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38587
CITY OF OSHKOSH N
PERMIT APPLICATION AND RECORD
TYPE: BLDGX HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /%';y wJ 1 rn62.0 w y PLAN NO. —D33 3 i R
OWNER ustii Co4DSv /c (X 770A
DESIGNER
USE /NATURE OF WORK c N/ f /4 /C-2 j ArT4GH6 64/2
BUILDING CONTRACTOR C/
Size bi S 1 3 B�P (1 )Ap
q Rooms Stor Height
Foundation Class of Const. a Occupancy Permit
HEATING CONTRACTOR 0Z
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR COMM 1 fr S
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT WH Disp I 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 q 1 Park Dedication /Od- oa
ISSUED BY "�'L��lt!'��, Date c3 Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ik'.. 3 26 gy
AGENT /OWNER D
ADDRESS
TELEPHONE
.7 --0' L 1 .'S
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)
PERIVIITREQUESTEDNi:i':':'
L Constr firrto9kt fil4ec —EI bg p.7.1 Erosion 0 Other:
OwrAs N r
e Mailing Address Telephone No. (include area code)
annat g 760 al."4-11~/711./ ad 3/- ?LOS
Contractor's Name Mailing Address Telephone No. (include area code)
.PRCOKriitOCAMOISiii ('1 iier)
Sq. ft. 1/4, 1/4, Section T N. R E (or) W
Building Address t Subdivision Name Lot No. Block No.
1 W d c u 0 ,ii ild riA,,m to f
Zoning District(s) 0 Zoning Permit No. Front Rear Left Right
Setbacks 0 ft- IOV ft- a 1 ft /1
rPAT:;;:':::::::: ii:9, :::::TICAtilkiiittitt::::::i::::: 12. thtlidtS011.1tql
7, ew 0 Repair I!, Ingle Family Entrance Panel V, orced Air Furnace F Nat. L. P. Oil Elec. Solid Solar
0 Alteration 0 Raze 0 Two Family 4 Size: /06 amp 0 Radiant Baseboard or Panel uel Gas
0 Addition fl Move 0 Garage Seryice: 0 Heat Pump Space Htg 0 0 0 0 0
0 Other (print): N.underground D Boiler
0 Overhead 0 Central Air Conditioning Water Htg 5102 12 0 0 0
0 Other
SM.ST..:;::TYPE::::::14::TWNDATIOK::. 0 Other 0 Dwelling unit will have 3 kilowatt or
more installed electric space heating equip.
NoSite Constructed M.Concrete
:40$14.0i4BING:::::::::::::::::::::::::::::::Mi:::::: Infiltration control option is: 0 Full sealing
:::ZiIiIi El Manufactured Fi r r a e s a o te n d ry wood
Sewi, of joints. D Blower door test. 0 Exterior
tAttittitV 0 Other RI ,unicipal air infiltration barrier.
Unfinished Basement 57‘ Sq. ft. 3%:iillEATKOn.::::(010040.0i:!:::::::
0 septic
Di-Story ::18. ':::111.S.E ii:i:::::::::::::iiiii:
Permit No. Envelope 4. BTU/HR
Living Area M sq. ft- 03eStory l
AtgWATER:ii::::::0:Miii.:::::i:iiin Infiltration _Ir Air BTU/HR
Garage KOther
I N Sq. ft. rman nt
IIN0Iffunicipal Utility 0
0 Other
Plus Basement 0 Private On-Site Well i iCA Oe
f
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 im d, on the Departm t or unicipality; and certifies that all the above information is lccurate.
APPLICANT'S SIGNATURE ....4.----- i 44 DATE SIGNED
APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to comply may result
revocation t in suspensionor
of h permit or other penalty.
/o) fAITALL Sbit. gaC5tOte ME•sd&bee g ()Z i L.A9Z 2)./2S.
2) C.),/atn I r
D Town 0 Village 14.ity 0 County 0 State of: Municipality Number of Dwelling Location:
i:i::::JuRismcnoloo CG14-Rcsil _10 e9 6 6
Q ::PERMt::::: ::::ciiimunawrvitekei*::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::*:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
:irrmli:1::!.!mrmgm:.:1::iiiii.!iiimimiimi.;:li.m.:.;:iiii;;;;;;:::::::::::::;::::::::::::::::::::::::::::::::::::::
I
Plan Review e'Kustruction ‘4 i i
Inspection «J HVAC Name
Wis. Permit Seal $::„3 Di .5 El Electrical i
Other i= Date
cze sion i
Total s 1q9D10 Cert. No ___VELT
SBD-5853. (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner/Agent
35;ico
ZONING /LAND US COM LIANCE CHECKLIST
JOB LOCATION: (Lk is ft} ZONING ie
PROPERTY OWNER/CONTRACTOR: )SGT/
CONSTRUCTION DATA: New Construction Addition Alteration
TYP OF CONSTRUCTION: (i.e. fence, pool, parking lot, sign, etc.)
<C/06FLE 4 tell)
COMPLIANCE CHECKLIST
1 /8 6 0
DEFICIENT 7 U C MMENTS
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 f
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: i DATE: /Z----,117
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City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address b 1 e W7
Owner's Name PO 5C/4 ausvocricA)
Name of Subdivision WET�f 1 44S
Lot Bldg. Permit 3.�5
No. of Units
Fee Required 7C0c 06
Fee Paid ir CO'
Owner's signature 7 7--
Date g
Inspector's signature
.4411110911V a' Date
p
Parks Subdivision
Improvement
Accts. Rec.. 252
GATE qLi
NAME O z i AOORESS
LOT 10) BLOCK WARD
/��1 7 dFsD
SUBOIV. W rely ms ZONE
STREET NO. PO) LX;hQt 2 Q/C) tay LOT DIMENSIONS
SIDEWALK E ALK EXISTING YES El NO 0
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 3 I2_ I g qq= BYY r1
FEE; $15.00
DEPARTMENT OF P U B L I C 'WORKS
I, the undersigned, owner or agent of the above described property agree to have the
grade estabiished before excavation has commenced.
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