HomeMy WebLinkAbout0039935-Building
~
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
110
~ 39935
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TYPE: BLDG~' HTG 0 ELEC 0 PLBG 0 SIGN 0 ZONING /Z f
FLOOD PLAIN ~.HEIGHT~
ADDRESS :(070 ~c-_'\ f:::r0l.,..L.t
OWNER_k .L ~ c..."-. l' ~~{t-u-e- ~J~ 1-....
PLAN NO~ L ->.rI-4 &~
DESIGNER
USE/NATURE OF WORK ;;tl~ - J:::- e-
/f/-e., A }
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BUILDING CONTRACTOR tO~.~ ~
.,3'2. ctSPwt. . 'C .~ ),d..
Siz Sq. Ft.l7'=-~ L"v,\~ # Rooms (") +- ~ J:J.e{ ",'rl# Stories
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Class of Const. <:)
~ Height ~
r
Occupancy Permit 't!.~qt?
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
_Lav
_Sh
_FOr
_ L Tub
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
_WC
_Ur
_ San. Sewer
_ Storm Sewer
_ Water
_Sink
Other
_ Eject
_SS
ij Fee Paid $ /~:.; .~.:-O
Dat/7/ //?/'"
Park Dedication $ /~
Final/O.P.
ISSUED B~
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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ADDRESS
TELEPHONE #
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NAME
LOT
ADDRESS
BLOCK
':1 ARn
SU8DIV.
STREET NO. 3D 70
ZONE
PLACE
SIDEWALK EXISTING
YES
LOT DIMENSIONS
o NOfZ}
&/a ,19'14
BY ~rJ
BUILDING GRADE ELEVATIONS STAKES SET AT SITE
FEE; $15.00
DEPART~ENT OF ?U8LIC WORKS
I, the unders i gned, owner or agenT of the above descr i bed properTy agree TO have the
grade estaoi ished before excavation has commenced.
O,lf)~O""'O
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~f6 @,/1S
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)
ApplICation No.
...
Parcel No.
.......................,.................................,.............
!:.:::::!'~~.I!rI.'i:..~R~g~.~i~.I!I~:.!:!:!::. ~onstr
g'HVAC
gElee
Wlbg
[91ro;ion 0 Other:
Telephone No. (includean:ia code)
;;;3/- z03
Telephof1eNo. (include area code)
:!I~..!:.:IIII~IIIII~~li~:IIIII!1 Lot Area ,
Building Address
1/4:Section
Lot N
T
N, R E (or) W
Block No.
ew
D Alteration
D Addition
D Repair
D Raze
D Move
Entrance Panel
Size: ~OO amp
Service:
~nderground
D Overhead
Fuel
Nat.
Gas
4W{'ONSr.tTYPEf ::U]f..
ite Constructed
. . . '.' ...................................... D Manufactured D Masonry
;2,:AREA INVQtVeg~:.::.::::::S.J:Sj'GR1ES:::{:rr:{\ D ~t~a::d Wood ~~niciPal
Unfinished Basement~Sq. ft. ..' .............. ....... D .
~:~:::'e.t::2~::: ~f;;: ~~1:@HM 0 ~:~~:;:.:UWrty
D Plus Basement D Private On-Site Well
:.lg4I~~plmN~::.::::.::::I::::;
Space Htg D tJ D D D
Water Htg D D D D D D
* D Dwelling unit will have 3 kilowatt or
....:.:........... more installed electric space heating equip.
{{{.{ Infiltration control option is: D Full sealing
of joints D Blower door test. D Exterior
air infiltration barrier.
:.::::::4~;:.aJ;;#m~Q,$$.}(HijMm~t~~n:r)
Envelope 33 ILX::JO BTU/HR
Infiltration ~~ 0 O' BTU/HR
D Other
j~n:eslm~:g~tphjG.'Q$t.
$ 7 000
:.:.:.:.:.:.;.:.:.:.:. ... ......
The applicant agrees to comply with all applicable codes, statutes and ordinances andwiththec9;,diti()rlsofthlspe~mit;understands that the issuance of
th. e permit creates no legal liability, e. xpress or imPlie~, on martment or m. unicipality; and certifies that all the above information is accura.te..
APPLICANT'S SIGNATURE 7Z- DATE SIGNED '7 94 .
APPROVAL CONDITIONS
This permit is issued pursuant to the following conditi~ns. Failure to comply may reiult in suspenslonor
revocation ofthis permit or other penalty.
. .. .. .. . . . . . . . . . . . . . .
........ .... ..... ......"
:::::::I$SUING:..:.:::::.::::t:t::::.:..::::::::
.::'!:~~I~.~.~~~~I~::::::!:!'
DTown
D Village
Ity D County D State of:
Municipality Number of Dwelling Location:
.::JO
20- ~ & f;:,
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~nstruction .r...
4]"HVAC Name VL
D Electrical . .,
D Plumbing Date ~
B Erosion I A./ Z ()(p :3 Cert. No. --f.3 ..yO
Total
$
'70
SBD-5823 (R. 07/92)
'5; 0&t5.
WHITE -Issuing Jurisdiction
ro""'"';,"'-'_,,',.'.,', ,..'.,............."..,.,.....1
YELLOW - DILHR
GREEI\I~ Inspedo~
piNI'(~ 6wner/Agefif~
City Of Oshkosh 1/1/85
Address
PARKLAND DEDICATION FEE COLLECTION RECORD
30/7D ~e'~t:er:l rl'~
~~~
?A~ C~
Owner's Name
Name of Subdivision
Lot # 1
B1 dg. Penni t # ..'J r 7:3 .s
No. of Units
Fee Required
Fee Paid
Date (fIr! rf
te 'CR// -,,;;1
I
Owner1s signature
Inspector's signature
Parks Subdivision
Improvement
Accts. Rec.: 362-041
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