HomeMy WebLinkAbout0144273-Building (roof) CITY OF OSHKOSH No 144273
OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1103 E IRVING AVE Owner MERCY MEDICAL CENTER OSH INC Create Date 12/03/2010
Designer Contractor LUEBKE ROOFING
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 and garage.
of Work
HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $12,496.00 Plan Approval $0.00 Permit Fee Paid $106.00 Park Dedication $0.00
Issued By: C? /11"!/J Date 12/03/2010 Final /O.P. 00 /00 /0000
❑ Permit Voided Parcel Id # 1104430000
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) and to secure any necessary approvals before starting such activity.
I have read and understand the afore mentioned information.
Signature Date
Agent/Owner
Address 2550 PROGRESS WAY KAUKAUNA WI 54130 - 9558 Telephone Number 766 -9019
* 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
PO Box 1130 • •
- Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050 Of HKOf -
Fax: (920) 236 -5084
Roofing & Siding Permit Application ON THE WATER
• Applicition(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 $100.00 plus the
normal permit fee, which ever is greater.
OR •
If you are a contractor participating iruhe Pern}itee Account System and have adeauate funds. check here
if vou want this processed through your account
JOB ADDRESS 110?) ( . Li - 0 ' n c-1 , n+I/ ( 1 - 5 k -!•- 1
j�
OWNER t' -e-(+c r re-
CONTRACTOR l`I L hke (G C 5 Pi (3 f-e
I am the: ❑ Owner OR ❑ Contractor
USE CATEGORY
01,18ingle Family 0 Duplex 0 Multi- Family 0 Rental 0 Commercial 0 Industrial
Work being done:
ROOFING
Tear off and replace existing roofing on cI house, l garage
O Replace wood decking
O Add 1 layer of roofing to the existing layer(s) on 0 house, 0 garage
t. This work is being done due to 0 Hail Damage 0 Other
SIDING -
Install siding on 0 house, 0 garage
O Replacing vinyl with vinyl •
0 Replacing steel, or aluminum with vinyl (circle steel or aluminum)
O Replacing with
This work is being done due to 0 Hail Damage 0 Other
When siding is done, one of the boxes below must be checked:
I) 0 Electric — Existing Electric Meter, receptacle, lighting and Electric Service entrance alterations/modifications are being performed
by
(Name of Licensed Electric Contractor)
AND 0 Electric Installation Verification fomt is attached Q$ 0 SeiREPett abirlysE
2) 0 Electric — Not Applicable because: 0 J Blocks previously installed. 0 No outside lights. 0 Other
DEC 0 3 2010
O Install new or 0 Replace gutters DEPARTMENT OF
DtPAR
O Install new or 0 Replace downspouts COMMUNITY AR DEVELOPMENT
INSPECTION SERVICES DIVISION
Other related work being done: (please note)
Value of the job $ , C' 1 1--k (i I (include fair market price for labor even if you are not paying for labor) • - 03/02