HomeMy WebLinkAbout0026220-Building CITY OF OSHKOSH N°_ 26220
,® PERMIT - APPLICATION AND RECORD
TYPE: BLDG HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING e--1 FLOOD PLAIN HEIGHT
ADDRESS // T 5.- A"� PLAN NOS7 /Z7 /I' //2
OWNER
DESIGNER �f y��/
USE /NATURE OF WORK / r- J /,5 a /
BUILDING CONTRACTORALAA:aii
Size Sq. Ft. 19 3 C # Rooms 54� 1 # Stories z Height '3 /
Foundation (..:d Class of Const. Q Occupancy Permit
HEATING CONTRACTOR Ad- 6C'e/y
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR ____eid.a2kt_lz+/
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
- BT WH Disp WSoft CBasin
Lav — Sh DW DF San. Sewer
- WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
4'7 460.0 O _
FEES: Valuation Permit Fee Paid $ 7 , Park Dedication $ /0 O, 0 0
ISSUED BY . 1 Date /j//3 Final /O.P. 3-fg - y
In the performance of this o rk I agree to perfor -II work p suant to rules governing the described construction.
S IGNA�� '/. .L� ////r/7/ /f �^ AGENT /0 , ER DATE
ADDRESS /1/ r G /V/ w /G/(/( /9 V / 3 5 5
TELEPHONE #
...7T11Iz7 /19///e-
state
Department o fInd WISCONSIN U NIFORM
Department f Industry, -� !'
Labor & Human Relations BUILDING PERMIT APPLICATION NO. 240 • Z.�,/
Division of Safety & Buildings
Box Madison, WI 53707 APPLICATION
Wisconsin Statutes 101. 63, 101.73 (See Instructions on back of pink copy) PARCEL NO.
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PE RMIT . . .REQ . . . . . . . . ::.::.::. . .
E . ........:::: : : ::g ::° CONSTRUCTION El HVAC El ELEC 111 PLUMBING 111 OTHER:
Owner's Name ... ! Mailing Address Telephone
235 Osk
7sNarn Teleone .3y :: ‘I' 4109 h' 17744.4c-'
iF. C 2 . 3 100
Lot Area
P : L
SECTION T N R E
,4444 .....:..:. : ::: ::;: ;; ;;;;: ;;; >;;
;;;;;;;:;
S9 f t• '/a or '/a ( )
// Building Address,, " Subdivision Name ame z ��i�,�,� Lot No. Block No. 5—F
Zoning Distri ) Zoning Permit No. Front Rear Left Right
/ .............................. Setbacks eD ft 7 n. / Co ft. / ft.
1:..l�R�' °:::.::: 4 : :::::: : : : : : : : : :
: '444::;:;:; ; ;�:.:
:.:�I�sY::: B: ELECT�AL :.::: 1«+EME�'
::....1:2 ENERGY SOURCE : ::
Q' N ❑ Repair !Single Family Entrance Pagel p� Forced Air Furnace Fuel Nat. L.P. Oil Elec. SolidSolar
'❑Alteration ❑ Raze Two family Size: Gd gI amp /❑' Radiant Baseboard or Panel Gas *
❑ Addition ❑ Move ❑ Garage Service: ❑ Heat Pump Space mg qp ❑ ❑ El ❑
❑ Other Underground ❑ Boiler Water Htg ('�• ❑ ❑ ❑ ❑ ❑
Overhead ❑ Central Air Conditioning
>. :; 7 F.O DA O�) :>
❑ Other * ❑ Dwelling unit will have 3 kilowatt or
❑Other 4 4 - ...:4444 , . . . , more installed electric space heating equip.
- 4444 4444... : ...................,..
Site constructed ' Concrete 1:Et:. Infiltration control option is ❑ Full sealing
' of joints. ❑ Blower door test. ❑ Exterior
liii EA ... fE # << ie:: ason Manufactured ry er
❑ Treated Wood Municipal
air infiltration barrier.
p ❑ Other Septic 1:3..:} AT OSS:. Ca {cfulatef }. �>
Unfinished Basement / a Sq. ft. S•° :S1'#RIES;:..
