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CITY OF OSHKOSH N2 33739
PERMIT - APPLICATION AND RECORD
TYPE: BLDG X HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING g –" / FLOOD PLAIN HEIGHT
ADDRESS c: 177 e/ t / PLAN NO. 6/6 30cg3
OWNER
DESIGNER
USE /NATURE OF WORK ki–f441 ,Ifi l o2e •
BUILDING CONTRACTOR _ L e 4deff Lam-
Size Sq. Ft. /29.3 # Rooms (P 3 a # Stories e2µe4-a' Height �7
Foundation afirt. Class of Const. a Occupancy Permit.
HEATING CONTRACTOR 411.1414.0
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR e
Electric Serv. New ❑ Change ❑ T emp ❑ Type Volts Amps
P
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR / 14 !o
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 $ -3 o 0 O � c� Permit Fee Paid $ (0%4 0 Park Dedication $ / 0
ISSUED BY//4O Date 6 4/93 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER D E
ADDRESS
TELEPHONE #
C/ca-62. Reiised: 8/P9
ZONING /LAND USE COMPLIANCE CHECKLIST
)67/
JOB LOCATION: eP87/ /�iec c ZONING:
PROPERTY OWNER/CONTRACTOR: pr
CONSTRUCTION DATA: ✓IVEW CONSTRUCTI{N ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
4 X`
COMPLIANCE CHECKLIST (Check only those applicable)
CO "LIES DEFICIENT DEFICIENCY /COMMENTS
_ Use
_ Lot Width
_ Lot Area
_ Floodplain
_ Front Yard
_ Side Street (frat yard)
•
_ Rear Yard
Side Yard (R)
Side Yard (L)
_ Parking Spaces
_ Building Area
_ Lot Area Per Family
_ Corner Lot
_ Landscaping
_ Transitional Yard
_ Off- Street Loading
_ Vision Clearance
Height
REVIEW AUTHORITY:
The Director of Community Development, or des' nee, 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 complies with the above criteria, the permit can be reviewed by the
Building Inspector without referral to the Director of Community Development, or designee.
�PPROVED DENIED
Plan Commission Action Required
Variance(s) Requi ed
REVIEWED BY: DATE: rff G 1
6743 0 - -. 9. 3 /e- -
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Laboand Human 9elations BUILDING PERMIT 3373
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)
aE.IIT ,' aY���TE> <`
:' .i C onstr HVAC 0 Elec 0 PI bg jkirosion 0 Other:
Owner's Name Mailing Address Telephone No. (include area code)
Cont actor's Name Mailing Address Telephone No. (include area code)
,(OIL. C�14 7!o o W..�� rea-L ,i. /.a ��-
:::.. '": ::::<•;>s:::::: : ::0: L ot Area
N PR - �-'�: » L!: ; :. ; . ;' . o iii
... ..........::.:.:..�W �:�: Sq. ft. 1/4, 1/4, Section , T N, R E (or) W
Building Addr ss Subdivision Name Lot No. Block No.
0297/)77e���A,.� /try � Cit� c / .cc� z
Zoning District(s) Zoning Permit No Front Re Left / Right
/v / Setbacks ft i e ft. 1 0 ,o / ft. 1 t.
? b t i
310 S
::: : :
•::. i *: ::01 .:. P > .:.:,:: :: : Ue /PM�}i E,yR..G. •:. :: �R{.': Y, y}'::::»<:>::
::: :• •
:<>:•::•;•:::•:: •
:•:<•:
�y':'��:.•..�..•..� .........: .: � :: •::: : •:::: .;. ..�IL..aw.�� �Y••A� �y..:G1¢:���Y�..�. .. �: ': i i:• i�> � �' ���' �. I�F��:•--+•!. n}:^; ��R! K' F�+ Y: �-. �' T . � :�•. L:•::: {:•:• }:•i:•
•::Y.
