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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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N~ 44493
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TYPE: BLDGJi::HTG 0 ELEC 0 PLBG 0 SIGN 0 ZONING ({.-I FLOOD PLAIN
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HEIGHT
OWNER
DESIGNER
USE/NATURE OF WORK
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Foundation
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Sq. Ft. d (:)48 # Rooms ?? ~ ~ '\SR
0b~C~ Class of Const;
# Stories
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Height
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BUILDING CONTRACTOR
Size \~
Occupancy Permit
HEATING CONTRACTOR
'B\2E\.o~
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
~Ml~S
ElectricServ. New 0 Change 0 Temp 0
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
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_WC
_WH
_Sh
_FOr
_ L Tub
_Disp
_DW
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_SP
_ WSoft
_DF
_ CBasin
_BT
_Lav
_ San. Sewer
_Ur
_ Storm Sewer
_ Water
_Sink
Other
_ Eject
_SS
ISSUED BY
Permit Fee Paid $_\ <iQ" ~ //
Date l-\ , \""3:. \ ~~
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Park Dedication $ ~ \. Oft), oj;<
Final/O.P.
FEES: Valuation
::A:::"):S 122e to ~rtonn all wom pu~am to rul~ go~ming the de~rlbed oon~;~frr
AGENT/OWNER . 'DATE
ADDRESS
TELEPHONE #
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ZONING
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CONSTRUCTION DATA:
V-r New Construction
Addition
Alteration
TYPE OF CONSTRUCTION: (Le. fence, pool, parkir)g lot, sign, etc.)
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COMPLIANCE CHECKLIST
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COMMENTS
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
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REVIEW AUTHORITY
As per Section 30-5 Enforcement of the City Zoning brdinance, 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) Main'tenance items, e.g. siding, windows, etc.,
when the use is conforming and when no change is proposed.
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~APPROVED
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I DENIED
Plan Commission Action Required
Variance(s) Required i
REVIEWED By:A~ 4J~
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DATE: ,r/;8IPJ~
Wisconsin Department of Industry, WISCONSIN UNIFORM BUILDING
Labor and Human Relations E RM T C 0
Safety and Buildings Division P I APPLI A TI N
POBox 7969 , (See instructions on back. of pink copy)
Madison, WI 53707 The information you provide may be used by bther government agency
Wisconsin Statutes 101.63 10173 proqrams [Privacy Law,s, 15,04(1)(m)]. /'
:'::m~:III:li!II!~~~g:,i:,! ~onstr 0 HVAC DElee .0 Plbg [31'rosion
owpr's NaJe . (1,-1- I r;;;tdd/~~lIM7h -.../1 '\ !2A
COjltractor's Narpe: 0 ConHI~~ HVAC 0 Plb9 Lic/Cert # Mailing Address
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COJ,1 ractor's Na~~ n C<?!J.-D Elec I!2rHVAC 0 Plbg Lic/Cert #,
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Corgractor's Nam~: 0 COIll g'Elec 0 HVAC ~Ibg LidCert #
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Contractor's Name: 0 Con 0 Elec 0 HVAC 0 Plbg Lic/Cert #
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Application No.
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Parcel No.
o Other:
Mailing Address
Telephone No.
( ) ::J.? I-~ ZtJ:;
Telephone No.
( )
Telephone No.
( )
Telephone No.
( )
Telephone No.
( )
Mailing Address'
Mailing Address
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Building Addlejs..L 'A A' '.
1736 ~. .'7: ^' VI U. A A....
Zoning District(s) Zoning Permit No.
. . 1/4, 1/4, Section T N, R E (or) W
su.p;b?tl:A A ~. Block No.
Front I Rear Left Right
Setbacks ft. ft. ft. ft.
