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4.) OSHKOSH
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING /C f FLOOD PLAIN HEIGHT
ADDRESS „/".1 l..'af PLAN NO. b 1 2.- 0793x.
OWNER #L4 -u s e 4
DESIGNER
USE /NATURE OF WORK i,... O ","e 0 Att4
BUILDING CONTRACTOR (��ar'c'ea-
Size /ti Sq. Ft. Rooms 6 Stori Height S
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR J�(,r4,AtCA._
Heat p A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR aw.'-rt -t .s-�
Electric Serv. New Change eT" mp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR /f79
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 3 9 00 0 0 Permit Fee Paid /c2 s' v a Park Dedication A00. D a
ISSUED BY fi 1 4 Date 77 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 77.--- 3
AGENT /OWNER DAT
ADDRESS
TELEPHONE
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT
Safety and Buildings Division
P.O. Box 7969 APPLICATION s Parcel No.
Madison, WI 53707
Wisconsin Statutes 101.63, 101.73 (See instructions on back of pink copy)
PERM REQUESTED C onstr HVAC Elec Plbg 0 Erosion ❑Other:
Owner' Name Mailing Address Telephone No. (include area code)
A Covet a7L. &C a3 Sd O3
Contractor' N Mailin Address Telephone No. (include area code)
642C1/4 M:::; 1Q�
PROJECT LOCATION Lot Area
Sq. ft. 1/ 4, 1/4, Section T N, R E (or) W
Building Address S bcf vision Na e Lot No. Block No.
1 1j 7
Zoning District(s) Zoning Permit No Front I Rear Left Right
Setbacks ft ft r ft. ft.
QJECf CUhANCY ,6.:fLEC"fiilCJ1L VAC: tti1fiPMENT: 1fEEl {GY:$0i`#IiCIE:<< »l n<'<<.
cffNew Repair ingle Family Entrance Panel &'forced Air Furnace Fuel Na t. L. P. Oil Elec. Solid Solar
Alteration Raze Two Family Size: /(1 O amp Radiant Baseboard or Panel Gas
Q Addition Move ❑Garage Ser Heat Pump Space Htg
Other (print): &Underground Boiler
O verhead Water Ht
0 Air Conditioning 9
Other O Dwelling unit will have 3 kilowatt or
4N.S TYi 7.:: atNAAltO f
ite Constructedncrete
gs 0ZPW.... PO more installed electric space heating equip.
r Infiltration control option is: Full sealing
❑Manufactured Q My ....:.:......s°�::.::..:::::::: P 9
'::AItI»A; NV I. EQ» >':v Sew of joints. Blower door test. Exterior
Treate asonr d Wood air infiltration barrier.
Unfinished Basement Sq. ft. fi ❑Other unicipal
Se tic 113, HEAT.
1- Story ...IrSE` ?rz: >s: Permit No.
Living Area Sq. ft. 2 -Story ❑,Seasonal Envelope BTUMR
:nom: :•n ::lr: yi£tij i:•i Tj::y}
0 Other �rermanent ``1NAT :6' •1.8p <Infiltration BTU/HR
Garage Sq. ft. Municipal Utilit is
Other P Y E:S ?II`:OS:.: »::a
Plus Basement Private On -Site Well J
The applicant agrees to com ply 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 lie n Department or municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE DATE SIGNED
APPROVAL CONDITIONS This permit revocation of is issued
this pursuant permit or ot er the penal following ty conditions. Failure to comply may result in suspension or
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.'s >ysv• T own Village City 0 County State of Municipality Number of Dwelling Location:
JURISDICTION
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Plan Review S Construction
Inspection S HVAC Name
Wis. Permit Seal S Electrical
Other S ❑Plumbing Date
0 Erosion
Total 50 /yin s
Cert. No.
e(9-cm).-e-eir 01 12l -o7?3 /e
WisconsirtmentofIndustry, WISCONSIN UNIFORM Application No.
Labor Human sDivons BUILDING PERMIT —o/c)
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)
QUE D Constr HV EI
ec Plb Erosion Other:
h r:
9
Owner's Name Mailing Address Telephone No. (include area code)
Con ctor's Name Mailing Address Telephone No. (include area code)
,1L_ 576o "...A &At L: S 333,3
R OjLN Sq. ft. 1/4, 1/4, Section T N, R E or W
Building Address Subdivi s�iof Name r Lot No. Block No.
