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CITY OF OSHKOSH N° 39488
PERMIT APPLICATION AND RECORD
TYPE: BLDG.HTG ELEC PLBG SIGN ZONING I FLOOD PLAIN HEIGHT
ADDRESS l ¶2 O edit Are PLAN NO.P� —77---
OWNER .'170.4..0/ SC 4 a 17
DESIGNER
USE /NATURE OF WORK /f/ —e t_) k_ i c -ek,,
BUILDING CONTRACTOR A% t e f
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Size�F'P"e Sq. Ft J—�,Si� C� �jl Rooms ��4 Stories 1.} L=VL'/ Height
Foundation S i )G 4.)-0 L.. Class of Const. -a Occupancy Permit
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HEATING CONTRACTOR IL "GQ r-r
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR evA, ht r
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR 4/e_o `t
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
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FEES: Valuatio P- i Fee Paid Park Dedication
ISSUED BY 4 L i Date C, Final /O.P.
In the performa his work I agree t• perform all work pursuant to rules governing the described construction.
SIGNATURE v 01—
AGE \NER DATE
ADDRESS 61 SE 2 :61' oe(�'�`J'
TELEPHONE
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)
PERt ITREQUESTED► ir• Constr ❑HVAC Elec Plbg i'� Erosion El Other:
Oer's Name Mailing Address Telephone No. (include area code)
rU t_ K. 6c....4 A.* 8/5 20 'y /4 23/ -08 y4'
Contractor's Name Mailing Address Telephone No. (include area code)
AF +Z NS" x c.Sv •tc 160 .'f/ Z3/ -08
yy Lot Area
PRl TIO 'TIOriy :ii
1/4, 1/4, Section T N, R E (or) W
Building Address 1 Subdivision Name Lot No. Block No.
/-S )IL t-n r)
Zoning District(s) Zoning Permit No. Front Rear Left Right
Setbacks 3(0 ft. c3 3 ft. I (o ft. 25 6
1V JEG 1' 4 IECEiPANE: 1f.::.. Et. ECIRICAU +a IPMEN#` >::l:Zi:<:ENERG:'ySR.
New Repair Ingle Family Entrance Panel orced Air Furnace F Nat. L. P. Oil Elec. Solid Solar
u
Alteration Raze Two Family Size: 100 amp Radiant Baseboard or Panel Gas
Addition Move Garage Service: Heat Pump
Other (print): Underground Boiler Space Htg
Overhead Central Air Conditioning Water Htg 121
Other ❑Other 0 Dwelling unit will have 3 kilowatt or
5; '!'1. ><y.: >I'QR?A'i'[l111' more installed electric space heating equip.
ite Constructed oncrete P g
'�.r h`� >3 Infiltration control option is: Full sealing
El Manufactured Masonry P 9
::::ME ::tNVOEVED'. Treated Wood sewer of joints ❑Blower door test. ❑Exterior
air infiltration barrier.
:v Other unicipal >;:;z:
Unfinished Basement QtN sq. ft Se tic X k.O.'� C Atd t at
1- Story p
Y S:K: ><r Permit No Envelope 2/ 2.9'5' 8 7 BTU /HR
Living Area 164 O Sq. ft. 2 -Story ['Seasonal
ti:: fAILI "<s! Infiltration 70 C 7 BTU /HR
rr�� Other ermanent
Garage VZQ S ft.
V
9 q
z «t)7: L. Other olunicipal Utility 10#400010:O'S:`s ><s?i
Plus Basement Private On -Site Well [s 70 6442
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 plied, on the epartment or municipality; and certifies that all the above information is accurate.
x APPLICANT'S SIGNATURE DATE SIGNED 6 q
This permit is issued pursuant he following conditions. Failure to comply may result in suspension or
APPROVAL CONDITIONS revocation of this permit or other penalty.
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NOV 4/ a
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Town Village I n f
El Cou t State o Municipality Number of Dwellin
9 Y Y P Y 9 Location:
kk 0 5� ___7 .f z„ ce
i t I E#y: i.:::::::.::::::::::::.: i g i
Plan Review
..„Ii4e1<struction
Inspection HVAC Name y PC. !'C/t
Wis. Permit Seal 30 Electrical f
Other 0 Date 472°
Erosion /a 0 A 340
Total ...c..2 "j' v Cert. No.
SBD -5823 (R. 07/92) WHITE Issuing Jurisdiction YELLOW DILHR GREEN Inspector PINK Owner /Agent 0
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: 1 SaD ZONING
PROPERTY OWNER/CONTRACTOR: T�V L
CONSTRUCTION DATA: New Construction Addition Alteration
TYPE OF CONSTRUCTION: (i.e. fence, pool, parking lot, sign, etc.)
1\ giJa_E 4M' L A i `tZ�C-
COMPLIANCE CHECKLIST t �S� l �1
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: At/ /411P7
DATE: 210
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24 x x
DATE 51/7/q
NAME ?Auk_ ADDRESS
LOT 5 BLOCK '.WARD
SUBDIV. ZONE
STREET NO. /a�-?o LOT 0 I MENS IONS
SIDEWALK EXISTING YES 0 NO ID
BUILDING GRADE ELEVATIONS STAKES SET AT SITE S 19 '94 BY k. i
FEE; $15.00
77 t
DE. ART�'"E!`.T OF PUBLIC WORKS
I, the undersigned, owner or agent of the ao. scribed property agree to have the
grade estaoiished before excavation has comm.nced.
CA
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