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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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N~-40830
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TYPE: BLDG ~HTG 0 ELEC 0 PLBG 0 SIGN 0 ZONING FLOOD PLAIN .. HEIGHT
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ADDRESS
PLAN NO. f;?~ J /:l -1/1L;//l
.
OWNER
DESIGNER
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USE/NATURE OF WORK l~jE2.J..._~ ~ ~~~ ~l~)
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Sq. Ft. \ q \ Ci # Rooms
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BUILDING CONTRACTOR
Size ; f2..-E"b
Height
Occupancy Permit
HEATING CONTRACTOR
. < ~"PE\Ju~
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Cu(v\ t t0~
Electric Servo New 0 Change 0 Temp 0
Type
Volts_ Amps_
Circuits
Fixtures
Switches
Receptacles
PLUMBING CONTRACTOR
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_BT
_WH
_Sh
_FOr
_ L Tub
_Disp
_DW
_SP
_ WSoft
_OF
_ CBasin
_WC
_Ur
_ San. Sewer
_ Storm Sewer
_ Water
_Lav
_Sink
Other
_ Eject
_SS
ISSUED BY
Permit Fee Paid $
Date
Park Dedication $
Final/O.P.
FEES: Valuatio
In the performance of this work
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SIGNATURE
ree to perform all work pursuant to rules governing the described construction.
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AGENT/OWNER
ADDRESS
TELEPHONE #
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WISCONSINUNIFORM '
BUILDING PERMIT
APPLICATION.
Application No. ~
L\O~~
Parcel No.
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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
Constr
(See instructions on back of pink copy)
DHVAC DElee Dplbg gfusion
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Mailing Address
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Owner~ame
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Contractor s Name
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TelephoneNo. (include area code)
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Telephone No. (include area code)
.,,:.:.... ..:::"':. ............ ......... .:.:.:.:. Lot Area
!~I'.::II~!II(.:~t:lII!.I~.:I:.. L';;. 10" SQ. ft.
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Zoning District(s) Zoning Permit No.
1/4. 1/4, Section T N.R E(or)W
SU15r~o~ ~a:e -I- a.An h J Lot S Block No.
Front Rear Left Right
Setbacks 3~ i ft. '-#11 ft.'Z. 'i 1 ft Z '-/ ' ft
:~:in~:~djEctttmrrr:~:r:::tmm)":r:t:t)q:at:tl:(GOpANbYtWWEtEctfdG(t:~::~:9.F.Ac:E.M1PMENT:~~::td::2n:ENER(;*SOU:Rttr::rrr~:tt):r~tmrmtt::~'
~ew 0 Repair ~ingle Family Entrance Panel 8I'orced Air Furnace Nat. L P. Oil Elec. Solid Solar
o Alteration 0 Raze 0 Two Family Size: '2.tJO amp 0 Radiant Baseboard or Panel Fuel Gas *
o Addition 0 Move 0 Garage Seryice: 0 Heat Pump Space Htg Ii!iI" 'n 0 0 0
o Other (print): ~nderground 0 Boiler
o Overhead 0 Central Air Conditioning Water Htg IQI 0 0 0 0 0
o Other ,:4B~~Ns.TnfVPE{ltFQUNDAnON) 0 Other ~)?re~~s~~;~egd ue7~~:~ ~;:cee 3h~~~~~~qO~iP
: '::::' ::...,'.. :.:':':': ..... '.':: .:"... '.. .:::::::::::::::::::: 15~:en ~~~~~~~ded ~oans~~~; ~ni;~:'''~UMIijNG:m~::::~':~~:m:::::~ft~~@ ~/ji~r:t~ oD~7~~~ ~~~~; ti~~p b ~ :::r'i~(
Jh4~~:mEA1Nv:OtYett}}:,,:,:,',:,,:,:,}},,: 0 Treated Wood ~
Unfinished Basement ilz.. Sq. ft. :'s.;m~~f~~~lE"trr:'tt::: "',.O,:~:th~r"",,',:,"',},,:,,:,"',:: 0 ~~~:~iPal ,ili:I~;'1;1~~tili;a~*b~:tO.'~R~~Jtmij~"9.g::mt
L' A I '! 1'1 0 S Y :.:.S..:JJSe::.::.:.:.:.:.:.:.:.:.:.:.:.:.::.:.:.:.:.:,'. Permit No. Envelope /1." h./-/~ "'" I BTU/HR
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The applicant agrees to comply with all applic~ble cocles. statutesa~'(ro~a,nances'a'~(fwri:hthec9ndIfionsotthTspermit;'U~derstands that the issuance of
the permit creates no legallia., bility. express or~he~~ent or municipality; and certifies that all the above inform~t/n is aturat~.
APPLICANT'S SIGNATURE I tt-....J .Ut DATE SIGNED 7/2.51,,&./ ..
A PPROV Al CONDITIONS This permit is issued p~rs~antt';thefollo~"ingcondltlons. Failuretocomplymay result in sus6ens,~nor
~\" .....:.-:-7' revocation ofthls permltor other penalty. _
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$ V (/J llAConstruction '., / Q: . -~_.\"\. n
$ (;.--, DHVAC Name f7\( #\./ . ')\~ .2V ~
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Municipality Number of Dwelling Location:
~_ OZ6€-~
Plan Review
Inspection
WIS. Permit Seal
Other
Total
SBD-5823 (R. 07/92)
7 t), {J{)CJ
.....wHlfE:!ss.ulngJU risd iCtTon--~-~"~'Y'IrLO'Wc.~[5rcr.:rR"".' ".C:' GRErt\1".:f'nspettbi
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ZON~NG/LAND USE COMPLIANCE CHECKLIST
. '3oS() ~ ~6:: ZONING
PROPERTY OWNER/CONTRACTOR: 'R\.JSQ. ~ :":s,.~ ..?
CONSTRUCTION DATA: ~... New Construction Addition
JOB LOCATION:
Alteration
TYPE OF CONSTRUCTION: (Le. fence, pool, parking lot, sign, etc.)
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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
REVIEW AUTHORITY
As per Section 30-5 Enforcement of the City Zoning Ordinance, the Director of Community Development, 01
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.
~APPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: f1.b
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DATE:0;j9h~
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pcycos addx 1 :360 19/ 6/95
~LA~ICAT~ON ~E COLLECT~ON RE~ .
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Bldg. Penuit # L'CJ2~~
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1$' {CO '
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Address
Owners Name
Name of Subdivision
r
~~
Lot #
City Of Oshkosh 1/1/85~. .
No. of Units
Fee Required
Fee Paid
Owner1s signcture
Inspector1s signature
Date
Date
Parks Subdivision
Improvement
Accts. Rec.: 362-041
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LOT
CATE
ADDRESS
SLOCK
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SU8DIV. f-JHEYtrS~ OZee;(
STREET NO..3 tJ5 tJ fIu,{.)~-f R"
NAME
1../ MiD
ZONE
SIDEWALK EXISTING
YES
LOT D I MENS IONS
D NO c:r-
~3
BUILDING GRADE ELEVATIONS STAKES SET AT SITE
, 19
94
aY~
FEE~ $15.00
~~
, .... DEPARTr-1ENT OF ?UaLfC WCRK~
I, the unders i gned, owner or agent' of the above descr i bed properTy agree 1"0 have 7'he
grade eSTaei ished before excavation has commenced.
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