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CITY OF OSHKOSH N2 38036
PERMIT APPLICATION AND RECORD
TYPE: BLDG I!!/ HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS !JUi 4 E 2 1 it/7y PLAN NO. O l ?�q9/
OWNER Q
DESIGNER ,Q
USE /NATURE OF WORK l (✓LULU' ;A I 111 t /2i` 6-
BUILDING CONTRACTOR Riceyte
Size 7/e Sq. Ft. J/O Rooms p' Stories PJ Height J
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR eA
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR 0)/ /A4---S
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR 1`Y
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 At 0 1 Permit Fee Paid cx� Park Dedication /Ca UL3
ISSUED BY
'Mi Date Z
Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
i
SIGNATURE
212 /Pe(
AGENT /OWNER DATE
ADDRESS
TELEPHONE
a., 4q 3( c t Q4 yz
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Safety and Human sDivsio BUILDING PERMIT '3)`)
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)
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L} ec Ib i n
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Other:
Owner's ame Mailing Address illy 2S/- No. (include area code)
Contractor's Name C I� al -7 kn w` thyt (Z i Z3! gza3
Mailing Address Telephone No. (include area code)
r OAT !f Lot Area
L a l +5�/l�q. ft. 1/4, 1/4, Section n T N, R E (or) W_
Building Address V Subdivision Name Lot No. Block No.
Q W 5 0 Z4 -I A L� UA7 C/JL492 I 2I 1/5
Zoning District(s) Zning Permit No. Front Rear Left Right
Setbacks c' ft. I 5'3 ft. /6'6' ft. /d i t) i
mow• .a:1..:
!Zn A.
d'i::::::��i:�iF. {:i:: ::i4::i :::!:4: ?:i i:�i(:•:iil[Ili:� �..:tC:•: ?ii:: ii'rii
L ew Repair iv, ingle Family Entrance Panel orced Air Furnace Nat. L. P. Oil Elec. Solid Solar
Alteration Raze El Two Family Size: /DO amp Radiant Baseboard or Panel Fuel Gas
Addition Move Garage Service: Heat Pum
Other (print): Underground Boiler Pump Space Htg
'dbverhead Central Air Conditioning Water Htg 14_
❑Other her
QTwIT ❑Ot more installed electric
ite Constructed oncrete 0 Dwelling unit will have 3 kilowatt or
space heating equip.
`'104 PL MII '�'r i> `>?:`i
Manufactured Masonry :ii.>•::::;::.:::•::•::;::•: Infiltration control option is 0 Full sealing
Treated Wood Sew r of joints. Blower door test. Exterior
air infiltration barrier.
Unfinished Basement Sq. ft. 4 #`I Other S umci al
1- Story P
Se t ic
El P i 1 <1
Permit No.
��d ft.
Sq. 2- for Envelope Ca) BTU /HR
Living Area
Y S sonal �3
AT
gggi Infiltration B T Garage 57 i Sq. m other ermanent c �3
.Ca BTU/HR
q" ft Municipal Utility
h P
Other e Y
lus Basement fl Private On-Site Well 1/161/
C.K
The applicant agrees to comply with all applicable codes, statutes and ordinances and with the conditions of this permit; un9erstands that the issuance of
the permit creates no legal liability, express or impl' on the Departm r m icipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE r v '7 DATE SIGNED %2
APPROVAL CONDITIONS This permit is issu'Ld pursuant to the following conditions. Failure to comply may resul in sus nsion or
revocation of this permit or other penalty.
1 c"643/72/1 f t rrA)4-C PC4itic
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3,1 t14/2f/7` iEzt eCC L4Gc.)/.c.
Town
village e
i t
County ou t
9 state of: Y o
Municipality
Y
N
um r
be of Dwelling
J RI! ICTIO :a t:3si- l koEV 70 _c6
Plan Review 5/0,05? F1�onstruction
Inspection H AC Name
Wis. Permit Seal ,.e. Electrical
Other Plumbing ii Date I
bL ct�
t rosion 1 j` I I
Total c l 1 I L2
Cert. No. "lt7
SBD 5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
io
Revised: 8/S
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: j A 1,6,x% i 612) A4 ZONING:
PROPERTY OWNER /CONTRACTOR: 7 i C_JDNS�/
CONSTRUCTION DATA: 4 W CONSTRUCTIO ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: i.e. fence, pool, sign, deck, etc.)
4 }u ..C2ti6C— /7 4 777/c1 G4Fil
(h00SE I1 ®y0
(P46= 3
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (fm t yard)
Rear Yard
Side Yard (R)
Side Yard (L)
Parking Spaces
Building Area
Lot Area Per Family
Corner Lot
Landscaping 4111YELWAIRMIII
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: w ,c____ e' j DATE:
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City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address a lab UM
Owner's Name ,770A-J
Name of Subdivision SeN r '1
Lot Bldg. Permit
of Units
Fee Required ca
Fee Paid
Owner's signcture L-- Date Z/zoc(
Inspector's signature �r x Date
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
DATE /ij
NAME k.-k Gtticvc ADDRESS
LOT t s
BLOCK
SUBDiV. J L
ZONE WARD
STREET NO. �O�,' S \I1A 1€1,1)
LOT DIMENSIONS
SIDEWALK EXISTING YES
NO z
BUILDING GRADE ELEVATIONS STAKES SET AT SITE I'_ ,19 q 4
BY ie
FEE $15.00
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.
09`31 ��O