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CITY OF OSHKOSH N 36383
PERMIT APPLICATION AND RECORD
TYPE: BLDG 14 HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS Li w 4k� \I PLAN NO. F L--- 6 /9
OWNER Tc-e..‘k C.. A C
DESIGNER
USE /NATURE OF WORK 1 1\b.) t� ��vP•k1_`Q VJ 1'�{ /1"j ��e
BUILDING CONTRACTOR RbSC!}
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat A/C Vent Fuel /System
Heat Loss BTU'S
ELECTRIC CONTRACTOR Ci?MPA t N6'j
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR 4- 29k--- T1
BT WH Disp WSoft CBasin
_Lay Sh DW DF __San. Sewer
_WC FDr _SP _Ur _Storm Sewer
Sink LTub _Eject SS __Water
Other
FEES: Valuation MD Permit Fee Paid Cog.
P ark Dedication
ISSUED BY Date (1 1 C a Final /O.P.
In the perform a of this work I agree to perform all work pursuant to rules governing the described construction.
Nt7LSIGNATURE /0/Z-1,7
C AGglWNER ATE
ADDRESS 3/ 7),45
TELEPHONE
F. 1 \CiR St
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT 34,3S%
Safety and Buildings Division
P.O. Box 7969 APPLICATION Parcel No.
Madison, WI 53707
Wisconsin Statutes 101.63 -73 (See instructions on back of pink copy)
Constr H VAC Elec Plb Er i
os on Other:
9
Owner' ailing Address Tele hone No. (in lude area code)
Contractor's Nam Mailing Address Telephone No. (include area code)
L t Area
!t ?I:.. J t Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Build Vd ess Su di ion a e, 5 Lot No •B o k No.
Zoning Dist ct(s) Zo ing Permit No. Front I Rear Left l Ri ht
Setbacks 2i5 ft. 56 ft. /Q 6 I ft. d (O if ft.
ew Repair r: ingle Family Entrap P nel orced Air Furnace Fuel Nat. L. P. Oil Elec. Solid Solar
Alteration Raze Two Family Size: amp E] Radiant Baseboard or Panel
Addition Move Garage Service: Heat Pump as
Other (print): Underground Boiler p Space Htg
Overhead Central Air Conditioning Water Htg
Other Ot Dwelling unit will have 3 kilowatt or
more installed electric space heatin equip.
Site Constructed oncrete x.t p g
3:•'.'104 MON 2:i 2 Infiltration
Manufactured Masonry
��7 filtration control option is: Full sealing
:2x::::J R 1 I»D of joints.
❑Treated Wood Sewer 1 ❑Blower door test. ❑Exterior
air infiltration barrier.
Unfinished B m 07 »33 >•<'•33 :3 unicipal
dse ent� IGSq. ft. Other !���<M i;:
❑Septic. .1 1tk.
-7 Y
Living Area l Sq. ft. 2 -Stor Envelope BTU /HR
0 Y 0 Seasonal
BTU /HR
t''
'€WAT .'3:i33i ll i;:z:' Infiltration E
Other ermanent #a a T
Garage Sq. ft. unicipal
❑Other 1: v ES x: I •G.. OS
Plus Basement Private On -Site Well 3c oo tt
The applicant agrees to comply with all applicable codes, statutes and ordinances and with the conditions of this permit; unHerstands that the issuance of
the permit creates no legal liability, pre im ed, on the Department or municipality; and certifies that all the above inform tion i accurate.
APPLICANT'S SIGNATURE i DATE SIGNED /d 7.5
APPROVAL CONDITIONS This permit revocation of is issu pursuant to the following conditions. Failure to comply may esult in suspension or
is permit or other penalty.
‹)8rniT 7..`S ?�f
Town
Village e
it
C
County State of:
Y Municipality Y a t Number of Dwelling `tom 9 Location:
Plan Review yo. bo Construction -1 rD
Inspection HVAC Name
Wis. Permit Seal 30* b' Electrical t q:1 Other Plumbing
Date
Total �a.� Q rosion 1;t4 Lk D Cert. No. ybp$
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
Revised: a./
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: 1 y bJ fC` F \ELF l f, ZONING: g
PROPERTY OWNER /CONTRACTOR: C
CONSTRUCTION DATA: 4NEW CONSTRUCT :0 ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
t\\ St t 6k E C kuA w Tv'->, E ,E
(160.s6 /o s- fp- (6 f2 5 --rii-
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
1 Side Street (frtnt yard)
Rear Yard
Side Yard (R)
Side Yard (L)
Parking Spaces
Building Area
Lot Area Per Family
Corner Lot
Landscaping
l_ Transitional Yard
Off- Street Loading
Vision Clearance
Height
4■14■40 /4
REVIEW AUTHORITY: ,i-- �G)
The Director of Community Development, or des gnee, 66st 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.
LPPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: ce-- `2 DATE: /0/7,31
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City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address va ?y Vvt\A
Owner's Name s �t s1Z�C�tt»
Name of Subdivision 110 L 'ktvv`f
Lot Bldg. Permit
No. of Units 1
Fee Required 4 I aD a
Fee Paid 44 ICE).
Owner's signcture Date d Z/ 9
Inspector's signature Date 40,9
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
GATE 0`
NAME B R r' 1 AOORESS
LOT lLIS BLOCK WARD
7
SUBDIV. TLE1 ZONE
STREET NO. aYL LOT DIMENSIONS
SIDEWALK EXISTING
4-4-04,e/4/4� YES NO 0
BUILDING GRADE ELEVATIONS STAKES SET AT SITE l/ ,I9 17 3 BY....4244L
FEE; $15.00
DE PART. "ENT OF P L J L I C WCRKS
I, the undersigned, owner or agent of the above described property agree TO have the
grade established before excavation has commenced.
eo4vsr.sis co 61-40*--Apc. 1
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