HomeMy WebLinkAbout0108568-BuildingOSHKOSH
ON THE WATER
GRADE STAKE FORM
Grade Stake Number 7160
Name RUSCH HOMESLLC
Address 1216 FAIRFAX ST
Create Date 05/25/2004
Lot 22 Block Ward
Subdivision 1st Add to Pheasant Creek
Zone
Street Number Lot Dimensions L_J Sidewalk Existing
Building Grade Elevation Stakes Set At Site 05/25/2004 SetBy D.W.G. BK-596, P-61
Department of Public Works
I, the undersigned, owner or agent of the above described property agree to have the~Cblis~d before excavation
has commenced.
Wisconsin Department of Industry,
Labor and Human Relations
Safety and Buildings Division
P.O. Box 2509 .
Madison, WI 53701-2509
Wisconsth Statues 101.63, 101.73
WISCONSIN UNIFORM Application No.
BUILDING PERMIT 0108558
APPLICATION Parca~ No.
[] Constr [] HVAC [] Elec [] Plbg [] Erosion [] Other:
Mailing Address
P O BOX 423 OMRO WI 54963 - 0000
LicTCert # Mailing Address
000000 P O BOX 423 Omro WI 54963 - 0
RUSCH HOMES LLC
Contractor:"~ Con[~
RUSCH HOMES LLC
Contractor:
CUMINGS ELECTRIC INC
Contractor:
Contractor:[] Con
HANSON QUALITY PLUMBING
Building Address
1216 FAIRFAX ST
Lot Area
Lic/Cert # Mailing Address
170792 PO BOX749 NEENAH WI 54957 - 749
Lic/Cert # Mailing Address
3202 PO BOX 184 RIPON WI 54971
Mailing Address
APPLETON WI 54914
1/4, 1/4,Section ,T
Subdivision Name Lot No.
1st Add to Pheasant Creek 22
Telephone No.
!Telephone No.
685-0241
Telephone No.
920-722-1240
Telephone No.
- 184 920-748-5050
Telephone No.
- 0 730-0205
N,R E(or)W
Block No.
Zoning Permit No.
Front Rear Left Right
Alteration [] Raze
Addition
Unfinished
Basement
Living Area
Garage
The applicant agrees to corr
the permit creates no legal liability,
APPLICANT'S SIGNATURE
$180,000.00
conditions of this permit, understands that the issuance of
; and certifies that all the above information is accurate.
DATE SIGNED
This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
APPROVAL CONDITIONS
revocation of this permit or other penalty
see standard conditions of approval
Town [] Village [] City [] County LJ state of: Municipality Number of Dwelling Location:
CityOf Oshkosh 7 0 2 6 6
Plan Review $150.00 Construction
HVAC Name Nicole Krahn
Inspection Electrical
Wis. Permit Seal $30.00 Plumbing Date 5/25/04
Other Erosion
Total $180.00 306892 Cert. No. 248101
SBD-5823 (R. 07/92)
OSHKOSH =
ON THE WATER
Job Address 1216 FAIRFAX ST
Name RUSCH HOMES LLC
Address P O BOX 423
Subdivision 1st Add to Pheasant Creek
Building Permit Number 0108568
Number of Dwelling Units 1
Fee Required $200.0f~¢~ ~
Owner's Signature
Inspector's Signature
PARKLAND DEDICATION FEE COLLECTION RECORD
Date 06108/2004
OMRO WI 54963
Lot 22
Number of Structures
Fee Paid
Date
Date
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oo' . s~.Ts' ~ ~.~
85.00' 85.00' 85.0
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