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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
23231
':
BLDG ~ HTG D ELEC D PLBG D SIGN D ZONING r< -I FLOOD PLAIN
HEIGHT
TYPE:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
'::N::S p1~ ~
USE/NATURE OF WORK /1..lAA..J J/;e M~
t:
PLAN NO, G'f137tJ5-"/~
~
DESIGNER
BUILDING CONTRACTOR #' ~ M 13 ~~
~ '. ~-
Size 2-(p ^ lfq Sq. Ft. 1/4V # Rooms ~ (15d
Foundation ~ Class of Const,
# Stories &: Height ;;lo I
P Occupancy Permit ~
HEATING CONTRACTOR
~4
Heat D NC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR >~
Electric Servo New D Change D Temp D
Type_ Volts_ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR ~4
_BT _WH _Disp
_WC
_FOr
_ L Tub
_Ur
_ CBasin
-----c San. Sewer
_ Storm Sewer
_Lav
_Sh
_OW
_SP
_ WSoft
_OF
_Sink
Other
_ Eject
_SS
_ Water
Permit Fee Paid $
Date
. ,..-
/'is.oo
.~/flql
.
Park Dedication $ / tJO.O 0
,
Final/O.P. 8 -.8 . 9 )
ISSUED BY
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ~ ~~
ADDRESS
DATE
TELEPHONE #
Revised: 8/89
ZONING/LAND USE COMPLIANCE CHECKLIST
JO~ LOCATION: IPtJ'('~4' c4r3f yt1dd~~ 12-1
PROPERTY OWNE~iAC~ ~~ ~~
CONSTRUCTION DATA: h CONSTRUCTICN _ADDITION
" ...
ALTERATION
PARKING LOT
TYPE OF PROPOSEQ CONSTRUCTION: (i.e. fence. pool, sign. deck, etc.)
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{
. COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (fnxttyard)
Rear Yard
Side Yard (R)
Side Yard (L)
Parking Spaces
Building Area
Lot Area Per Family
Corner Lot
Landscaping
Transitional Yard
Off-Street Loading
Vision Clearance
Height
REVIEW AUTHORlTY:~V-- -- ~f(;() ~^--- .,
The Director of Community Development. or detlgnee~ ~st a~prove all plans. except the
following: (1) Alterations or interior work when the use is conforming and when no change
in use is proposed. (2) t4aintenance items.. e.g. siding. windows. etc., when the use is
conforming and when no change is proposed.
Instances where work complies with the above criteria, the permit can be reviewed by the
Building Inspector without ref~rral to the Director of Community Development, or designee.
t-- APPROVED
Plan Commission Action Required
Variance(s) Required
REVIEWED ~~
DEFICIENCY/COMMENTS
DENIED
DATE: ., /8/W
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State of Wisconsin
Department of Industry,
Labor & Human Relations
Division of Safety & Buildings
Box 7969
Madison, WI 53707
Wisconsin Statutes 101. 63,101.73
G~!)7 &S7//G-
WISCONSIN UNIFORM
BUILDING PERMIT
APPLICATION
(See Instructions on back of Dink cODVJ
.:
APPLICATION NO.::2 3~3 /
PARCEL NO.
..........................
...........................
.... ..........................
:III.M,..,:,..,... ,1.:11111..:::: ~CONSTRUCTION D HVAC
::::;:::;:::::::::::;:;::.:............:::::::. ::;:;:;::::':::::: ::: :.: ... : "'::::::::':':';';";";';':':':.. .. jlS.j I
oW7:;;. ;6~ 2- (77IiJ:;:dre:;B,
Contractor's Name Mailing Address
D ELEC D
AZ~U
, I
PLUMBING D OTHER:
Telephone S r-.> --::> 'f'l.-::>
'-fUr-~92Y
Telephone
Setbacks ft.
1~$.t..t$lCIII: :${avAt:.:~j.l]PJlIO;.
Entrance Panel ~. Forced Air Furnace
Size: ::>&0 amp g Radiant Baseboard or Panel
Service: 0 Heat Pump
[ZUnderground 0 Boiler
o Overhead 0 Central Air Conditioning
:4~;QImFalI~:f;9QI.IIIQ"r:: 0 Other
~. Site constructed ~ Concrete1Q~:etiPMI.I.G.'
::lrrIRg]RVI'dl~r~){ ......... 0 Manufactured g Masonry Sewer
Unfinished Basement/IV.'! Sq.H~..:$r:$(r:OI.E$"} B ~~:~ed Wood fS ~eU~\~iPal
LI.vl.ngArea / I if U Sq. ft. 0021-_SSttoOryry ...0.JlsUe)a;...s'ofnfa1If::tIr: Permit No.
