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46) CITY OF OSHKOSH N° 08116
- PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING t 2.-- C FLOOD PLAIT HEIGHT/
ADDRESS 0 ( ! O rL-A /C- ( Pia C e-- PLAN NO
OWNER 64
DESIGNER p�–
USE /NATURE OF WORK ' Z' E - L Y �"`- l
BUILDING CONTRACTOR 40 _ A •
Size -. 7 ' Sq. Ft. /380 # Rooms Stories ( Height /..e.__ ___ j /___.e r.7. ,
Foundation 61 t4 • ,/ Class of Const. °v ' Occupancy Permit
HEATING CONTRACTOR —01. -A /Z a �.a-„
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR C" Pt-._ i
Electric Serv. New ❑ Change ❑ Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR t' C` U— cry -
- 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 � u IPer Paid $ I f Q Park Dedication $ (C p
ISSUED BY �r r � I '� , A..A,. /,ri/ Date (0 ' g � — Final /O.P. '" - 19
4/
In the performance of thi , • I. •ree t• • orm all w•rk pursuant to rules governing the described construction. /
SIGNATURE � � '� �i/l�.. _
AN. T /OWNER ` DAT
ADDRESS 2 71? /6 ./ L/ _ _�
TEL PH ONE #
/iz- 47- -5(8Sl i.
State Department o fInd WISCONSIN UNIFORM
Department f Industry,
Labor & Human Relations BUILDING PERMIT APPLICATION NO. /
Division of Safety & Buildings
Madison, WI 53707 APPLICATION
Wisconsin Statutes 101. 63, 101.73 (See Instructions on back of pink copy) PARCEL NO.
PER REQUESTED ST RUCTURE ❑ HVAC ❑ ELEC 111 PLUMBING
Owner's flame Mailing Address • Telephone
c L -4 ` P-.v sdA . ..7(.,g.0 We -c f- o0 •/ 2-31 S?G 3
Contractor's Name Mailing Address Telephone
t , . ?v t
PROJ LOCATION
' '/4, SECTION , T N, R E (or)W
Building Address Subdivision Name ,. No. Block No.
a ( m t Li 74*Cp K C, se z4
Zoning istrict Lot A e Front Rear Left Right
ice/ ` l / sq. ft. Setbacks SO ft. ft. � Y ft. 6 L ft.
la :: PAOJECT : . 3 YPE : 6:::ELECTRICAL : :.S� HVAC EOUIPMEN 12 :ENERG . SOURCE
■ ew ❑ Addition ❑ Raze,. "Single Family Entranc;Panel 4P Forced Air Furnace Fuel Na L.P. Oil E *ec. SolidSolar
■ : eration ❑ Repair ❑ Move El family Size: / iCt7 amp ❑ Radiant Baseboard or Panel
❑ Other Serv'ce: ❑ Heat Pump Space Htg. ❑ ❑ ❑ ❑ ❑
❑Other underground ❑ Boiler WaterHtg. ❑ ❑ ❑ ❑ ❑
❑ Overhead ❑ Central Air Conditioning
Ih GAR AGE :::: CONST Y.PE 7 FOUNDA TION ❑ Other Dwelling unit will have kilowatt or
9
more installed electric space heating equip.
Re constructed ❑ Concrete 10 : l L,UMBIING <` Infiltration control option is ['Full sealing
ttached ❑ Detached CI Masonry Sewer of joints. ❑ Blower door test. ❑ Exterior
❑ Manufactured air infiltration barrier.
AREA 0 Treated Wood unicipal
8'l� s ORIES: ❑ other Septic 7$ }#EAR:LOSS alct#lated}
Basements q. ft. S i SE Permit No. Envelop
a ' 00 BTU /HR
(3 s 1 -Story p
Living Area q• ft ❑ p -
Story ❑ ermanent asonal 1 ..ATER Infiltration "2.....i BTU /HR
Garage CI Other P sq. ft. •114 Municipal Utility 14 ESTIMATEDCOST
Other • Private on -site Well //7
The applicant agrees to comply with the Wisconsin U • • m D • 1./ .. . nici.al Ordinances and with the conditions of this permit; understands
that the issuance of the permit creates no legal li: - ity, ja r i .. , on the Dep. ent or Municipality; and certifies that all the bove information is
accurate.
