HomeMy WebLinkAbout0005304-Building
@ CITY OF OSHKOSH N2
~ PERMIT - APPLICATION AND RECORD
~~P_E~ - _~L*~- ~~E~_~- ~~B~_~- ~I~~ -~ _~ON~N~- ~ _(~_F~~~D_~L~I~- ~~~I~~T~
05304
OWNER
~()S t:í p~
G-«-l~ J ~ C- h
PLAN NOt<~-~O -4'67è..
ADDRESS
DESIGNER
USE/NATURE OF WORK
,u~
Ì3;(p~ /
,
c~/ /J#
~""'f
BUILDING CONTRACTOR ¡()v..:> Þ\.. e.. r-
;:c :;\~ ~ + ({...M Stories 'p;.'(p",.l Height ,k-
Siz rr~ Sq. F\. - # Rooms - rèFc//
Foundation 'pQ.- ~ Ciass of Cons\. ~ Occupancy permit~
IJ~ A-"'_~
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
.
ELECTRIC CONTRACTOR t?<tU"A/\ ~
Electric Servo New 0 Change 0 Te 0
Type- Voits- Amps-
Fixtures
Switches
Receptacles
Circuits
PLUMSING CONTRACTOR
IA -n~
_BT
_WH
_Sh
_Disp
_OW
_WSoft
_OF
- CBasin
- San. Sewer
_Lav
_Sink
_Eject
_SS
- Storm Sewer
_Water
_WC
_FOr
_SP
_Ur
- LTub
Other
ISSUED BY
Park Dedication $ r(;).f)
Final/O.P. '1.1- ð' I?
In the performance of this work I agree to e rm all work pursuant to rules governing the described construction.
ADDRESS
2'766
úJJ2A~~~
(~
9'~//~7
DATE
;2.33-// jf /
TELEPHONE #
SIGNATURE
~£A,
AGENT/OWNER
.."
NAME GÆJ¿ ÆRTi k!U)l~/!J
LOT 4d bl.:2-
SUBDIV. 5 #~4.} cR£r:k ZONE
STREET NO. X' /8 f!¡¡:;vPJi>s Y LOT DIMENSIONS Ç;o
YES 0 NO Œt
DATE
ç"- 51
fr7
ADDRESS
BLOCK
!.IARD
)( /c/o
SIDEWALK EXISTING
BUILDING GRADE ELEVATIONS STAKES SET AT SITE
'1-1
,1991
B Y /:::.:Ä/
FEE:
$10.00
Þ--
G;', £~¿/
DEPARTMENT OF PUBL I C '/laRKS þ-" h?'
/,-, /5.
I, the unde~s i gned, o..ne~ o~ agent' of the above desç~ i bed p~ope~ty ag~ee to have the
g~" ~"";,"," ,.,,~ O>Q/"'o' "'r;;;? ".., . ~ é
0;1701 'Æ1JJ .
TZ8 - 40- J{lS7 R..
State of WI"on,ln
Depactment of Indu"'y.
Labol & Human Aelatlon,
D'y,,'on of Safety & Building,
Box 7969
Madl,on, WI 53707
W,.con,'n Stetu,", 101.63. 101.73
WISCONSIN UNIFORM
BUILDING PERMIT
APPLICA TION
APPLICATION NO.
d
(See InstructIon on back)
PARCEL NO.
~CTURE OHVAC
Ma;;lng Add,e"
t<.JC":::s'¡:'~.. r-
OELEC
OPLUMBING
",SECTION
'D
,T N, A, E(o'¡W
Lot No. Block No.
~L
Left Right
?
1'! î
0 Detached
Fuel
LP G.,
Nat. G.,
Fuel 011
Elect/lc
Wood
Sol.,
Coal
Othe,
S ace HI.
0
"8-
0
0
0
0
0
Wate, Ht .
~
0
0
0
0
0
Gatage
Sq. ft.
