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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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NJ' 39938
1\J
TYPE: BLDG~TG 0 ELEC 0 PLBG 0 SIGN 0 ZONING /L f FLOOD PLAIN ~HEIGHT ;U/JI..
- . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ADDRESS
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PLAN No)>~~5J7~?~
OWNER
DESIGNER
USE/NATURE OF WORK ~ P-L.J -' S ~ tc-.
BUILDING CONTRACTOR . t:tCA.>-l"\.-f:?. f- . tj.
, ~~- a q..::Jc'u.tt!'#'L J J ( I)
SiZ;}rj-('-:! Sq. Ft.> 'U){) -:t..lcl'~.!i # Rooms /0 -fJ!7d!""1'\. # Stories G1 ~X Height
Foundation 71 z.. c;....4r-A.j 1'" Class of Const. Occupancy Permit
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HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New 0 Change 0 Temp 0
Type
Volts
Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF _ San. Sewer
_WC _FOr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
ISSUED BY
~20 ,
~II.J{ /9.y
Park Dedication $ / G/V
Final/O.P.
Date
SIGNATUR~
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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ADDRESS
TELEPHONE #
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ZONING/LAND USE COMPLIANCE CHECKLIST
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JOB LOCATION:
PROPERTY OWNER/CONTRACTOR:
ZONING
,
IL
.
CONSTRUCTION DATA:
y. '" New Construction
Addition
Alteration
TYPE OF CONSTRUCTION: (i.e. fence, pool, parking lot, sign, etc.)
NeD ~\NblJC FN'^\\...~ }
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.
~PPROVED
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
Sign age Standards
Drainage Plan
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COMMENTS
_~fa> ~r
DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWEDBY:~~~
/ .
DATE: t/;O/rv
, I I
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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
WISCONSIN UNIFORM
BUILDING PERMIT
APPLICATION
(See instructions on back of pink copy)
~VAC ~Iec B'Plbg ~osion
Application No.
I
Parcel No.
..........................................................,............
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o Other:
................................
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~Sdd ess
Zoning District(s}
1/4,
1/4, Section
Lot No. q
T
N, R E (or) W
Block No.
ew
o Alteration
o Addition
Leh
23ft. d h.
:12%:'ENElt'Mi:!oUla:m::::m:r::m::::rrm:t::mt
Nat. L. P. Oil Elec. Solid Solar
Gas *
Right
Fuel
Space Htg 0 0 0 0 0
Water Htg 0 0 0 0 0 0
; NSl1/1WPlt: * 0 Dwelling unit will have 3 kilowatt or
ite Constructed M~Q~I:piHjMmNtt::::::::':::':I::%:::::it ~~~:r~f~~I~~dn~~~f~~~~~~~: ~~~~~eeai~~~.
:'!'{!<<R!A:'INMOtveb))))):{'''' 0 Manufactured. 0 Masonry H~;HHHHHHHH HH.HHHHHHHH ~t/~~~:rafilo~I~:~re~oor test 0 Exterior
.'.UGLi":a:rna':giSe::'/~a~IZ2-mi:,Z~s:q:.:h:' i::Ot:h::GO:e!,-,;./l.,es.n.:::,:::tl%lllillli, I,~DU. t~ ~ourett,ehrh~m:e.~;;dn':e;nit:mm 0 ~~:~r:~ i::~~B!mI~;~i
~Vl ~er iM@':li,\t*-]~({::ffff:::::::::m:fm:fjjf Infiltration/(p 70 {;) BTU/HR
unicipa I Utility j.4~::e.$1~:i:OttmNG:::~Q$lt'::,::::;: .;,<,.,;.:,:.
o Plus Basement o Private On-Site Well $ '70 ooJ
The applicant agrees to comply with all applicable codes, st.atutes'a~dordinances and with the cl)nditionsof this permit; understands that the issuance of
the permit creates no legal liability, express or implied, on t Department or municipality; and certifies that alfthe above.information is ccurate,
o Other
APPLICANT'S SIGNATURE
APPROVAL CONDITIONS
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This permit is issued pursuantto the follovvi~gc~~ditib~s,
revocation of this permit or other penalty.
DATE SIGNED
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o Town
o Village .y 0 County 0 State of:
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Municipality Number of Dwelling Location:
Date
PINK- Owner/Agent E
Plan Review
Inspection
WIS. Permit Seal
Other
~()
~struction
o HVAC
o Electrical
o Plumbing
o Erosion
o
Name
Total
$
70
/4Z-04?Y
Cert. No.
SBD-5823 (R 07192)
WHITE -Issuing Jucrisdicti6n'
VEU:,OW: DICHR .
GREEN: inspectoT
'O,tJt!:>b
City Of Oshkosh 1/1/85
..
PARKLAND DEDICATION FEE COLLECTION RECORD
Address :so.r~- f4-,h-:s M-~ -e
Owners Name J2u sd ~~S {
Name of Subdivision Pit e.ec..S.Q.#J- Cf-ee l.
Lot # 9 Bldg. Permit # 'J<?9J8
No. of Units /
Fee Required /00
Fee Paid /00
Inspector's signature
Owner's signature Date
Date
Parks Subdivision
Improvement
Accts. Rec.: 362-041
NAME_'t?U'Se\-\. ~~~-qq-.J
LOT Yi q
SUSDI V ..3t\E~SA.J..S\: c.\C~
STREET NO. 305"::;- t\0~ Rt
DATE
bhs \ G4
ADDRESS
8 Lce K
'.'IARD
ZONE
SIDEWALK EXISTING
YES
LOT DIMENSIONS
D NO~
) II
~ -<8, , 19 q 4 i
8UILDING GRADE ELEVATIONS STAKES SET AT SITE
8Y t,ttJ
FEE: $15.00
DEPARn,1ENT OF PUB Ll e WCRK~
I, the undersigned, owner or agen~ of the above described proper~y agree TO have fhe
grade eSTaei ished before excavation has commenced.
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4Ef3/15