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Home My WebLink About0143466-Building (roof) CITY OF OSHKOSH No 143466 OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD ON THE WATER Job Address 913 JACKSON ST Owner ROBERT C /LORI E WILLIAMS Create Date 10/01/2010 Designer Contractor OWNER Category * 141 - Exterior Remodeling Plan 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 Occupancy Fee $0.00 Flood Plain Height Permit Park Dedication #Dwelling Units 0 # Structures 0 Use /Nature SFR / Tear off and replace roof on house only. of Work ** Robert Williams (owner) called and said he would take out the permit and he lives in 1/2 of the duplex. I told him that since his mailing address was to a PO box that he had to provide us with a piece of mail with the Jackson Street address on it which isn't the case I talked to Brian and he said he needs to fill out the THE AFFIDAVIT FOR PERMIT ** per Brian Noe 10/4/10 HVAC Contractor Plumbing Contractor Electric Contractor Fees: Valuation $3,500.00 Plan Approval $0.00 Permit Fee Paid $46.00 Park Dedication $0.00 Issued By: Date 10/05/2010 Final /O.P. 00 /00 /0000 ❑ Permit Voided Parcel Id # 0501230000 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) alto sec a any ecessary approvals before starting such activity. I have read and n rstan he afore mentioned information. Signature Date //447M- c/0 r Agent/Owner Address Oshkosh WI 54901 - 0000 Telephone Number * 141 - Exterior Remodeling See Chapter NR 447 of the Wisconsin Administrative Code and Notification Form 4500 -113 on the DNR Asbestos Program website; http: / /dnr.wi.gov /air /compenf /asbestos /. For additional information on hazards present in buildings see the Pre - Demolition Environmental Checklist at http: / /dnr.wi.gov /org /aw /wm /publications /anewpub /WA651.pdf 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 OfHKO /H Fax: (920) 236 -5084 I III I Roofing & Siding Permit Application ON THE WATER • Application(s) and fee(s) can be brought to City Hall, Room 205 or mailed to Inspection Services, PO Box 1128, Oshkosh WI 54903 -1128. Commencing work without permit(s) will result in fees being doubled or $100.00 plus the normal permit fee, which ever is greater. OR 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 fl JOB ADDRESS 3 7 6 _`'G'" 1,1- OWNER g /l! a.,41 ( CONTRACTOR I am the: Owner OR ❑ Contractor SE CATEGORY t y 8_ ❑ Multi- Family 0 Rental 0 Commercial 0 Industrial r„It Work being done: ROOFING Tear off and replace existing roofing otiliouse, ❑ garage ❑ Replace wood decking ❑ Add 1 layer of roofing to the existing layer(s) on ❑ house, ❑ garage This work is being done due to ❑ Hail Damage ❑ Other SIDING ❑ Install siding on ❑ house, ❑ garage ❑ Replacing vinyl with vinyl ❑ Replacing steel or aluminum with vinyl (circle steel or aluminum) ❑ Replacing with This work is being done due to ❑ Hail Damage ❑ Other When siding is done, one of the boxes below must be checked: 1) ❑ Electric — Existing Electric Meter, receptacle, lighting and Electric Service entrance alterations/modifications are being performed by (Name of Licensed Electric Contractor) AND ❑ Electric Installation Verification form is attached OR ❑ Separate Elect Permit will be requested. 2) ❑ Electric — Not Applicable because: ❑ J Blocks previously installed. ❑ No outside lights. ❑ Other ❑ Install new or ❑ Replace gutters ❑ Install new or ❑ Replace downspouts Other related work being done: (please note) Value of the ob $ j C (include fair market price for labor even if you are not paying for labor) 03/02 City of Oshkosh Division of Inspection Services 215 Church Avenue �// PO Box 1130 W H Office (9 0) 236 - 5050 HIC ON THE WATER Fax (920) 236 -5084 Web: www.ci.oshkoch.wi.us AFFIDAVIT FOR PERMIT State of Wisconsin, County of Winnebago, City of Oshkosh I, r-7 Wr , hereby swear and affirm under oath that: (print name) I am the owner of the property listed below and will self - perform the work. And do hereby submit an application for a permit pursuant to the Wisconsin Department of Commerce Licensing Act 28 (ss101.147), that does not require me to be licensed by the State of Wisconsin, to perform this work at: 9'3 �G. J0✓1 � � � � 5 STREET ADDRESS (THE "PREMISES ") CITY STATE ZIP I UNDERSTAND AND WILL ABIDE BY THE FOLLOWING STIPULATIONS: 1. That I will be personally doing the work as set forth in the Permit Application and no contractor for hire will be performing any work at the Premises. 2. I understand and acknowledge that if any person other than me is determined to be performing work upon the Premises a STOP WORK order may be issued. 3. I understand and acknowledge that if I am unable to complete the work at the Premises I must hire a Wisconsin State Licensed Contractor to complete the work and obtain a permit for the remainder of work to be done. 4. I understand and acknowledge that all work must be performed in strict conformance with all applicable building and zoning codes adopted by the City of Oshkosh. 5. I understand and acknowledge that all work performed will be subject to inspection by the City of Oshkosh. 6. I agree to take full responsibility for all work completed upon and the conditions of the Premises. 7. I am certifying the above under oath and am subject to laws for perjury for any untruthful statements made herein and understand that the permit may be revoked for false statement or misrepresentation as to the material fact in the application on which the permit was based. UPON SUBMISSION, THIS AFFIDAVIT BECOME ' .' OA' THE ACTUAL PERMIT. PRINTED NAME OF APPLICANT SIG '1 OF APPLICANT 9(3 7�.c J�� $ - o �s � c Szf ') STREET ADDRESS OF APPLICANT CITY STATE ZIP HOME PHONE NUMBER L ALTERNATE PHONE NUMBER SWORN and SUBSCRIBED to before me this 6(4 day of 06/01202- , 20 /O at Oshkosh, County of Winnebago, and State of Wisconsin. NOTARY SEAL HERE 401/tk 4 NOTARY PUBLIC