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State of Wisconsin
Department of Industry, WISCONSIN UNIFORM Z3a,D__.
Labor & Human Relations
Division of Safety & Buildings BUILDING PERMIT APPLICATION NO.
Box 7969 g� Q �
Madison, WI 53707 APPLICATION 1
Wisconsin Statutes 101.63, 101.73 (See Instruction on back) PARCEL NO.
: � STRUCTURE sl HVAC ►. LEC ❑PLUMBING
Own 's Name Mailing Address Telephone
J► O cd -' I2 Z Rio 8' A � aiv PL.
Contractor's Name Mailing Address Telephone
k ..
„- p::: l $. 7 1Z ,0 at d r = 5 , t Y4 ' /a, SECTION ril
T N, R, E(or)W
Building Address Lot No
Subdi • ion Name . Block No.
— ✓ ✓ o 474-44-JA �^' ,' F 5.— Zoni s istrict Lot Area /� Front Rear Left
�}, / b Right y x /S S , sq. ft. Setbacks z✓� f 4 ' o Z3 `6
d , ft. ft. ft.
r :, ew ❑Addition ❑Raze V ingle Family Entrance Pane [ 1. Forced Air Furnace Fuel .ace Ht.. Water Ht..
Alteration ❑Repair ❑Move lTwo Family Size:__( D amp /• Radiant Baseboard or Panel
■Other e vice: ❑ LP Gas ❑ ❑
❑Other Heat Pump Nat. Gas
, G nderground ❑Boiler
■ ❑
Overhead Fuel Oil � ❑
s s Central Air Conditioning Electric ❑ ❑
r ` ❑ Other
V • ttached ❑ Detached is ite constructed 0 Concrete € ¢ Solar
d ❑ ❑
- • Manufactured rI Masonry Sewer
Coal ❑ ❑
" • Treated Wood
Municipal Other
Basements '7 b 0 Sq. ft, s on ❑Other �7Septic
•1-Story Permit No ��
p
Living Area / Sq. ft. 1.42-Story Envelope _ BTU /HR
��)
• Other ❑Seasonal
Garage Infiltration BTU /HR
1 / S ermanent ❑private -on -site Well n.:' '
Sq. ft. Other 1 „ � . a r ;
► Municipal Utility $ 5 6eZ9
The applicant agrees to comply with the Wisconsin Uniform Dwelling Code and other Muncipal Ordinances and with the conditions of this permit; understands
that the issuance of the permit creates no legal liability, e pressfiriTp on the Department or Municipality; and certifies that all the above information is
accurate.
SIGNATURE OF APPLICANT A _. �6
DATE
CONDITIONS OF APPROVAL This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or revoca-
tion of this permit or other penalty.
d
ill
o
r . ; - ❑TOWN ❑VILLAGE PICITY ❑COUNTY Municipality Number Municipality Number of Dwelling
„ 4q ❑STATE I D ND , � Location, if different
FEES: • ,
e s a s , a Lv ,
Plan Review $ 4 ■- onstruction
Inspection �� 1IVAC giv' i i
$ 1� lectrical NAME 2 �/
Wis. Permit Seals) ... $ TA Plumbing DATE ' 3 -, -,4
Other $ ❑Other //
TOTAL $ 0 o �7 L° 04 CERT. NO. 6 f
DILHRSBD 5823 (R. 11/84) WHITE — Issuing Jurisdiction YELLOW — DILHR
GREEN — Inspector PINK — Owner/Agent
City of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address ! ,j /,9 /4/ L,4N�
Owner's Name / L 5
Name of Subdivision tTY •
Lot # Bldg. Permit # .23 ..
No. of Units
Fee Required) //1
Fee Paid
Owner's signatures �1-� i Date --` `�
/i ,�
_� 'i
Inspector's signature , Date 3— cj —a
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
DATE 2
NAME PUS S I pc�N� �-NC'
ADDRESS Z:
�CILSrC�O►J Q�
LOT � BLOCK WARD )
SUBD I V . j `f/ .51 ZONE at - 16,.
STREET NO./370 RD/eEcAA..) .Si LOT DI MENS IONS 2Dx ) SS , 1 cULA/t)
SIDEWALK EXISTING YES C NO
BUILDING GRADE ELEVATIONS STAKES SET AT SITE , 19 5 BY et‘...
FEE : fz-rGO /o 5 ?- 9— PG(,
(-Lc •••42.
DEPARTMENT OF PUBLIC WORKS
1, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
2 a xi
I 3412
L _ J
S e reryo 0 1494.44y 3 / 3 / 6 6 4r. GFNE YO U
ZONING/LAND USE COMPLIANCE CHECKLIST 94 by l
I. GENERAL
Building Peanit Zoning_ Conforming Non - Conforming
Job Location It PoR_ELAA-Y) Lot Dimension
Prey Owner J.OS S YO o N C2 / SN L It Area
II. • CCNSTRUCTICN DATA •
Describe Work: FfaM / [_ 4J /2 S 4 540/c E
NEW CONSTRUCTION ADDITION ALTERATION
Accessory Building Pool Single Family
_. Fence — Deck/Patio / Two - Family
— Boathouse Sign — Multi - Family
— Utility Structure — Porch _ Commercial
Other (specify) Manufacturing
III. COMPLIANCE CHECKS
Complies Deficient Deficiency /Comments
Use
Lot Width
Lot Area
— Floodplain
_ Front Yard
Rear Yard
Side Yard (R)
Side Yard (L)
Parking
Building Area
Lot Area per Family
4 — Corner Lot
_
Other (specify)
IV. REVIEW AUTHORITY
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, windows,
etc., when the use is conforming and when no change of use is proposed.
Instances where work complies with the above criteria, the permit can be reviewed
by the Building Inspector without referral to the Planning Director,
APPROVED NOT APPROVED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: /�
�` DATE:
133 `)t 0 k D.
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