New ❑ Repair Single Family Entrance Panel ' '1� Air Furnace Fuel Nat. L. P. Oil Elec. Solid Solar
Alteration ❑ Raze Two Family Size: /O,o amp ❑ adiant Baseboard or Panel Gas •
❑ Addition ❑ Move ❑ Garage Service: ❑ Heat Pump
❑ Other (print): Jnderground ❑ Boiler Space Htg ❑ ❑ ❑ ❑ ❑
O ❑ Central Air Conditioning Water Htg ❑ ❑ ❑ ❑ ❑
❑ Other ❑Other * ❑ Dwelli unit will have 3 kilowatt or
'` "''` ` `' .; more installed electric s heating equip.
XESite Constructed Concrete p ace g g
"� ' `:'` ? ? ? ?::::: >EE
' >: Infiltration control option Full sealing
❑ Manufactured '❑1Vl >'� a `��3 ����
asonry : : ::: s: >: >:> opt o is : ❑ F u
of joints. ❑Blower door test. ❑ Exterior
3M »''•''> `' ' <'> ❑Treated Wood Sewer air infiltration barrier.
Unfinished Basement :;�•.: >: : # ' # »> #'• 3 ❑ Other �Iuniupal
ed asement Sq. ft. ^�' � tic [ 5 CHEAT:F!�` SSAti :.. ,. ...
G( � ❑ 1 -Story : »SK> 5I: `>`<> »» '» Permit No. Z S 7
Living Area (7i 73 S ft. Envelope r /3 BTU /HR
Sq. ❑ 2 -Story ❑Seasonal •:.• ::: :::•• -. - -
#11 z'•W�.T'' IN ::::<'i? 'i >;E'; Infiltration f BTU /HR
, 9 f `Other imp ermanent� a.•:. :::: � : �� � ® l a 7
Garage ‘22 7 S ft. /"�
� Munici al Utility P
Ut t Y
� -4XL(o ❑O �C : E��t ��ttO'�T .....
❑ Plus Basement ❑ Private On -Site Well $ CD, Oo . /) c '
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 the D rtm nt or municipality; and certifies that all the above informa 'on is a urate.
APPLICANT'S SIGNATURE Y ,t DATE SIGNED S 1
APPROVAL CONDITIONS This permit is issu'Ld pursuant to the following conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
S Town Village e i
Ct n
❑ County ❑ Stat of:
9 Y ❑ ❑ Municipality Number of Dwelling L ocation:
Y p y
9
.I I 7 z 12_
::::.' :.:.::::.::..:.::::::.: :::::::::.:.::.::: .::.:.:::.::.::.::.::.:::::: .sue ..... . .:: ::::::..:::.:::.::.:.::.::::.:::::::.:.::.:::.;.::::::. �::::::::::::. :::::::::.::::.:::.::.::.::::.:::.::.::.:::.:::.::::::::: :::::::::::::::::::::::::::::..
Plan Review $ go. 047 K
/onstruction P/Ale4(41-4.4,2L-y-" Inspection $ ❑ HVAC Name
Wis. Permit Seal $ 30.00 ❑ Electrical
Other $ ❑ Plumbing / � '� �� Date S /(• /c....3
rosion
Total $ 70. 4:, fEj Cert. No. 2- S'TS"O
SBD -5823 (R. 07/92) WHITE - Issuing Jurisdiction YELLOW - DILHR GREEN - Inspector PINK - Owner /Agent
30
CATE J /5S 3
NAME `' /'4t . ADDRESS
LOT 4742- BLOCK WARD /3
SUBO 1 v . /* A-Ac c-- ZONE
STREET NO. 2 1 7 / � � LOT DIMENSIONS
SIDEWALK EXISTING YES NO [21
BUILDING GRADE ELEVATIONS STAKES SET AT SITE BY
BY
FEE; $15.00
4
DEPARTMENT OF PUBLIC WORKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
0017x`()
City Of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address n?F7/ . eyrX-e P�Ca• _ _
Owner's Name x,/___, L� /G j e jztce `
Name of Subdivision 4411 66.4 4,
Lot # qZ Bldg. Permit # 33739
No. of Units /
Fee Required /00 . o v
Fee Paid j p,p _ O a
Owner's signatureL, ' Date -5/1 Z.S
Inspector's signature Date S �
,ccG( � /q 3
Parks Subdivision
Improvement
Accts. Rec.. 362 -04
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