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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
27098
~P_E: _ _ ~L~~ ~ _ HT~_ ~ _ ~~EC _ 0 _ ~~B~ _ ~ _ ~'GN [~ _ ~ON~N~_ ~ ~/ _ ~~~D ~LAI~ _ _ _ _ _ _ H~'GHT_ _ _ _ _
ADDRESS
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ICuadt ~ ~
PLAN NO. Q 2, 0 to 0 fer lie-
I
OWNER
DESIGNER
USE/NATURE OF WORK H-Ud J /It ~4tU. r
BUILDING CONTRACTOR ~ ~
Sq. Ft. / (, fO
~ .
# Rooms f - 3/3..eA1 # Stories
Class of Const. ~
l- Height ;z..,r
Occupancy Permit ~
Size. ~-t
Foundation
HEATING CONTRACTOR L3/.A.L-W-eA../
Heat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR C!tL-?7l ~
Electric Servo New D Change D Temp D
Type_ Volts_ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
/r)C p~
,
_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
,
L-. yF'
D. O/f) Permit Fee Paid $ I ([(.1,00
~ Date 1/31/q Z-
Park Dedication $ IO(). 00
Final/O.P.
FEES: Valuation
::A :~::ance 52m 'iJierlorm all wo," pumuanl to rules 90ve,,'n9 Ihe dese"bed consl;0~3--1 d
AGENT/OWNER DATE
ADDRESS
TELEPHONE #
".l!
Revised: 8/89 '
ZONING/LAND USE COMPLIANCE CHECKLIST
JOB \OCATION: --'.kJ/ )/~ g~ ZONING: ~
PROPERTY OWNER/CONTRACTOR: ~A~~ ~
CONSTRUCTION DATA: ~EW CONSTRUcnKN ADDITION ALTERATION PARKING LOT
TYPE OF PROPOS D CONSTRUCTION:
)
pool, sign, deck,. etc.)
" Z -z. ?C3<f' -
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COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT
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 Fami.ly
Corner Lot
Landscaping
Transitional Yard
Off-Street Loading
Vision Clearance
Height .,
UTliORlTf: .C/ ~p~~
The Director of Commun~evelopment, or deSign~~~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) ~4aintenance items,. e.g. siqing, 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 referral to the Director of Community Development, or designee.
~PROVED DENIED
\
\
\
\
REVIEW ~
Plan Commission Action Required
Variance(s) Requir d
DEFICIENCY/COMMENTS'
REVIEWED BY:
w----
DATE:
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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
2,0&019/1e-
WISCONSIN UNIFORM.
BUILDING PERMIT
APPLlCA TION
See Instructions on back of ink co
APPLICATION NO,
.
:2 78ft'
PARCEL NO,
....,...................................................................
........................................................................
PEII:,]j:B,sIUISTED.::
..........,..........................................................................
o HVAC 0 ELEC 0 PLUMBING 0 OTHER:
Entrance ~,anel
Size: /,..;0
,
~rvice:
. nderground
Overhead
:I;ggle~ :Z~:f'Qp.IQI1Jg"
o Site constructed Concrete
o Manufactured 0 Masonry
o Treated Wood
" 0 Other
Owner's Name
;2-7(P 0
Lot Area
ew
o Alteration
DAddition
o Repair
o Raze
o Move
Single Family
wo family
o Garage
o Other
o Other
..2...........W.. "'a.."u..............N....V..'..O....V....ve........O.. '.',..', '
. ...... . .. . .. . ....
...... .... . ...
. ..... .. . ." .....
.. ..... ... ... ...
. ...... .' ... '" .....
::.. '~::::::":'" ..:..... .':. ::,.. :', ::. .':'.. ...... ,':', ,:,..... .':::::::
Unfinished Basement.2!tf2 Sq. ft.$i.$tO:~O"$.m
. , J6%O 0 1-Story
LIVing Area , Sq. ft. 2-Story
Garage '1 ~ t:f Sq. ft. Other
Plus basement
Mailing Address
Telephone
Telephone
Sq. ft.
%, %, SECTION
n Name
~
Front~ Rear()
./0 ft. 7 ?)
m:~~'HVAe:e.!!iOt;M~mH
,T
LotNbS
Left
N, R E or W
Block No.
ft.
ft.
Forced Air Furnace
Radiant Baseboard or Panel
o Heat Pump
o Boiler
o Central Air Conditioning
': 0 Other
olar
o 0 ODD
o 0 ODD
* 0 Dwelling unit will have 3 kilowatt or
more installed electric space heating equip,
Infiltration control option is: 0 Full sealing
.. of joints. 0 Blower door test. D Exterior
air infiltration barrier.
$;Q$f$.::J
jl;:HI$A1nt.;Q$$G~IQijj~Jijij~)
Envelope dO :;;.-3s. 3 BTU/HR
.. .......... ....:~ Infiltration :;l (P 2-7 I ~ 0 BTU/HR
14~:I)~];:Q~U~g!Nqq:g$]:J
$ rO t)eY;), IBCJ
o Seasonal
RPermanent
tJ-Other
Municipal Utility
Private on-si,te Well
The applicant agrees to comply wit al 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 Municipality; and certifies that all the above information is accurate,
SIGNATURE OF APPLICANT
CONDITIONS OF APPROVAL
DATE d-- 3-'1:J.