::11,.m:JICn\::mrr::mmm:,mu:":':':tr:r:,aUp(;e'JMiNCV::::6.n:e.c.~m1I~ttmn:9.n:HVAOeQQ~PMIN.::rtmf.~~::::'N!aGtv::'So.tJltemrtm:rmumr:::ummtmmUm
MNew 0 Repair ~Single Family Entrance Panel ~Forced Air Furnace I Nat L, P Oil Elec Solid Solar
o Alteration 0 Raze 0 Two Family Size: 100 amp 0 Radiant Baseboard or Panel Fue Gas *
o Addition 0 Move 0 Garage ~vice: 0 Heat Pump Space Htg ur 'D 0 0 0 0
o Other (print): ~ Underground 0 Boiler
. 0 Overhead 0 Central Air Conditioning Water Htg lY 0 0 0 0 0
o Other * 0 Dwelling unit will have 3 kilowatt or
,,: ,,: ,", , , ,more Installed electriC space heating equip
1(1., 'PLUMBING " ,:' 'InfiltratIOn control option is: 0 Full sealing
S . ' , " of joints. 0 Blower door test. 0 Exterior
~~i~iPal ::t:':J::':i\1't.i:lij~~~ti$.1.:::::(~~~i~?\~J::i:::i:!:::i
Permit No Envelope 'r-J..'-tJ ''''!'LJlj BTU/HR
:j1;?)v4t~~;n ..........'..... ..... Infiltration12.' b33 BTU/HR
MMun icipa I Uti I ity :1\i;::E$lMIUdlQlNl.eQ$i\:::::::~::mt:::::'t::::':::rr
o Private On-Site Well
o Other
IjARtll4.UilMQtViQ':':'::unn:
Unfinished BasementJotiiS Sq. ft
living Area 804 ~ Sq. ft.
5b'1
Garage
Sq. ft.
~kc;ONSllrTYPE:} lP:a:U1NQATlON:
~ite Constructed ri!?toncrete
o Manufactured 0 Masonry
o Treated Wood
$(:iS[QRI:ESli::::::::tr:: 0 Other
~ '::::o::::::j::tli':it:::::::::::::::::::::::::::::::::::::::::::::::
- tory~~"y:~~,{,:{:::,:,:,:,::????
-Story 0 Seasonal
o Other ~rmanent
/ 0 Other
~Ius Basement
$ 75;00 (:)
The applicant agrees to comply with all applicable codes, statutes and ordinances and with the conditions of this permit; understands that the issuance of
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APPROVAL CONDITIONS
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o Town
Plan Review $ 40
Inspection $
Wis, Permit Seal $ ?.{(':J
Other $
Total $ '1-0
SBD-5823 (W06/94)
This permit is iSsued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this perm it or other penalty.
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~~r;:~uction Name ~ c.;-*ro~ U (). ~
B ~:~~~f~~ Date ~ \ \3\<S{S
~rosion , 58 tb;5 Cert No l..\~~
MuniCipality, Number of Dwelling Location:
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WHITE -ISSUing JUrISdiction
YELLOW - DILHR
GREEN -Inspector
PINK - Owner/Agent
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LOT
CATE
AODRESS
i SLOCK
: ZONE
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NAME eSflI-J ('0 AiS lKUC77 ~ fit
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SUeD I 'I . Ii K (! IHI-S E..
STREET NO. /7.1tJ 4 Ai TElLS ().L€.fII.
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SIDEWALK EXISTING
LOT DIMENSIONS
YES. 0 NO S--
4/ II!. , 19 q S
BUILDING GRADE ELEVATIONS STAKES SET AT S TE
BY I<'N
FEE, $15.00
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i , O~oARTMENT OF ?ocLIC WCRK;
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I, the undersigned, owner or agenT of the:above describec proper~y agree ~o have ~he
grade eSTaoi ished before excaVtpatqi&o/nz'"2a 5 TI...m~,n /
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PARKLAND DEDICATION FEE COLLECTION RECORD
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Address
Owners Name
Name of Subdivision
Lot # ~
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Bldg~ Pennit #
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,i5 lDD
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lCb
No. of Units
Fee Required
Fee Paid
Owner's signature
Inspector's signature
City Of Oshkosh 1/1/8)
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Date
Date
Parks Subdivision
Improvement
;kcts. Rec.: 362-041