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CITY OF OSHKOSH N2 40132
PERMIT -- APPLICATION AND RECORD
TYPE: BLDG 4 HTG ❑ ELEC p PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 3! f 9' u.. r/ ELD gel u6- PLAN Nora-014 61ciLi
OWNER QL)SC C Sf2 ON'
DESIGNER �-; d 64/2,4c-6-
USE /NATURE OF WORK (v&() Si - F /C.1J / / 1 1 At. K D .'
BUILDING CONTRACTOR L,SQ p
Size Sq. Ft. O�l� # Rooms 6.— BIZ- # Stories Height /d ,
Foundation CbitERCE Class of Const. g Occupancy Permit
HEATING CONTRACTOR ` ;u P
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR C fri / •t
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR Sci- Pi
BT _ WH _ Disp _ WSoft _ CBasin
Lay _ Sh _ DW _ DF — San. Sewer
WC _ FDr _ SP _ Ur _ Storm Sewer
Sink _ LTub _ Eject — SS — Water
Other
CG
FEES: Valuation $ Permit Fee / y a• S
ee Paid $ Park Dedication $ f C
ISSUED BY Date 6/ggi 47 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 775/
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
1 . iA. f(ek..e G-0—,r e ti
ZONING /LAND USE COMPLIANCE CHECKLIST
ff /�
JOB LOCATION: �1' r e . _ I \ e a Vim. ZONING
PROPERTY OWNER/CONTRACTOR:
CONSTRUCTION DATA: New Construction Addition Alteration
TYPE OF CONSTRUCTION: (i.e. fence, pool, parking lot, sign, etc.)
/1)e-LA) Z
COMPLIANCE CHECKLIST
DEFICIENT COMMENTS
Use
Lot Width
Lot Area
Lot Area Per Family
Floodplain
Front Yard
Front Yard Side Street
Rear Yard
Side Yards
Building Area
Parking Standards
Off - Street Loading Standards
Vision Clearance
Transitional Yard Standards
Landscape Standards
Height
Conditions of Approval
Compliance with P.C. or , / / ,r , / � f t
oppval
Signage Standards
Drainage Plan
REVIEW AUTHORITY
As per Section 30 -5 Enforcement of the City Zoning Ordinance, the Director of Community Development, or
designee, must approval 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 nd when no change is proposed.
APPROVED DENIED
Plan Commission Action Required
Variance(s) Requir d ,
REVIEWED BY: �� DATE: IS fy
5045 -.. — DS 4 b [ ct4
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations BUILDING PERMIT ' O 3a
Safety and Buildings Division
P.O. Box 7969 APPLICATION Parcel No
Madison, WI 53707
Wisconsin Statutes 101.63, 101.73 . (See instructions on back of pink copy)
"t8 �onstr
Ow E-- Erosion ❑ Other:
� ...... Name Mailing Address Telephone No. (include area code)
l�uo , .. ..:::::. 077 6te G(/ 0131-1203
Contractor's Name Mailing Address Telephone No (include area code)
L Area
ea
:: PR E,>;' L.. ` ��':'" ON;:I
': *: : :; ;: "` '': ':J Sq.ft. 1/4, 1 /4,Section T N,R E(or)W
Building Address Subdivision Name Lot No. Block No.
3/17 - (j a '///�/�/,, ..d' 5 Zoning District(s) Zoning Permit No. C � % � (� Front o � ' ft . 6
I Rear Left Right
Setbacks 7 7 ' ft ' ft. /3 / ft.
. �3 .