-- - L:l:1%"W'Al'U)}': .. HHH
'/Rl/ Sq. ft. 0 O.tJJ,t .'e~. ~'OPethremranent I ~ Municipal Utili~~HHHHH
(2~ 0 0 Private on-site Well
o Plus basement
'~~'~$~!!I~!GI~!!:I: Lot Area
BUlt~A?e(j;/~A~ T/J/'-
Zoning ~~) Zoning Permit No.
i;PAOJS01fH H.....' ..:.. :~~.O#.i.UPi.Qi.Y}:
A2!'New 0 Repair IirSingle Family
blAlteration 0 Raze 1] Two family
o Addition 0 Move 0 Garage
o Other
Sq. ft.
y.., y.., SECTION
SUbjlivisi~~a,eAl ./ P? / /" /
~~ dA/He,~/bMA
Front Rear
,T
Lot No.
3Y
N,R
Block No.
Elor)W
Left
Right
o Other
~ ~ ~
'" " .. ....... "'UU$..$..~Y$OUI.t:.$....>
Fuel Nat. L.P. Oil Elec. Solid Solar
Gas *
Space Htg. ~ 0 D D 0 D
Water Htg. B.. 0 D D 0 0
* 0 Dwelling unit will have 3 kilowatt or
,....,........,.............., more installed electric space heating equip.
.:m:::m:m:: Infiltration control option is: 0 Full sealing
of joints. 0 Blower door test. 0 Exterior
air infiltration barrier.
Garage
ja;:H'4T-CO$$Np'~j~~l~i~ij}
Envelope "3 0700. ~~BTU/HR
."S Infiltration It( OOZ BTU/HR
j,;::gTl.Qg,~gJ.:II$T:)
50>~ ~O
$
The applicant agrees to comply with all applicable codes, statutes and ordinances and with the conditions of this permit; understands that the issuance of the
permit creates no legal liability, express or implied, on the Depart"'~ or M ~i~; and certifies that all the above information is accurate.
SIGNATURE OF APPLICANT ~......./ ':!#"!; ~ '~. DATE
CONDITIONS OF APPROVAL This p~mit is issued pursuant t0~e following conditions. Failure to comply may result in suspension or
/? . revoc~n of this permi!..or othef~alty. J ...
Y. A ~?'...t,l ......-~ /'lfl_A~ //7I)./..J/l:; ~ 1'.-" A '7//./ /~...
C / .AI' ~ , Jf' _ · n.../ ..// /J ~ A ..
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V
Plan Review
o TOWN 0 VILLAGE !if CITY 0 COUNTY Municipality Number of
..... O~;:AT~JJ~;N~~~ Ins2ta~uZ:it~ b
,...... PERMrrnSl"....... __.. 'UH""ORU' .PERMIT ",'.", ,.", "'" "'H '" HH' '.H'" ,.", ,.'" '.'" ,.', .'"" "'" "'" "'" "'" ""'" """" ""
..t$$U~6~:::r'.:.Hbi:.......,....,:~~~~1!~~~!p:ByEr:'}',y",..'.'"
$ Lf6.ao ~ ~~~~ruction /J~_., -/ 1//h ~ ~.
$ ~ 0 Electrical 97 L:) ~ NAME II ~/ jJ /C I v-'
$.../10 0 0 0 Plumbing ..:J..J DATE V ":;> I (J /-..y ~.'
$ 0 Other ~S~O
$ 70.00 CERT. NO.
Municipality Number of Dwelling
Location, if different
!.!.~I"~~Qii.i:.....:.....
Inspection
Wis. Permit Seal
Other
TOTAL
SBD 5823 (R 8/90). II WKlJE -Issuing Jurisdiction
'-t' 10 ) 00 0 ,Oc/
YELLOW - DILHR
GREEN -Inspector
PINK - Owner/Agent
City of Oshkosh 1/1/85
~ r~;
~,
PARKLAND DEDI CATION FEE COLLECTION. RECORD
Address Ii'o S- ~ //Yl-
Owners Name g <f);??~
\
Name of Subdivision I~ad/ ~~bk .;:~
Lot # 3 S" B1 dg. Permi t # ...2. "3 "'2-"3 I
Fee Required
I
la-o .00
/00
Date
5'/9 /9/
,
No. of Units
Fee Paid
Owner's signature
Inspector's signature
Date
Parks Subdivision
Improvement
Accts. Rec.: 362-041
~...
/
..
DATE
~ d' /9/
"
,
NAME #'>>1'" L!>~
~~
sueDI".' /pftf4;Lr:l ~~~
,
STREET NO. / 80 ~ OuAa<..t/ /.~
ADDRESS
LOT
a LaC K
~'l ARD
ZONE
SIDEWALK ~XISTING
YES
LOT DiMENSIONS
o NO~
sll6
BUILDING GRADE ELEVATIONS STAKES SET AT SITE
,I9Y \
BY K~
FEE:~
1$;.08
G,x~
OEPARH1ENT OF PUBLiC WORKS
/::./S~
i, the undersigned, owner or agent or the above described property agree TO have tne
grade estabi ished before excavation has commenced.
OOSl324
43C~~
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PERMIT #
ADDRESS I <fa s (i1 d aAAI' dr-
USE , h~ .[' .r;Je
Wc~k consists of
,
OWNER.
DATE
GENERAL CONTRACTO R
MASON CONTRACTOR
Width of lot
ZONE
DATE
INSPECTIONS
REMARKS
41
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41
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.MAI'Ll~ ADDReSS
F rent of lot