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CITY OF OSHKOSH N9 32348
PERMIT APPLICATION AND RECORD
TYPE: BLDG X HTG ELEC PLBG SIGN ZONING re-, FLOOD PLAIN HEIGHT
ADDRESS /2 8 g h/ ‘e)a PLAN NO* IO SO/ q3
OWNER
DESIGNER
USE /NATURE OF WORK I 6zze
BUILDING CONTRACTOR .err A ,L.r�2Z -7
Size Sq. Ft. /10.._ Rooms Stories Height
Foundation 672 Class of Const. k Occupancy Permit
HEATING CONTRACTOR /3,i/l J
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR A Y-1/
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 30, OO 0. 00 Permit Fee Paid 0 0 0 Park Dedication DO% 00
ISSUED BY if/1A./,le,v`t4 Date 3 1? -3 Final /O.P. 6/15/73
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ,3
AGENT /OWNER D ATE
ADDRESS
TELEPHONE
Revised:8/99
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: /2_,5 .�l,f��/,(l ZONING:
PROPERTY OWNER /CONTRACTOR: /6/ S
CONSTRUCTION DATA: L./141 CONSTRUCTI{N ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
J c2 t 2 >ez- 57641*.
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
j Lot Width
Lot Area
Floodplain
Front Yard
Side Street (frrnt 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: �0
ig
The Director of Community Development, or d nee, ust approve all plans, except the
following: (1) Alterations or interior wo k 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) Required
REVI£'AED BY: e G
DATE:
A 0 S`
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor Human Relations BUILDING PERMIT 2.3 4'8
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)
STED Constr El ec
HVAC PI 9
b E rosion 0 Other:
Owner's Name Mailing Address Telephone No. (include area code)
Contractor's Nam Mailing Address Telephone No. (include area code)
.-...Z/.... 'y/ 7 O L J% S '1 -0‘.1
Lot Area
ROJ O Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Building Address r Subdivision Name r Lot No Block No.
1 S' >A► /,e.2 YYA 0 ?9
Zoning Districts) Z.Iing Permit No. Front Rear Left Righ
i
e Setbacks a s ft. T 3 ft. 5 ft. C ft.
::::::::::i:: A :i
■II I�Y.. k•:. i. •::•i: i siR.::•: GLiF�i :i:�N.��'�i>�..�i:::'r::i 1[ F: :Fi•.t�i2:i:: 6 .�i.::i::i::::i::::i:::::: i:::ii::::::::::: j!
New Repair ingle Family Entrance Panel Worced Air Furnace Nat. L. P. Oil Elec. Solid Solar
Alteration 0 Raze Two Family Size: /0 o amp Radiant Baseboard or Panel Fuel Gas
❑Addition Q Move Garage Service: Heat Pump
Other (print): ,Underground Boiler Spate Htg
Overhead Central Air Conditioning Water Htg AZ 0
Other Other Dwelling unit will have 3 kilowatt or
<5':'#' »ItI±�IA't'It7inl' space more installed electric heating
Site Constructed Concrete p eat g equip.
0 T Masorea t n
e r
Sewer of oints.
l filtration control option is ❑Full sealing
Y
::2. >Ai:I `3s Exterior
d Wood
1 Blower door test.
air infiltration barrier.
i :;:•::.a
Unfinished Basement Sq. ft ❑Other uniapal
I S ept i >::<'1�� >��RT�t�55<:.:a���a#
Y AIS "v:: >i Permit No.
Living Area I o 5 S ft. y 0 Seasonal Envelope 2Z 022- BTU /HR
q Q 2 Stor
`'::ice z E ig Infiltration 3
ther Permanent
�3 .2 0 �p BTU /HR
Garage 5747 Sq.ft. Munici I
P
a Utilit
❑Plus Basement ❑Private On -Site Well .*.:.:::::::::::::::::::::::::::::::::.::::.1:.::::::::
COO. CID
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, o or municipality; and certifies that all the above informs on is a curate.
APPLICANT'S SIGNATURE V W& 4 4 DATE SIGNED 9)
APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to comply may resu in suspension or
revocation of this permit or other penalty.
T own Village a
e i
Ct
County 9 ate of: Y o Municipality Y a t Number of Dw e I I ing Location:
:Iii4intiSOICTIO 0 2
:::::.r
.............4....... ..sL NCB..:::::.. ::::.:::.::::::6:.
Plan Review o 01) Construction 7-01-4,4--" Inspection HHVAC Name
Wis. Permit Seal _3j 0 p 0 Electrical 1 v �o
Other Q Plumbing Date 3 93
rosion .>2 6St
Total 1O. O D Cert. No.
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
3 t 0
CATE ///3/3
NAME EA, 65.41 ADDRESS
LOT 629 BLOCK WARD
SUBDIV. ��/ji ZONE
STREET NO. b'7 14.2if jgtV 4201 LOT DIMENSIONS
SIDEWALK EXISTING YES NO
BUILDING GRADE ELEVATIONS STAKES SET AT SITE I S 19 °I 2 BY ►tea
FEE; $15.00
DEPARTS "ENT OF PUBLIC WORKS
1, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
00.,16715 4 7 1 I
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address /2- S 9 adf,c4tylid bOal
Owner's Name
Name of Subdivision J,�
Lot d9 Bldg. Permit 32-34i
No. of Units
Fee Required 0-0 0
Fee Paid 6 .o iJ
Owner's signature Date l 2
Inspector's signature iJJ.. Date /11
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
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