/.130 OkeQ.Ki ti../ .,I�L i� /Y7
Zoning Di trict(s) 1 Zoning Permit No. Orront R /0 Left Right
Setbacks N ft. I T y ft. (0 ft. to ft.
'Y:•. 'i::::::::i::i i s ii r. :iii i ii:i C ::::ii:t: y .^ii
...u_
,n, -.,p„ R.:. �,du„ .i: i
ii i::i::i :ii .•r. :i i:S:: :X r i:?:: i::: i:: •.t::::
•':ii:ii:•'.::ti::
..T.i.. Ivl�:: .���Y RN�I�I.�� '•7:•i;:.: �::.:•i:•:;;:: •i:::•:'
New Repair 1 Ingle Family Entrance Panel lir Forced Air Furnace fuel Nat. P. Oil Elec. Solid Solar
Alteration Raze II Two Family Size:/ On amp L. tadiant Baseboard or Panel Gas
Addition Move Garage Servi: Heat Pump
Other (print): nderground Boiler Space Htg
1 0 Overhead Central Air Conditioning Water Htg
Other 12 Other Dwelling unit will have 3 kilowatt or
>T Y more installed I
S ite Constructed Concrete electric space heating equip.
:10 PLUMBING iii Infiltration control option is Full sealing
M anufactured ]Masonry
of joints. Blower door test.
"'�IN`V'ED Treated Wood Sewer 1 ❑Exterior
air infiltration barrier.
Unfinished Basement /07 f M olikiE Other unicipal
l 77Sq. ft. 'i
1 Stor z
Y >:���I*> >`>�:::�3 Permit No
Living Area 7 7 S ft. Envelope Z3 P• cad BTU /HR
q 2 -Story Seasonal
'i it
s>? Infiltration
l C 7A-4. I L BTUlHR
9 0 Sq ft ❑Other `,permanent
Garage Munici al Utility
�S�a; IBC �')!F�'
i lus Basement Private On -Site Well o •c •O 00
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 D artment or municipality; and certifies that all the above information is acfurate.
APPLICANT'S SIGNATURE 77.---- 4 DATE SIGNED Q
APPROVAL CONDITIONS This per is issu`Ld p ursuant to the following conditions. Failure to comply may result in suspension or
revocat of th perm or other penalty.
To wn
Village e
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County
9 Sta
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Municipality a t Number of Dwelling
P Y e n Location:
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1SDI TI. N O -Z--
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Plan Review e0.0'0 Construction
Inspection AC Name Y il d e-04- 10 (1 ‘0 7■ 9
Wis. Permit Seal 30 N o o Electrical i,/ 3
Other Plumbing (p �P Date
Total Erosion
7o. i�, 0
Cert. No.
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
X-9 c{ 7 Reiised: r/ 9
ZONING /LAND USE COMPLIANCE CHEC <LIST
JOB LOCATION: VV Q ZONING:
PROPERTY OWNE. /CONTRACT
CONSTRUCTION DATA: ./I(EW CONSTRUCT:0 ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fen c pool, sign, deck, etc.)
4I AID- r
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Fioodplain
Front Yard
Side Street (fraTt 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 Development,' or designee, 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.
APPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: T DATE:
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POINT
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POINT 0 STRAW BALES
)00( FILTER FENCE
PROPERTY UNE
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GATE /7' o 9 3
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NAME i ee,c0 Cie AOORESS
LOT
ddj, r7Z7 BLOCK WARD
SU8DIv. E',� /.1.
ZONE
STREET NO. -I' 14 LOT DIMENSIONS
SIDEWALK EXISTING YES NO 2
19 i
BUILDING GRADE ELEVATIONS STAKES SET AT SITE P Zo ,I9 BY
FEE: $15.00 r i h
11,f: i ,n 7A/r.,---'-
DEPARTMENT OF P U B L I C WORKS
1
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
i,e stl
113
City of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address 1 O al )�1cy
Owner's Name /,f,Q-,(4A,
.it i ts' .l�t,
Name of Subdivision Z144,7 iL171 i Lot
S" 7 Bldg. Permit 3 3
No. of Units
Fee Required /00.0 -o
Fee Paid /00.0 0
Owner's signature
Date
Inspector's signature
Vi i.... Date
Parks Subdivision
Improvement
Accts. Rec.: 362 -041