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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
IlO.
Ng 44356
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TYPE: BLD~TG 0 ELEC 0 PLBG 0 SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
_ . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - T - - - - - - - - - - - - - - - - - - - - - - - - -
ADDRESS ~ s t-\ \ c...Ko ~ ~ Pi..I\N NO:lSCS -030 5/95 1
OWNER A N'DR8}0 \-\oVV\.E:s) ,~"
DESIGNER
USE/NATURE OF WORK N'E:\>J S\~bL'E:. ~"'Y\\.'-~
QA~) 'De:...Ko
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AnAL\"\Eb
Foundation
A~Jb~~ {-~€~
Sq. Ft. ,-\~\b # Rooms _\~- 5<:B'R# Stories
CoN c.1C.:E\E Class of Const. -g
I
8
Height
'3C)f
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BUILDING CONTRACTOR
Size l~
Occupancy Permit
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
~ec.
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
-"2.~,~s
Electric Servo New 0 Change 0 Temp 0
Type _ Volts
Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT _WH
W~T\~
_WC
_Sh
_FOr
_ LTub
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
_Sink
Other
_ Eject
_SS
.
_ San. Sewer
_ Storm Sewer
_ Water
_Lav
_Ur
FEES: valua~ :~permit Fee Peid $
ISSUED BY 0 . Date
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6qQ~S:O j
"3'~\\~S
,
Park Dedication $
Final/O.P.
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SIGNATURE
In the performance of this work I agree to perform all work pursuant to rules governing the described cons uction.
:3); r
f DATE
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AGENT/OWNER
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ADDRESS
TELEPHONE #
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Wisconsin Department of Industry, WISCONSIN UNIFORM BUILDING
Labor and Human Relations C 0
Safety and Buildings Division PERMIT APPLI ATI N
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 101.63 101.73 programs [Privacy Law,s. 1504(1)(m)].
'{- ,::!::'~~IM~::I:IQ~~~m"I!!:::!!~~~onstr 0 HVACDElec 0 Plbg ~rosion 0 Other:'
Oii-;:/DR. E vJ f-\ OV\1 E..S / / AJ 4 Ma73A~~ m I+f-I (..0 fJ J4.
Co~ra.r:; cto:r..'s Name: 0 Con 9fl::; ~VA(q Plbg Lic/Cert #
1? r. E- \.AI El 1"":t:1:::A-i- i (Va-:
c.z:.raw7 NE~E Con ~ Elec 0 HVAC 0 Plbg LicJCert #
C?~t~actor's Name: 0 Con 0 Elec 0 HVAC l&elbg LicJCert #
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c:rtractor's Name: 0 Con 0 Elec 0 HVAC 0 Plbg LicJCert #
.~~I~:~~I::~~lIm~~~.:'::'~gr,eS--Q OSq. ft.
Building Address ~ .. ~
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Zoning District(s) I Zoning Pt7itNo. Front. I Rear Left Ri~)
Setbacks '70 ft. (a-o ft. [ 0 ft ~ ft
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~~w 0 Repair -1:l Single Family Entrance Panel A~rForced Air Furnace Fuel Nat L. P Oil Elec Solid Solar
o Alteration 0 Raze 0 Two Family Size: ~amp 0 Radiant Baseboard or Panel Gas *
o Addition 0 Move 0 Garage Service: 0 Heat Pump Space Htg....eJ 0 0.0 0 0
o Other (print): ~erground 0 Boiler
o Overhead ~ralAirConditioning WaterHtg...0 0 0 0 0 0
7.. . ,: . DATION:': 0 Other * 0 Dwelling unit will have 3 kilowatt or
.. :. .Ertonc~~t~"" .:. ... . .. ..::: ::'Qi~J~UlMijtijG::::~:::::::::::n::::::rr: ~~r~~~~~~I~~n~~~f~~~~~:~: ~~~~;eeai~~~'
o Masonry .S...................... ........ of joints. 0 Blower door test. 0 Exterior
o Treated Wood ~. I air infiltration barrieL .
'.'.8g,~::.~~ '..:::::::::::::::: 0 se~~:~IPa :::::::n:::::j;:,~::~lJgAjftQ$.$~r(fi~~ij~~t.~)::~:~::):
1\..tmv~~{ ......."8..,.. Permit No. Envelope r".:5 / .oS- ~c..; BTU/HR
~::~nt :11;tw:*m~ft :.,.::::.:.,:,:::.:::':::..... Infiltration sltn OfL/ ~ BTU/HR
o Other ~icipal Utility :,jJ:E$1td{u.mQlNI:~ms.lt::::~~n::~~r:~f::f:::::::
o Private On-Site Well $ 300 f 00 d
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65-030
o Other
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Application No.
