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HomeMy WebLinkAboutBuilding CITY OF OSHKOSH N2 09325 PERMIT - APPLICATION AND RECORD TYPE: BLD HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING (el FLOOD PLAIN HEIGHT ti CO � r — P6'' l,O 4 (� fN c9 e' V 04 r i ADDRESS AO ( f P LAN NO. OWNER (T L .k.3o r-i -kr`ti at E. DESIGNER USE /NATURE OF WORK _ - _ `ti- 40 BUILDING CONTRACTOR a L SizeiZL1 Sq. Fto'' 13 '# Rooms-- a # Stories -- e-- Height r Foundation p . • , Class of Const. Occupancy Permit tae HEATING CONTRACTOR Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S ELECTRIC CONTRACTOR 0 -19 IAA- 4x-.1-4-_______ Electric Serv. New ❑ Change ❑ Teml ❑ Type Volts Amps Fixtures Switches Receptacles Circuits PLUMBING CONTRACTOR /� / 4- S L �^ - BT WH Disp WSoft CBasin __Lay Sh DW DF San. Sewer WC FDr SP Ur Storm Sewer - Sink LTub Eject SS Water Other FEES: Valuation / '0 '� I� 0 1 j• it Fee Paid $ /�� b/ Park Dedication $ /CD ISSUED BY t _.iI AIM ri Date 7 _ /,--; Final /O.P. / /-�q In the performance of this w•rk I agree • perform all work pursuant to rules governing the described construction. SIGNATURE • C\ , C� �l > AGENT /OWNER ATE ADDRESS TELEPHONE # aZ 3 7/ _ State Department o fInd WISCONSIN UNIFORM Department f Industry, � � Labor 8 Human Relations BUILDING PERMIT APPLICATION NO. Division of Safety 8 Buildings Box 79 Madison, WI 53707 APPLICATION Wisconsin Statutes 101. 63, 101.73 See Instructions on back o / pink copy) PARCEL NO. PERMIT RE# UERTED S TRUCTURE E HVAC El ELEC El PLUMBING Owner : . : a m ::.. Mailing Address Telephone ° �0� Ki tit vt C tractor's ame 7 `) Mailing Address / T elephone G " _ K s ite r � e vf-GG(t' l ( '~l / 7 7, lQ � PROJECT L :OC* T N ' /a, ''/4, SECTION , T N, R E (or)W Building Addy ss ` f� Subdi io n Name ! Lot No. Block No. / ( !t I\ t, emu"( ( u L° r Gg.t r` G / r 0 Zonin District Lot Area Front Rear ...._. Left Right O 000 sq. n Setbacks 3 n. ft. p n S ft VROJECT:: �3 'TYPE 6 ELECTRICAL. S. C F IPMENT 12.: ENERGY SOURCE ❑ Addition ❑ Raze gle Family Entrance Panel orced Air Furnace Fuel Nat. L.P. Oil Elec. SolidSolar ration ❑ Re air ❑ Move ❑ Two famil Size: Z-00 am ❑ Radiant Baseboard or Panel G s P Y P * ❑ Other Servj e: ❑ Heat Pump Space Htg. ❑ ❑ ❑ ❑ ❑ ❑Other ' Jnderground L ❑ filer WaterHtg. ❑ ❑ ❑ El 0 ❑ Overhead �'L.Central Air Conditioning * we i g unit will ave 3 kilowatt or :Ih GARAGE : 4�: CONST � 7 : FOUNDATION ❑ Other .. ..... more installed electric space heating equip. fife cons tructeQ o ncrete 10 PLUMBING Infiltration control option is: ❑Full sealing tt ached ❑ Detached ❑Masonry Sewer of joints. Blower door test. El Exterior • ❑ Manufactured ��Ar 2 AREA ❑ Treated Wood $Municipal air infiltration barrier. S STORIES ❑ Other ❑ Septic 3. I1.EAT!LOSS. CaIcu:Iatefi) Basements / 0/3 Sq. ft. Permit No. ❑ SE Envelope DO BTU /HR Living Area Sq. ft. ❑ 2 1 --Story � 0 sonal :2WATER Infiltration BTU /HR Garage �` 0 Sq. ft. 0 Other ermanent unicipal Utility '14 : ESTIMATED COST ❑ Other ❑ Private on -site Well $ Z© COO The applicant agrees to comply with the Wisconsin Uniform D ,, -- yy' g Code and other Municipal Ordinances and with the conditions of this permit; understands that the issuance of the permit creates no Ie•al liabil'ty, expr. implied, on the Department or Municipality; and certifies that all t e above information is accurate. SIGNATURE OF APPLICANT ( DATE ► 40.9 CONDITIONS OF APPROVAL This pe ued pursuant to the following conditions. Failure to comply may r suspension or revocation permit or other penalty. ` t '• �'i ( ` r r '' ( R) ( � IV• �t?r�"'� // f/f i�L. Or`�67� -4,2. t�l _ - - 14- �r-_. ./ .