-4444 Permit No.
.... ............. . ....:.::.:
1 -Story r ; « : < <?';< < >s Envelope 2 &/ 3 BTU /HR
Living Area Z 03 ri Sq. ft. 2 -Story easonal 11 . . A "E,.: Inflltration.3 5 / BTU /HR
Garage 7 � S Sq. n. Other Permanent M Municipal Utility 14 :. EST .BUILD COST
Other
Private on -site Well
❑ Plus basement $ 64-0 , Q 0
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 Department or Municipality; and certifies that all the above information is accurate.
SIGNATURE OF APPLICANT DATE
CONDITIONS OF APPROVAL This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
T Municipality Number of Municipality Number of Dwelling
<. ❑ OWN ❑VILLAGE CITY ❑COUNTY P tY P tY
❑ STATE ❑ DEPEND Inspection Authority Location, if different
:? R TI N < : JJp
PE r r . 1rly . UP4PFORM PERMXT » ll#
Plan Review $ t/ - Construction
❑ HVAC �� �� NAME g /
Inspection . . . . $ ❑ Electrical
Wis. Permit Seal. , $ 30 "CO ❑ Plumbing DATE �� l y
Other $ ❑ Other SSr�
TOTAL . . . $ 70.o o CERT. NO.
SBD 5823 (R. 8/90) y5 WHITE - Issuing Jurisdiction YELLOW - DILHR GREEN - Inspector PINK - Owner /Agent
Revised: 8/89
ZONING /LAND USE COMPLIANCE CHECKLIST / t
JOB LOCATION: )/L/C p ZONING: 4
PROPERTY OWNER /CONTRACTOR: ,d,t 1 iI,J
CONSTRUCTION DATA: CONSTRUCTFg4 ADDITION ALTERATION PARKING LOT
TYPE eF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
• Lot Width
Lot Area
Floodplain
Front Yard
Side Street (frait yard)
Rear Yard
Side Yard (R)
Side Yard (L)
Parking Spaces
Building Area •
Lot Area Per Family
Corner Lot
Landscaping
Transitional Yard
Off-Street Loading •
Vision Clearance
Height
R VIEW AUTHORITY:
Pie Director of Community Development, or des gnee, must approve all plans, except the
following: (1) Alterations or interior work when the use i5 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.
Instances where work complies with the above criteria, the permit can be reviewed by the
Building Inspector without referral to the Director of Community Development, or designee.
ROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: _ '�' DATE: /./4 97
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address 1/ q _sue , ih.
Owner's Name / dt 9 ) .& . R ��
Name of Subdivision 7--,/it-1 arc - "/.a „i,�' , (.a �.c: %).-/
Lot # S , Bldg. Permit #
No. of Units /
Fee Required /D-0. 0 0
Fee Paid J00 ,0 /.., ,.„,/
3 Owner's signature ` _/ / Date // /01 �/ j
Inspector's signature 7
(- 2 d Date j/// 2- /Cj j
-
A
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
DATE l4— °29''
NAME ADDRESS // j 5
5 C. 1
LOT :.! - ' BLOCK
UBDI`J.i. ) II )„.....41, W. � /3
S
�..., — to , . - 1._, E t 1
STREET NO. TS � � 'U � '1E
� " • '-[ �. L 7 D I NS I ONS � C X 13 Li
SIDEWALK EXISTING ' YES El NO El
BUILDING GRADE ELEVATIONS STAKES SET AT sITE_____4ig_____,19_22_____JJ
HY
FEE: 419 -OC
116= oo — _
■4�i - -
DEPARTM NT OF PUBLIC WORKS
I, the undersigned, owner or agent of the above describ property agree to have the
grade estaaiished before excavation has commenced.
...oar ./ , .440# .
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