HomeMy WebLinkAbout0066711-Building CITY OF OSHKOSH No 0066711
OSH' OSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 170 ROLLING GREEN CIR Owner DAVIS CONCRETE Create Date 10/1/98
Designer Contractor DAVIS CONCRETE CONSTRUCTION
Category 110 - New Single Family Plan C6- 105 -1098R
Type 0 Building 0 Sign 0 Canopy 0 Fence 0 Raze
Zoning R -1 Class of Const: 8 Size IRR 575x55'
Unfinished/Basement 1728 Sq. Ft. Rooms 7 Height 20 Ft. u Projection
Finished/Living 1728 Sq. Ft. Bedrooms 3 Stories 1 Canopies
Garage 440 Sq. Ft. Baths 2 Signs
Foundation Poured Concrete 0 Floating Slab 0 Pier O Other
Concrete Block 0 Post 0 Treated Wood
Occupancy Permit Required Flood Plain No Height Permit Not Required
Park Dedication Required # Dwelling Units 1 ; + .t # Structures 1
Use /Nature NSFR/ 1 Story home w/ 2 car attached garage NO DECK OR PAl 10
of Work
HVAC Contractor AMERICAN HEATING & A C CO Plumbing Contractor THORNE PLUMBING
Electric Contractor CUMINGS ELECTRIC �AD ` G,
Fees: Valuation OIL..., $84,000.00 Plan Approval $40.00 Permit Fee Paid $285.00 Park Dedication $100.00
Issued By: Date 10/7/98 Final /O.P.
Li Permit Voided
In the performan - of thiNs ork I agree to perform all work pursuant to rules governing the described construction.
Signature
Date
"� / Agent/Owner
,
Address 1042 TYLER AVENUE OSHKOSH WI 54901 - 0 Telephone Number 426 -3339
J
OSH'OSH
GRADE STAKE FORM
ON THE WATER Grade Stake Number 6036
Name DAVIS CONCRETE Address 170 ROLLING GREEN CIR Create Date 10/05/98
Lot 26 Block Ward
Subdivision Rolling Green Meadows Zone
Street Number Lot Dimensions I Sidewalk Existing
Building Grade Elevation Stakes Set At Site 00 /00 /00 Set By
Department of Public Works
1, the undersigned, owner or agent of the above described property agree to have th - grade s ablishe• before excavation
has commenced.
- aft
Wisconsin Department of Industry, WISCONS!N UNIFORM Application No.
Labor and Human Relations
Safety and Buildings Division BUILDING PERMIT 0066711
P.O. Box 7969 APPLICATION Parcel No.
Madison, WI 53707
Wisconsin Statues 101.63, 101.73
•• •:.: ° ; I ` ' a ' • ® Constr ❑ HVAC ❑ Elec Ell Plbg ® Erosion ❑ Other:
:s
6 ne s ' ame • • Mailing Address 1 elephone No.
DAVIS CONCRETE 1042 TYLER AVE Oshkosh WI 54901 - 0000 426 -3339
conuactor. x Con J Elec J HVAC ❑ PIbg Lic/Cert # mailing Address I l elephone No.
DAVIS CONCKE I E GUNS I {UC I I 1042 TYLER AVENUE OSHKO WI 54901 - 0000 426 -3339
contracror. a Con m Elec L HVAC Li Plbg Lic/Cert # mailing Aaaress i elepnone No.
CUMINGS ELEC I IC PO BOX 749 NEENAH WI 54957 - 0749 231 -5946 (Dick
contractor. J Con f I Elec HVAC u Plbg Lic/Cert # Mailing Address 1 elepnone No.
AMERICAN! HEA I IFG & A C CO 1129 MICHIGAN AVE OSHKOSH WI 54901 - 0000 235 -8090
Lontractor: J Con J Elec J HVAC X Plbg Lic/Cert # mailing Address i elepnone No.
THORNE JLUMBIN(. 402 FOREST HOME DR FRANCIS CRE WI 54214 - 0000 920 -684 -8046
� �otAiea Sq 1/4, 1 /4,Section ,T N,R E(or)W
•: ui .ing • ress Subdivision Name Lot No. Block No.
