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CITY OF OSHKOSH N2 38034
PERMIT APPLICATION AND RECORD
TYPE: BLDG 04 HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /093 3 1W0 P6Af fT& J WAY Ql"
-J PLAN NO.
OWNER USCH 6AlsTR j0//
DESIGNER
USE /NATURE OF WORK /V iu <5 f(nn- j ,47 4C, 6M6E,
s
BUILDING CONTRACTOR LOCH
Size 6116 Sq. Ft. la m Rooms 6"'3ge Stories Height
Foundation a /VC Class of Const. 5 Occupancy Permit 9
HEATING CONTRACTOR ai!'ge
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR (O"► /A 1 (T.S
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR S ii
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 ��0 Permit Fee Paid /C/-) 2 V Park Dedication G 00
ISSUED BY 1 `L Date n V Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE L Z
AGENT /OWNER AT E
ADDRESS
TELEPHONE
G S /9a9 a9- c Qi qta 7 R
Wisconsin Department of Industry, WISCONSIN UNIFORM APplicati n No.
Labor and Human Relations BUILDING PERMIT f3< E0 Li
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 I REQ EST D:ii
Constr VAC lec Ib sion Other:
Owner' a Mailing Address Telephone No. (include area code)
me c 7& GIJ...24b» iZ L WWI 241/ 8263
Contractor's Name Mailing Address Telephone No. (include area code)
of Area
PR w 8 i C86 Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Budding Address Subdivision Name_ Lot No. Block No.
/a '97 cu W X J A
Zoning District(s) ning Permit No. ront I Rear Left Right
Setbacks v� r Q ft
0! few Repair ingle Family Entrance Panel orced Air Furnace Fuel Nat. L. P. Oil Elec. Solid Solar
Alteration Raze Two Family Size: 1 do amp Radiant Baseboard or Panel Gas
Addition Move Garage A Heat Pump Other (print): nderground Boiler Space Htg
Overhead Central Air Conditioning Water Htg
Other
0 Other 0 Dwelling unit will have 3 kilowatt or
more installed electric space heating equip.
ite Constructed oncrete P g g
>P!������:`�':`: Infiltration control option i
0 Manufactured ❑Masonry o opt o s. ❑Full sealing
Treated Wood of joints. Blower door test. Exterior
ri :A A I `eo. li i.i E Sew
Other unicipal
Unfinished Basement
air infiltration barrier.
LZ ,ZSq. ft. i:. i iiiii >:<..:...;:...:,;•.;i.:. ii••.i.i:.i i:. g
Story i'
Septic >M�E'f��� :�f�J�s�#
y »fix:
c Permit No.
Living Area 2 35 S ft. 2 -Story Seasonal Envelope Z/ �S BTU /HR
y ><E 6: Infiltration 5 3g Z59 BTU /HR
Garage `7 Q S ft O th er giermapent
g q unici al Utility P
0
Other 0Y.��00SV':!<
t Plus Basement Private On -Site Well LC O 0 6
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 impli on the Deertt or municipality; and certifies that all the above informatio is accurate.
APPLICANT'S SIGNATURE DATE SIGNED 0 2 /S q j/
APPROVAL CONDITIONS This permit is issu'Ld pursuant to the following conditions. Failure to comply may resu in su ension or
revocation of this permit or other penalty.
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Plan Review L/O. ,Construction 1
Inspection HVAC Name
Wis. Permit Seal Electrical
Other Plumbing 3cl Date 18' C
Total 3� c I Cert. No. \-iile
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
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Revisal: as
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: (,c)4 ZONING:
PROPERTY OWNER /CONTRACTOR: VSCNN Culaq.zs%RoC=Ikvi
CONSTRUCTION DATA: ;4NEW CONSTRUCT:{N ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
5 133 y P 2
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
Side Street (front 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:
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.
1 .--is:PPROVED OENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: DATE: A1102
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GATE 44 9 4
NAME f Sie/ ?If i 6 714 5 7- 0 C77C41
ADDRESS
LOT /1/ BLOCK WARD
SU80I V .J/V /TLeMdle Igam.S ZONE
STREET NO. JGW3 Ai/76 3 Jd 1 LOT DIMENSIONS
SIDEWALK EXISTING YES 0 NO a
BUILDING GRADE ELEVATIONS STAKES SET AT SITE ZI 17 ,1994- BY F -.1•
FEE: $15.00
DEPARTMENT OF PUBLIC WCRKS
I, the undersigned, owner or agent of the above described property agree ro have the
grade estaaiished before excavation has commence
b
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2a bP/12 n
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address 1 �4=A \)■,t1
Owners Name,
Name of Subdivision "R T v\
Lot 1 Bldg. Permit Egu J l
No. of Units
Fee Requi red 1
Fee Paid 1
Owner's signcture AllW/ Date 2 7Z/9
Inspector's signature r �y s �.j Date r
Parks Subdivision
Improvement
Accts. Rec.: 362 -041