� , .r OII /f `• . - • • .. . �`z r` u� ) r'O 4 , L) a v e - a-- e ,tp IA QL - ed .10. /7 iSsIG+ ❑ TOWN ❑ VILLAGE I Municipality Number of Municipality Number of Dwelling •❑ STATE ❑ INDE NDEN Inspection Authority Location, if different 'J URISDICT ON ..: . ..< OF: Cc 's' . ©s T- TY ❑ COUNTY =- ___Z-__6 6 - --- — — PERM S) Wt,S: tI ORM PERMIT' A.S FSS P �lMfl'T t f SAC II E . . Plan Review $ -.5/0 ErConstruction El HVAC NAME /( `Y-L4 1 Inspection $ ❑ Electrical Wis. Permit Seal(s) $ 3 0 < ❑ Plumbing DATE 7- 1. - - 8' Other TOTAL . , , $ , ❑ Other D 6 e:76 7,3 CERT. NO. L �-/ SBD 5823 (R. 04/87) WHITE — Issuing Jurisdiction YELLOW — DILHR GREEN — Inspector PINK — Owner/Agent . r ,. _ _ • y • 0 - _. • - . • I • • y ) 1, Y Cd N6 , / is *> 56 _ . • •) . . . • . . . . . • • . : RI : VER. MILL RD. ZC NI GLAND USE COMPLIANCE CHECKLIST I. ORAL Building Permit * Zoning ( Conforming lion Conform ing Job Location /644 i2 (L I4 m ! L AO Lot Dimension Property Owner NME100 N t l A laic y Lot Area 11. CC STRUCTICN DATA Describe work: Alt fit '' ,7 64"____ & NEW CCNSTRUCTICN ADDITION ALTERATICN Accessory Building Pool !- Si}ygle' Family Fence Deck/Patio _ Moo-Family Boathouse — Sign _ Mild- Family Utility Structure _ Porch Cconiercial Other (specify) _ Manufacturing III. OOMPLIANCE Oanolies Deficient Deficiency/Consents ✓ _ Use lot Width c■ Lot Area Floodplain • Front Yard (V Pear Yard Side Yard (R) Side Yard (L) _._. Parking Building Area V1 _ Lot Area per Family /4 Corner It Other (specify) Gt- U11 IV. REVIESW AtTMORITY The Planning Director, or appropriate designee, must approve all plans, except the fc11cwing: (1) Alterations or interior work when the use is conforming and when no change of use is proposed. (2) Maintenance items, e siding. windows, etc., whe the use is conforming and when no change of vse is proposed.. Instances where work =plies with the above criteria, the permit c4n 1 reviewed by the Building Inspector without referral to the Planning Director. (/ - APPROVED NOT APPROVED Plan Commission Action Required Variance (s) Required REVIEWED BY: r / �'' DATE: 7 6i J Z DATE 7- ?- p1 NAME r c i S o,,,, K � r. mac' y ADDRESS LOT lD / BLOCK WARD SUBD I V . e`c.9 Q 1.4 ( (( jftE7 ZONE STREET NO. /lob ? 1Lc U r 0- vt ( re; LOT DIMENSIONS SIDEWALK EXISTING YES C NO EI BUILDING GRADE ELEVATIONS STAKES SET AT SITE ,19 y ,r5./ BY 7 172-64 7 FEE: $10 . iir, • G ' ,--` 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. . X( N.7 \ N (? :._k , -- (x851' City Of Oshkosh 1/1/85 PARKLAND DEDICATION FEE COLLECTION RECORD Address /67( 7 �f ck ti c (( Owner's Name eN).1-- c rrt,te 4c_K30&2 k/o Name of Subdivision K Lot # fb Bldg. Permit # No. of Units ( Fee Required WO Fee Paid t 00 Owner' s signature - 7‘1",,„ 1 , Date Inspector's signature r4 r 41E, Date T / Parks Subdivision Improvement Accts. Rec.: 362 -041