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CITY OF OSHKOSH N2-40835
L' PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC p PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS \L..\ 1 w tx- .\_._k p,\.. PLAN NO1F 01 p )Gly
OWNER 1 X1 C _..."N- S`CRjv■� v
DESIGNER
USE /NATURE OF WORK N 99)3 C L -7 1` hk
Aiz
1
BUILDING CONTRACTOR -C -tA.
Size 1 c7- Sq. Ft. 1 )94 Rooms 9 313g. Stories Height
Foundation )Ai Z Class of Const. Occupancy Permit h J
HEATING CONTRACTOR
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR i A
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS _Water
Other
FEES: Valu '4 5 OO Permit Fee Paid 14a- i Park Dedication
ISSUED BY Date 1'1 t Final /O.P
In the performance of this work I a ree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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AGENT /OWNER O
ADDRESS
TELEPHONE
0541 ctt `+I -rv?
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No
Labor and Human Relations BUILDING PERMIT 902
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)
PERMIT R €QUESTEI
L/Ah nstr HVAC Elec Plbg Erosion Other:
Owner' ame 1 Mailing Address Telephone No. (include area code)
J76o Li .Lp irnerJ2) C a31-82o
Contractor's Name Mailing Address �1 P 4., Telephone No. (include area code)
Lot Area
:::pR jE at o ATION:
lv� Q0d Sq. ft. 1/4, 1/4, Section T N, R E (or) W
Building Address Subdivision Name Lot No. Block No.
l y3/ w LQa i vi z/ GC/ i a 163
Zoning District(s) Zoning Permi nt Rear Left Right
Setbacks r ft. I Tyr ft. 7 '4 r ft. j 7 r/ 1‘ ft.
Et�C1FSt
RC N
"i ::i::ii' i:::i::i:': ':Yciiiii: i:: �r F'.Fx1�fa
�3.l i E�`!':.;:.;; SCE, fP .�)1[±E:Y.;:>�.;�.:a:�.i..
lew Repair I ogle Family Entrance Panel rced Air Furnace Fuel Nat. L. P. Oil Elec. Solid Solar
Alteration Raze Two Family Size: 10c amp Radiant Baseboard or Panel Gas
Addition Move Garage Seryyice: Heat Pump Space Ht p(
Q"tJ
Other (print): nderground Boiler P g
Overhead Central Air Conditioning Water Htg u
Other Other Dwelling unit will have 3 kilowatt or
4! SMIYPEi::: .N#3 4 1t' more installed electric space heating equip.
ite Constructed oncrete Infiltration control option is: 0 Full sealing
Manufactured M asonr
Y of joints ❑Blower door test. ❑Exterior
>J ii Treated Wood $ew air infiltration barrier.
Unfinished Basement ��9� Sq. ft.
Other L Mawunicipal
❑setic
i Ae for ;:i::.. Permit No Envelope 3? BTU /HR
Living Area 1 /94 Sq. ft. 2 -Story Seasonal BTU /HR
Infiltrationti� `f
Other Iermanent
11 f >:WATER 1
r
Garage S .ft
ni i I flit
9
q u c a Utility
0 P Y �?�ES"��11�
‘us Basement Private On -Site Well .S5'noo
The applicant agrees to comply with all applicable codes, statutes and ordinances and with the conditions of this permit; understands that the issuance of
the permit creates no legal liability, expresser implied, on e Department or municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE 7747 DATE SIGNED 7/2
APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permt perm or other penalty.
/'US7 AU.- Cxc 5i /t/I0(s'u2 P CNk el$
i--UP— /S/'( `77a 5.s L,'"i�lt 3 r) -7 i '7 6 bkC-
4VIA/ Al CYt?,
Town Village County State of: Municipality Number of Dwelling Location:
9 Y P Y
J4JR1S►DtC ION i 400 6)
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::i':::::':: iii:::$; i::':;.:::::::::':::: i::::::::: i:`:: :::::::::::::::•`:fi: >5:::i:i:i: ::::i i
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Plan Review
Inspection *onstruction
VAC Name Q
WIS. Permit Seal Electrical
Other lumbin (1 Date 1
rosion 1 �b L1
Total t Cert. No. I ��•r
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent
LOT /03 4 s
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: /93/ Gvs1e47 "p Z2 1 ZONING
PROPERTY OWNER/CONTRACTOR:()S/
CONSTRUCTION DATA: 0( New Construction Addition Alteration
TYPE OF CONSTRUCTION: (i.e. fence, pool, parking lot, sign, etc.)
tigt CO i Afic 61l2R6s
COMPLIANCE CHECKLIST 1196 Z
--p- e# Q
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
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 ee i DATE: 77;7,777)/
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DATE 9/dg/q
NAME PUSCh
ADDRESS
LOT /03 BLOCK
WARD
SUED 1 Y tkE327 M' 5/, ZONE
STREET NO. 3 ol .f LOT DIMENSIONS
SIDEWALK EXISTING YES 0 NO Er
BUILDING GRADE ELEVATIONS STAKES SET AT SITE ,I9 ?9 BY
FEE; $15.00
A e l /74,ti,e)
DEPARTMENT OF PUBLIC WCRKS
I, the undersigned, owner or agent of the above described property agree ro have the
grade established before excavation has commenced.
0 C5059
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6 d
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address \A _A):
Owner's Name ,U_'
Name of Subdivision UL2' L- ab v^.E
Lot 0 Bldg. Permit LI C
No. of Units 1
Fee Required 5- [m
Fee Paid -I IOC)
Owner's signature
T--e Date Z q 4
Inspector's signature 2 Date '7
Parks Subdivision
Improvement
Accts. Rec.: 362 -041