HomeMy WebLinkAboutServing Irrigation & Mop Sink (trans id #823478) /y0 d 5 -A / de/l ee ' 5 Safety and Buildings
2331 SAN LUIS PL STE 150
GREEN BAY WI 54304
TDD #: (608) 264 -8777
N:1r scons�n www.commercestate.wi.usisb
www.wisconsin.gov
Department of Commerce
James E. Doyle, Governor
January 10, 2003
CUST ID No.272034 ATTN :• Plumbing Inspector
JOHN CHIPMAN MUNICIPAL CLERK
CHIPMAN ADAMS LTD CITY OF OSHKOSH
1550 N NORTHWEST HIGHWAY PO BOX 1130
PARK RIDGE IL 60068 OSHKOSH WI 54903 -1130
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 01/10/2005 Identification Numbers
Transaction ID No. 823478
SITE Site ID No. 650296
Ihop Restaurant Please refer to both identification numbers,
Koeller St & Menard Dr Hwy 41 above, m all correspondence with the agency.
City of Oshkosh
Winnebago County
FOR:
Description: Serving Irrigation
Object Type: Cross Connection Control Device Regulated Object ID No.: 885943
Device Type: Pressure Vacuum Breaker; Location On Property: Mech Room; Manufacturer: Febco; Model: 715; Plan
Type: New; 1 -1/2" Valve Size
Description: Serving Mop Sink
Object Type: Cross Connection Control Device Regulated Object ID No.: 885944
Device Type: Pressure Vacuum Breaker; Location On Property: Hall #2 Rm 109; Manufacturer: American Standard;
Model: Internal; Plan Type: New; 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.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Key Item(s)
#1. Comm 82.40(3)(d)3. The installation of each RP, RP detector, PVB and SVB shall display a department
assigned identification number.
#2. Install assembly per Comm 82.41 (5).
Also Address
• - 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.
• - 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.
• - 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.
JOHN CHIPMAN Page 2 1/10/03
• - RP, PVB, or SVB's shall not be by- passed. Except for repair, they shall not be made inoperative or
removed without departmental approval.
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 $ 125.00
Fee Received $ 250.00
Refund Amt $ 125.00
Wesley C be
Plumbing Plan Reviewer , Integrated Services WiSMART code: 7657
(920)492 -5613 , M -R 7:00 - 16:30, F 7:00 - 11:00
wgrube@commerce.state.wi.us
cc: James E Zickert , Plumbing Consultant, (920) 948 -7336
Chipman Adams Ltd
Ihop Corporation