SIGNATURE OF APPLICANT !/ 4/ ��tG DA / ,r
COND TIONS • F 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.
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_At i r ISR+O ❑ TOWN ❑ VILLAGY ❑ COUNTY Municipality Number of Municipality Number of Dwelling
❑ STATE ❑ 11p9fPENT Inspclion Authority Location, if different
JURISDICTION
iiiiggEBREMEMS:MME
BERMITf ::
S WIS. UN PI> 1 MITE PEEUIlI'I' tSSE 8:Y
..: 4 E.... _ :: ;SEAL �C0 .. `
Plan Review . . . $ AO onstructi
HVAC NAME A y el � L , X( I N
Inspection $ ❑Electrical .111— j >v 6 ��
Wis. Permit Seal(s) $ ' ❑ Plumbing DATE
Other $ ❑ Other Q� -q� L 7 /
TOTAL . . . $ " 7 ) 6 o l 7o v3 CERT. NO.
SBD 5823 (R. 04/87) WHITE — Issuing Jurisdiction YELLOW — DILHR GREEN — Inspector PINK — Owner /Agent
ZONING/LAND USE COMPLIANCE CHEDIGIST
I. GENERAL
Building Permit j Zoning "( Conforming Non- Canfoaning
Job Location -a(Q v, e.h..cL.S C . Lot Dimension
Property Owner a 4 e. V S C_k Lot Area • .
• II. • CCNSTRX LTICN iici
Describe work: / � � E',,9 <P rl w ( r— 1C y
6e NEW CcsISTRUCriON ADDITION- ALTERATION
_ Accessory Building _ Pool .k Single' Family-
. Fence Deck/Patio _ Trao- Family
Boathouse _ Sign _ Multi..- Family
Utility Structure _ Porch • l
Other (specify) ginufacturipg
III. COMPLIANCE CHECKS .
Como Deficient Deficiency /Comments
. Use
Lot Width
Lot Area
7 ' _ Floodplain .
- Front Yard
Rear Yard
_� Side Yard (R) •
� Side Yard (L)
r c • Parking
_ Building Area • J
Lot Area per Family
• _ Corner Lot
Other (specify) C fr % 6 'P _> 4
IV. REVIEW AUZHORITY
The Planning Director, or appropriate designee,. must approve all plans, except
the following: (1) Alterations or interior work when the use is conforming and
when no change of use is proposed. (2) Maintenance items, e.g_., siding, windcws:r
etc., when the use is conforming and when no change of •se is. proposed:,.
Instances where work crlies with the above criteria, tine: p0atat can. }se reviewed
by the Building r without referral to the Planning Director. •-
p7 oto
APPROVED NOT APPROVED
Plan C :mission Action Required
Variance (s) - - • • -
, , A ll
REVIEWED BY: 0 • .; .` ct.4, ( 2 ii, DATE: S
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City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE OLLCTION RECORD
Address
r
Owner's Name
Name of Subdivision = `"` 1 �" -� - �: , L
•
Lot # G Bldg. . Permit / � 1
g #
No. of Units /
Fee Required
Fee Paid -
Owner' s si gncture: ' m =-` ,y` = J
Inspector's signature l ,. �P�' "'- �' ✓" "�' Date
Parks Subdivision
Improvement
Accts. Rec.: 362-041
//'�� � OATE "'C 6 ' O �`
NAMELTTAL e ADDRESS 2Z 4, p GL. ;4"..P o f-
LOT BLOCK WARD
SU8O 1 V . (� ( S r. ZONE
STREET NO. 08/ 4o.77LCl & i / OT DIMENSIONS
SIOEWALK EXISTING YES NO
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 1 , 19 '.a BY 4,
FEE: . 40 . 20 p 0 ;7
DEPARTMENT OF PUBLIC 'WORKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has c. , -. e.
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N.419°-15 = 40" W. 333,,' 1 dt .�7 —
UNPLATTED LANDS 4 -o
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SCALE IN FEET
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