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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
25415
~
TYPE: BLDG W HTG 0 ELEC 0 PLBG 0 SIGN 0 ZONING IL-I FLOOD PLAIN
HEIGHT
OWNER
070~
/Jft. _om d -:
PLAN No.IIOJ'/f)7911l-
ADDRESS
DESIGNER
USE/NATURE OF WORK
J1~.d ).:1. If. CU>f & .
BUILDING CONTAACTOr{f;&,,~ ~ ALd~.4')9" - :Z-~ kdd
Size '-:.~ 'l Sq. Ft. l./ I t..f "Z- J ROO~ t L- - 'Il3d ,# Stories 'Z...- Height 32 /
Foundation (~. Class of Const. R Occupancy Permit J&o
r~~ Jrr~
HEATING CONTRACTOR (1.,{,./ ~
Heat 0 NC 0 Vent 0 Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR
X~~~
Electric Servo New 0 Change 0 Temp 0
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR;(~ ~
_BT _WH _Disp
_Sink
Other
_FOr
_LTub
_DW
_SP
_ WSoft
_DF
_ CBasin
_Lav
_Sh
_ San. Sewer
_WC
_Ur
_ Storm Sewer
_ Water
_ Eject
_SS
FEES: Valuation $ ~ 5 O. tJ tJ tJ . 0 <J Permit Fee Paid $ fa 5'5'.00 ,
ISSUED BY ~ ;t,<L./~ Date o/h /91
Park Dedication $ /00.00
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Y SIGNATURE ~<?...) U~P/J It) A...Py~
AGENT/OWNER
'f'/ar>l91
DATE
ADDRESS
TELEPHONE #
. .
Rev i sa:l: 8/89
JOB LOCATION:
PROPERTY OWN~~A~ .,_
CONSTRUCTION DATA: ~ CONSTRUCTICN
ADDITION
ALTERATION
PARKING LOT
TYPE OF PROPOSED GONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
I7IlAA) rd_./-4 Cbt;t'jGL-U/ ~ 2-YY3iP fi(Ptf~r
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (fnxttyard)
Rear Yard
Side Yard (R)
Side Yard (L)
Parking Spaces
Building Area
Lot Area Per Famq!
Carner Lot
Landscaping
Transitional Yard
Off-Street Loading
Vision Clearance
Height .
REVIEW AWTHORITY: ~ ~cO ~F-- . .
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 proposed. (2) Maintenanceitemsi e.g. si~ing, 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.
. '
~ APPROVED
Plan Commission Action Required
Variance(s) Required .
REVIE\oIED 8~#
DEFICIENCY/COMMENTS
DENIED
~~
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
..I:; of'(() 79/ ~
WISCONSIN UNIFORM
BUILDING PERMIT
APPLICATION
See Instructions on back of ink co
:':':':':':':':':':':':':'":.. . :-:-:.; :.:.:.:.:-:.:
,:'IIII!~"il.IIII_I::i:::i
APPLICATION NO. ;J5f/5"
PARCEL NO.
D HVAC D ELEC D PLUMBING D OTHER:
Telephone
%.
Subdivision Name
Zoning [~~t~i
1M:::PflOJ.IC1l{::.... ....... ...
Setbacks
jj:S1:SUmIRlCAlN
.... ...........................................
ew
Alteration
OAddition
o Repair
o Raze
o Move
Entrance Panel
Size: ;::;0 tJ
~rvice:
Underground
Overhead
~'~;:tml~:f.QP"llnQ":
Forced Air Furnace
Radiant Baseboard or Panel
o Heat Pump
o Boiler
Central Air Conditioning
Other
l!Q;::P~QMIJNG::::
~wer
Municipal
Septic
Permit No.
o ather
Concrete
Masonry
o Treated Wood
'.:...::. 0 Other
Site constructed
Z AREA1WotveOH,: 0 Manufactured
Unfinished BasemeJ- "2.- L 7' Sq. ft.:$.~:$'tOI'E$:
Living Area c.f-Il.f V Sq. ft. ~~~~~~ ]$.W'$E
Garage ? /P f Sq. ft. Other
Telephone
3 l.f-!z.rz,
N.R
Block No.
