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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
24576
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OWNER
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PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR
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Class of Const.
# Stories
r
Height
Occupancy Permit ~o
Size
Sq. Ft.
# Rooms
Fou ndation
HEATING CONTRACTOR
Heat D AlC 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
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF _ San. Sewer
_WC _FOr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
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FEES: Valuation Permit Fee Paid $ /10.. coY Park Dedication $
ISSUED BY Date 7?1.hl Final/O.P.
ance of this work I agree to perform all work pursuant to rules governing the described construction.
ADDRESS
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TELEPHONE #
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ZONING/LAND USE COMPLIANCE CHECKLIST
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JOB LOCATION: 7 Si"Z- ~. 0~ AA- .
PROPERTY OWNER/CONTRACTOR: ,~ . ~
CONSTRUCTION DATA: ~EW CONSTRUcrKN ---ADDITION ---ALTERATION
TYPE OF PROPOSED CONSTRUCTI,ON: (i.e. fence, pool ~ deck, etc.)
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Revisej: 8/00
ZONING:
PARKING LOT
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OEFICIENCY/COMMENTS
REVIEW AUTHORIT1:
The Director of Community Development, or designee, must approve all plans, except the
following: (1) Alterations or interior work when the use is conforming and when no change
in use is prooDsed. (2) Maintenance ltems, e.g. siding, wind~s, ~c., when the use is
conforming and when no change is proposed.
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLiES ~FICIENT
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instances where work comolies with the above criteria, the permit can be reviewed by the
Buiiding Inspector witho~referrai to the Director of Community Deveiopment, or designee.
. ApPROVED DENIED
Plan Commission Action Required
Variance(s) Required
RE~IEWED BY: 1~ ~4db~
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (frcnt yard)
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
7/~7 Ie:; (
DATE: