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CITY OF OSHKOSH N° 33825
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING le—i FLOOD PLAIN HEIGHT
ADDRESS /Z 6 3 PLAN NO. b17.3td 93/
OWNER
DESIGNER
USE /NATURE OF WORK ai ,CP Q,&'e.
BUILDING CONTRACTOR el '1`.
Size s S Ft. (0 S Rooms 6 -3�:�°`, Stories Height `4
Foundation C�,Z Class of Const. Occupancy Permit
HEATING CONTRACTOR Al,,
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR C tc -»-t
Electric Serv. New Change D l i mp Type Volts Amps
P
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR ,if
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 3a 0 O O c' Permit Fee Paid 1 O ..o O Park Dedication 0 D 00
ISSUED BY Date 1E 2 -/f 3 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described constructio
SIGNATURE 1
AGENT /OWNER DATE
ADDRESS
TELEPHONE
44/- 3 Revised: 8/89
ZONING /LANG USE COMPLIANCE CHECKLIST
,JOB LOCATION: /7 i f/ Z� ZONING: k
PROPERTY OWNER /CONTRACTOR:
CONSTRUCTION DATA: ✓NEW CONSTRUCTI{N ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED ,CONSTRUCTION: COO�NSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
44) (Me tit_ 2 -t4
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (frait 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 d esi ee, mu 6 approve all plans, except the
following: (1) Alterations or interior work w en 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 wort complies with the above criteria, the permit can be reviewed by the
Building Inspector without referral to the Director of Community Development, or designee.
VPPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: ifdr OATS: T /t
,P-77q ec 41140 t: 73 O3.
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT 33a")--S
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)
OPERMitifittittESTEDNA
Constr 0 HVAC 0 Elec 0 Plbg ,Erosion 0 Other:
Owners Name Mailing Address Telephone No. (include area code)
Con actor's le Mailing Address Telephone No. (include area code)
276o Z4
eilAt- /24 e4iffieedic-
Area
MOROJECt LOCATION N Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Building Address Subdivision Name Lot No. Block No.
AL L- A A A AIL al&ANA WO .044411 3/
Zoning District(s) oning Permit No. Front ,I ft
Rear Left r Rik
s- Setbacks 0 ft. YO ft. ..r ft.
iiW:::: i •iiiiiiiIiIiiiiiiiiiii:iiiiiiiiii;i'MiliiiiiiiiiIiiiiii irlft=7: ilinItgati 11:::::::: ::::9.4111A i..! IPMEACIP 41:::Ell .Wil!Z
ew 0 Repair 74. ingle Family Entrave Panel 7. Forced Air Furnace Nat. L. P. Oil Elec. Solid Solar
Fuel
Alteration 0 Raze Two Family Size:l0 0 amp Radiant Baseboard or Panel Gas
0 Addition 0 Move 0 Garage Service: 0 Heat Pump Space Htg 0 0 0 0 0
0 Other (print): Underground 0 Boiler
0 Overhead 0 Central Air Conditioning Water Htg 0 0 0 0 0
0 Other
0 VilIODIASTAVPE::::::::14:::::FOUNDATION 0 Other 0 Dwelling unit will have 3 kilowatt or
more installed electric space heating equip
gSite Constructed Concrete 404:PLOMOR00;:;.11;:;:iii:;:;:ili:;:i:1:;:;::;::i:;:i:i:: Infiltration control option is: 0 Full sealing
Manufactured Masonry of joints. 0 Blower door test. 0 Exterior
illiiI]iiAREKINVOINEO::::::iiiiMiii.i:iliNi 0 Treated Wood Sewer
air infiltration barrier.
q ft i D Other VIEMunicipat
Unfinished Basement 'iIMEATIASSICAIdatediii'iii:gg]
earS ptic
1 Story 1:80':USES::i::::::::::EiM P r m it No. Envelope a s--4a.9,/or BTU/HR
Living Area /0 S17 Sq- ft- 0 2-Story 0:
0 Other
Garage 52- Sq. ft. ther 0•11inicipal Utility WEli..T:::114101140PPS11:::::::::::::::::::::::::::::::::ii:iii
0 O
"rPlus Basement 0 Private On-Site Well
1 (0 1 OC)D.03
The applicant agrees to comply with all applicable codes, statutes d ordinances and with the conditions of this permit; understands that the issuance of
the permit creates no legal liability, express or Ill r ent or municipality; and certifies that all the above informat nis acc rate.
APPLICANT'S SIGNATURE IMP DATE SIGNED 0
APPROVAL CONDITIONS This permit is issuld pursuant to the following conditions. Failure to comply may res t in 7 suspension or
revocation of this permit or other penalty.
ISSUING ,:iiiiii 0 Town 0 Village City 0 County D State of: Municipality Number of Dwelling Location:
41).10 soldioiitai 2 _c2 z .62_
puvonsr:::::i::::::::VvismNFORMpoUNTI:: ::::iikgkai.i:idkg::iv.;:::::::::::::::::::;:::::::::::;:::::::::::::::::::::::::;:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.::::::::::::::::::::,
EALNOMIlii:::::::i:::1:::i:;:::::::i:i$!:::i:igiii:iiiiiii q7;r7,11:.1:77
Plan Review YID. 0 6onstruction
Inspection VAC Namq;07---4/..e.,./.21.--,..---
Wis. Permit Seal 3 0 ob ID fl Electrical
r2- g Date 1( 2/9 3
Other fl Plumbing
Erosion
Total 7 0 0 0 Cert. No.
SBD-5823 (R. 07/9S WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner/Agent
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..---STREET Iss,LNQ
POINT STRAW BALES
/23 f/ 1 1 ii FILTER PI
PROPERTY LINE
CATE S/( 24 3
NAME ADDRESS
LOT 3 BLOCK WARD
SU80I V 44214P Gtr ZONE
STREET NO. /243 ��J LOT DIMENSIONS
SIDEWALK EXISTING YES 0 NO IE
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 1 ,I9 9,3 9Y
FEE:O
$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.
004743
4 6 2 6
City Of Oshkosh 0/0/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address /243 MA.e�, e�jd
Owner's Name jec.ac-k- 7 (j y,
Name of Subdivision f 4c ,�,�,,��y
Lot Bldg. Permit 373O,2s
No. of Units
Fee Required /00.00
Fee Paid /00.o0
Owner's signature Date ,S/
Inspector's signature Date Sk,/43
Parks Subdivision
Improvement
;cots. Rec.: -04