HomeMy WebLinkAbout0061304-Building fiirz
RHEIN BUILDING COMPANY.
W 180 Eureka Lock Road
Omro, Wisconsin 54963 SEP 2 9 1997
(414) 361-2243
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INSPECTION REPORT AND
NOTICE OF NONCOMPLIANCE '
Report Date ,- Inspection Date: Permit No.: Parcel No.:
Project Address: Subdivision: Lot No.: Block No.:
Inspection Type(s): ❑ Footing ❑ Erosion Control ❑ Foundation ❑ Bsmt Drain Tile ❑ Construction.
❑ Heat/Vent/AC ❑ Plumbing ❑ Electrical ❑ Insulation /Energy ❑ Occupancy
Owner: Contractor:
AN INSPECTION OF THE ABOVE PREMISES HAS DISCLOSED THE FOLLOWING NONCOMPLIANCES:
ORDER CODE SECTION FINDINGS AND REQUIREMENTS
NO.
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IMPORTANT: Please REPORT when violations are corrected. AVOID DELAY.
NOTICE OF NONCOMPLIANCE
All cited violations shall be corrected within 30 days after written notification unless an extension of time is granted. Each day that the violation
continues after notice shall constitute a separate offense and is subject to remedies and penalties by the authority having jurisdiction.
Enforcement ❑ Town ❑ County ( , City OF Authority By Municipal Ordinance Section:
Jurisdiction: ❑Village ❑ state _ ''
Inspector's Name: Violations Explained To: Compliance Date:
Inspector's Address: Ottice Hours: Telephone No:
SBD-6025 (R. 1/93) 0 Page Of
1i Wisconsin Department of Industry, WISCONSIN UNIFORM BUILDING Application No.
Labor and Human Relations PERMIT APPLICATION t S
Safety and Buildings Division
P 0. Box 7969 (See instructions on back of white ply) Parcel No
Madison, WI 53707 The information you provide may be used by other government agency 2 , - Sf.J �, !
Wisconsin Statutes 101.63, 101.73 programs'Privacy Law, s. 15.04 (1) (m)]
PE .M T REQU STED : nstr ❑ HVAC ❑ Elec ❑ PIbg Erosion 0 Other:
Owner's Name , Address Telephone No « -�:
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7 0 7 C 1 L...‘ s r(- L . i —�t 1L YI (`T 4 Z- 7, V` l 1 1 I
Copractor's Name: (on ❑ Elec ❑ HVAC ❑ PIbg Lic /Cert # _.- Mailing Address, Teleph$ ,
V_... -\ \ _ \ N', i::>L� '� . V\..1'- ,; t\ -k...' �°- l,k i C t (_ t Lit- 4` C:--\ ( ) : :a(C1 1-- y
Contractor's Name: ❑Con ❑ Elec ❑HVAC ❑ PIbg Lic /Cert # Mailing Address 4 °- �� L a Telephone No.
Contractor's Name: ❑ Con ❑ Elec ❑ HVAC ❑ Plbg Lic /Cert # Mailing Address Telephone No
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Contractor's Name: ❑ Con ❑ Elec ❑ HVAC ❑ Plbg Lic /Cert # Mailing Address Telephone No
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IRAN EC T LOCAT1 311 L ot A rea
Sq ft. 1/4, 1/4, Section , T N, R E (or) W
Buildina Address Subdivision Name Lot No. Block No
Lf4
Zoning District(s) Zonin4Permit No. ] Front Rear Left Right
' I Setbacks ft. ft. ft. ft.
1 .COE:c ; :: 3 . .tOCCUP.ANCY: :. 6' E1.ECITOCAL 4 HVAC EQUIPM NT :?E2. NER(S SOURCE . :.:
ArNew ❑ Repair Fngle Family Entranc Pagel aftrced Air Furnace Nat L. P Oil Elec. Solid Solar
❑ Alteration ❑ Raze ❑ Two Family Size: (---, A) amp ❑ Radiant Baseboard or Panel Fuel Gas *
❑ Addition ❑ Move ❑ Garage Service: ❑ Heat Pump Space Htg ❑ ❑ ❑ ❑ ❑
❑ Other (print): - Tnderground ❑ Boiler
❑ Overhead „Central Air Conditioning Water Htg ❑ ❑ ❑ ❑ ❑
❑ Other * ❑ Dwelling unit will have 3 kilowatt or
I$�. TF ,;IFitJN:DATtQ1at:
Site Constructed ncrete :10 PLUMBIN
❑ Manufactured ❑ Ma so nry G more installed electric space heating equip Infiltration control option is ❑ Full sealing
of joints. ❑Blower door test. ❑Exterior
AAA EI11V+C!VEi? Treated Wood
Sewer
❑ air infiltration barner.
t Lnici al
Unfinished Basement W q ft- ''• ST RIE i.::.' 0 p ,t3 ; HEAT , $ .tdi4ii. #3. `
t- Stor
❑Septic
/� . ❑ Y 0ktAg .> . Permit No. iz � -� BTU /HR
• Livin Area �` S q . f Story ❑ Se sonal Envelope
/r-$ 1 Infiltrati ✓`�' BTU /HR
Garage (.‘24 sq. ft. ❑ Other ermanent
❑ Other I unicipal Utility ! :::10. BUII .DkNG S S '. > .....
❑ Plus Basement ❑ Private On -Site Well $ ; .,- 1
1 agree to comply with all applicable codes, statutes and ordinances and with the conditions of this permit; understand that the issuance of the permit
creates no legal liability, express or implied, on the Department or municipality; and certify that all the above information is accurate If I am an owner
applying for an erosion control or construction permit, I have read the cautionary statement regarding contractor financial responsibility on the reverse
side of the pink ply. !
APPLICANT'S SIGNATURE . t /�� D ATE SIGNED i t l / S ' f / �
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APPROVAL CONDITIONS Th'. per it is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
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I SSUI ❑ Town ❑ Village i .amity ❑ County ❑ State of Municipality Number of Dwelling Location:
;IURI ,( ,\- \ — — — —
rzEES tTnpil T {S) NIS! Ut,IIE�SRRM PERMIT PERK `1S$ E DD BYx
ISSUED Sg NO
Plan Review $ .- onstruction
Inspection $ ❑ HVAC Name i ��
Wis Permit Seal $ ❑ Electrical yy -' ` C
Other $ ❑ Plumbing Date ' t 1
Vision \C1Zj OQ sq Cert. No �4 k�A
Total $ ❑
5BD -5823 (R. 07/95) WHITE - Issuing Jurisdiction YELLOW - DILHR GREEN - Inspector PINK - Owner /Agent