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CITY OF OSHKOSH N2 32350
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /Z-6 y 14 GCJ
PLAN NO.,0lO70I9
OWNER
DESIGNER �J
USE /NATURE OF WORK -Q� /d9//e a
BUILDING CONTRACTOR 69-74...41-'a Size Sq. Z
r r Ft. 8 i
�y R��ms Stories Height
Foundation Class of Const. a Occupancy Permit
HEATING CONTRACTOR
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR elv,-n 4%
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR A
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, 000. 00 Permit Fee Paid /Og; OD Park Dedication `ao O(7
ISSUED BY Date //8/7- Final /O.P. ‘3" 93
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE Of 93
AGENT /OWNER DA
ADDRESS
TELEPHONE
av
Revised: 8/89
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: 2./0 Z 1 ZONING: eq
PROPERTY OWNER /CONTRACTOR:
CONSTRUCTION DATA: ✓EW
N CONSTRUCTI{N ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: p (i.e. fence, pool, sign, deck, etc.) f
COMPLIANCE CHECKLIST (Check only those applicable)
COMP IES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (front 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: C 44 The Director of Community Development, or de e, 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.
L-- APPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY OATS: i
///4715
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations
BUILDING PERMIT 3
Safety and Buildings Division
P.O. Box 7969 APPLICATION Parcel No.
Madison, WI 53707
Wisconsin Statutes 101_63, 101/3 (See instructions on back of pink copy)
ftgRWCRY14RFRP::::::::::::::::onstr 0 HVAC 0 Elec 0 Plbg cZErosion 0 Other:
Owner's Name Mailing Address Telephone No. (include area code)
Contractor's Name Mailing Address Telephone No. (include area code)
,.e larrA ke rty44 1 4-. 2 74 0 b.). ,a I 9 4 e 7 p r t.1 4e, d x 1 e 4 1 `5 4 7‘C h 3/10
:ii:ia':•"iMili7 Lot Area
iiocialatiA Orifl
:•i•ii Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Building Address Subdivision Name Lot No. Block No.
12_40q wite.dziLdiedo zwitd.e2e-r f-A.4-„gAs 39
Zoning District(s) ning Permit No. o nt I Rear Left Right..„
/e Setbacks 'f:. j CP S ft. 6- ft.
1 iili.:10.iiti4atii:::::::::::::iiiiiiiii:::: gidatiPArittiti litTititftitittili 9. 122:004#3,00003:::::0:iiiiiIiiiiiiiiiiiiiiiliaiiii::::1
Jew 0 Repair *ngle Family Entrance Panel 156arced Air Furnace Nat. L. P. Oil Elec. Solid Solar
F
10 Alteration 0 Raze 0 Two Family Size: /0 amp 0 Radiant Baseboard or Panel uel Gas
El Addition 0 Move 0 Garage Service: Heat Pump Space Htg WT 0 0 0 0 0
0 Other (print): ݤIlnderground 0 Boiler
0 Overhead 0 Central Air Conditioning Water Htg 0 0 0 0 0
0 Other
CONSETYPE::::: TION: °Other *0 Dwelling unit will have 3 kilowatt or
:m:: more installed electric space heating equip.
Xr.Site Constructed 151:Concrete :::40ftUMBINW:lii:::::: Infiltration control option is 0 Full sealing
i2oAREA 0 Manufactured p niraesaot:rdywood Sewer r infiltration of joints. 0 Blower door test. 0 Exterior
5
IE:iii::::::::::::M IE T
i i STORIES 0 Other unicipal ai barrier.
Unfinished Basement, i a Sq. ft. p• ee tic ICHEAt
L itiZiattiatedYni:iii!!!:
XI Story ISMSENiiMil':::i.:::::::i::: Permit No. Envelope .20 k/0.1 BTU/HR
iving Area /2-S8 Sq. ft. 0 2-Story ID Seasonal :41VilliAltlitir::::;:::::;:;::;::!::::::Nlliigglig Infiltration /0 BTU/HR
Garage 45 Li( sq. ft. 0 Other
pg/lunicipal Utility foL:::ESUBUILDINGICOSV::i:::ONM
°Other
us Basement 0 Private On-Site Well L b° 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 Department or municipality; and certifies that all the above information accurate.
APPLICANT'S SIGNATURE 1:- DATE SIGNED /9 C3
APPROVAL CONDITIONS Trehvisopaetrimonitoisf this s o ua r n o t t t l o e t conditions. Failure to comply may result in suspension or
ittifialtdti..ii:iiiiigilig 0 Town 0 Village I4ity 0 County 0 State of: Municipality Number of Dwelling Location:
ISSUING JURISDICTION
OftiLe4-4.1-- 2 0
D
........,:pERm mpoo
:::::::!::!:1!:::::::::ii::::::SRA.CNOIg::::i:iiiiiiiiiiiiiii:iiiiiiiiiiiiiiiiii:::1:::::iiig
Plan Review 1 +0 .0 0 p5onstruction
Inspection 12 VAC Name
Wis. Permit Seal ar), 0 0 0 Electrical 2'' 1// 3h3
Other 0 Plumbing Date
Erosion
Total 10, 0 0 0 Cert. No. 2- V
SBD-5823 (R.07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner/Agent
3 6
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---STREET Er" ND
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POINT 0 STRAW BALES
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PROPERTY LINE
p7-r7 i ,r
DATE /4393
NAME •t ADDRESS
LOT 39 BLOCK WARD
SUBOIV. ZONE
STREET NO. IdG 4 1104 ,Ir,1='tetio Gud"( LOT DIMENSIONS
SIDEWALK EXISTING YES LJ NO
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 1 (1S ,Ig °t3 BYICO
FEE; $15.00
DEPARTMENT OF P U B L I C WORKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
004673
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address Z 4 i l ZdAz -g G -cl IN
Owner's Name d�tc/ /.ey1.
Name of Subdivision l,(Z r
Lot 39' Bldg. Permit 32-3.S
No. of Units C
Fee Required 017 o o
Fee Paid /0 00
Owner's signature /1 01 Date 0/A3
Inspector's signature Date i
Parks Subdivision
Improvement
Accts. Rec.: 362 -041