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ISCON
STAOFWSIN WISCONSIN UNIFORM / �C.2-
H UPA TE NR E LA IOINDUSTRY,LABORAND PERMIT NO.
HUMAN RELATIONS
201 DIVISION
O/ E. SHIN
WAGTO AND BUILDINGS BUILDING PERMIT
X ENINGTON AVE. PARCEL NO.
M"CONSIN' STATUE
07
S APPLICATION
WISCONSIN TATUES 101 A7
PERMIT REQUESTED ACONST `( HVAC LEC ❑PLUMB
• is Name Mailing Address lephone
'F ��
' 2_ -.C ? 30 LID .Q, 2A-c-- a,d . ✓�
.ntractor's Name Mailing Address Telephone
PROJECT LOCATION 1 4 %, SECTION , T N, R E(or►W
Building Addres D Subdivision Name Lot No. Block No.
—
Zonin Distric t Area g Front Rear Left Right i
,-/ ( �" ����° Sq.ft. Setbacks 2-5 ft. 7.2- ft. 7 ft. ft.
1. PROJECT 2. TYPE 3. ELECTRICAL 4. HVAC EQUIPMENT 5. ENERGY SOURCES
Entrance Pan Forced Air Furnace Fuel Space Water
*New ❑Addition Single family Size: AMP Htg. Htg.
Alteration Two famil Radiant Baseboard or Panel ❑ Ili �e vice LP Gas
Garage ❑ A' O-
Other Underground LI pump
Ind
Nat. Ga
Boiler
ttached ._a' - ! Fuel Oil ❑
Detached ❑Central Air Cond. El El
6. CONST.TYPE . FOUNDATION ❑ Other Elec.
El Other Wood ❑ ❑
El Master plan no. ] Site const. MConcrete 8. PLUMBING Solar ❑ ❑
(if applicable) Manufactured Masonry Coal ❑ ❑
Outside ❑Treated Wood
El Sewer
Municipal
9. AREA
(Dimension) 10. STORIES Other
❑ Basement I ( 4.(1— sq.ft. El 1-Story 11. USE — Septic
// ❑2 -Story ❑Permit No. 12. WATER
❑ Living Area `[ sq.ft. ❑Othe ❑Seasonal
� Permanent El Private
El Garage sq.ft. A AA Other Municipal
The applicant agrees to comply with the Wisconsin Uniform Dwelling Code and other Municipal Ordinances and with the conditions of this permit; understands
that the issuance of the permit creates no legal liability, express or implied, on the Department or Municipality; and certifies that all the above information
is accurate. `
SIGNATURE OF APPLICANT v DATE /4
CONDITIONS OF APPROVAL This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
13. ISSUING JURISDICTION ❑ VILLAGE TY El TOWN ❑COUNTY ❑STATE
NAME ��it0s- MUNIC. NO. 70---- 2 lU
FEES PERMITIS) WIS. UNIFORM PERMIT FERMI i•SUE • : Y
ISSUED SEAL NO.(S)
/
PLAN REVIEW $ 1LTCONST. 1 .3` 7 -1 i
INSPECTION !!! NAM ,
�HVAC
3 J
WIS. PERMIT SEALIS) ..m P / . 4-( +! DATE 3S Z/
OTHER ( ) 2 / -4P�
TOTAL $ 2 /J CERT NO.
DI LHR -SBD -5823
ISSUING JURISDICTION /AGENCY
DATE 'i624.)E a7 f g3
NAME PCX.94 ( � (L (-APO S ADDRESS �3o iv (Ac---
LOT (/ I
/�
BLOCK WARD
� 4
SUBDI V.14k) (A-SrtfAZJ ZONE 7g
STREET NO. e-,2‘ `/17o,J7e 4./` LOT DI MENS I ONS UG.4
SI DEWALK EXISTING YES NO
BUILDING GRADE ELEVATIONS STAKES SET AT SITE - '",*
19 g BY fer'
FEE: $2.00
DEPARTMENT OF PUBLIC WORKS
I, the undersigned, owner or agent of the above described sroperty agree to have the
grade established before excavation has commence /
25SS ---37/65‘ /.‘-•2<ot,A‘r-
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PERMIT - APPLICATION AND RECORD CITY OF OSH SH
D ,,/ � N_ 13522
Address 2 k 0 D ��D,�r�4G� ! y Owner �itGD / / �ebr Id. No.
(7 Rlock Ward Subdivision 'l 1 ►A G S 7 Zoning l � Flood Plain
f Permit: Building 7i., Electrical ❑ Heating ❑ Plumbing ❑ Sign ❑ Wrecking ❑ Occupancy Permit 1 e ' InspP 0 -
Permit Date A�-3
of Work //. %bfit -
e2_ C d Z , p BUI LDING Use �- . r___ ' ' -
7
// .
q a_ - _ 20 "" General Co / !�. .
:� 'I Roof Cv y / y Siding
i .arm .....4.41.!... �I d ���'^ l !/ ��
Foundation % T of Construction �
IBING CONTRACTOR ' ' A NA /''. Size: feet wide X feet long Square feet area 1 1 S�
an. Sewer Cur Bu. Main to Curb: Height: 7 Stories and Basement • feet above Grade
1. Sewer Curb to Bu. Main to Curb ra-� 1 2
Width of Lot O� No. of Rooms - ✓�`"""
Sewer Fees Mason
Service 7
rub Floor Drain Urinal Carpenter
Basin Garbage Disp. S. Sink 1 Architect
Closet Dish Washer Catch Basin 1
nit Laundry Mach. S. Pump t „ ' � f °„
Heater Water Soft. B & S Waste ,.„ — >� ` /. Inspections -
er Bath Bubbler Conductors 4
/ G eb P , Footing Foundation
ring Fees Total Fees L
a Electric Service R.I.
S
LNG C iACTOR r a Sewer Water Service
Gas L Oil ❑ Elec. ❑ Solar ❑ Solid ❑ � i. Z S 8 Final
tioning Forced Air ❑ H.W. ❑ Elec. Base ❑ Steam ❑ Radiant ❑
Ti High Eff. ❑ Supplementary ❑ Air Cond. ❑ Ventilation ❑ Estimated Cost .... Fees Par o Date Y :14-1.-d-
ley: "A" ❑ "B" ❑ Direct Vent ❑ Con. Burner ❑ Flue Damper & E.I. ❑ TO THE BUILDING INSPECTOR. In accordance with Section 18 of the Municipal Code of the City of Oshkosh. it is agreed that if work shall be
fated Heat Loss System BTU Rating discontinued for a period of 30 days at any time for any cause after excavation work is commenced, a solid barrier, wall, or wire fence not less than
five feet in height shall be erected all around such excavation. Such harrier, wall or wire fence will remain in position until removal is approved by the
I Building Inspector. X I/
TRIC CONTRACTOR In the performance of work the un rsigned agrees to abide by and do work pursuant to all statutes, ordinances.
c Service: New Changes v Temp. codes, and rule � inning the ribed construc '.n.
iption -Type Volts Amps � %
as Switches Recep's Circ's (Signed) �� ® /�� � JJOwwner
noes Addres - ' �.M_l�r�ll _ c V.... if Phone �L`�.Lr
By Agent
(ANtndzed s:gnmure)
cal Signs
Address Phone
9 --
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