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N2 34906
CITY OF OSHKOSH
PERMIT APPLICATION AND RECORD
TYPE: BLDG X HTG ELEC PLBG SIGN ZONING re-1 FLOOD PLAIN HEIGHT
ADDRESS /ZD e ,.f.) T.C.GP 1A PLAN NO. t'/ k O'73/C,
OWNER
DESIGNER J/�
USE /NATURE OF WORK /.4 ),1I1e i4
BUILDING CONTRACTOR d elte- MA y t /(Jo dW/fr
Size S Ft. �4 J O R Sto ries '-.1 Height a.��
p
Foundation Class of Const. o Occupancy Permit .__4_____
HEATING CONTRACTOR 527e YJ7'
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR (q�f
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR i
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
__WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other 7
FEES: Valuation 7 O j 0 0 0 0'0 Permit Fee Paid 3 o •CJO Park Dedication C O c')
ISSUED BY Date 7/t 3 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
7JtY//""`" 3
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SIGNATURE
AGENT /OWNER DATE
ADDRESS
TELEPHONE
yam: 1J 1 11 b? 01g3/-
Wisconsin Department of Industry, S CONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT l/
Safety and Buildings Division T �(o
P.O. Box 7969 APPLICATION Parcel No.
Madison, WI 53707
Wisconsin Statutes 101.63, 101.73 (See instructions on back of pink copy)
::PER. R EQ•UESTEa:
Constr HVAC Elec Plb Erosion Other:
Owner's Name Mailing Address Telephone No. (include area code)
Co tractor's Name Mailing Address Telephone No. (include area code)
�40 �O S' /��r Y' �-t6 9 O
,fi Lot Area
:i iiii:I ,f •e l,, Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Building Address Subdivision Name Lot No. Block No.
2 4 ,1�ti0-212,P eZ /.d /teeidt,e- 3
Zoning District(s) I Zoning Permit No. Front Rear Left Right
/e Setbacks 3o ft. s r ft. Z"` ft. 8- ft.
...a,.A.�..h•. ..*EtE.. «::IFilfA .A NMEN'.t`:.:.10,«: •Y: ,a.
ew Repair ingle Family Entrance Panel Forced Air Furnace Fu Nat. L. P. Oil Elec. Solid Solar
A teration Raze Two Family Size: /0 amp Radiant Baseboard or Panel Gas
Addition Move Garage Service: Heat Pump
Other (print): Underground Boiler Space Htg
Overhead Central Air Conditioning Water Htg
Other ❑Ot Dwel ng unit will have 3 kilowatt or
more installed electric space heating equip.
Site Constructed oncrete
rPE mi#p� Infiltration control option is Fullsealing
❑Aanufactured Masonry
of oints. Blower door test. Exterior
x`I?f >z''• ❑Treated Wood Sewer air infiltration barrier.
fs. i SST E�. i iii:
i Other M
Unfinished Basement /02-0Sq. ft. unicipal
<a "'tii:i
1 Stor
septi <:<MttiTfrS�S11i slid
Y •i :'•'•:>s` >s` Permit No.
Living Area /(p 0 Sq. ft. }FQ -Story Envelope 7i BTU/HR
S
y ❑Seasonal
t ATER ?''<i Infiltration 1,1M BTU /HR
Garage 4 Z S .ft Ot her ermanent
9 q
ni i I Utility u c a Ut t
❑Other Y1 05 A 4��. Y�,
Plus Basement 0 Private On -Site Well J, 000,00
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 epartment or municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE y"' '7' DATE SIGNED '2 //11q 3
APPROVAL CONDITIONS This permit is issu'bd pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
Town
Village it
County State of: S ate o Municipality Number f
9 Y Y of Dwelling Location:
P Y 9
RI DI 2 o Z 6 ,4
�>Q re
�i>
Plan Review V.0 �nstruction
Inspection HVAC Name
Wm. Permit Seal 3C). 0 0 Electrical 1 -Z �O 3 Z q 3
Oth Plumbin Date t
rosion
Total ?O. 0 Cert. No. 2-S
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner/Agent
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address /1 ZD Audzi
Owner's Name /ri
Name of Subdivision /�i %yam
Lot /3 Bldg. Permit 3 '19°
No. of Units
Fee Required /o0
Fee Paid l 00. D a
Owner's signature (/t/ ®Date /1 '/3
Inspector's signature .74e- zr•,-- Date 7/(
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
Revised: B/B°
ZONING /LAND USE COMPLIANCE CHEC: <LIST
JOB LOCATION: ZO 1, Afiw� ZONING:
PROPERTY
PROPERTY OWNER /CONTRACTOR: c4"
CONSTRUCTION DATA: CONSTRUCan ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSE) CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
COMPLIANCE CHECKLIST (Check only those applicable)
CDM.LIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (frost yar)
Rear Yard
Side Yard (R)
Side Yard (L)
Parking Spaces
Building Area
Lot Area Per Family
Corner Lot
Landscaping
Transitional Yard
Off- Street Loading
Vision Clearance
Height
REVIEW AUTHORITY: L//7 •G^
The Director of Community Development, or signee, must approve 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.
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.
C-- DENIED
Plan Commission Action Required
Variance(s) Requir
REVIE'WED BY: e r, E GATE: AL%
CATE 7 //s 43
NAME A 4:4.k 4‘ 7 t t ADDRESS
LOT 1 3
BLOCK
WARD �lO
S UBO i V kb-7444/ duff-
Tr//'' ZONE
STREET NO. /(2-e)/14 A,d.,,4,f LOT DIMENSIONS
SIDEWALK EXISTING YES LJ NO IR
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 1G ,Ig c[ 3 BY k?
FEE; $15.00
7 4 e1 1 -C- id
DEPARTMENT OF PUBLIC ''1CRK_
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
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10T 13, WESTFIELD HEIGHTS, CITY OF OSHKOSH, WINNEBAGO COUNTY, WISCONSIN.
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117.97'
.33 i •6'' UTILITY EASEMENT
22' I
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g 2.33 5.67' g 0
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CO I-4 0 301 I
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co
30.00 v I
117.91'
it CAROW LAND SURVEYING CO., INC.
1".201
oReNn+ BY
f EW EAS
1837 W. WISCONSIN AVE., AYE. P.O. BOX 1297
APPLETON, WISCONSIN 54912 -1297 PAO�E� NO A937.13
PHONE 414-731-4168 FAX 731 -5673