HomeMy WebLinkAbout0141022-Building CITY OF OSHKOSH No 141022
OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 500 S OAKWOOD RD Owner MERCY MEDICAL CENTER OSH INC Create Date 05/14/2010
Designer Contractor CR MEYER
Category 220 - Alteration Hospitals & Institutions Plan 02- 2943 - 0310 -R
Type • Building 0 Sign 0 Canopy 0 Fence 0 Raze
Zoning Class of Const: Size
Unfinished /Basement Sq. Ft. Rooms Height Ft. ❑ Projection
Finished /Living Sq. Ft. Bedrooms Stories Canopies
Garage Sq. Ft. Baths Signs
Foundation • Poured Concrete 0 Floating Slab 0 Pier 0 Other
0 Concrete Block 0 Post 0 Treated Wood
Occupancy Permit Required Occupancy Fee $0.00 Flood Plain No Height Permit Not Required
Park Dedication Not Required # Dwelling Units 0 # Structures 0
Use /Nature Hospital / Interior alterations to convert existing dark room 260 to a procedure room for new Panorex as per plans approved by DHFS.
of Work
HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation � 8,251.00 Plan Approval $0.00 Permit Fee Paid $142.00 Park Dedication $0.00
Issued By: // Date 05/17/2010 Final /O.P. 00 /00 /0000
❑ Permit Voided Parcel Id # 0613660000
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work
described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement
holder(s) and to secure any - - ,3ary - pprovals before starting such activity.
have read and unde - d the afore enti•ne. info - '.n.
Signature _� Date// �Q
Agent/Owner
/
Address 895 W 20TH AVE OSHKOSH WI 54902 - 6766 Telephone Number 235 -3350
To schedule inspections please call the Inspection Request line at 236 -5128 noting the Address, Permit Number, Type of
Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone
Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may
continue if the inspection is not performed within two business days from the time the project is ready.
City of Oshkosh
Inspection Services Division
P O Box 1130
Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050
Fax: (920) 236 -5084 DJIHKDJ H
Building Permit Application- Additions , t O THE WATER
If you are a contractor participating in the Permit Fee Account System and have adequate funds. check here
if you want this processed through your account Ft
JOB ADDRESS 5 S d . 7H 0/11 1" v n• 0514 - %L'ss )4 v.
OWNER IN•FF tti < <7 14 AA-T S`C S
BUILDING CONTRACTOR G
ELECTRICAL CONTRACTOR - -'-�- G. cZ2i
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PLUMBING CONTRACTOR ss rt__Z1_ A.c tt - a - Nst c-/acL
HEATING CONTRACTOR f' ss4,t ‘A-Q- c. % CA`
I am the: ❑ Owner OR 'Contractor
USE CATEGORY
❑Single Family ❑Duplex DRental . ^� 144 - z A A44)5 P T
❖ Full description of work being done: r gr.,,.n.v 0 cr Cr � a — k P —v cam^ 1")
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Any work not included in this application is not permitted. Please make sure to attach your
Plan Submittal Checklist to this application with all the required information.
Building Value of the job not including mechanicals $ 18,25 I .00
PLEASE READ, SIGN, & DATE:
I certib, the above information is complete and accurate. Any deviations from the above submitted
information may require additional permits to be obtained. I acknowledge and agree to these terms.
Name: TEA= t "LAt
(Please print)
Signature:
Date: "1/ I f L d
11/03