. )4 JE;. » >< >> > > >< < << :«:; R _ :. < «`> > > > :11 :1 <`1
...: �.)E�`I;.::::::. :.. :....:.... .3... . CEi! ?'. �i :1t >: �,Ef.E�`1�� : :: >: >'�:;` � : �A.�:EQ��PM��T.::`: - �:2�:'E��s1F��E ---- --- - - -- -
New ❑ Repair ingle Family Entrance Panel &'Forced Air Furnace Fuel Nat. L. P. Oil Elec. Solid Solar
❑ Alteration ❑ Raze ❑ Two Family Size: ( 00 amp ❑ Radiant Baseboard or Panel Gas *
❑ Addition ❑ Move ❑ Garage Se ce: ❑ Heat Pump
❑ Other (print): [Underground ❑ Boiler Space Htg ❑ ❑ ❑ ❑ ❑
❑ Overhead ❑ Central Air Conditioning Water Htg ❑ ❑ ❑ ❑ ❑
❑ Other ❑Other * ❑Dwelling unit owtt
" ' S'" 7 ' ` NA more installed electriwill c s have ace 3 heatin kil equ ip.
Site Constructed oncrete P g a
�� #`.':P " #��`�`'`' Infiltration control option is: Full sealin
❑ Manufactured ❑ Masonry ....:::................... ........... P ❑ 9
...... ................ ...................
"' s> of joints ❑ Blower door test. ❑ Exterior
<'•: >;A> s' >: %` "•s» <i >: ❑Treated Wood S _ ew � air infiltration barrier.
5t5 ORLES' : : : #:: : > : : :: ' &Municipal
Unfinished Basement ZIDSq. ft. ........... .............................. ❑ Other :::: >sE:::c.:' >>. . r -.; :< :. "-t T : ::.: ;:.: )::: :: >;:
/ ::': ::: ::S :: >:::: >:; <: >:::,:::`:;::, ❑ Septic ; £ 5�.:: >>�J t <<::<: >:<:
I [�I S to rye;;;::;. ;;: -:; Permit No EnvelopeJ BTU /HR
Living Area / Z,0 Sq. ft- ❑ 2 -Story ❑ Seasonal
❑ Other rmanent
i
E� .•:..: 3QTER ; >> <z >: <> <:> Infiltration / 932 • 9 BTU /HR
Garage % S . ft
9 q
d n i I it
L./ c a Utility / u
❑Other . �., ........:.:.::.-:•.:::::.::_::::::::::::::._ ...,..._._:::::........... ....
Plus Basement ❑ Private On -Site Well $ it �i�4410.0 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 th artment or municipality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE ri;; DATE SIGNED 00/9y
APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
l i e ; DNS ,4L. . , '11C. 6e0StoosJ mCA5oA- X /c.N/2 VJ.la.s-.
I ..ri it ea./5S . .MC.7 110 / p/LA(..f., / - s .
%) —9.)/3/14 i r Tx2.uS tcz,
Town Village t County f
❑ ou S tate o . Municipality Number of Dwelling Location: ss ❑ 9 Y ❑ Y ❑ P Y 9 n: a o
Plan Review $ zin J rctsa construction k eAA
Inspection $ ❑ HVAC Name
WIS. Permit Seal $r ❑ Electrical 1 a � qy
Other $ ❑Plumbing I ^ � ^ 1
Date t �
,Erosion H C JJ� • Jl .
Total $ ,,„7.0,w.... ❑ Cert. No.
SBD -5823 (R. 07/92) WHITE - Issuing Jurisdiction YELLOW - DILHR GREEN - Inspector PINK - Owner/Agent <..
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City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address 31/7 ,0P
Owner's Name ,PU.1`I
Name of Subdivision ‘7ZeEO
Lot # Bldg. Permit # 1 70 3?
No. of Units /
Fee Required '/
Fee Paid
Owner's signcture )70: /` Date 7 i4
Inspector's signature ,,� M Date • a
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
CATE Ce �Z�
NAME I2--VXCk. ADDRESS
LOT BLOCK WARD
S UBD I V . L ' �r ��e� � ZONE
STREET NO. .R117 e
��'� i � �� 1)4 LOT DIMENSIONS
SIDEWALK EXISTING YES 0 NO El
BUILDING GRADE ELEVATIONS STAKES SET AT SITE , D IA/ ,Ig •j` gY,
FEE: $15.00 •
2/212.ez,6.6
DEPARTMENT OS/PUBLIC ''VGRKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
007 045
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