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CITY OF OSHKOSH N° 33827
PERMIT APPLICATION AND RECORD
TYPE: BLDG A HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /Z7/ �.C-1 zeit PLAN NO. b17 /0 SW/Z
OWNER
DESIGNER
USE /NATURE OF WORK r) odiz.e&Z`e
BUILDING CONTRACTOR
Size Sq. Ft. Rooms ���!�z� Stories Height I
Foundation C.d'n Q
Class of Const. Occupancy Permit
HEATING CONTRACTOR irif oue1ili
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR 6
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR "4.
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 34 000 "0 0 Permit Fee Paid
7"fl',J./14i—i—r Park De dication MO, na
ISSUED BY am Date 6-- X 3 Fi nal /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE f-3
/7
AGENT /OWNER DATE
ADDRESS
TELEPHONE
‘‘,),e4470-0)// 1)17 (0* 3/
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT 33 F2-7
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)
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IliMMFAgSRP rl
HVAC 0 Elec El PI bg Erosion 0 Other:
Owner's Name Mailing Address Telephone No. (include area code)
Co tractor's Nam Mailing Address Telephone No. (include area code)
is'(
PROJECT LOCATION Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Building Addre Subdivision Name Lot No. Block No.
A ......1-4e. A
Zoning District(s Zoning Permit N Front I Rear Left Right
ie.- f Setbacks .2s' ft. j 4-5 ft. (e ft. er ft.
1:110 AiiiiIM:::i:Iiii::i:ini:ii:i:in'i 4.-2. P ::<2.'::::::::::4:::*filiii.i. iZ;2.::' ititti V.i.-X
Repair Mi s
l Entrance F
P
ance Panel F. Forced Air Furnace Nat. L. P. Oil Elec. Solid Solar
trATtw Elec. FIJ R e /0,0 amp adiant Baseboard or Panel uel Gas
0 Addition 0 Move D Garage ServiCe: 0 Heat Pump Space Htg 0 0 0 0 0
0 Other (print): lat)nderground 0 Boiler
110 Overhead 0 Central Air Conditioning Water Htg 0 0 0 0 0
0 Other .:i4gcoNsTaypil infouNDAnot 0 Dwelling unit will have 3 kilowatt or
more installed electric space heating equip.
0 Site Constructed Xoncrete 164 PLUMBING Infiltration control option is 0 Full sealing
TvAREA 0 Manufactured 8 T
Sewer of joints. D Blower door test. 0 Exterior
air infiltration barrier.
A- VtiOitit$M 1 I i l l i l i l' i n Othe
Unfinished Basement 1Z. ft- er la-Septic giffigAirlt0Stit4itAtedtHiii:ii$
.17g1- Story 21NUW:'':'iu:i:'!:'niU Permit No. Envelope A.70 Ivo w. BTU/HR
Living Area 11-i b Scl- ft- 02 Story 0 Seasonal
Infiltration 1/ /07 I BTU/HR
i 0 er ermanent
Oth W
Garage f 40 sq. ft. $1/1unicipal Utility 1*:1:0$%41#30014040Sti:::::::iii:iiiiii:IiiiiiiIiiiiiiiiiiiiiiii:i$1
D Other
t Kelus Basement 0 Private On-Site Well
40,000.•coD
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 imiIAI, on the Dep m t or municipality; and certifies that all the above inform tion is ccurate.
APPLICANT'S SIGNATURE -4--....., DATE SIGNED
APPROVAL CONDITIONS Trehvisolcriaetrimoniteisf this s e ua r n o t t t h o e t r h p e e f n o a ll it o y wing conditions. Failure to comply may result in suspension or
iii iiiN4 0 Town 0 Village pkty 0 County 0 State of: Municipality Number of Dwelling Location:
INJURISDICTION gl _7 _I L_
i lO •g tiN ;:goami;illiiimmiiiiIiiiimig:Mii: 1 01::PERMIARi i i i :::::::::VVISMfORIVCPEROVI:::pirtMitittiiktj:100::::::::::: 1 1 :::::::::::•:::::::::::::Mi:::::::::::::::::::::111i:::::::::::::::::::::::::::::::'::1:::::::::::::::::::::
::::::::::1.77::::::::: I i i i i;:::::::::: i i:::g::::;:::::::::::::::: i i 0 StSUED::::::::: 6 :::1:::: ::SEAk. i til(X:!:::;::::ii. i ::::::::::i::::Iii::1:::::::::::::::::::!:i:iiiii::::::::::::::.ii:iiiiii::::;::::::4::::::;:::::::::::::::::::::::::::::::::::::,:::M::::::::::::::::::E::::::ii:::::::::•::::::::::::i ::::::::::::::iii:gaiiiiiiiiiniiiiii:iiIiiiiiiii::::
Plan Review p it00 ,onstruction
Inspection 0 HVAC Name p 9t-frit t4 ).0„,...../
Wis. Permit Seal .30.0 0 ID Electrical
Other 5 0 Plumbing 2. 'R, 0 C, Date
osion
Total $7o..o) 6 cert. No.
SBD-5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner/Agent
/6/143,S Revised: 8/89
ZONING /LANG USE COMPLIANCE CHECKLIST
JOB LOCATION: A //U ZONING: tr-
PROPERTY OWNER /CONTRACTOR:
CONSTRUCTION DATA: ✓44 CDNSTRUCTI{1 ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.
/.044/ ,2.,, )(zz y9(0
COMPLIANCE CHECKLIST (Check only those applicable)
CO PLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (frmt yard)
Rear Yard
Side Yard (R)
Side Yard (L)
Panting Spaces
Building Area
Lot Area Per Family
Corner Lot
Landscaping
Transitional Yard
Off- Street Loading
Vision Clearance
Height
REVIEW UTHOR ITY
The Director of Community Development, or si ee must 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.
PROVED DENIED
Plan Commission Action Required
Variance(s) Requi ed
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REV I E'WED BY :„_a DATE: slZ 9j
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STREET LExact
STRAW BALES
POINT
XXX FILTER 01 7/ W tN TER F=NC:
U PROPERTY LNE
GATE S //2/7 3
NAME //,J ��,d� ADDRESS
LOT 3 BLOCK WARD
SUBO I V ZONE
STREET NO. /2-7/ 1j.4 JJ, t) LOT DIMENSIONS
SIDEWALK EXISTING YES
No
BUILDING GRADE ELEVATIONS STAKES SET AT SITE ,19 9.3 BY
F EE; $15.00
DEPARTMENT OF PUBLIC WORKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
OO
2,G
City Of Oshkosh 0/0/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address /Z 7 /,(J l�
Owner's Name
Name of Subdivision jb y wy
Lot 3S Bldg. Permit 33827
No. of Units
Fee Required /00 o-
Fee Paid 06 o
Owner's signature Date y /7 P3
Inspector's signature Date S6Z./Q3
Parks Subdivision
Improvement
Heels. Rec.. 352 -0