HomeMy WebLinkAbout0094290-Building (windows)CITY OF OSHKOSH No 0094290
OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 2490 KINGSTON PL Owner JAMES A/KATHY J BAULDRY Create Date 05/13/2002
Designer Contractor WRIGHTWAY INC
Category 141 -Exterior Remodeling Plan
Type ~ Building ~ Sign ~ Canopy ~ Fence Q Raze
Zoning Class of Const: Size
Unfinished/Basement 0 Sq. Ft. Rooms 0 Height 0 Ft. ^ Projection
Finished/Living 0 Sq. Ft. Bedrooms 0 Stories Canopies 0
Garage 0 Sq. Ft. Baths 0 Signs 0
Foundation ~ Poured Concrete ~ Floating Slab ~ Pier
Concrete Biock ~ Post ~ Treated Wood
Occupancy Permit Not Required Flood Plain
Park Dedication # Dwelling Units
Other
Height Permit
0 # Structures 0
Use/Nature ~SFR/Install 11 replacement (same size & location) windows.* NO
of Work
HVAC Contractor
Electric Contractor
Fees: Valuation
Issued By:
Plumbing Contractor
$6,101.00 Plan Approval $0.00 Permit Fee Paid
^ Permit Voided
$50.00 Park Dedication $0.00
Date 05/13/2002 Final/O.P. 00/00/0000
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Signature Date
Agent/Owner
Address W6764 HWY 23 FOND DU LAC WI 54937 - 0000 Telephone Number 1-800-923-0721
M Y-10-02 FRI 14:06 WRIGHTWAY, INC. 9209298999 P.02
clnr of osHlcosH
BUILDINt~ PERMIT APPLICATION
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1 Address of Property '
2 The Property is owned by
3 I am the O Owner OR 1 am the ~Contracto~
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4 The contractor doing the work Is Wr igh~wdy ~ Inc . )~ond du Lac ~,
5 'this is a ~Single Family Residence, Q Rental. D Commercial '
6 Work being done;
SIDING
D Install siding on Q house, ^ garage
^ Replacing vinyl with of nyl
D Replacing steel or aluminum with vinyl (circle steel or aluminum)
Q Replacing with
This work is being done due to D Hail Damage A Other
When siding is done one of the boxes below must be checked:
D Electric -Electric Meter. receptacle. lighting and Electric Service entrance
alteratwns/modifications are being performed by
Electric Installation Verif'~cation tome is attached "'~ °A'"'
D Electric -not applicable
. ~
' D Install new or ^ Replace gutters ~,~,~'~ ~ ~° ~~ s ~
D Install new or D Replace downspouts ~~
'Other work bein done: ease note 1 ~
,,~ -
' Value of the job Z fa ~{~~~ (include fair markot price for labor even it you are
not paying for labor)
MAY-10-02 FRI 14:07 WRIGHTWAY, INC. 9209298999 P. 03
Fill in one of the o lions below. You ma attach form to work contract. Maintain thin form for three ears.
OPTION 1-OCCUPANT ACKNOWLEDGEMENT STATEMENT
1 have received a Copy of the pamphlet, Protect Yaur Family from Lead to Yovr home, infomung me of the
potential risk of lead hazard exposure in my dwelling unit. t received this pamphlet before the work began.
Printed Name;
Signature:
pate: -~ "~~'' ~ ~-T-
Address of un~Undergoing Renovation:
OPTION 2 -RENOVATOR'S CERTIFICATION OF DEt.IVERY
I certify that I have made a good faith effort to deliver the pamphlet, Protect Your Family from i,ead in the
Home, to the unit listed below at the dates and times indicated, and that the occupant refused to sign the
acknowledgement or was unavailable to sign the acknowledgement. 1further certiy that 1 left a copy of
the pamphlet at the unit by sliding it under the door or by other means indicated below.
Name of renovator or designated representative who delivered pamphlet;
Address of the unit undergoing renovation:
Date(s), Time{s), and Method of attempted delivery:
Date. Time, and Method of Actual Delivery:
Reason for lack of Acknowledgement by Occupant: (check one}:
O occupant Unavailable
p Occupant Refused to Sign
Signature Of Renovator or Designated Representative:
Date of 5gnature:
OPTION 3 ~ SELF CERTIFICATION OF MAI~.ING
t hereby certify that I mailed a copy of the pamphlet. Protect Your Family from Lead in Your Home, to the
unit listed below at least 7 days prior to the Start of the renovation of the unit. I have attached a certit'icate
of mailing (or other proof of mailing such as registered mail receipt or certified mail receipt) to this form,
Signature o Renovator.
Date of Signature:
Address of unit Undergoing Renovation:
/rlStructions; Renovator must either obtain signature of occupant or self-cattily that pamphlet was delivered and
occupant was unavailable or refused to sign acknowledgement. or that renovatar mailed the pamphlet 1o the
occupant at least 7 (seven} days before renovation work began.
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MAY-10-02 FRI 14:08 WRIGHTWAY, INC. 9209298999
CStr of oshknsA
Di+if+011 of Inlycction Sawxr-+
YU [)OX 1170
U+IJ:mAWI 5190]-1110
()Ircr 921Y15~-5050
~, wrr -' Few 92D.2)6.SOt1~
Electric [n/st Nation Verif cation
riot homeo+lvner(s) name)
the homeowner(s) of _ ~.,~~C/_.._/_!.t'_~ ~a?_'1._.-.~1~S~"._____.........~ ....~..
(acidr • ~ here work is to be performed)
accept the responsibility for performing the electrical work as stated below for the property listed
above.
"!'he Harare of the work consists of: (Check one or Describe the Nature of Work)
Reeonnoction or new circuit for replacement bleating Plant and/or A/C Condenser.
Rcc:onatection or new circuit for replacement Electric Water ITeater.
ltc~conncction of the Scrvicc Fntrancc Cable, Meter Box, alterations to receptacles
_~_.__ and lighting fixtures due to siding / soffit installation. Note: New Serviee
Entrance Cables will rzquire a separate permit.
~Yteconnection or new circuit for other permancntty wired al+pliances /fixtures.
~./ Other /~ ) /'~ /l ~) ', __- -
..._ _~tL-y /V.~ .-- -.__.~----~--~--_-_._---~~.._.._~-.-
The value of this work is S ,~ ____
1 hereby verify this work wilt be performed vy me and further verify the recotmection
installationT< will be done in compliance with n>tanufacturer and Electric code requirements.
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