HomeMy WebLinkAbout0017643-BuildingCITY OF OSHKOSH N° 17643
PERMIT - APPLIICATION AND RECORD
TYPE: BLD~TG ^ ELEC ^ PLBG ^ SIGN ^ ZONING ~ FLOOD PLAIN HEIGHT
ADDRESS ~ ~ ~ ~~ PLAN NO. `~ ~ QO~
OWNER ~ ~o"l~ C~.S ~' y~~
DESIGNER
USE/NATURE OF WORK _ i~~u~ ~ ~ ~ °~/"
BUILDING
4
CI~
Sq Ft ~~ ~ ~ l{~ Rooms ~~- # St ~
- ~ ones
Foundation Class of Const. ~ Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR ~'w ~` ~"
Electric Serv. New ^ Change ^ Te ^ Type Volts Amps
Fixtures Switches R ece ptacles Circuits
t
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
. ___. .,...,.,,,,. - - r i rCC raiu ~ ~ ~~ ~-' YarK UetllCatlOn $ ~ ~~
ISSUED BY Date ~ ~ PCB FinaUO.P. ~~/~/~
In the performance of this wor ree to perform all work pursuant to rules governing the described construction.
SIGNATURE ~~ „~
AG N (OWNER DATE
ADDRESS ~~ ~ ~~ ~ ~ ~ ~ >~
~l-1~i13
TELEPHONE #
Height ~--
Revised: 8/8.9
ZONING/LANDUSE COMPLIANCE CHECKLIST
J08 LOCATION: Z y
PROPERTY OWNER/CONTRACTOR: (; s.r--
ZONING:JZ/
CONSTRUCTION DATA: NEW CONSTRUCTION ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
COMPLIANCE CHECKLIST {Check only
COMPLIES
f~A,
1%
'~,V
~L~
._.~
~~
G y~~-.
-1~=t-~-
DEFICIENT
Use
tot Width
Lot Area
Floodplain
Front Yard
Side Street (front yard)
Rear Yard
Side Yard (R)
Side Yard. (L)
Parking Spaces
Building Area
Lot Area Per Family
Corner Lot
Landscaping
Transitional Yarc
Off -Street Load i r
DEFICIENCY/COMMENTS
Vision Clearance
He-fight
REVIEW AUTHORITY : l~~ ~~G~ .
The Director of Community Development, or designee, must approve all pla ,except the
following: (1) Alterations or interiorl,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.
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 DENIED
Plan Commission Action Requ~d
Variance(s) Required ~_ ~ 1 _ _ e
applicable)
REVIEWED BY : _ /~/~~.~ ~~~~1[~1~1.~ DATE
Df tit A 4a N ~-+
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State of Wisconsin
Department of Industry,
Labor s Human Relations WISCONSIN UNIFORM
BUILDING PERMIT
APPLICATION NO.
Division of Safety 8 Buildings
Madison, wl 53707
Wisconsin Statutes 101.63, 101.73
APPLICATION
See lnstruCtfOns on back of ink co
PARCEL NO.
PERMIT REQUESTED ' ~TRUCTURE ^HVAC ^ ELEC ^ PLUMBING
Own is Na a Mailing Address Telephone
~-- ` ~ ~e ~ ~~ e r- ~' ~ ~ P 7
Contractor's Name Mailing Address Telephone
PI~~I~~iT LQCAT~QI~ ''/a, ''/s, SECTION , T N, R E or W
Buil ing Addre~s~ ~ Subdivis]or} Name , Lot No. Block No.
Zoning District Lot Are
s . n.
Setbacks ~ Front
3 ~ n. Rear
~ ~ n. Left
3 ~ n. Right
~~ n.
1a. PFI4JECT > 8. T^~`pE t3. `f~I.EC'C~ttCAL 9. HY/#C S#UiPM:~1~IT 12.>'~N ~t~'GY 30URCE
ew ^ Addition ^ Raze
Alt
r
ti
n ^ R
ir ^ Move Single Family
^ Two famil Entrance Panel
Size: ~~ am rced Air Furnace
^ Radiant Baseboard or Panel Fuel N
C' L.P. Oil Elec.
* Solid lar
e
a
o
epa y
^ Other p
Serv'ce: ' ^ Heat Pump Space Htg. ^ ^ ^ ^ ^
^Other ndergrolnd ^ Boiler WaterHtg. ^ ^ ^ ^ ^
^ Overhead ^ Central Air Conditioning
* ^
tb GARA~tE ; ' 4 t`0l~5f TYPE 7. Ft)iINDATIQN '< ^ other
Dwelling nit will have 3 kilowatt or
more installed lectric space heating equip.