170 ROLLING GREEN CIR Rolling Green Meadows 26
zoning District(s) Coning Permit No. Front Hear Lett Hight
Setbacks ft. ft. ft ft.
:: '' 4' .. ❖. ❖. ❖.•.•. . : t e a ! [ °' 7 - '� ) s °' "' I a ° 4 �� ''t s
® New ❑ Repair ® Single Family n rance -ane ® Forced Air Fumace Fuel E • oar
El Alteration ❑ Raze ❑ Two Family Size: 200 am. El Radiant Baseboard or Panel
❑ Addition ❑ Move ❑ Garage Serv ❑ Heat Pump Space Htg El — u ❑ ❑ ❑
❑ Other (print): ❑ Overhead ❑ Boiler Water Htg ® ❑ ❑ ❑ _ ❑
❑ Other 0 Underground C entral Air Conditioning * u
® Dwelling unit wil have 3 ki owatt or
.f -"'' { <' v L `I e) Other
-.. .. M more installed electric space heating equip.
F4 w a ,...,._....,. :N Site Constructed ® Concrete is , { 1 ,'I ... :. :. :.�. :. Infiltration control option is: Full sealing
Unfinished Manufactured ❑ Masonary Sewer _..•... of joints. n Blower door test. — Exterior
Basement 1728 Sq • ft •o• � • , ❑ Treated Wood ® Municipal air intiitra i i barrier.
'`- • • ;M Oth ..
Septic i � ; f
Living Area 1728 Sq. ft. ®1 -Story � ^
Gara a 440 ❑ 2 -Stor _ .. -..... Permit No Envelope 1 . • BTU /HR
9 Sq ' tt ' ❑ Other M easona •: Infiltration 16718 BTU /HR
® Permanent •:�:�s :s:..
® Municipal Utility -- ,
® Plus Basement ❑ Other ❑ Private On -Site Well $84,000.00
The applicant agrees to comply with all applicablq.cacle , Stqtues and ordinances and with the conditions of this permit, understands that the issuance of
the permit creates no legal liability, express or, i li d, o th Depart r municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATUR r I t I \ ' 1 DATE SIGNED
his permit is issued ursuant to the followin i i
APPROVAL CONDITIONS p 9 d t oils. Failure to comply may result in suspension or
revocation of this permit or other penalty
SEE PLAN REVIEW LIS 1 ATTACHED
• : :.- 1 . ❑ Town ❑ Village ® City ❑ County ❑ State of Municipality Number of Dwelling Location:
'1 g . Ci Of Oshkosh 7 0 - 2 6 6
.. ❖s�.•oo:.. ❖s�• ry
� . • � h d' wa l ef ♦♦ t1 tot. - ••,*!l4, •
i d,, e Lid ' `: :: • • O•
.. • ........ • ..... ! . ........ • : .... s ....... • .. . e
...•.•!... ! c. a 1..Q ...
.! :.... e$' e
... .... .... c • i0 ••A t • •: • ••• : i•O.❖ *: i i xt:
Plan Review $40.00 Constructio
Inspection HVAC Name Nicole Krahn
Wis. Permit Seal $30 Electrical Date 10/05/98
Other Plumbing
Erosion
Total $70.00 207851 Cert. No. 248101
SBD -5823 (R. 07/92)
(a) OSH'OSH
PARKLAND DEDICATION FEE COLLECTION RECORD
ON THE WATER
Job Address 170 ROLLING GREEN CIR Date 10/7/98
Name DAVIS CONCRETE
Address 1042 TYLER AVE Oshkosh WI 54901
Subdivision Rolling Green Meadows Lot 26
Building Permit Number 0066711
Number of Dwelling Units 1 Number of Structures 1
Fee Required $100.00 Fee Paid
Owner's Signature l ; Date
Inspector's Signature Date
�' , 50„._ S1' I C \\ ti SLp 2' 1998
o `�
- ' DEPARTMENT OF
COMMUNITY DEVELOPMENT
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