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CITY OF OSHKOSH N2 40344
PERMIT APPLICATION AND RECORD
TYPE: BLDG X HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS WI 1 w+k'EpTFIE WA PLAN NO. Fa" Goa My
OWNER VC,! -k cCNSTIZO C,1n 01■1
DESIGNER Q Q n
USE /NATURE OF WORK V CKf ✓ice )501/(4 4774(..HEb i Q /c.l 6
BUILDING CONTRACTOR WOSCIA.
1 t
Size FZ Sq. Ft. 1 b' Rooms 3S Stories 1 Height 16
Foundation /,-Y-- Class of Const. T Occupancy Permit
HEATING CONTRACTOR 1-12 V3e
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR CUM I 1
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR h
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valua SD t/
1
Permit Fee Paid Park Dedication �e
ISSUED BY MAUL Date it q9 Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE W 746/W
AGENT /OWNER
°s
ADDRESS
TELEPHONE
Fa-009 —W91/ 91/
Wisconsin Departme t of Industry, WISCONSIN UNIFORM Applicatio N
Labor and Human Relations BUILDING PERMIT L `7 y
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)
:P REQUESTED ti
[�C onstr [^�El [�'Pl g .[✓Erosion Other:
Ownej.:A Name Mailing Address Telephone No. (include area code)
,C il C071.0.i 02 7 6 0 U 1 D,0Z mL 4A-- ,Z3/
Contractor's Name Mailing Address Telephone No. (include area code)
41kk E
Lot Area
S J 80 Sq. ft. 1/4, 1/4, Section T N, R E (or) W iiiii
Building Address Subdivision Name Lot No. Block No.
/0 q/ W/ flr ,LiVei W Gll.0. FQz J 2—
Zoning District(s) honing Permit No. r ont Rear Left Right
Setbacks ft ft ft ft.
�j, �Eyy ...Al ff.: thy �`:j�'�«���: >::E�€ERGY�:t
�:�.r.:. /..,y�b.� fEf'i�::: >::.:.:i'#k� �,ac. 4Ui:'A .�a::.GLE�7Ni.:: i!K .Pa. A kF'.�Ia"itR.1
r ew Repair L' ingle Family Entrance Panel I! orced Air Furnace F ue l Nat. L. P. Oil Elec. Solid Solar
[I Alteration Raze Two Family Size: O 6 amp Radiant Baseboard or Panel Gas
Addition Move G Service: Heat Pump
Other (print): underground Boiler Space Htg
Overhead Central Air Conditioning Water Htg
Other Other Dwelling unit will have 3 kilowatt or
11 1 ST`''• it F NDA ON mo installed electric space heating equip.
ite Constructed oncrete Infiltration control option is Full sealing
❑Manufactured ❑Masonry of joints. Blower door test. Exterior
>K >A z< ❑Treated Wood
Sew 9r air infiltration barrier.
>:J i Vo it i O ther unicipal
Unfinished Basement 1 'L Sq. ft.
❑Septic s N��R� '�.435'.�.:�����ild
Story r 1►'e 'x':> iili >s »ri Permit No
ft. Envelope BTU /HR
Living Area 0.2, S
4 2 -Story Se sonal
E1 AT >.s Infiltration BTU /HR
Other ermanent
Garage SZ sq. ft.
9 I I
nia a UtI rt
❑Other L� P Y
l is Basement Private On -Site Well 55/06 0
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 implied, on the De artment or municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE 77; ..,.../4 DATE SIGNED 6/z r p 9,/
APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
1 /NSSACA- S E S cia AScW/ff3 Fere c H# a/. /off;
ill ititg071111,111 Town Village Cit Count State f: M ni i alit Number f Dw Ilin Location
g y u y S a e o u c pa ty o e g
;.JURISDICTION: OS� o a c
ter
x:::::::::::::::::.:::::::::::::::
Eli::::
Plan Review lib onstruction
Inspection HVAC Name Ai l is+ 1 ---tild
WIS. Permit Seal 3 Electrical /�9
Other ❑Plumbing Date l rosion JlI WO‘Cg Total S t Cert. No. gloss'
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner/Agent
1 13;e2 400
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: 9l G(Jldy ZONING
PROPERTY OWNER/CONTRACTOR: ,C)_S CSJN W Cam �l f
CONSTRUCTION DATA: New Construction Addition Alteration
TYPE OF CONSTRUCTION: (Le. fence, pool, parking lot, sign, etc.)
_A Sim 04/ AT%aC1G
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
Landscape Standards
Height ,t
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.
L./
APPROVED DENIED
Plan Commission Action Required
Variance(s) Requir-d
REVIEWED BY DATE: ‘__,77/7/77---
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City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address &9 HEM /eat) wx(
Owner's Namesc4i
Name of Subdivision Goes ai f 1,'z/)'LS
Lot ?/9 Bldg. Permit 1/(2.3qv
No. of Units l
Fee Required
Fee Paid -#lam
Owner's signature Date
Inspector's signature !l Date o ff.
I
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
GATE 1
NAME X504 (.10r.- ADDRESS
LOT t la BLOCK 'JARD
SUBO I V ■ESTL ZONE
STREET NO. t 9S\ l.�* 're1& LOT DIMENSIONS
SIDEWALK EXISTING YES 0 NO 1:::]
BUILDING GRADE ELEVATIONS STAKES SET AT SITE ,1 9 g'4 BY
FEE ;$15.00
DEPARTMENT OF PUBLIC CRKS
1, the undersigned, owner or agent of the above described property agree ro have the
grade established before excavation has commenced.
0(27048 6/°a`l