HomeMy WebLinkAbout0019126-Building J _CITY OF OSHKOSH N° 19126
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING - r( FLOOD PLAID. HEIGHT/
ADDRESS / 3 � 0 /J0. 4Act A to PLAN NO� r T ` PC
OWNER u/c. 1 e a ( 40.- . f . i 4 1 - s . )r
DESIGNER fJ
USE /NATURE OF WORK A @f t9 e
BUILDING CONTRACTOR S cwt. ‘ �/
Si Sq. Ft.` T f a cer) # Rooms e L n# Stories Height Z
Foundation Class of Const. Occupancy Permit ) C7
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
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 $ , - rmit Paid $ l 0 Park Dedication $
ISSUED BY i. _ - - /
Z "_� I /, Date 9. Final /O.P.
A.
In the performance of this work I agree to •erform all work pursuant to rules governing the described construction.
SIGNATURE ...."
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
State a tment o f ln d
D WISCONSIN UNIFORM
Labor & Department f Industry,
Division o an Relations BUILDING PERMIT APPLICATION NO.
Divion f Safety 8 Buildings
Box � on WI 53707 APPLICATION
Wisconsin Statutes 101. 63, 101.73 See Instructions on back of pink copy) PARCEL NO.
ESE...1` E.." `.' 'E
O.. ;.::.::;:.;:
STRUCTURE 111 HVAC ❑ ELEC ❑ PLUMBING
Owner's Name J .Mailing Address Telephone
Contractor's Name i ( Mailing Ad ss Telephone
1/4, ' /a, SECTION , T N, R E (or)W
Building Address Subdivision Name Lot No. Block No.
/ ,l)J . 11 .T
Zoning District Lot Area Front Rear i I _ Left � Right
( 70 O Sq. ft. Setbacks 2S --\ ft. ,r / ft. ft.
.iii:]:••04L: ' Ct:Mg:iM:N:MMB:;:: itc.:::::11tormom: ' :. ' iiiitivAtleautpstairm::::::::::i::::::::::::12i::::::ENERGIPSOURCE:::::::::::::::::::::::::::::::::::::::::::::
New ❑ Addition ❑ Raz ngle Family Entrance . _ • rced Air Furnace Fuel In L.P. Oil Elec. •lar
• Iteration ❑ Repair ❑ Move ❑ Two family Size: /APB" amp ❑ - adiant Baseboard or Panel
LLL���ttt
❑ Other rv' • - : ❑ Heat Pump SPooe M9• ' ❑ ❑ ❑ ❑ ❑
■
❑Other -46_ derground ❑ Boiler Water Htg. 11� ❑ ❑ ❑ ❑ ❑
• Overhead ❑ Central Air Conditioning • ❑ Dwelling nit will have 3 kilowatt or
kii : :: ❑ Oth er 9
:;;:` :� :.... tIQtjl ric space heating equip more
oncrete Infiltration control option is: Fu ll sealing
❑Attached ❑ Detached iteconstructed *::::' 11 :: : >;:;: p ❑ g
❑ Manufactured ❑ Masonry war fUU of joints. ❑ Blower door test. ❑ Exterior
«<<<<> <
<__ < < « << >` > > > >» nl 0 Wood S . cl . pal
air infiltration barrier.
❑ Other ❑ Septi ;;: ::.:; : : : :.. .:.: :: ::::;;
: < IF i : : : : :: >:: ; s :: : LOSS {Caldl latiad < < <€ <:
Basements -4 / 1 -S,7 7 0 sq. ft. Permit No.
❑ 1- Story Envelope n4, loo BTU /HR
PI
CO Area CO Sq. ft.
•
O BTU /HR
2-Story 0 liil 'I'.' €! > »! > >?! > :! > > > > > >> infiltration rY � 1
�— ! �• her
Garage S . ft.aunici al Utili 'I'ITKBIL ::00.81':: >< > > >»
9 q Q d� U ermanent
Other LJ'Privat on -site Well
$ -S 021r:,
The applicant agrees to comply with the Wisconsin Uniform Dwelling Code and other Municipal Ordinances and with the conditions of this permit; understands
that the issuance of the permit creates no legal liability, express o implied, on the Department or Municipality; and certifies that all the above information is
accurate. �,
SIGNATURE OF APPLICANT "V DATE
CONDITIONS OF APPROVAL This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
v` .t - U- S-1 (Pit r W.
r� -- / ... % , L - am L% it- Vie. ' rC.- =� / t ., _ 1 'e'
•
'i i f .S r f r 1F- .1‘ a- /k. c‘ -s
o�v t 9 P P sal #—
T Municipality Number of Municipality Number of Dwelling
❑ OWN ❑VILLAGE CITY ❑COUNTY P tY p ty u
:; E;;;;;;,,,, : : : ° ':>:: ❑ STATE IN END IfInction Authority Location, if different
'`N : » > »'
OF. �C �i - - - - --
<: ;: illy; €tourom.. _ iyi t i y
. ..........
Plan Review . $ - -_ onstruction ,
NAME MI . 14
Inspection . . . . $ ❑ Electrical
Wis. Permit Seal(s) $ as ❑ Plumbing DATE - I i
Other $ 0 Other
TOTAL C ? . 1 '--- CERT. NO. �
$ = �J Z
SBD 5823 (R. 4/89) WHITE — Issuing Jurisdiction YELLOW —DILHR GREEN — Inspector PINK —Owner /Agent
DATE �P � 9
ADDRESS
LOT Zd BLOCK WARD
SUBDIV. ZONE
STREET N0./.3 Tiff /e ,e,Ce,44,;" C LOT DIMENSIONS
'
SIDEWALK EXISTING YES NO 0
BUILDING GRADE ELEVATIONS STAKES SET AT SITE ,I9 BY
FEE: $15.00
6
DEPARTMENT OF PUBLIC WORKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
0e 176
•
Revised: 8/89
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: //3572%P �L ZONING: ie.`/
PROPERTY OWNER /CONTRACTOR: (1' % 4 ( A44waolr �..,r? ?..i
CONSTRUCTION DATA: IEW CONSTRUCTION ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, et9
COMPLIANCE CHECKLIST (Check only those applicable)
COMP ES 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.
APPROVED DENIED
Plan Commission Action Required
Variance(s) Requi ed
REVIEWED BY: ' 1 rd�� . DATE: j D
X EXISTING PENCE
X x x x
NEW 4'-e H 16tH CA-IA-it-4 t. 46,. ieryce /2 .
- x�f"1' -U" X X x
•
154'- ID
IN
STCRAG E .
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SHED'
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PATcf -I EXISTING L. M. sEE SITE 11
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LOT 2 8 sire 10 /IIl
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