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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
'10
N~- - 47438
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TYPE: BLDG id' HTG D ELEC D PLBG D SIGN D ZONING '14 \
FLOOD PLAIN O~. HEIGHT3D
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OWNER I\V\ ~ (~,'v..) \\'O~
DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR A V\~ (~W ~ c')fV\R.&
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Size.J-rr~_'::) Sq. Ft. '":?06CJ /tJ'i # Rooms ~ # Stories
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Foundation ? 0\2) ( e ). Class of Const. B
c;( Height 30
Occupancy Permit (e.. i v; f ~ ~
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HEATING CONTRACTOR Br-<...,~<...('
Heat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
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ELECTRIC CONTRACTOR ~ W I ~C 5
Electric Servo New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR '\N r.... -t-t.~..s S
_BT _WH _Disp
_Lav _Sh _DW
_WC _FDr _SP
_Sink _ L Tub _ Eject
Other
_ WSoft
_DF
_ CBasin
_Ur
_ San. Sewer
_ Storm Sewer
_ Water
_SS
FEES: Valuation $ (io ~ OOb
ISSUED BY Da
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Permit Fee Paid $ S'Lt d . ftJ / Park Dedication $ /0 () 0-0
Date j 0 ""'::3 ~ '1.~ Final/O.P.
SIGNATURE
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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TELEPHONE #
ADDRESS
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ZONING/LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: )7d I \-\-\. ) ()t'Z\ 5 (<") l<2-V) D\'\v~ ZONING JZ.,
PROPERTY OWNER/CONTRACTOR: A,V' ?..-r..f6W rtUvY\..e.-S
CONSTRUCTION DATA:
~ New Construction
Addition
Alteration
TYPE OF CONSTRUCTION: (Le. fence, pool, parking lot, sign, etc.)
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COMPLIANCE CHECKLIST
WS'f? R
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DEFICIENT
COMMENTS
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
nO\~~b--t P\AV1 ~(S YhY\- S~ow
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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.
~ APPROVED
DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: DA
DATE: 9 -- ~6 .-qr;
Wisconsin Department of Industry, WISCONSIN UNIFORM BUILDING
Labor and Human Relations
Safety and Buildings Division PERMIT APPLICATION
P.O. Box 7969 (See instructions on back of pink copy)
Madison, WI 53707 The information you provide may be used by other government agency
Wisconsin Statutes 101.63101.73 programs [Privacy Law, s. 15.04 (1) (m)]. .
:..i::::,I~:l!ml.ll.gi~lm~.I:":.,::: ctConstr 0 HVAC 0 Elec 0 Plbg [R[ Erosion 0 Other:
OW~N~m~~l.AJ H0}";1fE-5 I ) AI G IM~il~~~e~A-1<-lCc1PA- fr300S-
Contractor's Name: 0 Con III Elec 0 HVAC 0 Plbg Lic/Cert # Mailing Address
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Con~c~r's Name: 0 Con 0 Elec ij(HVAC 0 Plbg Lic/Cert #
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conw~.&:o~ 0 Elec 0 HVAC ~Plbg LidCert #
Contractor's Name: 0 Con 0 Elec 0 HVAC 0 Plbg Lic/Cert #
.
Application No.
,
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L-/7 '-I ~ ~
Parcel No.
Mailing Address
Telephone No.
(41412 3 :$ -7'8 c
Telephone No.
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Telephone No.
( )
TelephoneNo.
( )
Telephone No.
( )
Mailing Address
Mailing Address
'.~II~~~I::~~III~I~:.::'.:::' LotArea Sq. ft. 1/4, 1/4,Section T N,R E(or)W
B'7~ ~dri~v (\+e Cs G \-eo",,", Dc, v~ sFdi~n2ar;; J+ 5 E LGN7 Block No.
Zoning District(s) I Zoning Permit No. Front I Rear Left Right
Setbacks ft ft ft. ft.
