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CITY OF OSHKOSH N° 36888
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS V j t M A F7 C 1 I PLAN NO. 1 0 3 /Q
OWNER 11 u i C6/1/:. ,0 7o/A-/
DESIGNER
USE /NATURE OF WORK b4L /Q f /0/:gN 1477461/11
BUILDING CONTRACTOR Pi hL
Size Sq. Ft. 7 a Room "an S tories ,L��`� Height
Foundation UCW Class of Const. Occupancy Permit Ye-
HEATING CONTRACTOR 01;7-'
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR esiN (KYz
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR t'
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
Permit Fee Paid A--- Park Dedication /cVt
ISSUED BY Q C 14(62 (1 Date /l) 9 i 9 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE o Q 3
AGENT /OWNER ATE
ADDRESS
TELEPHONE
R -/6 ///q3R
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT '.36 Fgg
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)
1
ER 1 E Qt EE TE
EgC ec< Other:
Owner's Name Mailing Address Telephone No. (include area code)
pa :2716e W a&,,LC. ,4 (23/- 16
Contractor's Name p oziaol Mailing Address Telephone No. (include area code)
tt 11 it 1 1
Lot Area
:"'PRO``": Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Building Address Subdivision Name Lot No. Block No.
Zoning District(s) oning Permit N n t I Rear Left Right
Setbacks ft J
ft t t ft.
EC` t::i::i::: ::::Ii <•:::::::i iiiii iii :i: ER Y:: O .R >j:::
�PA� f�,.. F�, ECT� .►►�...:.:...:.V�4.�"F`E�.` y.
ew Repair ngle Family Entrance Panel Pforced Air Furnace Fuel Nat. L. P. Oil Elec. Solid Solar
Alteration Raze Two Family Size: /!)t, amp Radiant Baseboard or Panel Gas
Addition Move Garage Service: Space Htg Heat Pump [1'
Other (print): ,i!p•Ilerground Boiler
Overhead Water t
❑Central Air Conditioning H g
❑Other
❑Dwellin u nit will have 3 kilowatt or
S P1» >I M di'tA W more installed electric space heating equip.
ite Constructed oncrete P g q
'IIICIrA M.POWS:E Infiltration control option is: Full sealing
❑Manufactured ❑n of joints. Blower door test. ❑Exterior
P 9
s<<`A ❑T ry Wood Sew
air infiltration barrier.
Jr I.. o. i in Other unicipal
Unfinished Basement 757 Sq. ft.
a ;s:>
1- Story ❑Septic
>:M>ltT5 #C::
OS Y ;;fix: >SE< >:ai> Permit No.
Living Area 7 Sq. ft. v Sea onal Envelope �.r BTU /HR
,JA :1 :iW' TE t: ::Infiltration /"7 3 BTU /HR
V e y er manen t
Garage 1,/Z Sq ft
ni i I Utility t
Other Y
Plus Basement Private On -Site Well 9J/'1// 660
The applicant agrees to comply with all applicable codes, statutes and ordinances and with the conditions of this permit; uunnntlerstands that the is ance of
the permit creates no legal liability, express or impli n the Depart nt or unicipality; and certifies that all the above information i accur e.
APPLICANT'S SIGNATURE 1—...... DATE SIGNED
APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to comply may result in suspe Sion or
revocation of this permit or other penalty.
s) 547Bf7)er 7KoaS
°z,.) a)«. czstZer- ✓1/16i4 X aL•2/.195 Ise ;A1/sr,ft EA•
aiuD SiLL.S V /7..2D f 4-01".111-1 g) of f 7 6?
p f&W(?- 21. to,
Town Village
Count State of: Municipality
Number of Dwelling 9 Y Y 9 Location:
I I rI 7 6 6
....SEAL: �k7i; :::::i;::S!:::::::a::: i; i:::::::: isli:;::::::> i::: i:::::::::::::::::: c: S: Y:::: iis::: i%: isf33i :i::::::::::::::::::::i::::
Plan Review t 446onstruction
Inspection HVAC Name
Wis. Permit Seal ce ['Electrical
1
Other Plumbing Date i "1,3
Total O rosion 134 I 9' Cert. No. �Ovr�
SBD -5823 (R.07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
g 34 660
ZONING/LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: i L» 3 -i- j 1M1A ZONING
PROPERTY OWNER/CONTRACTOR: VSQk\ r
CONSTRUCTION DATA: X New Construction Addition Alteration
TYPE OF CONSTRUCTION: (i.e. fence, pool, parking lot, sign, etc.)
Nak) SWa_E )3T ki AR.P.r._-
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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 ait-/i Height ye
Conditions of Approval
Compliance with P.C. or
BZA Conditions of Approval
Signage Standards
Drainage Plan
y
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: e DATE: 7//��p7
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CATE 1(1 Ell q3
NAME V`.�CA Li-. AODRESS
LOT 1,4 B LOCK WARD
;2N0 1
SUBD I V TLTI rikci 3 ZONE
STREET NO. l WE J LOT DIMENSIONS
SIDEWALK EXISTING YES NO E
BUILDING GRADE ELEVATIONS STAKES SET AT SITE G��- /c2. ,193 BY ...4;L:
FEE; $15.00
/t/ /(fi/T.,e
DEPARTMENT OF PUBLIC 'WCRKS
1, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
d 2p97, c__ s(
09-2833
Ui33
--(7-t- U Al' CA e_. /4114 ?,I
a-- /I7z3x14-'t-- /us- 7-. C....
City Of Oshkosh 1/1/85
PARKLANDD DEDICATION FEE COLLECTION RECORD
Address /9?
Owners Name /?&ii S L iox.)
Name of Subdivision UJO 7 F74/21'1_
Lot 6 Bldg. Permit g6ES'S
No. of Units
Fee Required
Fee Paid i/
Owner's signature 74: A04 Date 0 /6
Inspector's signature h (ALM Date 7
Parks Subdivision
Improvement
Accts. Rec.: 362 -041