'Ii.1~
OP,;vate-on-slte Well
~unlclpal Ut;;lty
BTU!HR
BTU/HR
Ba"ments
~7
<f~ 7
'-(<:.fa
J:4: :tJ
$ -"{' .;:s- (J(;) 0
LIving A,ea
The applicant aglOes to comply with the WIsconsin Uniform DwellIng Code andothel Mundpal O,dlnances and with the condition, of thl, pelmlt; und",tand,
that the '"uance of the pelmlt mates no legal liab;;;ty, expres, 0' Implied, on the Dep.,tment 0' Munldpallty; and Celtlf;es that all the above Info,matlon Is
ŠIG~A TURE OF APPLICANT -Yæ.-
CONDITIONS OF APPROVAL
DATE
Thl, pelmlt " '"ued pu"uant to the followIng conditions. Fa;;ulO to comply may IOsult In suspension 0' IOvoca-
tlon of this pelmit 0' othel penalty.
OCOUNTY Municipality Number
Municipality Number of Dwelling
Location, if different
Plan Review. . $
Inspection. .$
WI,. Pelmlt Seall,) . . . $
Othel. . . . . . . . . . . $
TOTAL.. .. .. . $
DATE
'- <,,:s:- { .s:-..5:'
CERT. NO.
DILHR.sBD 58231R. 11/841 WHITE - '"ulng Jurl,d;ctlon
YELLOW- DILHR
GREEN - In,pecto,
PINK - Ownel/Agent
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address ~~çr:¡;?; II {" I>! 1/, " :5 '3 \/
Owners Name /:.... c (,-. ,... ,_.~{,,_. ""'7 i f'
l.-""", , !.-.,,-,:7CV:
Name of Subdivision ,,5.[,-, /,. L< ) (',,;-, (" <2 k
Lot *
¿_-,
Bldg. Pennit *
S3c/j
No. of Units
/
Fee Required
Fee Paid
/¿o
Owner's signcture
,I oê) .--""
~. íf). À
(t;,'-- K--:""./ Ii)
I/,I! V (', )
Inspector's signature U¿Yì,~:</\.LA.~A",
Ii
f
1 /1 -/.,..... t!-/'/ "::'-<:::'-"-7
/1,( ;Date-~"€~f~.:"::. //
1/ /1/ fA i /'Y7
.f/4!/7!' Date 1 !! V ,
.. ¡ I .
lí
Parks Subdivision
Improvement
Accts. Rec.: 362-041
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ZGIING/UND USE CO1<1PLIANCE CHECKLIST
I.
:: petmit # Zoning £ -/15 Confomin;¡'- Non-Confomin;¡'-
Job üxa.tion-ÆJ.$ . HeÞl f'(p.:s:5Y ID~ D.iIœnsion
I 7
Property Owner G-- (¿ .
a:NSTRœTICN DATA
Describe ~: 4 c<.-J
tot Area .
:)rt:;/è
&U (/1# C-ðr
:I
- NEW. a:NSTmX::rION
- ADDITICN-
- h:cessoJ:Y Building
- Fence
- Eoathcuse
- Utility StrlJctu:œ
- Other (specify)
- Pool
- Deck/Patio
- Sign
_Porch.
~ ALmOO'ICN
- $lliglë' Family.
- Twc-F~:(
- Hiïti..,.Pamily
-~~.
- ~Ufact~.
CDMPLIJ\NŒ æEX:!<S
CatÐlies Deficient
l"./"
.J::::
~
c../
v'"
I./""
~
(.../"
Use
IDt Width
tot Area
Floodplain .
Front Yard
Rear Yard
Side Yard (R)
Side Yard (L)
Parking
Building Area
Ict Area per Family
\.,./'
............-
-/11
Conler tot
Other (specify)
Deficiencv ICcmœnts
bflí d- :Úõ ~ r
REVIEW AU'ŒORITY
The Planning Director, or appropriate designee, .must approve all plans, except
the following: (1) Alterations or interior 'toOrk when the use is confotming am
when no change of use .is proposed. (2) Maintenance items, e;.g.;'~ windows:~ .
etc., when the use is ccnfoDning ana when roO c:han<;e of.'use is. p¡:cpo.s.ed.. .
Instances where \\,Un =:plies with the al:ove crite1::ia, t1i.e. p$:ml.t ~..l:i= revi.5'h'ed
by the Building Inspector without referral to the Plann.U1g Directbr.
~ APProVED
- Plan Comnission Action ReqUired
- Variance{s) Required
NOT APProvID
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