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CITY OF OSHKO$H
PERMIT - APPLICATION A~D RECORD
N2
06591
TYPE:
BLDG D HTG D ELEC D PLBG D SIGN~ZONINGCi-4
FLOOD PLAIN ~ HEIGHT jJ I A
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OWNER
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PLAN NO.
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ADDRESS
DESIGNER
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USE/NATURE OF WORK
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BUILDING CONTRACTOR A~~u~~~S"&.1\J ' G -
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Size X-~ Sq. Ft. 5: "Z..-- # Rooms # Stories
Class of Const.
II "" , 1
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, , 1
Height 1;3 r
Occupancy Permit ,el-CYJ11'ULJ
Foundation 1...
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HEATING CONTRACTOR
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Heat D NC tJ Vent D Fuel/System
Heat Loss,
BTU'S
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ELECTRIC CONTRACTOR
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Electric Servo New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
, Circuits
PLUMBING CONTRACTOR
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_WC
_WH
_Sh
_FOr
_ L Tub
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
_BT
_Lav
_ San. Sewer
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
FEES: Valuati
ISSUED BY
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Permit Fee Paid $
Date
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1')...-1 b-R 7
Park Dedication $
Final/O.P.
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUREJ&t~",~~~. I 2111151 ')
A ]NiT/OWNER /i ! DAfE
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ADDRESS ,,';2..:L ~ .. c. ( 01J <~~7 37 7&;0 '
T LEPHONE #
GE:NE:RAL
Building Pemit ,;00SCj ( Zonirl:JC""'1
Job Iocation j 0 '3 ;I-I [ &.I-A~vf( ,
Property Owrer~v~ I) Et2-(cJC;:So~
II. . a:NS'l'RU:TICN DATA
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Oesc:ribe Nxk: 4 X' 0
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zamJG/u'ND L'SE CONPUANtt CHEX::KUST
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COnfominq_ Non-ConfoJ:minq_"
Lo:t Di.m:msion
Lot: Area ..
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tSUfLOI/Vc....
WeLC
J'(C'N
"':><.NEW ~ON
ADOITICN:"
'.~CN
Accesso ~.~ , ~~......
_ .ry &oI...............u:l
Fence
Boathouse
_ Utility St:rtJcture
_ Other (specify)
III. o:M?!.D\NCE cmx::I<S
CatJ,:)lies Deficient
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. _ $1hqle' Family.
~Famil:
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MiIti.~Fami1
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;;<" ~cia1
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~Ufact: ..
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Pool
Oeck/Patio
-X..Si9I1
Porch
. Deficiencv/Came1ts
Use
Lot Width
Lot Area
Floodplain .
Emnt Yard
Rear Yard
Side Yard (R)
Side Yard' (L)
Patidng
Bni 1 ding Area
Lot Area per Family
Comer Lot
Other (specify)
IV. REVm'l AUImRITY
The Planninq Di.re<:::-...or, or app.ropriate designee, must approve all plans, except
the following: (1) Alterations or interior ....-ark when ti".e use is confol:Itling and
when 00 change of use is proposed. (2) Maintenance items, e;.q~i'~ windows:f:'
etc., when the use is confonning arxi when r.o C".han<ge of..1Jse is ~ed'..,
Instances where work a::liplies with the al:xJve CJ:;'itel::ial tne,. ~t ~. ,be revie..:ed.
by the Building Inspector without referral to the Planning Directbr. '
'" ~ APProVED
Plan Conmission Action Required.
, Variance (s )"" Rea1,!ired
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NOr APProvED
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bWNER 'nA \J J [) -E~( c/CS O.~
DATE \;;(-{~-~ , PERt1IT # 0.&sq r_
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GENERAL CONTRACTOR
0-4
ZONE
MASON CONTRACTOR
Width of lot
DATE . INSPECTIONS
REMARKS
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.MAXLl,NG'ADD.RSSS
Front of lot
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