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37139
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
1YPE: BLDG I\1Q. HTG 0 ELEC 0 PLBG 0 SIGN 0 ZONING - FLOOD PLAIN- HEIGHT-
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OWNER
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DESIGNER
USE/NATURE OF WORK NGJ.J <';U'-'b\£ ~(Y\\\"~
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Size
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Sq.Ft. ¡he;[) #Rooms?-38Î(. #Stories ¿;;; Height t);;.?'
(h. r ~ Class of Const. g Occupancy Permit ~
BUILDING CONTRACTOR
Foundation
ERr::IIJfl? (œ /VIcm)
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
CUiV1M ,/1.16'5>
Electric Servo
New 0 Change 0 Temp 0
Type- Volts- Amps-
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
IA/IITr'EP3:
(0Iê ~I/I1 S' )
_BT
_WH
_Sh
_Disp
_DW
_WSoft
_DF
- CBasin
- San. Sewer
_Lav
_WC
_FDr
_SP
_Ur
- Storm Sewer
_Water
_Sink
Other
_LTub
_Eject
-SS
FEES: valuati~ ~
ISSUED BY
Permit Fee Paid $
Date
~7.SD
I :b!rf5
Park Dedication $ /<::::c>. a2..
Final/O.P. '31 YI ¡c¡;J
I '
SIGNATURE
In the performance ot this work I agree to perform all work pursuant to rules governing the described construction.
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/02-1-/5
DATE
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ADDRESS
TELEPHONE #
SIDEWALK EXISTING
NAME ~RIT)' .~~ INC..
LOT If BLOCK
SUeD I V. ff6J1flT óF LfJ/(E fisr IiJWJ<zONE
STREET NO. :&JIb ~D f).) LAe fP, LOT DIMENSIONS
YES 0 NO IgJ
1"1..1 (, ,19€f3
CATE
1;;< )31 93
ADDRESS
'..IARD
BUILDING GRADE ELEVATIONS STAKES SET AT SITE
BY ~rJ
FEE: $15.00
DE?ART¡'-'ENT OF ?USLIC '~CRKS
I, the unders i gned, owner or agent of the above descr ¡bed prOperf", agree to have the
grade esi"ab j i shed before excavat i on has commenced.
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WISCONSIN UNIFORM
BUILDING PERMIT
APPLICATION
Application No.
3'+\39
Wisconsin Department of Industry.
Labor and Human Relations
Safety and Buildings Division
P.O. Box 7969
Madison. WI 53707
Wisconsin Statutes 101.63, 101.73
Left
I'S"
ft.
Right
~
Parcel No.
(See instructions on back of pink copy)
D HVAC DElee D Plbg~ErOSion___g_Ot~~---
Mailing Addres; Telephone No. (include area code)
. 1/1/ e'SrH ez.i> sr.
1/4,
1/4, Section ,T
Lot No.
N, R E (or) W
Block No.
ft.
0 Other
0 R~~~~~:~::~~~~~~ or Panel Fuel
8 ~~~~;ump Space Htg 0
0 Central Air Conditioning Water Htg 0
0 Other * 0 Dwelling unit will have 3 kilowatt or
more installed electric space heating equip.
Infiltration control option is: 0 Full sealing
of joints. 0 Blower door test. OExterior
air infiltration barrier.
;~WÄMÄllììilOI¡M¡¡tI
Unfinished BasemenvO20sq. ft. ','!I)ji)mdïiìE5Þiblt?
Living Area /6:5l:>
Garage ~z..
01-Story
Sq. ft. ~-Story
Sq. ft. OOther
0 Seasonal
Ø'Permanent
0 Other
;,<"\k/i."""'"
Plus Basement
unicipal Utility
0 Private On-Site Well
The applicant agrees to comply with all applicable codes, statutes and ordinances and with the conditions of this permit; understands that the issuance of
the permit creates no legal liability, express or implied, on the Department Dr municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE
DATE SIGNED /2-,5-9.;'
Failure to comply may result in suspension or
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Name
+(QM. ~
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~
Total
$ 7b.~
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Date
Cert.ND.
SBD-5823{R0719.rtl~a>O - ;::-:;~U~Sd;;
YELLOW-DILHR
GREEN -Inspector
PINK-Owner/Agent
City Of Oshkosh 1/1/~5
PARKLAND DEDICATION FEE COLLECTION RECORD
Address ~6,;z::;;ub bLJ fA::.,
Owners Name 7)/J¡/£ ~ræ¡
Name of Subdivision ~ nF l.IJK£
Lot # L/ Bldg. Permit #
~
t(E5/ /Yl;<¡!I/(Jf
39 /39
I
Fee Required Jflm. ~
Fee Paid 1tJ[1J~ .~
Owner', ,i goo "re ~~ 'Daatte' ;:~;; 3
Inspector's signature ---------------------- - ------
( .
No. of Units
Parks Subdivision
Improvement
Accts. Rec.: 362-041
LD-r- 4 -
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ZONING'LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: ~lG '"F=<-'>D D.:> LAc... ~
PROPERTY OWNER/CONTRACTOR: ~\C....\'::i
ZONING
t/
t\:::/\},CS, , \ ~ '
,
CONSTRUCTION DATA:
'I- - New Construction
Addition
Alteration
TYPE OF CONSTRUCTION: (I.e, fence, pool, parking lot, sign, etc.)
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COMMENTS
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COMPLIANCE CHECKLIST
DEFICIENT
Use
Lot Width
Lot Area
Lot Area Per Family
Floodplain
Front Yard
Front Yard Side Street
Rear Yard
- Side Yards
----'- Building Area
- Parking Standards
- Off-Street Loading Standards
- Vision Clearance
Transitional Yard Standards
- Landscape Standards
- Height
- Conditions of Approval
- Compliance with P.C. or
BZA Conditions of Approval
Signage Standards
- Drainage Plan
~/VD fU-f^-
REVIEW AUTHORITY
As per Section 30-5 Enforcement of the City Zoning Ordinance, the Director of Community Development, or
designee, must approval all plans, except the following: (1) Alterations or interior work when the use is
conforming and when no change in use is proposed. (2) Maintenance items, e.g. siding, windows, etc.,
when the use is conforming and when no change is proposed.
V-------APPROVED
DENIED
Plan Commission Action Required
V"'""I') """,ired ~
REVIEWE/~ . i?-
DATE: lz(tf/f:ß
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OWNER..J)AIIE :>'n<e;j
DATE lôl}l)q~ PERHIT # '57/39
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USE ;JSF
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MASON CONTRACTOR
Width of lot-----
ZONE
DATE INSPECTIONS
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