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N2 35527
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
TYPE: BLDGIG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAT EIGHT
ADDRESS j I y , l-c, r PLAN NO. -/ )
OWNER Q P CL /,‘
a r 'C
DESIGNER
USE /NATURE OF WORK/PI/Pe-C.) ._-- 7 A 7 �"�te-C
BUILDING CONTRACTOR ( ez -A.e--e. _
Siz Sq. Ft. # Room t �a6 # Stories T
O �2 Height /
Foundation C-,2
Class of Const. � Occupancy Permit � P-g�
HEATING CONTRACTOR a°�.n) to /'� l
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss
BTU'S
ELECTRIC CONTRACTOR �U AP'. I
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR rkru.,s'
- 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 w
/�%� =rmit a Paid $ -I I Park Dedication $ _
ISSUED BY /G�� ;S . - -4_ -,4.--... Date 'tA/ Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE 1 / if
1/ D /� - P 3
AGENT /OWNER (. f3
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ADDRESS a U - S 3 /Z-C, s,, ■ ,
TELEPHONE #
Revised: 8/B9
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: C ‘?- 15 Al Oh. r o t ZONING:
PROPERTY OWNER /CONTRACTOR:
CONSTRUCTION DATA: NEW CONSTRUCT - NM ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
, S
COMPLIANCE CHECKLIST (Check only those applicable) •
COMP ES DEFICIENT DEFICIENCY /COMMENTS
Use
_ Lot Width
Lot Area
_ Floodplain
_ Front Yard
Side Street (frtnt yard)
_ Rear Yard
__ Side Yard (R)
TOY 7----
Side Yard (L)
Parking Spaces 1 . 0 Air a
Building Area
Lot Area Per Family � �---� r� � r
__ Corner Lot 7
Landscaping
Transitional Yard 4 11911Pr
_ Off- Street Loading .�
_ Vision Clearance
Height
R IEW 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 compl' with the above criteria, the permit can be reviewed by the •
Building Inspector with referral to the Director of Community Development, or designee.
PROVED DENIED
Plan Commission Action Requ' ed
Variance(s) Require . r 1 /
REVIEWED BY: I II ri 0,2 r ra
.� � ALA.—ea/AV/ C— 4 :: ir
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Wisconsin Department Department of Industry, WISCONSIN UNIFORM Application No..
, . .
Labor and Human Relations
BUILDING PERMIT
Safety and Buildings Division
P.O. Box 7969 APPLICATION Parcel No.
Madison, WI 53707
Wisconsin Statutes 101.63, 101.73 i nstructions nstructions on back of pink copy)
PERMITREQUESTEDgi:i:i:::::
onstr 0 HVAC 0 Elec 0 Plbg 0 Erosion 0 Other:
Owner's Name Mailing Address Telephone No. (include area code)
CcAtractor's Name ,/ Mailing Address I, n Telephone No. (include area code)
-375%.
1. :.!PRO . JECIrtiOCATIONig . i
1/4, 1/4, Section , T N, R E (or) W
Building Address Subdivision Name Lot No. Block No.
/ 2-1 S n7e7a.0-e it-e . oho), i,
Zoning _
g District(s) 1 oning Permit No. Front I Rear Left / Right f
[ / 7ft.I _c ft. ' 7 ' 1 ?__ ft- ft-
iiiiIii:ifii: ''' itetii:::::::iiiiiiii:ii:iiiiiiiii:iiiiiiiiiii::iiii:::::::::::::::iiiii!ii: iiik::::: ''''''''''''''''''''' ' . ''' :.:;:v::::::i: riatit .;;: ' . ' i Setbacks ''...t,;:kiPi•;:V i / lON.tilitAtti'i illiii:ittitit ' ::iiC
Dt New 0 Repair Z ingle Family Entrance Panel ' tr, Forced Air Furnace F l Nat. L. P. Oil Elec. Solid Solar
rAlteration 0 Raze • Two Family Size:0 ue
0 amp 0 Radiant Baseboard or Panel Gas *
0 Addition 0 Move 0 Garage Service: D Heat Pump Space Htg X 0 0 0 D 0
['Other (print): 0 Underground 0 Boiler
pverhead 0 Central Air Conditioning Water Htg ' ;Ar: 0 0 0 0 0
0 Other
Aii:MONSIMPCMIOUNDATION: 0 Other * 0 Dwelling unit will have 3 kilowatt or
,. more installed electric space heating equip.
0 Site Constructed 0 Concrete 40ji:iiIPEARAPPO;i,i;iiiii Infiltration control option is: 0 Full sealing
2kAREMNVOWEV:::::::::;:::::::::::::::::::::::::: 0 Manufactured E l T
Sewer of joints. 0 Blower door test. 0 Exterior
air infiltration barrier.
y . )
Unfinished BasementtAkSq tiliEi.kkei;:::::1;;;I:i:::::;:::::::
0 Other ; . •.....,;,...::::::: ... 4hic
. ft. ''''''''''''''"'"'". ix::::HeArLOSS::01:4014ted):::;::::::::!::
Story MAI.Srii]Mi'''-*i*i*i':::*i'i:
..-.....—..........--.......... Permit No. Envelope /"29e9 . BTU/HR
Living Area 4 010 Sq. ft- 0 2-Story 1 1;14 .. .ea-sonal
: 41: : ::::::WATERMi:i:ii:$1;;;::!.::::::::::::1:::::::::: Infiltration F < BTU/HR
D Other
Garage 10 Sq. ft. .. Utility *iitSVii iNi■Mbdtatiiig.iiiin:inn:i:!iiii
0 Other . .- .....„.... ..:....:..... . ..............................................
D Plus Basement 0 Private On-Site Well
$ 519
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, expreyr implied, o? the j Dep ment or munOality; and certifies that all the above information is accurate.
APPLICANT'S SIGNATURE --.74-4,0 A KA-1.4/14
rt
DATE SIGNED a" /8- F.....?
APPROVAL CONDITIONS T i t conditions. Failure to comply may result in suspension or
i / /
--
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7i° CPJPir.- %ail ."---. . le. — -- ...-- - -
fl Town 0 Village A 0 Co nty 0 State of: Municipality Number of Dwelling Location:
JURISDICTION G , / 7 0 - ?_- _ 6
AEstma::::::::::::;:1:::::::::::::::::: • . ..... :: ,.......:: .:::::::: ::::. : U .... . ......ii.: :
i,U1:,:.i:::::":::::::
Plan Review $ 1 :.- nstruction i
Inspection $ 0 HVAC Name / M . ..L._-( ( 4-44P-11
Wis. Permit Seal $ 0 Electrical
Other $ fl Plumbing Date
0 Erosion
Total S. 0 /2/6 4i7 Cert. No. A fi ,
5BD-5823 (R. 07/92 WHITE - Issuing Jurisdiction YELLOW - DILHR GREEN - Inspector PINK - Owner/Agent
f< 50
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DATE F//‘ /?3
NAME (',1 . f ADDRESS
LOT /5 BLOCK WARD
SUBOIV. ZONE
STREET NO. /a/f00 � LOT DIMENSIONS MENS I C NS
SIDEWALK EXISTING YES a NO 0
BUILDING GRADE ELEVATIONS STAKES SET AT SITE ,Ig BY
FEE; $15.00 •
DEPARTMENT OF PUBLIC WCRKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
004813