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N9 39251
CITY OF OSHKOSH
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS M kl.. QDLv T PLAN NO w 5 j)9y
OWNER C.L t MEsS
DESIGNER
USE /NATURE OF WORK f' ontL Pc,1 -k ft
BUILDING CONTRACTOR 1 "C.I)R 1 -�CA'NfkS
Size i'QEo Sq. Ft. 1 `-t0� Rooms v ESR Storie s I Height
Foundation c! C_1 E
Class of Const. o Occupancy Permit I REiq
HEATING CONTRACTOR JV
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR COM 1 NGS
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR 11 M t
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 Di O�� Permit Fee Paid g0 o 4 Park Dedication /OD°
ISSUED BY Date 5 /'7 CPI Final /O.P.
In the performance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE (.....1-1,..1..,..7i Y
AGENT /OWNER
DATE
ADDRESS
TELEPHONE
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT 3Ct QS l
Safety and Buildings Division
P.O. Box 7969 APPLICATION Parcel No.
Madison, WI 53707
Wisconsin Statutes 101.63, 101.73 (See instructions on back of pink copy)
PERtT°`ETD C onstr HVAC El Elec 0 PI bg Erosion 0 Other:
Owner's Name Mailing Address Telephone No. (include area code)
5� -c.(- a. 7 /e rn �S
Contr or's Name Mailing Address Telephone No. (include area code)
6.- C-A r-j /4 SZ,r A/ LAj rA Eve Sr. W Y— Vzz zoo 1
Lot Ar
of eat
PR O A .ON
Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Buildin• ddress 1131 574‘,..7-e2.1.- Subdivision Name Lot No. q Block No.
a-T weSr 67-o dem Hr3
Zoning 0 istrict(s) Zoning Permit No. Front Rear Left Rig ht
9 9
Setbacks 3o ft. l Z 3 ft. _-S ft. ft.
�I JET'I` F S R0 <s: i
����P. ��I�t.... E: L tlf`:::::;<: �V�. ��PIVI��I :�:��:<:E�,tER Std.
Al New Repair ,atingle Family Entrance Panelrced Air Furnace Fuel Nat- L. P. Oil Elec. Solid Solar
Alteration Raze Two Family Size: /00 amp Radiant Baseboard or Panel Gas
Addition Move Garage Sery e: Heat Pump
Space Htg
Other (print):derground Boiler
Overhead Central Air Conditioning Water Htg s ie
Other Other Dwelling unit will have 3 kilowatt or
more installed electric space heating equip.
ite Constructed ,a-Concrete P g
>�����II�I#IIti`::«<'z<z:' In f iltration contro option is Full sealin
Manufactured Masonry of joints. Blower door test. 0 Exterior
g
<`JtiN >s >z: Treated Wood
Sew
air infiltration barrier.
SS :'fi L I ❑Other unicipal >::::s:;
Unfinished Basement 5q. ft. Se tic A=< HgATVO::J :1-': 40100
>::<::zz<::
p
1- Story: Permit No Envelope BTU /HR
Living Area Sq. ft. 2 -Story Seasonal
BTU /HR
rmanent
11. ATE Infiltration y' 3$8
Garage Sq. ft. Other
❑Other �unici al Utility
s Basement Private On -Site Well Or
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 orimplied, on the Department or municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE 6o-,-....gr/i..--, DATE SIGNED -5 L`! y
k APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revoca o f this permit or other penalty. n n �r-
1 PA/ cbIL E Si/�J M 5V2 r LS lLN/ gio /O�J
a) So8nvr QTLuSS 7)e—r4/t..
Town Village e Cit County of: State Municipality
o N m r f
u be o Dwellin Location:
9 Y Y o
9 n:
JURISDICTION "?.-a 6 6
::::00.AI i:i; :.!._,..rfA i:i::::t;:y' i i:: i;::::::::::: i::::: i:: ::;::::i;::;:.:>:.::.::.,:.:: r:;:.::::.::::::::::::;:::•:::: i::>::::::: 5::::::::::>:::::::::::: ii;:: i:::::i:::i:::::::::::::::i:.
Plan Review Lib, o,_ 6 Construction
Inspection AC Name
Wis. Permit Seal `'e.:)• Electrical
Other 4 Plumbing Date
Erosion I L' OLI
Total a
L C ert. No.
S8D -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
.5/11 /S ham, oco ,C .u¢cl,
ti■El X0
`3I ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: ZONING
PROPERTY OWNER /CONTRACTOR:
CONSTRUCTION DATA: New Construction Addition Alteration
TYPE OF CONSTRUCTION: (i.e. fence, pool, parking lot, sign, etc.)
New c AT\ toklzkr-x;E.
COMPLIANCE CHECKLIST NOS- z zNoil
DEFICIENT COMMENTS
Use
Lot Width
Lot Area
Lot Area Per Family
Floodplain
Front Yard
Front Yard Side Street
Rear Yard
Side Yards
Building Area
Parking Standards
Off Street Loading Standards
Vision Clearance
Transitional Yard Standards
Landscape Standards
Height
Conditions of Approval
Compliance with P.C. or
BZA Conditions of Approval
Signage Standards
Drainage Plan
REVIEW AUTHORITY
As per Section 30 -5 Enforcement of the City Zoning Ordinance, the Director of Community Development, or
designee, must approval 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.
APPROVED DENIED
Plan Commission Action Required
Variance(s) Requi d
REVIEWED BY: DATE:
CATE 519194
NAME ADDRESS
LOT BLOCK WARD
SUBOI V. W EST F\ .L b lblA j ZONE
STREET NO. ti•< WELL— CDJiLT LOT DIMENSIONS
SIDEWALK EXISTING 1 V YES 0 NO
BUILDING GRADE ELEVATIONS STAKES SET AT SITE S I9 9 C BY Kf\
FEE: $15.00
DEPARTMENT OF PUBLIC 'WCRKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
Of2 4'94/6
CATEA( 9
NAME -C r
ADDRESS
LOT BLOCK !BARD
sum' y 1/CI CSI Fi LD /(TS ZONE
STREET NO. 1/3/ 4W i7 Z L C'T. LOT DIMENSIONS
SIDEWALK EXISTING YES NO a
BUILDING GRADE ELEVATIONS STAKES SET AT SITE �C� ,I9 WI BYO
N
FEE; $15.00
DEPARTMENT OF PUBLIC WCRKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
(_Yr003 4 ;a
City Of Oshkosh 1/1/85
131
PARKLAND DEDICATION FEE COLLECTION RECORD
Address -4)51 CO
Owner's Name COR -1 4- b'n E 5
Name of Subdivision W S
Lot 4 Bldg. Permit 39 as
No. of Units
Fee Required d'`
Fee Paid`'
6?—Cr
Owner's signature
Inspector's signature Date gy
Parks Subdivision
Improvement
accts. Rec.. 362-041
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