HomeMy WebLinkAbout0018362-Building_CITY OF OSHKOSH N° 18362
PERMIT APPLICATION AND RECORD
TYPE: BLD~HTG ^ ELEC ^ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
------------------------l--------------------------------------------
ADDRESS ~~ ct r ~! Nrl,- PLAN NO.
OWNER_ ~~ ~` ~ ~ i ~
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Foundation
Sq. Ft.
~~~# Ro~ s ` /~~~y ar# Stories ~ Height
Class of Const. ~ Occupancy Permit
HEATING CONTRACTOR ~
Heat ^ A/C ^ Vent ^ Fuel/System
Heat Loss BTU'S
a
^ Type Volts Amps
Receptacles Circuits
ELECTRIC CONTRACTOR ~ ~ ~w~..~
Electric Serv. New ^ Change ^ T
Fixtures Switches
PLUMBING CONTRACTOR
BT WH
Lav Sh
WC FDr
-Sink LTub
Other
Disp
- DW
SP
Eject
WSoft
DF
Ur
SS
CBasin
-San. Sewer_
-Storm Sewer
-Water
FEES: Valuation $ ~ ~ ermit Fee Paid $ -~v Park Dedication $
ISSUED BY Date ~ Final/O.P.
In the performance of this work I agree to perform al work pursuan:o rules governing the described construction.
SIGNATURE ~ ,~ 0
AGENTIOWNER ATE
ADDRESS
TELEPHONE #
wised: 8/~
NING/LANO USE COMPLIANCE CHECKLIST ONING:
Z1 Z
JOB LOCATION: - PARKING LOT
ADDITION ALTERATION -
PROPERTY OWNER/CONTRACTOR ONSTRUCTIC~ -
NEW C deck , etc . )
CONSTRUCTION DATA: -- i'e, fence, Pool, sign.
TYPE OF PROPOSED CONSTRUCTION: ( ~ ~ ~ ~
,~_ ~ ~~~
LIST (Check only those applicable)
OMPLIANCE CHECK DEFICIENCY/COMMENTS
C
~ Use
----- ~- Lot Width
-•-~- ~- Lot Area
~ Floodplain
~~ -"-- Yard
~ Front
_ Side Street (front yard)
----'-' Rear Yard
-~ Side Yard (R)
.~ _,__._
~_ Side Yard. (~)
Parking Spaces
- Building Area
~- Lot Area Per Family
~~~ Corner Lot
Landscaping
Transitional Yard
Off-Street Loading
Vision Clearance
Height ~~r~'~
C9~
REVIEW AUTHORITY: /"
' ctor of Community Development, or designee,heuuseapsrconformingaand whenpno Chang
The Dire
following: (1) Alterations or interior work when
in use 15 proposed. (2) Maintenance items; e.g. siding, windows, etc., when the use is
conforming and when no change is proposed.
the permit can be reviewed by the
Instances where work complies with the above criteria,
ildin Inspector without referral to the Director of Community Development, or designee.
Bu 9
C / DENIED
1~ APPROVED -----
_ Plan Commission Action Required
Variance(s) Re
REVIEWED BY:
?/- 7~ ~ s~~ 01z
State of Wisconsin WISCONSIN UNIFORM
Department of Industry,
^
LaborB Human Relations BUILDING PERMIT APPLICATION NO. ~
Division of Safety 8 Buildings
so APPLICATION
n, WI 53707
Madi
Wisconsin Statutes 101.63, 101.73 See InsduCl/o/1~ O/I lJACk 0/ lnk PARCEL NO.
'R~~;~'1'~.~~~#E~~I~~':`<>: , HVAC ^ ELEC ^ PLUMBING
STRUCTURE ^
Owner's Name ~ ~ ~~ Mailing Add ~ ` ~c ~
QQ(rr/~ (F-.Q Telephone
f ~~~~
Contractor's Name Mailing Address q.
~L ~~ Telephone
...........:.. .
::::::::.:..:::.:......:' "'
__
''/a, '/. SECTION
T N, R E or W
Building Address
z ~ Subdivision Name _
~ Lot No.
~ Block No.
~. K ~
Zoning District of Area Front Reams Left Right
;~u:::1~R~~1::......... '; ~:::;'#~~E::,; ..:: ,:, : :~.;;E~I~~::::':: ::~:<:R#';~C:~~` 1~..:..... EHQ'1~:8~ ~11 ~ ''
ew ^ Addition ^ Raze Ingle Family Entranc$,P~r~gl orced Air Furnace Fuel Nat. L.P. Oil Elec. lid Iar
Iteration ^ Repair ^ Move ^ Two family Size: Cam) amp ^ Radiant Baseboard or Panel s ~
^ Other Se ice: ^ Heat Pump ~e ~9• ^ ^ ^ ^ ^
^Other nderground ^ filer WaterHtg. ^ ^ ^ ^ ^
^ Overhead antral Air Conditioning .