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~ew 0 Repair ~ingle Family Entrance Panel .r.srFurced Air Furnace Fuel Nat L. P Oil Elec Solid Solar
-0 ~Iteration 0 Raze 0 Two Family Size: ~) amp 1]'Radiant Baseboard or Panel Gas *
o Addition 0 Move 0 Garage Service: 0 Heat Pump Space Htg ~ 0 0 0 0 0
o Other (print): ~nderground 0 Boiler
o Overhead ~~entral Air Conditioning Water Htg ~ 0 0 0 0 0
o Other4dCQNSTfllYPEf:: :V:'fQUNOA.no.Nf 0 Other * 0 Dwelling unit will have 3 kilowatt or
more installed electricspace heating equip.
. - ~te Constructed .::gconcrete . :::,nl'ritUMBJNG::::::t:::::::::'::::,':rr::::::: Infiltration control option is: 0 Full sealing
J~:ART~A!JNMQJ;Vt;Q:tI:t':")r:u 0 anufactured 0 ~:~~~;rWOodS~~~~'dd"dddddd'dddd"ddddd ~;rj~~~i~:~a~~I~:~re~~ortest. 0 Exterior
U"fm"h'dB~m."t~sq ft ~,~';' ~= ',w~~~:P:~ ~~~IlI!~~;
~:~:::'" I ~~ :: : ~:~~;y i~~:i:;"t :~:=~,;;:W8Wl ~~@;II
~Ius Basement. 0 Private On-Site Well $ ~f~Z; , !J {'")7}
The applicant agrees to comply with all applicable codes, statutes and ordinances and with the cqnditions of this permit; understands thatthe issuance of
the permit creates no legal liability, express o~e~or mu~pali~; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE - - . DATE SIGNED 9)2 ~ CfS-
This permit is issued pursuantto the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty. .
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A~PROVAL CONDITIONS
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o Town 0 Village ~ity 0 County 0 State of:
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MuniCipality Number of Dwelling Location:
Plan Review
Inspection
Wis. Permit Seal
Other
$l.10 CioC)
$
$~O<.J"
$
$ 10 6.0
-*,,?nstruction
o I'WAC
o Electrical
o Plumbing
~sion
o
I b'J'-IO~
2J2-d...h.h
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NameD u. rl"'J'" Gd , '. ('" :L-.
Date \B~ 5- 9~
Cert. No. S~""3~
Total
5BD-5823 (R 06/94) WHITE - Issuing Jurisdiction
dO'5 )'000
YELLOW - DILHR
GREEN -Inspector
PINK - Owner/Agent
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NAME~~_.f 'U...J t+D~
LOT LeA- b'"
sueD/V. ~t:9X 6~~~
STREET NO. 1'7 ~ 9' HL"^~~ -;. blov'\
SIOEWALK EXISTING
CATE
J --- as'-- <1~
ADDRESS
BLOCK
~.; AiiD
ZONE
f)('.
YES
LOT DIMENSIONS
D NoD
q j7S
BUILDING GRADE ELEVATIONS STAKES SET AT SITE
,19<is
8Y ~,j
FEE~ $15.00
~ ~)~ '
~Lot.-~~
DEPART~.1ENT OF ?I.Ja L I C ','/eRKS
I, the undersigned, owner or agen't of the above described proper'ty agree iO have the
graae eSTaci iShed before excavation has commenced.
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City Of Oshkosh 1/1/85
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PARKLAND DEDICATION FEE COLLECTION RECORD
Addres s \ 7;) I ~.hJ rrh:~ cs c~~ \ ~/\ 'L) ('~ \.J e
Owner's Name AV\ ~,( ~ \. ...J th."'n/VlO.s
Name of Subdivision <Ff))( c'v--.~)A ,
Lot # (; 9 Bldg. Permit If -=cEi3 ~
No. of Units
/
Fee Requi red J 0 0 0 e>
Fee Paid I () 0 60
Owner's s;gn~ture '!~ tl~
Inspector's Signatu~ . ~
Date lD/s/qr_
, ,
Date 1-d.~- G<
Parks Subdivision
Improvement
Accts. Rec.: 362-041