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CITY OF OSHKOSH N2 32349
4_10. PERMIT APPLICATION AND RECORD
TYPE: BLDG J HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 I 41).-11-1-4 yc.ILeY 6j1 PLAN NO. (0 O t Q 3 re-
OWNER
DESIGNER
USE /NATURE OF WORK )/m.(4) ,I ?/e ezee. j 441z
t
BUILDING CONTRACTOR J ✓L
Size v/ Sq. Ft. Rooms w 4 Stories Height /S
Foundation C.41 Class of Const. 8 Occupancy Permit
HEATING CONTRACTOR /��LGG0-C.L
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR &/47t t/l
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR At
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, Ofl c7 Permit Fee Paid 0 S• 0 Park Dedication /00. 0 a
ISSUED BY Date i 3 Final /O.P. i P 93
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE -Z— A
AGENT /OWNER DA
ADDRESS
TELEPHONE
Revised: 8/e9
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: /2,_(. N i e ZONING: X—
PROPERTY OWNER /CONTRACTOR: („9yiGG
CONSTRUCTION DATA: MEW CONSTRUCTI{N ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
1V...,./. (2:1619e-,Agi4 2 L,(4,01.
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (fr t 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: __CZ z (e��,,t t 0
The Director of Community Development, or desi nee, m t 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.
LAFPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: ,G4..._-... ari OATS: //5 "1
Ai I 0 40 0
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
and Hu ildings man ReDivisi lations
BUILDING PERMIT 3 2_3 q c
Sfety and Buon
P.O. Box 7969 APPLICATION Parcel No.
Madison, WI 53707
Wisconsin Statutes 101.63, 101.73 (See instructions on back of pink copy)
likiiiiiititOtitaidiggi
P; Constr 0 HVAC 0 Elec 0 PI bg 0 Erosion )"4Other:
Owner's Name Mailing Address Telephone No. (include area code)
Contractor's Name Mailing Address Telephone No. (include area code)
7
e N i4t'a ff. e s 0 z3 s 4.03
Lot Area pkwEeriaco"' Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Building Address Subdivision Name Lot No. Block No.
1Z PI Zear eeii144- el-1Areelige-..-AVM-4V 30
Zoning District(s) Zoning Permit NV Front I Rear Left Right
4 Setbacks S ft. L c-3 ft. 7 ft. 7- s ft.
1 atiatalliii::::::iiiiiiiii!:::::::• iiiiioiliteitatiorfitlit:i:::i:i::5124 glaRG.V.SOURCEEMI:::::::::MEME
New 0 Repair S i n g I e Family Entrance Panel p:1 Air Furnace
Fuel Nat. L. P. Oil Elec. Solid Solar
'0 0 Raze 0 Two Family Size: foo amp 0 adiant Baseboard or Panel Gas
°Addition 0 Move fl Garage Service: 0 Heat Pump Space Htg ki 0 0 0 0 0
0 Other (print): Underground 0 Boiler
Overhead 0 Central Air Conditioning Water Htg 0 0 0 0 0
0 Other
40::::COIVSTAYPE:::::: 7::::::EOUNDATION 0 Other 0 Dwelling unit will have 3 kilowatt or
more installed electric space heating equip.
ite Constructed roncrete O
,.ii;iiA01 Infiltration control option is 0 Full sealing
2&AREN:INOLVE11
Manufactured Masonry
Sewer of joints. 0 Blower door test. 0 Exterior
0 Treated Wood
air infiltration barrier.
tt I
Unfinished Basement /1 Otfeci. ft. HEAmssgaItiwiedro::::
Story ANUSEN:iiiiiiii:::::::::iii:::::::: Permit No. Envelope /1 07 7. 3 BTU/HR
Living Area 1 104 Sq. ft. 0 2-Story 0 Seasonal
Infiltration VG. 24 0 BTU/HR
Garage e t 'l• 0 sq ft 0 Other ermanent
0 Other "(Municipal Utility 14.::::ESV)I411DINGPStii:ME::::::gq
Xlus Basement 0 Private On-Site Well
4 4 0 t0 il 0.<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 im I t or municipality; and certifies that all the above information ccurate.
APPLICANT'S SIGNATURE ~.4d DATE SIGNED i l i 4 4 3
APPROVAL CONDITIONS rTehvisocpaetrimonit(izst this issued pursuant o ua r n o t t t h o e t r h p e e f n o a l l I t o y wing conditions. Failure to comply may result in suspension or
ilit
tbiiitNipiRiiiiiip 0 Town 0 Village Xity 0 County 0 State of: Municipality Number of Dwelling Location:
jiiiRISMCriCate i_ 0 z- 6 G_
p
6s
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wuTi:.ct t iiiv.ngii]::immmm:i:::ili::im:ggmigm:iiii:'::i:iin:::i
imm.mir.:irrm:vgiii:::::::1::::::1::::::::::•::::::
Plan Review 40.04 'Construction
Inspection VAC Name ifiefrt- #4412-00-/
Wis. Permit Seal 30 .0 0 0 Electrical //q(149/
Other 0 Plumbing Date ///3 1 F-3
Erosion Total 70. a o El Cert. No. a 5
SBD-5823 (R.07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner/Agent
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GATE 1/7
NAME yee ADDRESS
LOT 3 0 BLOCK WARD
SUBD I V 1 loth ice ZONE
STREET NO. /0Z4 1,40Y LOT DIMENSIONS
SIDEWALK EXISTING YES El NO 1E-
BUILDING GRADE ELEVATIONS STAKES SET AT SITE '1S ,19 ctS BYa1t'
FEE; $15.00
DEPARTMENT PUBLIC WORK:
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
o 1§,
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address /2-6 /,d Gd
Owner's Name C d )-z,ei.e
Name of Subdivision .�Q�
Lot 3o Bldg. Permit 3
No. of Units 1
Fee Required j 0-0. o -o
Fee Paid /oo.o'D
Owner's signature ail Date 0q 9
Inspector's signature
44extylE-
444-1
Date //O A -3
Parks Subdivision
Improvement
Accts. Rec.: 362 -041