~~ ~~~::
~
'
:~
~
~~ '~~~~~:: ^ Other
Dwelim umt will have 3 kilowatt
tin
e
ui
i
h
i
ll
d
l
t
;...:.....;:...:.::
, ;
:~
.
:
file constructed
crete
;.. .
',
'~~ :~,;~~~
''
:.::: g
q
p.
r
c space
ea
nsta
e
e
ec
more
Infiltration control o lion is: Full sealin
P g
ttached ^ Detached ^ Mason of joints. ^ Blower door test. ^ Exterior
~.. ^ Manufactured ry
^ Treated Wood war
unicipal
air infiltration barrier.
asements ~..r~r~ Sq. ft.
:'fir;::>sa~:~?.:::<.< ^ Other
tic
p
P
it N
. .
'lt':~a (c~lait
7:~«:>~
1-Sto
$:::::~$~::;:::>::> ::::::::::::::::'::::;;: o.
erm
Envelope BTU/HR
Livin
Area ~~ S
ft ry `' '"
'
'
'
g
q.
. Story ^ Seasonal 1~=:
.~:>': ::
.: Infiltration BTU/HR
Garage ~ Sq. ft. Other rmanent unicipal Utility R:.; ........:.::....:...............:.....:.;..:...........
'~;:."~'.:~~:~......:.:::
Other Private on-site Well ~-
$
The applicant agrees to comply with the Wisconsin Unifo rm Dwelling Code and other Mu ipal Ordinances and with the conditions of this p rmit; understands
that the issuance of the permit creates no legal li ility, ress or implied, on the p merit or Municipality; and certifies that al the a e;il,formation is
accurate.
~ ~ Jv//~
SIGNATURE OF APPLICANT D ATE
CONDITIONS OF APPROVAL T is it is ed pursuant to the following conditions. Failure to comply y r suit in suspension or
rev i n of is rmit or other penalty.
Q P t r' ~"
~ f?
•, P S' '--
(. ~
~-
~~ ^ TOWN ^ VILLAGE ITY ^ COUNTY Municipality Number of Municipality Number of Dwelling
^ STATE IN ENDE Ins action Authority Location, if different
,~URI~CT~OI~ ~ ~ - ~ ~
oF:
;.
.
...~ I~~~ ....
'' .. ;; .
Plan Review $ ~~ Construction
HVAC NAME ~ ~
Inspection $ ^ Electrical
Wis. Permit Seal(s) $ ~~
^
Plumbing _
DATE '~ '- y
`
Other . $
~ ^ Other
~'~~SZ ,
CERT. NO. ~?' /~ t I^
'T [/
TOTAL $
SBDSf323(R.Mf39LQS~~ WHITE-Issuing Jurisdiction YELLOW-DILHR GREEN-Inspector PINK-Owner/Agent
0
~4~
6.66
x.09
190
.4~
r
~ ~ ~
+ ~~~H~c~ut1TE
0•
0
U
2I
Z
}
J
F-
Q
Y
6 0~
50
774. 7
776.15 ~ 774. 776.90 I
-.-. 2 9
73.C
~~~ ~`l~ 72.90 773.12
775.1 ! ~~' - 772.83
-3
?4 0 ~
4' j I S2
773.05
~~~,\
~ 772.66 ~~
g 773.35 ~~~,~ ^ L
~ ~~~.2\
pis'
772.OC
_____
7.71.94
772 2 4
772
T 7 ~ ~n1
DATE S - / ~ g~
NAME ~C ~t°E- ~--V~.'e i h ADDRESS
LOT ~~r BLOCK TaaRD
SUBOtV. ~ ~~ ~ ZONE
STREET N0. ~~30 ~~ r ~l.i K K C~~ LOT U I MENS I ONS
SIDEWALK EXISTING
BUILDING GRADE ELEVATIONS STAKES SET AT
FEE: ~~15.00
U~''"
YES ~ NO
SITE 1 2 , 19~_BY ~t
DEPARTMENT OF PUBLIC WORKS~~
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has cc~~~~^~^^~'
~~~ ~
Address
Owners N
City of Oshkosh 1/1/P5
Name of Subdivision
Lot # ~ ~ ldg. Permit # ~ ~3CQ ~
No. of Units
Fee Required ~~~
Fee Paid
Owner's signature
Inspector's signa
Parks Subdivision
Improvement
Accts. Rec.: 362-041
PARKLAND DEDICATION FEE COLLECTION RECORD