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(--41), CITY OF OSHKOSH N9 32347
PERMIT APPLICATION AND RECORD
TYPE: BLDG AC HTG ELEC PLBG SIGN ZONING e--( FLOOD PLAIN HEIGHT
qq r e
ADDRESS t2 4-7 /AJ4, /1' ��J PLAN NO.1/O 4 01'7 3 P-
OWNER
DESIGNER
USE /NATURE OF WORK Ze. ef 405'4 #44
BUILDING CONTRACTOR iel-e.4C".4.- ".BN•Q./t f/r-64
Size Sq. Ft. I Z- Z-L Rooms 40 3/ Stories r Height 4 120 f
Foundation Class of Const. 4 Occupancy Permit
HEATING CONTRACTOR /4LI(4NA
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR eiyJ'/ 1•'y
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
1
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
FEES: Valuation `3o, O 0, 00 Permit Fee Paid 0 Park Dedication 00. Da
ISSUED BY ie4/ Date x Final /O.P. 9 a 1 73
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
7....7.,
AGENT /OWNER DATE
ADDRESS
TELEPHONE
Reiised: 8/84
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: /1(47 .�l ZONING:
PROPERTY OWNER/CONTRACTOR: e, 9,144
CONSTRUCTION DATA: i./ NEW CONSTRUCTIQV ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.) I p
cuy, COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (fist yard)
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.
The Director of Community Development, or dfsignee 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.
(_APPROVED DENIED
Plan Commission Action Required
Variance(s) Requir
REVIEWED BY: ir/ 417 DATE: Ar
O o l's
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT 3z3(/-7
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)
:PERI I REQUEST i'• :i
c t 0 HVAC 0 Elec 0 PI bg Erosion 0 Other:
Owner's Name Mailing Address Telephone No. (include area code)
Contractor's Name 2a ng Address Telephone No. (include area code)
7 ld get l a��ti so E 23/ 8io3
otAea
ROJE O Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Building Address 4. Subdivision Name Lot No. Block No.
i
23
Zoning District(s) Zo ng Permit No.. Front Rear Left Right
t Setbacks as ft. I �a ft. 0 ft. 0 ft.
C`. t' i,a,.. �P >::.:'I�.:.;EI1.:E.::. 'A IIIi1'T: :�:�:«:NE VI
i_ New Repair Ingle Family Entrance Panel is orced Air Furnace Fuel Nat. L. P. Oil Elec. Solid Solar
Alteration Raze Two Family Size: 0, amp Radiant Baseboard or Panel Gas
Addition Move Garage Service: Heat Pump
Other (print): �tlnderground Boiler Space Htg
Overhead Central Air Conditioning Water Htg
Other ❑O the r ❑Dwelling unit will have 3 kilowatt or
more installed electric s
ST'```'` space heating equip.
)?Site Constructed oncrete p g
q g
a'> I I MIRA z' >�M:i >f Infiltration control option i F II sealing
Manufactured [�asonry d 1.::::: s u sea g
of joints. Blower door test. 0 Exterior
>:i.MEMN1ILVED?:] :i» »::::iii:::' ❑Treated Wood Sewer air infiltration barrier.
Unfinished Basement lLZ2
:S: :S'Ir•QI 3E Other Municipal rsq. ft fi lt <z:..;
❑Septic :NE41!:.! .'S.I.::::(: f1: kite
1- Story Permit No. Envelope aO SI (o BTU /HR
Living Area 12. Sq. ft. 2 -Story Seasonal t
ti AT Infiltration
Other Permanent BTU /HR
7
Garage 7 t0 Sq.ft.
ni i I
u c a Utility P
❑Other Y x: f 7
,lus Basement Private On -Site Well
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 im lied, on the a ment or municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE c DATE SIGNED q/9?
APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to comply may res It in suspension or
revocation of this permit or other penalty.
Town o Village e Cit
Count St f:
9 ate o Munici alit Number f D
City Y be o wellin Location:
,t P Y 9
;;:JURISDICTION: 0 2
Plan Review 74O c2 0 `Construction
Inspection HVAC :::e tSeal 30 a ❑Electrical (L(L ///3/93
A54Erosion 5-50
Total QQ Cert. No.
SBD -5823 (R.07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
30
DATE ///3/9 3
NAME /C i1-a 6' ADDRESS
LOT .23 BLOCK WARD
Su8D 1 V a ZONE
STREET NO. Ick tJ tel�w 4.00c( LOT DIMENSIONS
SIDEWALK EXISTING YES 0 NO 0
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 1 IBS ,19 9 3 BY ,La
FEE: $15.00
,4/-.(17(//
DEPARTMENT OF PUBLIC WORK_
I, the undersigned, owner or agent of the above described property agree TO have the
grade established before excavation has commenced.
0016711
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address 1 Z 4-1 /lL .1 fi
Owner's Name ifLj 444i
Name of Subdivision .A.17140
Lot 23 Bldg. Permit 323 1 7
No. of Units
Fee Required 1 n O• 0 o
Fee Paid 100.00
Owner's signature i--- <'A Date (/1 /43
Inspector's signature Date //►3/93
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
/02 y7 ca
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