4Y 3Db
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Parcel No.
Mailing Address
Telephone No.
( ).;83 -737<;'
Telephone No.
( )
Telephone No.
( )
Telephone No.
( )
Telephone No.
( )
Mailing Address
Mailing Address
.
Mailing Address
1/4,
1/4, Section
Lot No.
N, R E (or) W
Block No.
T
Subdivision Na_t~
N CJ fC"t n
Pc> t ,Uy
'4".' NST'TVPE
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.. ..., . .. . ..... ..
:':','. .,:,:::. )01.:. .::. ::;;,::.\." .'.'.:.
~te Constructed
.... 0 Manufactured
:Z~:~Ri4]NMQltVeQr ...::.....
Unfinished Basemen~4.5;:}$TQRli$}:r:::rrr:
U <1 0 1 Story
Living Area (I 0 10 Sq. ft. ~ory
Garage c; / D Sq. ft 0 Other
~us Basement
The applicant agrees to comply with all applicable codes, statutes and ordinances and with the conditions of this permit; understands that the issuance of
'1- ::;~~~::~,s;~:;~:~:~e;pre~~d certifie~:~:I~~:~::e i;/~;)~?e.
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APPROVAL CONDITIONS This permit is issued pursuanttothe following conditions. Failure to comply may result in suspension or
revocati'on of this perm it or other penalty.
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Plan Review $
. Inspection $
Wis. Permit Seal $
Other $
40
aD
Total $
10
SBD-5823 (R. 06194) .
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Municipality Number of Dwelling Location:
La - Q6~
.
o Village ;:;a1:ity 0 County 0 State of:
O~I-II(D:;H
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~nstruction
L1HVAC
o Electrical
~umb. ing
~ ~roslon
Name
Date
l5<6 \SL
Cert. No.
.$ ~W~T~SS6g ~r~ictlon
PINK - Owner/Agent
YELLOW - DILHR
.;<
GREEN" Inspector
~R-m 16\(--:l\. RN
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ZONING/LAND USE COMPLIANCE CHECKLIST
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JOB LOCATION:
PROPERTY OWNER/CONTRACTOR:
;Z(
ZONING
ANDkE\.D
\~DD\ E'S
CONSTRUCTION DATA:
'* New Construction
Addition
Alteratiol
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
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COMJENTS
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REVIEW AUTHORITY
As per Section 30-5 Enforcement of the City Zoning Ordinance, the Director of Community Development,
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.
V' APPROVED
DENIED
Plan Commission Action Required
Variance(s) 7 . ~Y:---..
REVIEWED BY: t:~ .
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NAME A \oJ b \U:;:.tJ..:J ~^-A. c: '::>
LOT 'd, 't-h
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SUeD I V. ~R-n-\ \6\l-'::'~ W-c-
STREET NO. 1 94S\-\ \c..,Ko\C.-~ L)-.j.
CATE
ADDRESS
SLOCK
31dq I Cis-
1,.iARD
ZONE
SIDEWALK EXISTING
LOT DIMENSIONS
YES D. NO D
SET AT SITE ~_ 2?
BUILDING GRADE ELEVATIONS STAKES
, 19
9~
3Y~
FEE~ $15.00
OEPARn.~ENT OF ?1..IcLiC ','jeRKS
I, the unders i gned, owner or agen1" ot the above descri bee proper-:-'{ agree TO have the
grade eS7aDi ished before excavation has commenced.
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495/ {pI
Ci ty Of Oshkosh 1/1/85 ~..
Address
PARKLAND DEDICATION FEE COLLECTION RECORD
,Q4s t-t\C'f(OR-Y
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L-\ L\ 3D6>
Owners Name
Name of Subdivision
Lot #
dib
Fee Required
Fee Paid
Bldg. Permit #
, \
~tOO
$' LCO
No. of Units
-40wner's signature
Inspector's signature
Date
'$(3\ )C{~
Parks Subdivision
Improvement
Accts. Rec.: 362-041
MASON. CONTRACTOR
Width ot lot
ZONE
ADDRESS t q 4"5 t-t\CXo~
USE ~SF! e..~J ~
WO"J:k consists of
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PERMIT .. 4430;.
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CONTRACTOR
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DATE INSPECTIONS
.. II J/\- REMARKS
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Front of lot
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