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CITY OF OSHKOSH N°_ 29930
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING e l FLOOD PLAI HEIGHT
ADDRESS ,2 ‘6 PLAN NO.R i lls f 079Z
OWNER /e l 6 L a.r,41
DESIGNER �j
USE /NATURE OF WORK J /Q/i) JfX ii2 /4
BUILDING CONTRACTOR ea)�/ s%1
Size Sq. Ft. 7 7 Rooms �p 3
Stories 1 Height
Foundation .fit Class of Const. Occupancy Permit
HEATING CONTRACTOR /6/GGC.r/`«
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR e„,....,
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
2
FEES: Valuation 3o) 00 0 0 0 Permit Fee Paid o S .0 0 Park Dedication 1 0 0. 0 0
ISSUED BY 90 4.211.44--" Date 77 Z Final /O.P.02 "/O 9 3
In the performance of this work I agre to perform all work pursuant to rules governing the described construction.
SIGNATURE Lam--
7/?//f)
AGENT /OWNER DA
ADDRESS
TELEPHONE N
Revised: 8/89
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: f7 ZONING:
J
PROPERTY OWNER/CONTRACTOR: .e,c,a— z
CONSTRUCTION DATA: NEW CONSTRUCTKN ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (frrnt 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: (411,(Arf
The Director of Community Development, de nee, .�st approve all plans, except the
following: (1) Alterations or interior work when th 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.
PROVED DENIED
Plan Commission Action Required
Variance(s) Required AR
T 'v
REVIEWED BY: �i AK DATE:
g Y /'Y o79 2 -4 C--'
State of Wisconsin
Department of Industry, WISCONSIN UNIFORM Q
Labor Human Relations BUILDING PERMIT APPLICATION NO. Division Division of Safety Buildings
Box Madison, Mad n, WI 53707 APPLICATION
Wisconsin Statutes 101.63, 101.73 (See Instructions on back of pink copy) PARCEL NO.
RIM REQU ST CONSTRUCTION HVAC VAC ELEC PLUMBING 111 OTHER:
Owner's Name Mailing Address Telephone
Contra tor's Name Mailing Address Telephone
l` Ca r 1 7 G Zejf,el n8DL G ,`lh,L.. ,3/ Z3
Lot Area
E.. .C..,.T.....; L TION
Sq. ft. /s, SECTION T N, R E (or)W
/2 Building 7 r 7� /4/ Subdivision 6 r Lot No. Block No.
Zoning strict(s) ing Permit No. G� ront Rear Left Ri ht
Setbacks T f ft n ft.
:<::PROJE :x: 0 c iiii V: E...,.
&.�t11#i� II...Et..E�'ER��AI�. �f�!`AG:.EI!?�tEEI�' i�.:.:EI+lERG3�.SOURCE....
ew Repair Single Family Entranc Panel Forced Air Furnace Fuel Nat. L.P. Oil Elec. SolidSolar
❑Alteration Raze Two family Size: /00 amp Radiant Baseboard or Panel Gas
❑Addition Move Garage £e vice: Heat Pump SP lib.
Other Underground Boiler Water .1
Overhead Central Air Conditioning
Other
Dwelling m will have 3 kilowatt or
unit ❑Other <il« 't more installed electric space heating equip.
Site constructed
Concrete ')f�I Infiltration control option is: ❑F ull sealing
P g
Mason
of joints. Blower r
E14? €I�'�> Manufactured Masonry Se er 1 doo test. ❑Exterior
Treated Wood Municipal air infiltration barrier.
Other Se tit
Unfinished Basemen1 if r lE p 7: I A Lt)E Cale latacl}
:..o.i No.
0 1 Story 8 Envelope
Living Area 177 sq. ft. E 3 Z3 /O A TU /HR
-Story Seasonal iWA 'ER<: 7 ilk BTU /HR
Infiltration
cf Other Permanent
Garage S ft. Municipal Utili "��)TIt)Cf t'�'<
0 Other
Private on -site Well
Plus basement 000, 0 0
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 Department o icipality; and certifies that all the above information is ccurate
SIGNATURE OF APPLICANT
DATE
CONDITIONS OF APPROVAL This
revocation permit of ist this issued permi p t urs or uant other top pen the following conditions. Failure to comply ay result in suspension or
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TOWN
VILLAGE CITY
C OUNTY Municipality N umber of Municipality
Number of Dwelling
STATE IND P NDEI�T Inspection Authority Location, if different
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Plan Review 40. Construction
A ."."...zwit;._
HVAC NAME
0 9%44-
Inspection ID Electrical I fl tiO q
Wis. Permit Seal, $30. Plumbing DATE /3 0/9
Other Other SAS O
TOTAL 7 0 CERT. NO.
SBD5823(R.8/80tj_ WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK —Owner /Agent
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DATE 7/2—
NAME (4-7-14-7". AOORESS
LOT a BLOCK
WARD /3
SUBOIV. 2/4 to ZONE
STREET NO. r7 c)
LOT DIMENSIONS
SIDEWALK EXISTING YES EJ NO 0
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 8 /3 ,199'2 BY let
FEE :I-m. D
DEPARTMENT OF PUBLIC WORKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
O 535 /156/31
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address /2_57 7x ,L1 /4
Owner's Name 4A,Q /�t. 6).--„►. ti tl
Name of Subdivision l,(r Gr', c://t et-%Z it
Lot .n Bldg. Permit
No. of Units 1
Fee Requi red o o
Fee Paid o .o p
T
Owner's signature Date 7
Inspector's signature
y6t-kl ti 44,c-f./44 Date 7 3 0
Parks Subdivision
Improvement
Accts. Rec.: 362 -041