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Home My WebLink About2012-Plumbing Plan Review (cross connection control) S�EYklIT:cit,, Safety and Buildings �� . PO BOX 7162 %-"'(\ S Imo) MADISON WI 53707-7162 y PS ,f \ __ 4j Contact Through Relay c•St NAB�'" \ O www.dsps.wi.gov/sb/ www.wisconsin.gov Scott Walker,Governor Dave Ross,Secretary December 21, 2012 CUST ID No. 1238337 ATTN: Plumbing Inspector DAVE RICHARDS MUNICIPAL CLERK GMS INC CITY OF OSHKOSH PO BOX 2264 PO BOX 1130 OSHKOSH WI 54903-2264 OSHKOSH WI 54903-1130 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 12/21/2014 Transaction ID No.2190490 SITE: Site ID No. 753519 Dermatology Associates Oshkosh Please refer to both identification numbers, above, in all correspondence 2351 State Rd 44 with the agency. City of Oshkosh Winnebago County SW1/4, SE1/4, S33, T18NN, R16E FOR: Facility: 702768 DERMATOLOGY ASSOCIATES OSHKOSH DAVE RICHARDS Page 2 12/21/2012 2351 STATE RD 44 Plan Type: Addition-Alteration; 1 Interior Fixture(s) Object Type: Cross Connection Control Device, Health Care Regulated Object ID No.: 1406258 Device is Serving: Lab Equipment; Device Type: Reduced Pressure Preventer; Location on Property: Under Lab Sink; Manufacturer:WATTS; Model: 009 OT; Serial No.:419633; 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) 1. SPS 382.41(5)(e)3.a. If an RP or RP Detector is located within a building, a drain or receptor shall be provided to receive the vent port discharge. If a floor drain is to receive the discharge from the vent ports of a reduced pressure principle backflow preventer or a reduced pressure detector backflow preventer, the flow or pathway of the discharge may not create a nuisance. 2. SPS 382.41(5)(f).This cross connection control assembly shall be installed in accordance with this paragraph. 3. SPS 384.10(2) Product Review and Approval. (a) 1. Each type of plumbing product which falls into one of the of the categories in Table 384.10 shall be approved by the department in accordance with this subsection before the product may be sold for use in a plumbing system or installed in a plumbing system. Health care plumbing appliances furnished for installation in this plumbing system shall have received prior department product review and approval and shall be installed by a properly licensed plumber. The owner of the facility and the representative responsible to purchase such equipment shall be made aware of this requirement. DAVE RICHARDS Page 3 12/21/2012 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 SPS 382.40(3)(d)3. Each device shall be tested and reported as per SPS 382.22(8). 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. If plan index sheets were submitted in lieu of additional full plan sets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. If these plans were submitted in an electronic form, the designer is responsible to download, print, and bind the plans along with our approval letter. A department electronic stamp and signature shall be on the plans which are used at the job site for construction. 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 $ 170.00 Fee Received $ 170.00 Balance Due $ 0.00 Timothy J Lamb Plumbing Plan Reviewer, Integrated Services WiSMART code: 7657 (608)266-9647, 07:00-03:30 M-f tim.lamb @wisconsin.gov cc: Gms Inc Dba Gartman Mechanical Services Thomas L Braun, Plumbing Consultant, (715) 340-5387, Mon. 7:45-4:30 Bryce Buntin, Dermatology Associates DAVE RICHARDS Page 4 12/21/2012 Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS"to recognize the relocation of the Division of Safety& Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services.Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366.