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N2 38588
CITY OF OSHKOSH
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 Q `v v- \c_b wiN8 PLAN NO B> C 3)
OWNER tUSCH t vtic
DESIGNER
USE /NATURE OF WORK i. 1J rr tr MT-1— t 1 11 ft1 C' 6
BUILDING CONTRACTOR v�
Size '1 Sq. Ft. °t «oC Rooms 6 3 (B'R. Stories 1 Height 1
Foundation Ct Class of Const. Occupancy Permit R
HEATING CONTRACTOR
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR Cv`■l t`S
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR" 1\
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 T
Permit Fee Paid So Park Dedication (t
ISSUED BY 4 I Date 1Q_` 1
y Final /O.P.
In the performance of this work I ee to perform all work pursuant to rules governing the described construction.
SIGNATURE a(/■ Z S C/ 7
AGENT /OWNER DATE
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 Parcel No.
Madison, WI 53707
Wisconsin Statutes 101.63, 101.73 (See instructions on back of pink copy)
PERMITREQUESTECIN::::: Er on pierm El-PI raib EZ L.... os i o n 0 Other:
Owner's Nianne Mailing Address Telephone No. (include area code)
0 -di Ce a760 W-e4-7",nice.A.) PA Zgi-gzes g
Contractor's Name Mailing Address Telephone No. (include area code)
LotArea
PROJECT :t(KATIOISIE 7
1 t ..1C. 70 Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Building Address Subdivision Name Lot No. Block No.
d 1
2 1 1 J A i Ar 1 f i .1 /14 2--
Zoning District s coning ermit No. Ant I Rear Left Right
Setbacks 2 5 .1 ft.1 65 ft. 1 I 1 ft. 8 l el 1. ft•
1 V:eR47)1ECt.::::::::::::::::::::::::::::::::MR: :::6 :::::::ELEC11UAl2::::::: ::::9:::ffitAteritilPfiAEritr::::::::::::42 Eiktetidt USURCE::::::i::::;ii:*.:i.i:]:i:ii:i:i::i:::ii:
('lew 0 Repair jpcingle Family Entrance Panel Intforced Air Furnace F Nat. L. P. Oil Elec. Solid Solar
0 Alteration D Raze 0 Two Family Size: 160 amp 0 Radiant Baseboard or Panel uel Gas
0 Addition D Move 0 Garage Servce: 0 Heat Pump Space Htg li;e0 0 0 El 0
0 Other (print): Underground 0 Boiler
fl overhead 0 Central Air Conditioning Water Htg i( 0 0 0 0 0
0 Other
04STAM:::: :70.1.1NDAIVIM: 0 Other 0 Dwelling unit will have 3 kilowatt or
more installed electric space heating equip
igs i t e Constructed L:fft oncrete iigkiipp4MptitiEj•Nni§i Infiltration control option is: 0 Full sealing
.....7' 0 Manufactured 0 Masonry of joints D Blower door test. 0 Extericir
ilgAREASIVOINIONINg: D Treated Wood Sewjr
•:'"•::43011ftS:: air infiltration barrier.
Unfinished Basement/ 227._ ft
sq. JD Other gMun
riporStory .:::t::: D i
p ermit No. Envelope /Y BTU/HR
Living Area I 222 Sq. ft- ID 2-Story
(.02•Sesonal :41,.1,Mi:i Infiltration/ I) c.Q.37 5 BTU/HR manent
Garage 400 sq ti 0 Other
D Other 1unucupalUtuluty I4
P
lus Basement 0 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 led, on the Department r municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE 2,—. DATE SIGNED 4/
3/21/f
APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to cam ply may result in suspe sion or
revocation of this permit or other penalty.
0).__/A C -.g 07GISURC: 16 l'‘ -1.25.
.i /1 072°>_S
Sta te of: Municipality Number of Dwelling Logtion...,
1 40 R 6 i 0 N 3
ii:.:::•::::,:.:::::::::::::::::::::.::::.,::::::::::::::,::,:.:::::::::::::::;:iili,i. c:-//ec--5'H `7.0_ -_:_•Q____ Ls,
1„,nest:::::::::::,:::::::.:„„„„„:„,„:„:::::::::.:::::::::,:„:::,::::„.:::::::::::::::::::::::::::::::::::,:::::::::::::::::::.•••:::.
0Atail:(K .....FoomPERMIT.*iPERMIISIMieri*if:'::i'"'""imi*m*m''"i'i':':*'''''*''''''"":"""''''''''':::::::':":""'
Plan Review t 1.7.. onstruction
Inspection Fil HIAC Name WC/A-"-- 31 k C- 13
Wis. Permit Seal __;:a 0 Electrical
Other 0 Plumbing Date
e ec aiTrosion LVC)C-).
Total 1 L ODI I Cert. No.
SBD-5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner/Agent
Yir;DOC'
K lit
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: 1 uduc\QA
ZONING
PROPERTY OWNER/CONTRACTOR: C
CONSTRUCTION DATA: New Construction Addition Alteration
TYPE OF CONSTRUCTION: (Le. fence, pool, parking lot, sign, etc.)
[Oat...)
COMPLIANCE CHECKLIST
DEFICIENT COMMENTS
Use
Lot Width
Lot Area
Lot Area Per Family
Floodplain
Front Yard
Front Yard Side Street
Rear Yard
Side Yards
Building Area
Parking Standards
Off Street Loading Standards
Vision Clearance
Transitional Yard Standards C
Landscape Standards
r 1/
Height
Conditions of Approval
Compliance with P.C. or
BZA Conditions of Approval
Signage Standards
Drainage Plan
REVIEW AUTHORITY
As per Section 30 -5 Enforcement of the City Zoning Ordinance, the Director of Community Development, or
designee, must approval 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.
APPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY' w DATE:
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City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address lascA0
Owner's Name
Name of Subdivision VJ I R
Lot �1 Bldg. Permit
No. of Units
Fee Required *103t
Fee Paid
Owner's signature Date
S
Inspector's signature 1 Date
Parks Subdivision
Improvement
Accts. Rec.: 352 -04
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