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PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS .2-
A PLAN NO. I lZ `fQ 7�/�
OWNER 44.4 64
DESIGNER
USE /NATURE OF WORK /1 -e.t /17z, a/27
BUILDING CONTRACTOR f
Size Sq. Ft. 94-'1- 5.--21341 Rooms —��J� Stories Height C f
Foundation Class of Const. r Occupancy Permit
HEATING CONTRACTOR 6j1 1-eA
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR /r
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR 4 V
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 30107 c'� PU S
Permit Fee Paid Park Dedication
0 o
ISSUED BY ./�.ru-sr- Date 7 03 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 7-. -93 A A°4 6(
t; /OWNER DATE
ADDRESS
TELEPHONE
b 0 79 Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT 33'/6
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.MI RE TESTED f` ?s
C onstr 0 HVAC 0 Elec 0 PI bg Erosion 0 Other:
Owner's Name Mailing Address Telephone No. (include
l( area code)
Co tractor's N e Mailing Address Telephone 3 i !lude area co de)
z� d Ao -c -3333
Lot Area
P O t' Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Building Address Sub. ivision Name Lot No. Block No.
Zoning District(s) Zoning Permit No. Front Rear Left Right
Setbacks ft. ft 1—, ft. 2 'Z- ft.
i:i :iii :i i ;.:U ■P.�iyyN( E L 'C:T
:Ti. W ::1
.�T.... v r11�.1A'�1�.�.....�..: ..�:.�il�. ii i i�Y'•����� :R �y �e �y ri:::i::i:::::::: is :i:::::::: ?:::::::i::::::i
'New Repair r.. Ingle Family Entrance Panel Forced Air Furnace Fuel Nat. L. P. Oil Elec. Solid Solar
Iteration Raze o Family Size: /C 0 amp iant Baseboard or Panel Gas
Addition Move Garage Service: Heat Pump
Other (print): Underground Boiler Space Htg
❑Overhead Central Air Conditioning Water Htg
Other ❑Other Dwell i g unit will have 3 kilowatt or
more installed electric space heating equip.
ID Site Constructed oncrete p g g
'��aR(L���� Infiltration control option i ❑Full sealin
Manufactured Treated asonry
o o t o s g
of joints. Blower door test. Exterior
Wood Se er air infiltration barrier.
i5« OI i Othe i.� unicipal
Unfinished Basement F( ft.
i >;:::u:'
Story S �3M��ttT :����v.:. >�C�I����c��
y z S :z; >s'• Permit No. Envelope cAle S'" BTU /HR
Living Area 'S O Sq. ft. 2 -Story Seasonal E Infiltration 5� p
BTU /HR ?''r'':'`•`.... �b 9 Q
Garage Other ermanent 3
9 'I"T S
nici I Ili
u a Utility
Other Y 0��1 0N��3
`/asement lus B Private On -Site Well
le0. 600• 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 implied, on the Department or municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE 1 _1 y ar v• DATE SIGNED 7--
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.
T own
Village i
Ct
Count
S tate of Municipality Y unici alit Number of Dwelling L ocation:
County p y e
9
Plan Review O. a O �Construction
Inspection HVAC :::e
Wis. Permit Seal 3o.•0 U Electrical Z 3 r
Other Alruabning 74-0 3
Tota l O r• 0 0 Cert. No. 7 T' 0
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW- DILHR GREEN Inspector PINK Owner /Agent
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Revised: °/B°
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: Z Aire ZONING: /2✓
PROPERTY OWNER/CONTRACTOR:
CONSTRUCTION DATA: NEW CONSTRUCT:RCN ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
�L
COMPLIANCE CHECKLIST (Check only those applicable)
CDMP,LIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (frrnt 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 Oevelopment, or si nee 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.
�PPROVED DENIED
Plan Commission Action Required
Variance(S) Requir
REVIEWED BY: j �/s OATS: Z
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address 2-6 L or
Owner's Name ,�U�
Name of Subdivision Zeit,Q.(,fT s"_ A,,,,v4
Lot 3, Bldg. Permit 3 r/6 /6 z
No. of Units
Fee Required /0
Fee Paid 10o.o
Owner's signcture Date
7 f3
Inspector's signature Date 7 403
.Cg__4(1,(Af Parks Subdivision
Improvement
Accts. Rec.: 362 -041
CATE '77 7P 3
NAME �2 9& ADDRESS
LOT 3� BLOCK
WARD
SUBOI V. 41Q,aZn._,- y ZONE
STREET NO. (,0 (,dam, LOT DIMENSIONS
S I OEWALK EXISTING YES El NO
BUILDING GRADE ELEVATIONS STAKES SET AT SITE "7 u ,19 93
BY KW
FEE: $15.00 4 o�' l (1
j A 4 )1j c-fr f/ j‘
DEPARTMENT OF PUBLIC WORKS
KS
I, the undersigned, owner or agent of the above described property agree to have the
grade estaoiished before excavation has commenced.
00
493