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State of Wisconsin
WISCONSIN UNIFORM
Department of Industry,
Labor & Human Relations
Division of Safety & Buildings BUILDING PERMIT APPLICATION NO. � �
Box 7969
Madison, WI 53707 APPLICATION
Wisconsin Statutes 101.63, 101.73 (See Instruction on back) PARCEL NO.
�� ❑STRUCTURE ❑HVAC ❑ELEC ❑PLUMBING
Owner's Name 410 Maaiil Address Telephone ^ Q
„....„,....„..„.„,.,,,,,.......„.....,
Contracto Name .76f:50 CO E�C m • 0/?_- t a � J � � ljp2 0 �
Mailing Address ay, phon
fl-L 1 l a ` � 7 002 b131 - ' 20
/e, SECTION
Building Address ++� ji Subdivision Name Lot No. T N Block No. E(or)W
—
Is �`s 1N 1 A � S % & � , - - S Cb -1 - I P
�T 3
Zo g District Lot Area Front Rear Left
Right
_ 1 f?.:) Sq. ft. Setbacks o ZS ft ` °� ft e 1,4 `Z ft. 1 � ft_
Ft' - w ❑Addition I. 'ogle Famil Entra ce 'a
y ne
r Fuel orced Air Furnace . Ht�. Water Ht..
❑Alteration ❑Repair ❑Two Family Size: �� amp ❑R adiant Baseboard or Panel
❑Garage ❑Raze ❑Other Se •ce: LP Gas ❑ ❑
❑ Heat Pump Nat. Gas
❑Attached ❑Move 74 nderground ❑goiter
❑Detached ❑Foun dation ❑Overhead Fuel Oil r ❑ ❑
❑Central Air Conditioning Electric ❑ ❑
❑Master plan no. a _ ° ❑Other, Wood ❑ ❑
Of applicable)
❑Site constructed rs��. ncrete i ❑
���� } '- Solar ❑ • + , anufactured ❑ Ma s onry Sew r Coal ❑ ❑
❑Treated Wood 1, ..1 unicipal Other
Basements Sq . ft. ❑Other ❑Septic
.Story Permit No.
Living Area � ��8 Sq. ft. ❑2 Story Envelope I BTU /HR
Infiltrati
Dottier
BTU /HR
Garage Sq. ft.ermanent ❑private -on -site Well
❑Other ,P1' unicipal Utility 3
00 $ � �
The applicant agrees to comply with the Wisconsin Uniform r g Code and other Muncipal Ordinances and with the conditions of thi
permit; understands
that the issuance of the permit creates no legal liability , s or i. •.lied, on the D partment or Municipality; and certifies that all J above information is
accurate.
SIGNATURE OF APPLICA % , , DATE +. 1P
�� ,� ,
CONDITIONS OF APPROV This permit is issue. pursuant to the following conditions. Failure to comply may result in suspension or revoca-
tion of this permit or other penalty.
F = . L O ._a O V - L s �z
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❑VILLAGE TY ❑TOWN ❑COUNTY ❑STATE
N AME - • '"' //
I ,, �; � ,,. ' ?.
MUNIC. NO. ` �- b
� *:
Plan Revie 1 $ �,► ns truction
Inspection $ • AC NAME b��
fp (M
Seals) . $ 3 .. ���or.
Wis. Permit Sea DATE 6° 3y
Other $ / ❑Other o 85�
TOTAL $ K? C� c CERT. NO. �✓"t'
')ILHR SBD 5823 IR - 1/82) WHITE — Issuing Jurisdiction YELLOW — DILHR GREEN — Inspector PINK — Owner /Agent
ZONING /LAND USE C MPLSANCE .IST
I. GENERAL
Building Permit tow4e-e, zoning / 2 7'/3 aonf
ormi.ng Non- Confozming
Job Location ,Q I S M (AJ 02-04 �ST_ Lot Dimension
Property owner - 0m,A s �► S L . (4 lot Area
11. • acr Ian DATA
Describe tbrks �(.�„�,,—
CCNSTRUCTION ADDITION ALTS tATICN
Building — Accessory _,.._ Pool Single Family
-- Fence _ Deck/Patio Two- Family
_ Boathouse _ Sign _ __. Multi- Fataiiy
Utility Structure Porch Cumercia].
_..._ Other (spemoify) ____ Manufacturing
III. CONPLEANCE CHECKS
S
Commies Deficient Deficiency /affluents
Use
Lot Width
Lot Area
Floodp
Front Yazd
_.,._ Rear Yazd
Side Yard (R)
Side Yard (L)
✓' —' Parking
�.. Building Area
Lot Area per Family
Corner Lot
—
Other (specify)
IV. REVIEW AUTHORITY
The Planning Director, or appropriate designee, must approve all plans, except
the following: (1) Alterations or interior work when the use is conforming and
when no change of use is proposed. (2) Maintenance items, e.g., siding, windows,
etc., when the use is conforming and when no change of use is proposed.
Instances where work complies with the above criteria, the permit can be reviewed
by the Building Inspector without referral to the Planning Director.
APPROVED NOT APPROVE
Plan Commission Action Required
variance (s) Required
REVIEWED BY: li — /
City of Oshkosh 1/1/85
PARKLAND DDEDICATION FEE COLLECTION RECORD
Address cQ5 5 A l I ■D £O VA Y72 ET
Owner's Name 7 MA V V G 4-1
Name of Subdivision )sc44 &EJ( PLAT
Lot # Bldg. Permit # .Q O a 4'6:,
No. of Units ONE-
Fee Require Ti 10t
Fee Paid iCTAIII
Ad 1
Owner's signature 111 �, Date '
' 1
Inspector's signature �� ` Date
.r-
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
�
DATE `t.,.( O 0 /-/
to
.. NAM. „ _ 4 L .�� ___ ��, 1 ADDRESS, G Ai. _ice , i..._.1 +,..„1,
LOT — 7 3 BLOCK WARD l
t
SUBO I ` �,,.:... 1 � _ a. ZONE f-2.....- jj
j
STREET NO. d3 m /12-e/Z -✓6� DIMENSIONS
SIDEWALK EXISTING YES
LI NO El-
BUILDING GRADE ELEVATIONS STAKES SET AT SITE ,I9 BY V
FEE: $2.00
1 ` _- je - 2 "buNei ok—r,(0,)
(
r To S 3a -i3S i . 4 - .�
�1tZ��GZ
DEPARTMENT OF PUBLIC WORKS LJ ,
I, the undersigned, owner or agent of the a• . - de rived property agree to have the 341.1. ,?..../ grade established before excavation has - 9
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OWNER / #i'/ /vs ADDRESS /S /V/I ,2-04
PERMIT # ,w USE 5 / -
DATE � " � � _ (-(/ /�{c� ti o frk A consists of
GENERAL CONTRACTOR /0vs,4v ...E.:&-
MASON CONTRACTOR ZONE p .4/ !G E CJ-5 oi 7
DATE . INSPECTIONS - < -•-‘ az - - el6le; / FOOTING N
FDTN SLAB
1 liildi Ohs BACKFILL
''' OM STRUCTURE
.1111~101~. ENERGY
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FINAL /OP er/ /f/ �� ' FA--
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