HomeMy WebLinkAbout0041659-Building_ l !~
CITY OF OSHKOSH N°- 4169
PERMIT - APPLI ATION AND RECORD
C
TYPE: BLDHTG ^ ELEC ^ PLBG ^ SIGN ^ ZONINGS" L FLOOD PLAIN HEIGHT
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ADDRESS
OWNER
DESIGNER
USE/NATURE OF WORK / `~ L ~-~' ~~NC'~.L ~~rL ~ ,~
HEATING CONTRACTOR t >~'
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR ,L~/ {~~~~~
Electric Serv. New ^ Change ^ Temp ^ Type Volts Amps
Fixtures Switches Receptacles Circuits
~3
PLUMBING CONTRACTOR ~`~"
- BT - WH _ Disp - WSoft - CBasin
Lav _ Sh _ DW _ DF -San. Sewer
WC _ FDr _ SP _ Ur -Storm Sewer
-Sink LTub _ Eject - SS -Water
Other
FEES: Valuation 7 5 ~~~ Permit Fee Paid $ ' ~- Park Dedication $ ~~`~'~~
ISSUED BY Date ~ ~ ~ Final/O.P.
In the pertormance of this work I agree to pertorm all work pursuant to rules governing the described construction.
SIGNATURE ~ Z~ ~~
AGENT/OWNER pA~
ADDRESS
TELEPHONE ~
Size ~~~~ S Ft.~~ y~~~~ # Rooms # Stories Height ~~-=`'
Foundation _~~+~~-''~~--~~ Class of Const. ~ Occupancy Permit ~ ~ _.~---
ZONINGS/L/AND USE COMPLIANCE~CHECKLIST
JOB LOCATION: ~~ ` ~ t~dv~ ~.11`e ~~ T '~~G'.~ ZONIN ~~
l
PROPERTY OWNER/CONTRACTOR: ~y~~~. ~_S'-~~~-~ti~-~
CONSTRUCTION DATA: _~ New Construction Addition Alteration
TYPE OF CONSTRUCTION: (i.e. fence, pool, parking lot, sign, etc.)
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
REVIEW AUTHORITY
As per Section 30-5 Enforcement of the City Zoning Ordinance, the Director of Community Development, or
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.
~PPROVED
Plan Commission Action Required
Variance(s) Requi
DENIED
REVIEWED BY: C~` DATE:
COMMENTS
~D/ ~_ l~~ ~Q7
Wisconsin Department oflndustry, WISCONSIN.UNIFORM BUILDING APPlicatio No.
Labor and Human Relations PERMIT APPLICATION ~ l ~~~
Safety and Buildings Division
P:o. 9ox 7969 (See instructions on back of pink copy) Parcel No. -
Madison, WI 53707. The information you provide ma be used by other government agency
1
Wi ` nsi t t 1 1.6 1 1.7 pro rams (Privac Law, s. 15.04 (
) (m)].
:p~~~,_<'~:;?,.~~;ai`~
:.:>::::..:; :::::::.;..;.:...:::. onstr ^HVAC Elec Plbg Erosion Other:
awn _ ' Name Mailing Address. Telephone No.
cyi~i 23h Zo
.on ctor's Named ^ Con c ^HVAC ^ Plbg idGert # Mailing Address Telephone No.
( )
.o rector s Name Lon Elec VAC ^ Plbg ic/Cert # Mailing Address Telephone No_
( )
tr ctor's me: Con ey, H AC Ibg ic/Cert # Mailing Address Telephone No.
:ontractor's Name: ^ Con ^ Elec ^ ^ Plbg iUCert # Mailing Address Telephone No.
( )
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,fitr:;`>~.>' ° Area
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• ~~ Sq. ft. 1/4, t/4, Sectio n , T N, R E (or) W
B ild~n
dress ~ Subdivision Na a Lot No. Bloc No.
as
oning District(s) Zoning Permit No. Front Rear Le Right
Setbacks .~ ` ft. ft. $ ft. r1S ft.
ew ^ Repair
^ Alteration ^ Raze Ingle Family
^ Two Family Entrance Panel
Size: ~
Q
amp orced Air furnace
^ Radiant Baseboard or Panel
Fuel Nat L P Oil- Elec
,~ Solid Solar
,
_
~ s
^ Addition ^ Move ^ Garage Ser
ce: ^ Heat Pump
ace Ht
S
^
^
^
^
^ Other (print): ~Jnderground ^ Boiler g
p
^ Overhead ^ Central Air Conditioning Water Htg ^ ^ ^ ^ ^
^ Other ....:::
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.
