HomeMy WebLinkAbout21909-Cross Connection Control (annual test) 12/27/2013 CITY OF OSHKOSH INSPECTION SERVICES DIVISION ROOM 205 �
215 CHURCH AVE DEPARTMENT OF COMMUNITY DEVELOPMENT �
PO Box 1130 CORRECTION NOTICE OSHKOSH
OSHKOSH WI 54903-1130 ON THE WATER
Issue Date 12/27/2013 Re Issue Date Complies No
Address 2351 STATE RD 44
Sent to ✓ Owner DAW BUILDINGS LLC 801 YORK ST MANITOWOC WI 54220 -4630
Required for Occupancy � Occupancy
Introduction The"Permit to Operate"for the cross connection control assembly or assemblies registered to this address has expired.
Item# 1 Code SPS 382.22(8)(b)1.c Complies No Comply By 01/26/2014 IMMEDIATELY
Description An anuual perfomance test shall be conducted for all cross connection control assemblies.
Summarv You are required to have your assembly or assemblies tested within the next 30 days by a certified Cross Connection Control
tester. The results must be submitted to the State and the local municipality. Failure to comply with these instructions will
result in further action up to disconnection of your water service.
Violations must be corrected and approved by the noted compliance dates of each item. Call for reinspections prior to concealment
and/or occupancy. Upon completing the corrections,the owner/contractor/agent must sign and date at the bottom of this notice
and return it to the Inspection Services Division by the Compliance Date of 1/26/2014
Office hours are Monday through Friday 7:30 a.m.-4:30 p.m. or by appointment.To schedule inspections please call the Inspection
Request lin at 2 6-5128 noting the address, permit number(when applicable),and the nature of what needs to be inspected.
Signature G2� Date �.��.27-/�
Inspected by: Jon Mueller 236-5049 jmueller@ci.oshkosh.wi.us
I hereby certify the violations listed on this report have been corrected in compliance with the applicable codes.
Print Name Company
Signature Date
Also Sent to: Bldg � _
Elec , ---- ---- - — -- -- _
HVAC --- — -- --- _
Plbg ; _
Designer � _
Other -
Inspector ,
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