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CITY OF OSHKOSH N2 36897
PERMIT - APPLICATION AND RECORD
TYPE: BLDG IM HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS Sl b O T)CliFlEL M .1E- PLAN NO. r_ 1 - ilSili193 R
OWNER elkla2eT A.Nbs C ��i V.}k clk
DESIGNER
USE /NATURE OF WORK Ma S 1.16,E k UJ I% , QT; rkeb 64216E.
BUILDING CONTRACTOR e(�'EZ 4 - # Rooms . ? kk , l
Size Sq. Ft. f l .6 # Stories �1 r' Height a Foundation atz Class of Const. 8 Occupancy Permit___ __
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR Co fY\ m i t■\G
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR ` V.
- 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 $ -411 Permit Fee Paid $ 1 CD1 4 °b Park Dedication $ 1C0.
ISSUED BY . i - _ Date < < j Y, 43 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 7/--� /�
AGENT /OWNER TE
ADDRESS
TELEPHONE #
ifri- igs /193 e
Wisconsin Department of Industry, WISCONSIN UNIFO M Application No.
Labor Human Relations BUILDING PERMIT �� 89
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)
R rtit `.. TESi :''
• < T ' i onstr HVAC El PIb rosion Other:
Owner's Name Mailing Address Telephone No. (include area code)
6x %� yea 4 �im e �7& t]J J►nc,,, 44.s 0
Contractor's Name Mailing Address Telephone No. (include area code)
1 . i cc f e it
:i:: Lot Area
. >: ><.ri .:�! : ':. D : : :: : Sq. ft. 1/4, 1/4, Section , T N, R E (or) W
Building Address Subdivision Name Lot No. Block No.
I D? EE ia_v) z ' 'e.. (J ilk i . i2��14 ) aa� Air
Zoning District(s) Zoning Permit No. Fro Rear Left Right
Setbacks mT 15� ft r
. � � ft . 1 1 ft. / / ft.
W
■: ew ❑ Repair ! Ingle Family Entrance Panel • 1i orced Air Furnace F Nat. L. P. Oil Elec. Solid Solar
❑ Alteration ❑ Raze ❑ Two Family Size: / O Oamp ❑ Radiant Baseboard or Panel Gas
❑ Addition ❑ Move ❑ Garage Service: ❑ Heat Pump Space Htg ❑ ❑ ❑ ❑
❑Other (print): underground ❑Boiler
❑ Overhead ❑ Central Air Conditioning Water Htg ❑ ❑ ❑ ❑ ❑
❑Other ❑ Other * ❑ Dwelling unit will have 3 kilowatt or
` "�' y`'' more insta electric s ace heatin a ui .
ite Constructed oncrete �•• •••� • � P 9 q P
:`1 <I .' MBINk ? >E >» ' >z » >F #E >s Infiltration control option i
:: ❑Manufactured ❑Mn ••••�•�'� �� � �•� � ���������������•��•��• � opt o s. ❑Full sealing
'• ""' :. ❑ Treated asory Wood of joints. ❑ Blower door test. ❑ Exterior
air infiltr ti n
..., ;. ;.;;..;...;:.;;;:.:;:•:•:• a o barrier.
Unfinished Basement 7 Sq. ft. ° t ::' ' ...•:.' : <: »> %`• » %'� ❑Other urncipal
Se tic : ;. : ::::::..::::.;..:..::,,:,'.:
nn / Sq. ft. ❑ ❑ Story I'•:iI*:.: ' ::'E » >'''•. Permit No.
Living Area 1 2_ ry ❑ Se onal rt Envelope / Y 096 BTU /HR
:.It ....: A' • :: • . iiiiitii :: '''''' 'r Infiltration
ther er manent ...:: �` ���; ` i
. � ::::: I7 64/5 BTU /HR
Garage / `(J Sq. ft. unici al Utility P
❑Other Y ?�.: �S�� RAIN�ip. ��O', i� . >; ;;:�
lus Basement ❑ Private On -Site Well $ Lir oar
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 Dep me t or municipality; and certifies that all the above information 's accurate.
APPLICANT'S SIGNATURE DATE SIGNED r/ Zd/
APPROVAL CONDITIONS This permit is issuld pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
i0) rn/r 77ev.ss 7R *;S.
2. .i:2(G -- R icax..) meAs .92 - c2 p y (..), TA/ / u 1/Z Z1- / Z r;
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❑ County
State of: 9 e o
❑ Municipality
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JURISDICTIO - 2 6
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........ ............... .................. ii ..... . .. . . . . � � .: ;i : >i >i i::;;; { :i ii::. ...................... .K.................... . ..... .............................
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J ...........:..:.�.:� ,,.::::..:::::: ;:.....: i ::.::.::.>:.....: iii:::: ii<:;:::: :::.. iiiii:;: : :: i;}: fi:;:: `;; }: :;:i:
Plan Review $ 1/� 6 / C4 Name ���
Inspection $ e0 []HVAC
Wis. Permit Seal $ 3 ❑ Electrical 7 3
Other $ ❑ Plumbing Date
$ rosion )3�Q`
Total ❑ / o / Cert. No. �
SBD -5823 (R. 07/92)) WHITE - Issuing Jurisdiction YELLOW - DILHR GREEN - Inspector PINK - Owner /Agent
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Org
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: _)/ (� " LD D4 ZONING /
PROPERTY OWNER/CONTRACTOR: CN C)e
CONSTRUCTION DATA: New Construction Addition Alteration
TYPE OF CONSTRUCTION: (i.e. fence, pool, parking lot, sign, etc.)
_Nau -- r"))/(- sk czy2)(1
COMPLIANCE CHECKLIST
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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.
C./ APPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: "�--. f DATE: //! 0/
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City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD II
Address /()g E-Gz-LF)ez.bD! V6
Owner's Name G9W2E*1 /fob ascH
Name of Subdivision t/? (_L r4Ee
Lot # U 7' Bldg. Permit # 89
No. of Units
Fee Required SO),
Fee Paid le a C
Owner's signature ► / Date f a /1-1 93
Inspector's signature ! 11110t %i Date 6�
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
CATE qui g/',3
NAME RV jC, c�1 S �R .
ADDRESS
LOT (y 9 BLOCK r.
tAhD
SU8DI V. i/1(.CA6e" E� ZONE
STREET NO. 3 /of � LOT DIMENSIONS
SIDEWALK EXISTING YES 0 NO El
BUILDING GRADE ELEVATIONS STAKES SET AT SITE HAS ,I9 93 BY Aen
FEE: $15.00
,/ /
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.
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