This permit is issued pursuant to the following conditions, Failure to comply may result in suspension or
revocation of this permit or other penalty.
................. ..............
. . . . . . . . . . .. . . . . . . . . . . . , . . . . . . .
............,.................. '"
:1$.$.OIIQ:) ,."
aDRllbICiIIN:;
Plan Review . .
Inspection . . .
Wis. Permit Seal.
Other . . . . .
TOTAL. .
. $ i/fJ.O '0
. $
$ 3D.oO
.$
. $ 70.00
Construction
VAC
o Electrical
o Plumbing
D Other
SBD 5823 (R, 8/90) j 0 WHITE -Issuing Jurisdiction
to /D?J () .
CITY 0 COUNTY Municipality Number of
Inspection Authority /
-2 0 _"2.-- 1a- <0
~~~~IS_~~II::p~il!l~~~yi!.x~:::;:::::
Municipality Number of Dwelling
Location, if different
.... ................ ..................
.....................................
.............................. .
. ................
...... .."...........
..... ...............-.
.............,.....-...
...........,...........
.....................
.........,..............
........ ..........
/03fbo
NAME
DATE
CERT. NO.
YELLOW - DILHR
GREEN--Inspector
PINK - Owner/Agent
'I'
DATE
~ho/7 L-
V I. "",,
~M'~d-
LOT h s:- BLOCK
SUBDIV. ftJ-1c ~ ZONE
STREET NO./h~/ ~~~ ..8./~ LOT DIMENSIONS
SIDEWALK EXISTING YES 0 NO [Kj
. Z If., ,199z...
I
NAME
ADDRESS
HARD
BUILDING GRADE ELEVATIONS STAKES SET AT SITE
BY /~,J
FEE: $':ttr:lJt) f D
fJj S':.d/
c5'.~
DEPARTMENT OF PUSL i C 'NORKS ~,~
I, the unders i gned, owner or agenT of the above descr iced properTy agree to have the
grade eSTabi ished before excavation has commenced.
{/fl-FJ 001477
Ci ty Of Oshkosh "1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address J/pRI ~~~~~
Owner's Name ~ ~
Name of Subdivision /cVY ~
Lot #
{,s:--
Bldg. Pennit #
2- 709 J7
No. of Units
/
Fee Required
!OfJ.&D
Fee Paid /0&.08
Owner's signature ~ ~
Inspector's signature ~ ~~
t7 .
Date
;)-3-9:(
/ /31 );z,
f I
Date
Parks Subdivision
Improvement
Accts. Rec.: 362-041
OWNER ~ ~
DATE JAN 3 u 1991 PERMIT #
GENERAL CONTRACTOR
MASON. CONTRACTOR
Width of lot
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....
'W
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Q,
CD
Q
Front of lot
ZONE
~
L(11/9J.,.
'1/1 h7-
,
#/P/c;'2-
,
ADDRESS
USE
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Wo~k consists of
INSPECTIONS
REI-1ARKS
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MAILING ADDRESS
CITY OF OSHKOSH, CODE ENFORCEMENT DIVISION, 215 CHURCH AVENUE, OSHKOSH, WISCONSIN 54901
VIOLA TION/CORRECTION NOTICE
. INSPECTED:. 'f /e Ii( V
I
OCCUPANCY INSPECTED
ADDRESS
NOTICE DELIVERED/EXPLAINED TO:
ee:
, !
ITEM il ORDER FINDINGS OF INSPECTION
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2.3
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'2:'l.,
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3, 1'- IJ jl ;:::::~~ bn4t:~ 9-rL ~ I~F~
2-'L
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COMPLIANCE DATE: ~~ ~. INSPECTOR: IJrd A~.//A~
~ ,
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CITY OF OSHKOSH, CODE ENFORCEMENT DIVISION, 215 CHURCH
VIOLA TION/CORRECTION NOTICE
DATE INSPECTED: . 1"7 k( /:;-z.-/
:: r" I
OCCUPANCY INSPECTED :Jz~a,~ (,f'l /J I'd /, :"IY
ADDRESS II" xl ftt"".M1JA.__ ----c!_ . {
OWNERS NAME AND AnDRESS . //?;"/f,4.k (~'A/).Lt/U-7.ZiVl- ~7(",() khd:7A-/7~ yf'ji /fl/1,4UA;p/~
~ . ..."1 .... ,,'" "
NOTICE DELIVERED/EXPLAINED TO: Yc-?-Yl ~,'V;;;I(!-/t .
ee:
TEM t ORDER
I
FINDINGS OF INSPECTION
.!),~ pYtxd:-i- ~?tld"I4-,~-'7'rt.A~vJ./,
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ImSPECTOR:
COMPLIANCE DATE: 2,u-t <J--M C .;; L-d7.L.o ~\.,c"':';""
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