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CITY OF OSHKOSH N9 32842
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
�,t PLAN NO. 67 2 Co 3 93n-
ADDRESS 11 4 4 2 V
OWNER 6
DESIGNER
USE /NATURE OF WORK /.C4) 1 Cam''
BUILDING CONTRACTOR 41.4.4e4' d Q
Size Sq. Ft. 9S Er Rooms 5--2 -11 1 Stories Height /9
Foundation Class of Const. Cr Occupancy Permit
HEATING CONTRACTOR /C7cee..
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR CUB
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
FEES: Valuation A 0 0 0 Permit Fee Paid o S O V Park Dedication /00%00
ISSUED BY Date 3 ///9 3 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE 1 114 3/6 "3
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ADDRESS
TELEPHONE
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ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: 1 Z(o 5 .1.9 Ab lj ZONING:
PROPERTY OWNER /CONTRACTOR: /4.
CONSTRUCTION DATA: fEW CONSTRUCTDi ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
ig-e,iii z ef7, diV 2-0 >e z., Li-4 0 (i. A
COMPLIANCE CHECKLIST (Check only those applicable)
COMP IES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (trait 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
REVIL AUTHORITY:
The Director of Community Oevelopmerrt, or d ignee, st 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.
PPROVED DENIED
Plan Commission Action Required
Variance(s) Required Ag e
REVIEWED BY: i AI'' -DATE:
c fi .Z 5 0 3 9 3 /7
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT 32F L
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)
::<PER Ill R £...:ISTE::
Constr HVAC Elec Plbg grErosion 0 Other:
Owner's Name Mailing Address Telephone No. (include area code)
Contractor's Name Mailing Address Telephone No. (include area code)
'Z? 6 0 9. 44 t ill t K 0 S
yy:��,,
PRO l. '':f:#.
Sq. ft" 1/4, 1/4, Section T N, R E (or) W
Building Address r Subdivision Name Lot No. Block No.
Z S� �mN (�/iii2 !i1'�i� r
Lf� .7C..■
Zonin g D District (s) Zonin g Per o. Front Rear Left Right
Setbacks ft. ft. ft. ft.
1%::::PdgCr ii VOCCOPANCriiii !iiCii iiiftigHVACEDUIPMENTIE.:::::: itEISOERGICSOURagliii::::::iiii:::::KM:::::::::::::::::::::::i:::
A New Repair Single Family Entrance Panel Forced Air Furnace Fuel Nat. L. P. Oil Elec. Solid Solar
Alteration ID Raze Two Family Size: APO amp ❑Radiant Baseboard or Panel Gas
Addition Move Garage Service: Heat Pump Space Htg X
Other (print): jgr Underground Boiler
Overhead Central Air Conditioning Water Htg
Other Other 0 Dwelling unit will have 3 kilowatt or
more installed electric space heating equip.
Site Constructed Concrete Infiltration ntrol o tion is: Full sealing
,B[ control P 9
Manufactured Masonry of joints. [I Blower door test. ❑Exterior
air infiltration barrier.
Sewer
Treated Wood
Munici al
#::::s:: Other P Unfinished Basement? /r?i Sq. ft ....................�J......... Septic 4e'��'i'
Story
p Y •:.<z..` Permit No.
Living Area 95 s ft. Envelope J S BTU/HR
q- 2 -Story Seasonal
��''i�A�` ?<':<i»' Infiltration .3 �k7 BTU /HR
Ot her ermanent 1�
r
Ga a e U_4' S ft
T
Sq. M ni i I Utility u c a U
❑Other P Y 1 ?����x:ILPINts`
Plus Basement Private On -Site Well T o 7 ciao �a
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 or municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE DATE SIGNED
APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
i i../.010N er.41.41.•/- pee--.1/fr gICV14,4 e4ortsa—
T own Village Cit County State of: Municipality Number of Dwelling Location:
�];;�EE 9 Y❑ Y P Y 9
JUR I SD ICTION y 7 D Z G. 6.
........i{701�j 1! 1F
lS::: 11ppoRi�t1( is� �iI�AMN�: y:::: i::•':"'`. ii<: S?:•`::::::? :':�:`•::i:
S E�'1 n
Plan Review 40t 0 1 0 gConstruction I
Inspection HVAC Name U 44—.....
Wis. Permit Seal 30 O 0 Electrical
Other Plumbing Date 3 3
E rosion
Total 70 '00 Cert. No. 2-S J 0
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address 2-( S �iev.e. i- cd7
Owner's Name 4,244 e
Name of Subdivision ii, ,!,(i1,r,L
Lot 3i- Bldg. Permit .32 2
No. of Units
Fee Requi red /00.00
Fee Paid /00,0 a
Owner's signature Date Sfr/q.? _F2/
Inspector's signature Date 3`/`93
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
CATE sif /S 3
NAME /('.t. C ADDRESS
LOT .3
BLOCK r.
r lAFsD 1.
SU8D I V t/ 2 Z' c� ZONE
STREET NO. A2 ‘6 0 LOT DIMENSIONS
SIDEWALK EXISTING
YES 0 NO El
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 3 Z ,19 `1� BY
FEE; $15.00
DEPARTMENT OF PUBLIC 'WCRK_
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
6A/A