^ ite constructed oncrete 'iQ. P{~~lMf3tMG Infiltration control option is: ^ Full sealing
Detached
Attached
^
^ Masonry
of joints. ^ Blower door test. ^ Exterior
',x ~, Manufactured ^ Treated Wood ewer
nicipal air infiltration barrier.
Z ~ ~~~RI~~
^ Other
Septic
~$, !#~ATLOSS, Ga{culated}
Basements
Sq. ft.
'~
^ 1 Sto
~' '~ Permlt No. ®~ gTU/HR
Envelope
~$~
living Area S°"-'~-~_ Sq. ft. ry
^ 2-Story ^ S asonal "~1 ~~`I:,~ ' 4nfiltration BTU/HR
~p
Garage ~ Sq. ft. the ermanent
Municipal Utility
9~. 'twSTfNF~I't'E~ CCIST
t'f C ~ Other ^ Private on-site Well
$ 7~ ~~
The applicant agrees to comply with the Wisconsin Uniform Dwelling Code and other Municipal Ordinances and with the conditions of this permit; understands
that the issuance of the permit creates no legal liability, expr s or plied, on the Department or Municipality; and certifies that all the above information is
accurate. '~ ^ ~~
SIGNATURE OF APPLICANT ` DATE ~ ~`~ "' ~ ~+
CONDITION OF APPROVAL This permit is I s pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this mif or other penalty.
C9 ' / ~ to I'- r ~ v
'ISSUING '
JURISDICTION ^TOWN ^ VILLAGE ITY ~ COUNTY
^STATE ^If~ppEPENqq~~N
oF: ~'15~l~oS/~ ~ Municipality Number of
Inspecti nAuthority
~d ~~ Municipality Number of Dwelling
Location, if different
_
- - - - -
~€$: PEtSR~N[~S)< UlflSi ~ R~ ERMiT
............ PAR#IT lSSU~fl BY'
Plan Review $ ~ onstruction
HVAC
NAME
Inspection $
Wis. Permit Seal(s) $ ~- ^ Electrical
^ Plumbing
~
DATE
Other $
~ ^ Other Q'/ Q'
U ( ~I!/~ "i ~'~~
CERT. NO.
TOTAL $
SBD 5823 (R. 04/87) WHITE -Issuing Jurisdiction !~ YELLOW - DILHR GREEN -Inspector PINK -Owner/Agent
City of Oshkosh 1/1/85
PARKLAND DEDICATI',ON FEE COLLECTION RECORD
Address
Owner's Name
Name of Subdivision
Lot #
No. of Units ~
Fee Required _~' b c~
Fee Paid
Iw/
Bldg. Permit # ! ~'/ (, ~,3
Owner's signature \ ate
Inspector's signatur Date ~0~
Parks Subdivision
Improvement
Accts. Rec.: 362-041
DATE 3 - ~ ~ " ~U
NAME ~ ~ r-°t-t~ ~-~N.(P'~
LOT ~i`~
v r
SUED I V . G. r 1 .a. N--
~? fl.~
STREET N0. z
SIDEWALK EXISTING 1
BUILDING GRADE ELEVATIONS STAKES SET Al
FEE: Q~h5~.00
I, the undersigned, owner or agent of 1
grade established before excavation has
~~ ~~~
~S"(
ADDRESS _ /~. ~~ ~~~~ r~,,r~~ / ~~
BLOCK "- ?,iAAD / °'~
ZONE
_ LOT DIMENSIONS
ES ~ NO
SITE ~~13 ,l°~~BY ~:rl
DEPARTMENT OF PUBLIC WORKS
e above described property agree to have the
commenced.
OWNER.--~ •a 1~ Y~r
DATE PERMIT ~_
GENERAL CONTRACTOR
n"~-r~ Z~ ~3 Q ~~
l'^~ f~ -/ cc cc
ADDRESS Z'~ Z
vsE ~~h
Wo~rlc consists of '
MASON CONTRACCTOR
DATE
INSPL~CTIONS
FOOTING
~~
FDTN SLAB
BACKFILL
~~
~-~-- STRUCTURE l~
ENERGY
~~ _
q~ I " 17~`/
0
~ ~.
INSPECTIO.1 REPORT
FILE: DATE: ~~ ~~
RE : a ~~
FOOTING -SLAB __BACKFILL -STRUCTURE -INSULATION ~CU~AiJCY
-OTHER _~
VIOLATIONS/REKARKS: