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CITY OF OSHKOSH N9 35816
L PERMIT APPLICATION AND RECORD
TYPE: BLDG 14 HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 19• kk)\ 1_ VE� \NA1 PLAN NO. I 4 03 R
OWNER G'-f\ tx–t'1 ''C1A
DESIGNER
USE /NATURE OF WORK v i t _E ATr C—\ ''•07\ e
BUILDING CONTRACTOR GflW 4 i \SC.I-
Size Sq. Ft. Rooms S E/� p
Stories 1 Height
Foundation COIOCR- ✓c Class of Const. g Occupancy Permit__
HEATING CONTRACTOR B
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR CON" i kS
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR J* 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 'O O
1 Permit Fee Paid IDS v Park Dedication 100
ISSUED BY'���'G.. Date q l ?I C3 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE L'_ Q
AGENT /OWNER D TE
ADDRESS
TELEPHONE
F/- r 9 q /q3R
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT 3 6 1 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)
ER ITR'.' ETE
Constr HVAC Elec El Plbg Erosion Other:
Owner's Name Mailing Address Telephone No. (include area code)
GABeiZ\ A� se..N X60 ISUE >T7IkoR RD. ao0.5 6 1) 9 -,931- 63a3
Contractor's Name Mailing Address No. (include area code)
rn
Lot Area
ROJ I OCAT OJ 1/4, 1/4, Section T N, R E (or) W
Building Address Subdivision Name Lot No. Block No.
j r tAixy W 22, D 1 /z/
Zoning Diss rrictt(s) Zoning Permit N F nt I Rear Left Right
W1 Setbacks A ft_ 6 ft_ p 160 ft. ft.
>3::.: i.::::: t'#`' t I E S UR iilili:�:
New Repair RSingle Family Entrant Panel •orced Air Furnace Fuel Nat. L. P. Oil Elec. Solid Solar
Alteration Raze Two Family Size: d 6 amp Radiant Baseboard or Panel Gas
Addition Move Garage See: Heat Pump Space Htg
Other (print): underground Boiler
Overhead Central Air Conditioning Water Htg i
Other Other Dwelling unit will have 3 kilowatt or
.y more installed electric space heating equip.
ite Constructed 1
ncre I
....L Infiltration control option is ❑Full sealing
El Manufactured Manufactured Masonry of joints. Blower door test. Exterior
Treated Wood
Sewe air infiltration barrier.
i:` i::: is Other unicipal
Unfinished Basement /a9ZSq. ft.
S z >;<'€:M(«!ti7'$I�£fe1::
Permit No.
-Story �ti: %`'r`::::::••.....;:•;; ,.ii;;;i;.;;;i: Envelope �JD 6 BTU /HR
Living Area Sq. ft. 2 -Story Se nal
if IN `i :Il >`.'igini:iili Infiltration 1( 16-7-. BTU /HR
Other e rmanent
Garage 76 Sq. ft �gu al Utility 1:16: �s`.Y' >i<z<< >t
Other p .R........:...:..:......:::•:,
Plus Basement Private On -Site Well Yo tae
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 im lied ee artment or municipality; and certifies that all the above information 's accura
APPLICANT'S SIGNATURE 7 L-- /=iG? DATE SIGNED
APPROVAL CONDITIONS This permit is issu'%d pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this perm it or other penalty.
1.) Sk-'VAsv C1 S s1.-icavAL. Dcei ku.X..
2.,) 43O BM VC 11Z. S Pu1/4...
FiligibiNieMilpiliMi T own Villa it n
e C County State of: Municipality Number of Dwetlin
9 tl� Y Y P Y 9 Location:
ISL ION 7 —a6
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Plan Review ti o+ Construction i4' :FZ' -I '""`7
Wis. Permit Seal 30. 5 ['Electrical Name o
Other ❑Plumbing Date 9 0
O b0 0 L
Erosion )�p
Total J J Cert. No.
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
3c5, 66e
Revisal: 8/E9
ZONING L
AND USE COMPLIANCE CHECKLIST
JOB LOCATION: I aS (J/ 4l V J iA /A L ZONING: 12-
PROPERTY OWNER /CONTRACT ��..7S -2 fi� lv� I
CONSTRUCTION DATA: EW CONSTRUCT ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
A)E ito.6-1__E f 4T OVASE Zo je 't._,
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIE`iNCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (frtnt 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: t fj4 .4 (4)
The Director of Community Development, or desi nee, it 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.
PROVED OENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: Air
DATE: 8
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1 DATE 7° J 3
NAME ...._._O ADDRESS
LOT BLOCK WARD
SUBO I v r,)f," ,1, ZONE }v-/
STREET NO.
JP d 7 L �k�
LOT DIMENSIONS 1341-
SIDEWALK EXISTING YES 0 NO
B U I L D I N G GRADE ELEVATIONS STAKES SET AT SITE p 19 93 BY
FEE: $15.00 d& e-
DEPARTMENT OF PUBLIC 'WCRKS
I, the undersigned, owner or agent of the above described property agree to have the
grade estaoiished before excavation has commenced.
OT 1831.
4 G/ 77
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address 1Rg \N)fJ
Owner's Name dr K
Name of Subdivision \XJ1T b\\
Lot 14 Bldg. Permit
No. of Units
Fee Required
C 6 6
Fee Paid /000
r►. 4
er/er
Owner's signcture �'Lj Date
Inspector's signature S Date c /4/ l.3
Parks Subdivision
Improvement
Accts. Rec.: 362 -041