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CITY OF OSHKOSH N° 46789
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING FLOOD PLAIN( HEIGHT
ADDRESS I4 11 w '-A i i \/V G..- PLAN NO. r cr 7Ai1 011e)
P 1 t.
DESIGNER
USE /NATURE OF WORK 'V 5 i'"" a- 4 (--k'' A e...._ L.. j
BUILDING CONTRACTOR IL-'5<-
f
Sq. Ft. L 4`'ll,ku Rooms our
SizeM S Height
Foundation z"-, t
Class of Const. e Occupancy Permit (1t v1 l@
HEATING CONTRACTOR gc‹,w44.
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR (✓N/1 t •-•6_,
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR S d
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 '5'. 01 :-/C‘ Permit Fee Paid i .3+ 5 Park Dedication 100 c
ISSUED BY 0 Date '.5---- c Final /O.P.
In the performance of this work I a• perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER DATE
ADDRESS
TELEPHONE
Wisconsin Department of Industry, V(IISCQNSIN UNIFORM BUILDING Application No
Labor and Human Relations PERMIT APPLICATION
Safety and Buildings Division
P.O. Box 7969 (See instructions on back of pink copy) Parcel No.
Madison, WI 53707 The information you provide may be used by other government agency
Wisconsin Stf1 ite� 101 6 101.73 pro rams [Privacy Law, s. 15.04 (1) (m)].
PE.I MJT REQUESTED onstr 0 HVAC [J El 0 Plbg 0 Erosion 0 Other:
Ow s Name Mailing Address Telephone No.
I '477 u elep )Z3 3
Ca tractor's Name: Co l HVAC Plbg ic/Cert Mailing Address Telephone No.
./1 J
C tractor's Na on Elec RHVAC Plbg idCert Mailing Address Telephone No.
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Conyp 's Name: AN Elec EJ HVAC bg idCert Mailing Address Telephone No.
Contractor's Name: Con Elec HVAC Plbg ic/Cert Mailing Address Telephone No.
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RODE <>E: TION; L.tArea
<;I i!� S ft 1/ 1/4, Section T N. R E (or) W
Building Ady -ss e 'F z 7
Subdivision Name Lott No. Block No.
Zoning District(s) i Zoning •ermit No. Front Rear Le Right
Setbacks
°lg ft. l El' ft. 30 ft. 4a r ft.
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�t {y :i: •:i .�y�( y. :i::::: i:;� :+g• ►m'+�py ::ii:::i:i:: iyy:: :i::•,: ��a{ •�y(� '�..y i:::::::: ti: i::•, iv:',:;:::::
'K: YN�.��M�.. !:R�i :T-R..�.IT ^iiii }:v ?ii: ^i::iii�� iii }:i:i:
Mew Repair ingle Family Entrance Panel EKorced Air Furnace Nat, L. P Oil Elec Solid Solar
ID Alteration Raze Two Family Size: 00 amp Radiant Baseboard or Panel Uei Gas
Addition Move Garage Ser ice: Heat Pump
Other (print): Underground Boiler Space Htg
Overhead Central Air Conditioning Water'Htg
Other Other
�T <'1`'y1Y!IE> .N�1A:T1>I»1(i�.'' *0 Dwelling unit will have 3 kilowatt or
Site Constructed oncrete py
#•1 iiiiMI more installed electric space heating equip. Infiltration control i
Manufactured M asonry i opt on is Full sealing
of joints. >��`.<�!�a���: >s ?i ❑T reated Wood Se 1 Blower door test. 0 Exterior
qr�_ unici al air infiltration barrier.
Unfinished Basement 4 .ft. S::_:$TRge''• >I ❑Other P s> r :zi:.'• 's:<
0.�sq se tic iliffi >gaMi1' �C I M!ii
f 1 a `f Story >::8::I Perm it No.
Living Area Sq. ft. 2 -Story S sonal Envelope BTU /HR
`''s>::: Infiltration 13 .,►3 c D BTU /HR
t her
d e €s
Garage T 6 Sq. ft. n i I
u c a U tility 42612O.Ii. t:�:t......
Plus Basement Private On -Site Well •-o
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 D mm t or municipality; and certifies that all the above information is ccurate.
APPLICANT'S SIGNATURE !/GL.-.. It DATE SIGNED qq
g�l r
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.
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y.n.rs Gi-r.....- in.c_
Town o Village e i
C t Count
Stat of: Municipality Number
9 Y Y p of Dwelling Location:
tt Y 9
S0 CTI fp5111(011,
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Plan Review l'i0 vb
�Construction
Inspection ❑Ii VAC Name /•"i• Zv {,C-
Wis. Permit Seal S 3 0 4;; Electrical 3 1 I
Other Plumbing Date S- It r
p r3 .r rosion 6" Total Cert. No.
SBD -5823 (R. 06/94) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner/Agent
ZONING/LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: )/t I W e,=, e t c, \NI L. ZONING I lL 1
PROPERTY OWNER/CONTRACTOR:
CONSTRUCTION DATA: New Construction Addition Alteration
ii
TYPE OF CONSTRUCTION: (i.e. fence, pool, parking lot, sign, etc.) I j r i` =mac Ivy ia
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
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: DATE: Fl
Loo le
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pcycos addx adtx 1:360 19/ 4/95
CATE
NAME C l7 vrt5 ADDRESS I I q I
LOT t BLOCK WARD
STREET NO L LOT 0 I MENS 1 GNS 734 •5 x 13 Ge
SIDEWALK EXISTING Y NO 1
BUILDING GRADE ELEVATIONS STAKES SET AT SITE (6:4 ,I9 9 S 9Y
FEE: $15.00
DEPARTMENT O F O P U B L I C WCRK:
1, the undersigned, owner or agent of the above described property agree to have the
grace estabiished before excavation has commenced.
areE
4q/:/// 40
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address LJ1. ,c lc'
Owner's Name 9,k15,-,
Name of Subdivision \t54✓1„P,I 5C, (vr
Lot Bldg. Permit
No. of Units 1
Fee Required IOC) c)()
Fee Paid 1 0 0
Owner's signature L, Date 2 ?A'S
Inspector's signature `s P Date 7' 5
Parks Subdivision
Improvement
Accts. Rec.: 362 -041