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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
19642
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9!~ -
ADDRESS
PLAN NO.
OWNER
DESIGNER
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USE/NATURE OF WORK ItJAAJ j:' ~ Gk. Y;1/(.J ~ ~ t/~
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BUILDING CONTRACTOR ;;;/ ~ ;e~
Size Sq. Ft # Rooms _ ()
Foundation ~....../' Class of Const.
# Stories
p
IY~
Height
Occupancy Permit
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New 0 Change 0 Temp 0
Type_ Volts_ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _ San. Sewer
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
ISSUED BY
Permit Fee Paid $
l\
~ Date
/
,
SO.OC?
7/3-0/'10
Park Dedication $
Final/O.P.
In the perlormance of this worn I agr"/ "jrm all work pursuant to rules governing the described construeUon.
SIGNATURE ~ / -It{Y 7'-5d- cgC/
I . AGENT/OWNER DATE
ADDRESS I) 'I 7 ~ ~ ; V'-<' I ~~ 2 '3:3 7 o.:t t
, TELEPHONE #
Revise:!: 8/~
ZONING/LAND USE COMPLIANCE CHECKLIST
., JOB LOCATION: 11/3 ~ ~ ZONING:
.5 PROPERTY OWNER/CONTRACTOR; ~ ~,~~
CONSTRUCTION DATA: ___NEW CONSTRUCITON ADDITION ~TERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
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COMPLIANCE CHECKLIST (Check only those applicable)
REVIE~ AUTHORITY:
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) Maintenance ltemsi e.g. siding, 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.
~ROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWEO BY:~;(.~~ DATE: -;/3o/CjiJ
COMPLIES
~
DEFICIENT
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (fra1t yard)
Rear Yard
Side Yard (R)
Side Yard (L)
Parking Spaces
Building Area
Lot Area Per Family
Corner Lot
Landscaping
Transitional Yard
Off-Street Loading
Vision Clearance
Height
DEFICIENCY/COMMENTS