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CITY OF OSHKOSH N° 30515
PERMIT APPLICATION AND RECORD
TYPE: BLDG x HTG ELEC PLBG SIGN ZONING I FLOOD PLAIN HEIGHT
ADDRESS Z 7 3 iti,,A idol_ PLAN NO. ell 3 o ORcZ Z
OWNER G 22Z v i
DESIGNER
USE /NATURE OF WORK Ve4() i ef/ /6
BUILDING CONTRACTOR OffhW
Size /f Sq. Ft. f Z7� Rooms 3 Stories Height 2.-7., 2.-7., Foundation c,.1 Class of Const. Occupancy Permit
HEATING CONTRACTOR Ai
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR d 'l !mot'
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR J
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 O e Permit Fee Paid 0 0
Park Dedication /dam •0
ISSUED BY 26f t/`Ct .4--- Date q 5 2-- Final /O.P. 1/026/9.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE t DATE
A DDRESS
TELEPHONE
//30 o ?9Z
State of Departme Ind WISCONSIN UNIFORM 3°573'
Department of Industry,
Labor Human Relations BUILDING PERMIT APPLICATION NO. Atallnalf
Division of Safety 8 Buildings
Box Madison, Mad n, WI 53707 APPLICATION
Wisconsin Statutes 101. 63, 101.73 (See Instructions on back of pink copy) PARCEL NO.
PERMIT:;R ES IF.
CONSTRUCTION ❑HVAC ELEC El PLUMBING U OTHER
Owner's Name Mailing Address Telephone
Contractor's Name Mailing Address Telephone
/2C,4&A 7-7 6 o (Ail 4 for i f/ G f
:`Z Lot Area
SECTION T N, R E (or)W
Building Address n n 1` bdivision Name Lot N9 f Block No.
1273
Zoning District(
s)
/Diis�s o nt Rear Left Right
/C.� Zoning P mit No. Setbacks ft. Le ft. ft. 0 ft. 1 PROJECT::: 3. :Occupancy ::I6 ELE� AL :E: :$VAC:E i MENT 2::EI4ERGY SOURCE
N ew Repair S ingle Family Entrance Panel Forced Air Furnace Fuel Nat. L.P. Oil Elec: SolidSolar
A lteration Raze Two family Size: 0 amp Radiant Baseboard or Panel Gas
❑Addition Move Garage Service: Heat Pump Space 9•
Other Underground oiler WaterHtg.
Overhead Central Air Conditioning
Other Dwelling unit will have 3 kilowatt or
Other >.;._:;j:;: >:::i more installed electric space heating equip.
ite constructed
Concrete IOE PLU) BIN Infiltration control option is: Full sealing
of in Blower door test. Exterior
�iAR�;IIVED< Manufactured Masonry Sewer o joints.
T reated Wood Municipal air infiltration barrier.
Unfinished Basement r �7`� Sri IE ❑Other ptic 13 HEAT LOSS C alcu{atek#
Sq. ft. Permit No Z z (o BTU /HR
Envelope
Living Area Z. 7 5 S ft.
-ry
r
q
2- Seasonal <���`I(f�<<<<«'< i q BTU /HR
[�[�n Sto Story Seaso a Infiltration
Garage 7 7 V S ft. Other /15gRermanent Municipal Utility 14 .<EST B UILDING COST'
Other Private on -site Well
Plus basement ��--71J,,��yy V (I a 0 V
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 Departme Municipality; and certifies that all the above information is accurate.
SIGNATURE OF APPLICANT DATE mo t' /T 9/;
CONDITIONS OF APPROVAL This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
/w'�1 F'7 F'7 /7 Z�x
TOWN VILLAGE CITY COUNTY Municipality Number of Municipality Number of Dwelling
STATE IN END Inspection Authority Location, if different
I I: N ap _2
PERMITS): WtS. IJ HPFORM 1 ERWT PEltlllMIT t iY
Plan Review Lio •o v 1KConstruction
HVAC NAME
Inspection Electrical C Wis. Permit Seal 3° AO O Plumbing 1 I DATE
Other Other
TOTAL 7O o 0 CERT. NO.
SBD 5823 (R. 8/90) f c o WHJ5,5 Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
Revised: 8/89
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: 1 Z73 gf ZONING: ie
PROPERTY OWNER /CONTRACT
CONSTRUCTION DATA: NEW CONSTRUCM ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
/V (/;e CO M4 Zo SL za 4- o 4,1r
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (fr nt yarn)
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 esign 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.
L APPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: ,7� GATE: 'Of
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City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address /2-73 VA/L.4 ..6114
Owne
r% Name g.t4te44- 6,44,
Name of Subdivision V.
Lot 3(o Bldg. Permit 30C S"
No. of Units
Fee Requi red 0 0
Fee Paid /Oo,O0
Owner's signcture Date 7 4/ 9-
Inspector's signature pic4c Date c7�i /91—
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
DATE 97//q
NAME 4 f ADDRESS
LOT 3 (v BLOCK WARD
SUBDIV' ZONE
STREET NO. //017;..7.3 G[/ Gv
LOT DIMENSIONS
SIOEWALK EXISTING YES 0 NO 0
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 4/_/ 2 ,19 Z BY
FEE:ft$:gp
disc
/PAr
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.
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