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CITY OF OSHKOSH N 35644
PERMIT APPLICATION AND RECORD
TYPE: BLDG.- ELEC PLBG SIGN p ZONING FLOOD PLAINC HEIGHT
ADDRESS >g A kie.2,f Opt( Al PLAN N 7i
OWNER v C. 4 7
DESIGNER I �/f��/
USE /NATURE OF WORK t-c 7f /7`� ,1` +ec.._
BUILDING CONTRACTOR OCcl-d^ -`e V
Size f tle f Sq. Ft. c tear/ 'Rooms t i r( Stories r`��E -t-EP
Height
Foundation Lt /�C Class of Const. Occupancy Permit
HEATING CONTRACTOR J_s -b9wre,
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR i.,, 04-4.-r‘
Electric Serv. New Change T
9 p Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR c FO_ _.��e'-_
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuatio jim P- /'t Fee Paid 16)-C— Park Dedication
ISSUED BY Date Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 7
AGENT /OWNER
D A
ADDRESS
TELEPHONE
I'7Cf6' I)/ /2/ 0 7 9 3 it-
Wisconsin Department of Department of Ingustry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT 3s
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)
i• PE `RE E :E.D
Constr HVAC El ec Pl bg Erosion ❑Other:
Owner's Name Mailing Address Telephone No. (include area code)
Co tractor's Na Mailing Address Telephone No. (include area code)
Y -1 loo /.//i�2 r 'pr s'.Ys� 3333
'I O L o ot oi of r ea
;i Sq. ft. 1/4, 1 /4, Section
T N, R E (or) W
Building Address Subdivision Na a Lot N Block No. e a
Zoning District(s) ac oning Permit No. Front Rear Left f Right'
Setbacks 2 ft. I S f ft; I
ft
3yri .i i a `i:i i; ii?i t i �Bf :i :i %k:
<:i:;::: >iii: ii<:::: iisi ii :<:i::i:::::::::i: <i::: .F >:_i:1f:::iEt�. :��A. t?!M�I�ET ii �E
►.l •ew Repair Ingle Family Entrance Panel :7 Forced Air Furnace Fuel Nat. L. P. Oil Elec. Solid Solar
Alteration Raze J Two Family Size: /do amp Radiant Baseboard or Panel Gas
Addition Move ['Garage Service: Heat Pump
Other (print): IRUnderground Boiler Space Htg
Overhead Central Air Conditioning Water Htg
Other Other 0 Dwelling unit will have 3 kilowatt or
:.!i:i C r more installed electric space heating equip.
e Constructed Concrete Infiltration ntr I tion is: Full sealing
�Sit
y° gOMP a control option g
1j Manufactured lasonry of joints. Blower door test. Exterior
air infiltration barrier.
'2r A N `e >s> Treated Wood
Sewer
::S «:<:S#O Other unicipal i> r
Unfinished Basement �ZiSq. ft a tic 1100-01RT: OS 1 :4iat
1 St r
�+y� 9 y Permit No.
Living Area? Sq. ft. 2 -Stor Envelope i BTU /HR
2-Story ❑Seasonal x, t0 BTU /HR
•ii r <'a r' 'Infiltration r Q 7
1/-�0� Permanent
Garage X�Tv S .ft. Other
�A
9 q
n i I it
c a Utility
['Other "'u i P Y e< .1� �'s.
>i
Plus Basement Private On -Site Well
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 i d, on the Depa e or municipality; and certifies that all the above informatio is accur e.
APPLICANT'S SIGNATURE DATE SIGNED
APPROVAL CONDITIONS This permit is issu'Ld pursuant to the following conditions. Failure to comply may result in suspe sion or
revocation of this perm it or other penalty.
Town Village i
e C t County State of: Municipality Number of Dwelling Location:
//i� 9 Y Y O p y o e g ocat n: o
7 _a
r ::2:::f::::i <::::::::::is2::: ii:::;::: iii:: ii::::;:: i::>:: i:: i:?: Si::::: :;:ii; >::i::i::i::i: ::i::i
::::i ::1 r:.�1 EE��11
�a7ii CGG::i::::iii::;. i: :i::::::::i:::::::::::::: :i:i i::iii::i:: <2:ii:::i i:::i::i:Y:i:: iii:;: i s ::Y:i::Y:ii::i::i::i:::::iii> si:: iiii:::
i::::: i:: ii>: :•iii.'�:::;:ii::i::ii::
SE;AL.� .a.
Plan Review 4().O/0 Construction
Inspection VAC Name Zi1A`7e..-,"•
Wis. Permit Seal 30.6c) Electrical 2 --(0
Other Plumbing v Date
$erosion
Total 7 0.O 0 Cert. No. 2S i
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner/Agent
3
Reiised: 8/84
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: Zd ZONING:
PROPERTY OWNER /CONTRACTOR: 1e 4-Cit
CONSTRUCTION DATA: CONSTRUCT N ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
44 0
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (fiwnt yard)
Rear Yard
Side Yard (R)
Side Yard (L)
Parking Spaces
Building Area
Lot Area Per Family
Corner Lot
Landscaping
Transitional Yard
Offi- 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
Variances) Required
REVIEWED 8Y: OATS:
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POINT
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)0C( FILTER FENCE
PROPERTY UNE
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City Of Oshkosh 1/1/85
PARKLAND DEDICATION
J FEE COLLECTION RECORD
Address G� /J
Owner's Name J 2e1 eht4A
Name of Subdivision 1
Lot /4, Bldg. Permit ;1C0/k
No. of Units 1
Fee Required /00•00
Fee Paid (O.O.
i n Date 9S
Owner s s g at ure
Inspector's signature Date
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
DATE
NAME ALC,od 1._ t. j'- ADDRESS
LOT 4C, BLOCK '..IARD
S BO I v ix �yyl,� ZONE
STREET NO. /'?,g2 LOT DIMENSIONS
SIDEWALK EXISTING YES EJ NO 2
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 8/2a ,19 9_ BY )./1
FEE; $15.00
i
DEPARTMENT OF PUBLIC WCRKS
I, the undersigned, owner or agent of the above described property agree to have the
grade estauiished before excavation has commenced.
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09'731