010 SITE: Renaissance Center 2400 W itzel Ave City of Oshkosh, 54904 FOR: Facility: 674203 RENAISSANCE CENTER 2400 WITZEL AVE OSHKOSH 54904 Identification Numbers Transaction ID No. 1594948 Site ID No. 714935 Please refer to both identification numbers, above, in all cones ondence with the a enc . Hospital, Nursing Home, or Ambulatory Surgical Center; .Plan Type: New; Sanitary Diameter: 5.00; 4 Interior Fixture(s); Water Diameter: 6.00 Object Type: Cross Connection Control Device, Health Care Regulated Object ID No.: 1203144 Device is Serving: Ultrasonic Cleaner; Device Type: Reduced Pressure Preventer; Location on Property: Utility Room A116 West Wall; Manufacturer: WILKINS; Model: 975XL; 3/4" Valve Size Object Type: Cross Connection Control Device, Health Care Regulated Object ID No.: 1203145 Device is Serving: Pre Processing Sink; Device Type: Reduced Pressure Preventer; Location on Property: Utility Room A116 West Wall; Manufacturer: WILKINS; Model: 975XL; 3/4" Valve Size Object Type: Interior Sanitary Drain & Vent System Regulated Object ID No.: 1203146 Object Type: Interior Water Distribution System Regulated Object ID No.: 1203147 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) -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 maybe 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. DEREKJANDERSON Also Address Page 2 10/ 15/2008 • - 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. Adepartment-listed Backflow Prevention Device Tester shall perform the test. A list of testers is available from the deparUnent 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. 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, ~~~~~ ~. Wesley C Grube Plumbing Plan Reviewer ,Integrated Services (920)492-5613 , M-r 7:00 - 16:30, F 7:00 - 11:00 Wesley. grube@wiscons in. goy Fee Required $ 350.00 Fee Received $ 350.00 Balance Due $ 0.00 WiSMART code: 7657 cc: J D Ogden Plumbing & Heating Inc Thomas L Braun, Plumbing Consultant, (715) 340-5387 ,Mon. 7:45-4:30 Renaissance Surgery