HomeMy WebLinkAbout0040832-Buildingl .
~ CITY OF OSHKOSH N~ X0832
`' PERMIT -APPLICATION AND RECORD
TYPE: BLDG HTG ^ ELEC ^ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
ADDRESS ' ~" -' ' -1~,^ f~ tl~~ ~ l'--,~~~-- PLAN NO. ray` ~~ ' ~ rI~'~ ~~;~
OWNER ~USC~.t~ ~~~5'~t~'a`~.-'~llp~~
DESIGNER
USE/NATURE OF WORK J ~ "`~-~ ~ t ~~~ ~ ~~M ~~ ~-Q ~~~~~--t'~
BUILDING CONTRACTOR ~~~~-~~ _
Size ~ I2.~~ Sq. Ft. ~~~ # Rooms ~ ~ # Stories Height <~~c~~~
Foundation ~~ ~~~~ Class of Const. ~ Occupancy Permit I``~--~
HEATING CONTRACTOR ~~
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR - ~ n~ t ~ ~'-- ~'~
Electric Serv. New ^ Change ^ Temp ^ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR --_ ~__L`~
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 ~ ~ ~~~'~ Permit Fee Paid $ `~ °1' - ~ Park Dedication $
ISSUED dY ~a-+ ` ~~,~, ~ Date ~'`' ~ ~ ~~ Final/O.P.
In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE ~'` ~ Z rf G~
AGENT/OWNER DA
ADDRESS
TELEPHONE N
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
LaborandHumanRelations BUILDING PERMIT ~~~~
Safety and Buildings Division
P.O. Box 7969 APPLICATION Parcel No.
Madison, WI 53707.
Wisconsin Statutes 101.63, ioi.73 (See instructions on back of pink copy)
>PERI~I'I~f `' a~ESTI~d <>
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: v Constr C, rosion Other:
Owner' ame Mailing Address Telephone No. (include area code)
a~ ~~~ Szo
Contract_or's Name Mailing Address ~~~ Telephone No. (include area code)
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~~ ~ Lot Area
" "' S . ft. 1/4, 1/4, Sectio n T N, R E (or) W
Buil in ddress
~~ ~ Subdivision Name ~ Lot No. Block No.
Zoning District(s) Wing Permit No. ront Rear Left Right
Setbacks ft. ft. ft. ft.
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ew ^ Repair Ingle Family Entrance Panel orced Air Furnace fuel Nat. L. P. Oil Elec. Solid Solar
^ Alteration ^ Raze ^ Two Family Size: [ O O amp ^ Radiant Baseboard or Panel Gas '
^ Addition ^Move ^ Garage Ser ce:
~ ^ Heat Pump
Space Htg
^
^
^
^
^ Other (print): [
lnderground ^ Boiler
^ Overhead ^ Central Air Conditioning Water Htg ^ ^ ^ ^ ^
^ Other
'
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' ~~~'~ ^ Other * ^ Dwelling unit will have 3 kilowatt or
ite Constructed °
oncrete
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~" more installed electric s ace heatin a ui .
p g q P
Infiltration control o tion is: Fulls lin
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"~ ~'~~~~ ~ ~ >' '~ '''`~~<•?» ^ Manufactured
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^ Njasonr
^ Treated Wood
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Sew
of joints. ^ Blower door test. ^ Exterior
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Unfinished Basem Sq. ft.
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^ Other
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unicipal
^ septic air infiltration barrier.
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Living Area ~ ~O Sq
ft ^1-Story >
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`:>~K.>~~~~<?<:>'>«>><`>:>:~:> Permit No. ...;:
Envelope BTU/HR
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c~the ^ S sonal
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Infiltration BTU/HR
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Garage Sq. ft. t~
ff~~
W~ manen
Other
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P
Y
~~~ ~:~>h~3~~'~~ .........:.::::::...:.::::
us Basement ^ Private On-Site Well $ ~C
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 liability, express or implied, on the art ent or municipality; and certifies that all the above informati n is a curate.
APPLICANT'S SIGNATURE ~ SATE StGNEU rJ y
APPROVAL CONDITION S This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
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Plan Review $
Inspection $ onstruction
HVAC ~~''-~
-.
Wis. Permit Seal $ ~
Other $~
^ Electrical
Pl
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Name
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^
um
ing
~rosion ~,,,,~.,
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Date
.
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Total $
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+7 l j1
~
Cert. No. [~~"
SBD-5
8
23 (R. 07/92) WHITE -Issuing Jurisdiction YELLOW - DILHR GREEN -Inspector PINK -Owner/Agent
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