HomeMy WebLinkAbout0025438-Building i
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416.) ' - CITY OF OSHKOSH N° 25438
PERMIT APPLICATION AND RECORD
TYPE: BLDG [/ HTG ❑ ELEC El PLBG El SIGN El ZONING R FLOOD PLAIN HEIGHT d
ADDRESS // 4G • PLAN NO. M/b q / e
OWNER � I ' °
r
DESIGNER �/J p /�.�
USE /NATURE OF WORK / 2 / J / l t�r�e .
BUILDING CONTRACTOR 4 flit:( / - 0-17-1-11-4 e t1-44- P / ( ieb:A
Size S Ft. /73 (?-36-ei z ,21
�J� q. # # Stori Height
Foundation c. g 't Class of Const. Occupancy Permit
HEATING CONTRACTOR e
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR Lt.
Electric Serv. New ❑ hange ❑ 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
FEES: Valuation '. 70 0 a Permit Fee Paid $ e9 0 S. O 0 " Park Dedication $ /MOO
7
ISSUED BY i . « . /. _ . . i� .e , , Date 9/2 0// Final /O.P. /-°"1 —/ a
In the performance of this work I agree to per :II work pursuant to rules governing the described construction.
SIGNATURE ��� / 9 p)
AGENT /0i • DATE
ADDRESS
TELEPHONE #
2 !o Sfp 04:V104:V17/7Z. �i —
State of Wisconsin
Department of Industry, WISCONSIN UNIFORM
� ,38
Labor 8 Human Relations BUILDING PERMIT APPLICATION NO.
Division of Safety 8 Buildings
Madison, WI 53707 APPLICATION
Wisconsin Statutes 101. 63, 101.73 (See Instructions on back of pink copy) PARCEL NO.
RM ' REQUESTS i.:.::: CONSTRUCTION 111 HVAC 111 ELEC ❑ PLUMBING ❑ OTHER:
I
Owner's Name Mailing Address Telephone
Contractor's Name Mailing Adslress Telephone
. 6 ., ::
2/ 2 &• 6.41. 62.0144404 q2-6-3925
� :;<:......: Lot Area
R I I ACTT
. ........... ............ S .ft. ' i
Sq. /a /. SECTION T N R E (or )W
Building Address Subdivision ame Lot No. Block No.
......
//‘O " 44-4 1 ( - , k;u, Yo
Zoning District(s) 1,c
Permit No. Front Rear Left Right
/ Setbacks 9Th 4(' / /
ft. � � o ft. 7 ft. _ 1� t� ft.
:1 PR . ... 3 I : :ELECT :RICAL: ' S: *$VAC:EQ PME)?N' 12': ENE RGV SOURCE.
M New ❑ Repair I Single Family Entrance Panel Forced Air Furnace Fuel Nat. L.P. Oil Elec. SolidSolar
Alteration ❑ Raze Two family Size: V-4 amp Radiant Baseboard or Panel Gas *
❑ Addition ❑ Move ❑ Garage Rrvice: ❑ Heat Pump Space Htg• f -d ❑ ❑ ❑ ❑ ❑
s.
❑ Other Underground ❑ Boiler WaterHtg. ❑ ❑ ❑ ❑ ❑
Overhead ❑ Central Air Conditioning
Oth r ❑ O ther * ❑ Dwelling unit will have 3 kilowatt or
9 equip.
ace heatin
❑ e ' ' : ';_: i Iallat : more installed electric s a ui .
Site constructed E Concrete •i0 PLUMBIING Infiltration control option is ❑ Full sealing
Manufactured Masonry Sewer of joints. ❑Blower door test. ❑Exterior
0 Treated Wood Municipal air infiltration barrier.
Septic
Unfinished Basement 0)" Sq. ft. `� ST ❑ Other Se P 1�: I}'T LOSS : {OS[Cit18t} . _
. .... .... . . ..: . .. . .. .. .. . .... . ... . :.::. .: Permit No
Living Area / 7;3,0 Sq. ft.
❑ 1 -Story $ 5 >> „-.<...: <? Envelope ! ` BTU /HR
2 -Sto
Season I 1�tWA: < rs«<< ><z<<<<<
ry ❑ a TER.. Infiltration if - TU /HR
Garage 7 r Sq. ft. Other Permanent E • f
Municipal Utility 14 ESTIL COST
Other ❑ Private on -site Well
❑ Plus basement $ oi 000, o C7
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 Departm =nt or Muni"' • - ty; and ce rtifies that all the above information is accurate.
SIGNATURE OF APPLICANT � / i� — _� DATE q -- 7
CONDITIONS OF APPROVAL This permit s issued pursuant to the fo . ing conditions. Failure to comply may result in suspension or
. _ revocation • f this permit or other penalty •
Municipality
TOWN
❑ V Num r f Munici
❑ VILLAGE CITY 0 be o all Number of Dwelling
Municipality :RNN .....:: ❑ STATE ❑ IND PENDENT Inspection Authority Location, if different
$' PERlf . l'JNIFORM PERMIT PEEL 11� 1SSt 8?C
IS :;: SEAL. trt0
Plan Review $ ` , °‘)
Construction
HVAC q-7 � / NAME , ' !' Inspection . . . . $ ❑ Electrical 59 O p
Wis. Permit Seal. . $ 3o >0 O ❑ Plumbing DATE 9/�//./
Other $ ❑ Other S J S�
TOTAL . . . $ 70. 0 CERT. NO.
SBD 5823 (R. 8/90) , 70 WHITE — Issuing Jurisdiction YELLOW— DILHR GREEN — Inspector PINK — Owner /Agent
Revised: 8/89
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: //5 re ,� ( ZONING: /2
PROPERTY OWNER /CONTRACTOR: , d Y� .
CONSTRUCTION DATA: ./I1EW CONSTRUCTION ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
S /.P,(x 2z-- Zz 4 -14//t -
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
• Lot Width
Lot Area
Floodplain
Front Yard
Side Street (front 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
REVIEW AUTHORITY:
The Director of Community Development, or designee, must approve 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.
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.
APPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: ;;,L - !✓ — DATE: 40 9
DATE z'47 9/
NAM . ADDRESS
LOT 440 BLOCK WARD
SUBD|Y. ZONE
STREET NO. //S(J ^ Z�. _ LOT DIMENSIONS
SIDEWALK EXISTING YES [::: NO El
4 , 2 2 BUILDING GRADE ELEVATIONS STAKES SET AT SITE "~`. |9 BY
/4 ' ,19 c� �/ �
FEE:1W440e
$/6:ua0
•
DEPARTMENT OF PUBLIC WORKS
|, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
00 �
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/-_
City of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address // iC e Xf-k-t--
Owner's Name )W- 4 1 +
Name of Subdivision Y,Xt't.0L , f �.,...4 - /1
Lot # 'T Bldg. Permit # .25438
No. of Units 1
Fee Required /0 0, O 4
Fee Paid /00.00
Owner's signature a<<%,_ _ Date
Inspector's .25438
No.
is �,�,/.� Date q /Zo /
C
A
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
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