E orW
,T
Lot No.
2-i-z--
Left I r Right I /r
ft. g. (p I ft. 7 ~
:::1~;:$8$fl~Y:$()Q$e$::?:>
Fuel Nat. L.P. Oil Elec. Solid olar
Gas *
Space Htg. 0 0 0 0 0
Water Htg. 0 0 0 0 0
* 0 Dwelling unit will have 3 kilowatt or
H' more installed electric space heating equip.
j Infiltration control option is: 0 Full sealing
of joints. 0 Blower door test. 0 Exterior
air infiltration barrier.
ft.
o Seasonal
2 Permanent
o Other
H" Envelope . BTUlHR
::1:1j',}W4itel"H "H' :,:::::,:::::,:,::::::,:,::::::::::,::/::':::':':':':':.' Infiltration . 2- BTU/HR
Municipal Utilityll;::gIT~,g~ggJ.ql$T:::
o Private on-site Well $;21; OOC) , f) tJ
o Plus basement
,
The applicant agrees to comply with all applicable codes. statutes and ordinances and with the conditions of this permit; understands that the issuance of the
permit creates no legal liability. express or implied. on the Department or Municipality; and certifies that all the above information is accurate.
IGNATURE OF APPLICANT ~v U~ IA.J ~
CONDITIONS OF APPROVAL
DATE
9/ ao! '1/
I
This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
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o COUNTY Municipality Number of Municipality Number of Dwelling
Ins7t12.~u2:itt.Ie.. Location, if different
· 'IoJ$'_falm~lllrillI-:~~~'~P:~X;::::I::::i..........
Construction
HVAC
o Electrical
30 . Cf7) 0 Plumbing
o Other
70 - '(X)
Plan Review . .
Inspection . . .
Wis. Permit Seal.
Other . . . . .
TOTAL. .
SBD 5823 (R. B/90};2 50/tJCJO .lJ~TE -Issuing Jurisdiction
NAME
975Cjlp
DATE
CERT. NO.
YELLOW- DILHR
GREEN -Inspector
PINK - Owner/Agent
City of Oshkosh 1/1/85
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PARKLAND DEDICATION FEE COLLECTIbN RECORD
\
Address Ol-O'-f6'I(~. X'/'?'V . .
Owner's Name fA. ~Hf ~ (~#~)
Name of Subdi vi si on 1) tJ..e.?nlJ ~
Lot # ,;).12-
No. of Units I
Bldg. Permit #
,;). S 'II ~
Fee Required
Fee Paid
/tJCI.tJlO
/ 00. 0 0
i Owner's signature ~ U~/TlAl'/V1 u)~/YU
Inspector's signature ~ ~~
Date 9/3d/c{ I
Da te CJ /:;. 5.-- It /
I I
Parks Subdivision
Improvement
Accts. Rec.: 362-041
./
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NAME .E&q.,t;.~r /I~
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Dr..TE
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ADDRESS
LOT
BLOCK
. ~'l ARB
SUSDIV. [) ~f/~
STREET NO.,;!.O<j{:!/~ /~
SIDEWALK EXISTING
ZONE
YES
LOT DIMENSIONS
o No0
9/t.t: , I 9 9/
BY .111-,1
BUILDING GRADE ELEVATIONS STAKES SET AT SITE
FEE: $'.10.00
'3/S-;'dJ
G .~ ~~J/
DEPARTr-'ENT OF PUS L, i C 'NOF;KS..t---
/'-.-. ~
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I, the undersigned, owner or agent of the above described properTy agree TO have the
grade estabi ished before excavation has commenced.
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.. ~R./1.t2A:.n~~i ADDRESS 20lfS!/~ ~
, ~ '~f..TE... ... . p. EOO #;lsi.ft y- USE >1 / r/C- a#-. ~
~_ .. .. - . ~~ Wo"%k consists of
~RAL CONTRACTOR
MASON. CONTRACTOR
W:l,dth of lot
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Front of lot
ZONE
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INSPECTIONS
REI'1ARKS
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$2- ,~~ V-!L l1A~
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MAILING ADDRESS
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