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^ Dwelling unit will have 3 kilowatt or
. ......:
..:.:................. .::
ite Constructed
^ M
n
f
ct
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. .. .... .:..:.:...
oncrete
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?'~~~'•>~ :.'~ ~. ~ ~ ;~iE~~?'':a##?>]>'~>>»~
:...........;:....:,.....:....::..........
more installed electric space heating equip.
Infiltration control o tion is: Full sealin
P ^ 9
. ..
.................. :<.;:.;:;::::<:.s::>::;:•:.;:.:
~~<~~~ -~~..:.: a
u
a
ure ^
asonry
Treated Wood
^ 5e er of joints. ^ Blower door test. ^ Exterior
:•;:.>:~•::.;;:• ~ air infiltration barrier.
.... Mums al ;:~»s:~»:>:::: ;:~:::.;~:::.;•:.;•::.;:.;::..;...;~:.;"~::»: >:>::>: •:>s <»:::- ~•;::;;•:;
Unfinished Basement q. ft. >~` `~~:'•::'•`:"=:`:" ^ Other P .. :..::. .. ::::::::::::
..... ......:.:.................. Se tic :.:.,•::::'( 7'~, )
1- Stor <`'~ '
..:~>.<,•:::...::<•»»;:•>;::<::>:»>:«•: Permit No. Envelo a BTU/HR
Living Area ~ Sq. ft. Y ^ Seasonal P
^ Stor '~ ~~~ ~~~~ ~ Infiltration BTU/HR
[the ~rmanent ... ................................................
Garage Sq. ft. _. .»~^:`::<::..;.,:..;>~:;:.:•:..:.;:;:;.;::;:;:::::;::.~:,<:::<>:::~>:>:::i:?:::<:::>::,
Munici aI Utilit • ' ~~ ~ . ~ :U
^ Other P Y ::<~::;:~'t~.~;~..:..'...~~~.~~.~;:~:>~<>z::>:~?'::#«,
lus Basement ^ Private On-Site Well z <~~["
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 habihty, express or implied, on Department ormunicipality;-and certifies that all the above information i accurate.
APPLICANT'S SIGNATURE !~- DATE SIGNED
APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of thispermit or other penalty.
b i NS~"~4(.(. ~c ~1 ~^~ ~ leir'2 c K ,,
?~ -~ci~2^JIS K ?~t4S ~~ ~1 ~ ~ ~'~~.r-'f7~ i» ~,Ll~, ~ _aL_. c ~rrx ~.
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^ Town ^ Village City ^ County ^ State of: Municipality Number of Dwelling Location:
~~5~~ ~ a - ~~ ~
Plan Review S y~
Inspection S onstruction
i
HVAC ~
Name
N~
Otlherermit Seal s~ ^ Electrical
^ lumbing
f ;
Oate
Total 3 ~rosion
"'LLLJJJ 4~/•/ C ~ ~ / /
Cert. No. C~
SBD-5823 (R. 06/94) WHITE -Issuing Jurisdiction YELLOW - DILHR GREEN -Inspector PINK -Owner/Agent
~s~
. ~5
___ _ __
__~__~
~ cao
~~ as
NAME ~ ~ ~,~
LOT ,~ ~~
STREET N0.°?~~ ~7,C,~% ~,~'/~"
S I DE4VALK EX I ST l NG
E^
LATE ~~ ~Z
AOORESS
BLOCK 'dA&D
ZONE
LOT OIMENSIGNS
YES ~ NO
BUILDING GRADE ELEvaTtONS STAKES SET AT SITE ~ ~-1 ,19~BY Imo. N
FEE;~~5.00
A2~'l~`~
ti [;2~/
OERARTr°E!`:T OF ~Ur'sL I C '~VCr~KS
I, the undersigned, owner or agent or the above described property agree ro have the
grade estaDiished befor3 excavation has commenced.
City Of Oshkosh ~/~/85
Address
Owner's Name
Name of Subd
Lot # ~'aC~ Bldg. Permit # ~~~ ~~
No. ofi Units
Fee Required ~ ~~
Fee Paid _ ~~~
Owner's signature
Date
Inspector's signature _ ___' Date
Parks Subdivision
Improvement
nccts . Rec.: ;,52-04
PARKLAND DEDICATION FEE COLLECTION RECOP.D
~.~~y ~1~,~4 ~~~ ~~ ~.~