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ZONING /LAND USE COMPLIANCE CHECKLIST
I. GENERAL
• Building Permit # Zoning ile.3 Conforming Non- Conforming
Job Location 13 4% Lot Dimension
Property Owner , i A c y`: Lot Area
II. . CONSTRUCTION DATA
Describe Work: 2.r4A -> •
NEW CCNSTRUCPION ADDITION ALTERATION
� sory Building _ Pool Single Famil
_ Y
_ Femme 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
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
y� ZZA.— ),�1�� Z
REVIEWED BY: i.G// H ATE:
. , DATE 2 -- 3 rek
NAME i s E LL 4 D J /' ADDRESS filt- a'a?' J4Cx ( ) ,19A-
LOT BLOCK WARD 4-3
S UBD I V . o� "� UA.o • ZONE / ' - IS K
STREET NO./3/1r-i1/4041/.412t4/ 5D LOT DIMENSIONS _
SIDEWALK EXISTING YES 11111 N
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 2.-6 , 1 984 BY V.I'-.)
FEE: $2.00 /�
62_ 7 2)
` //
DEPART ENT OF PUBLIC WORKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
_27 1-- ' 41-1.;
■
3406 (,l
City of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address i S ', /,.2.6--
,. 6-'
Owner's Name ik..4...d gt-4.7
Name of Subdivision -r 45, 'Ail
Lot # Bldg. Permit # a3'
No. of Units 4—
Fee Required
Fee Paid i'P'
Owner's signature (0 Date
Inspector's signature �_ . , IL/ /„A„,„( Date a.2 73 J afr
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
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Safety & Buildings Division PLANS APPROVAL APPLICATION E-
201 E. Washington Ave. Departmgnt of
P.O. Box 7969 INDUSTRY, LABOR AND HUMAN RELATIONS PLAN NO. ef a - 4/415
Madigan. WI 53707
INSTRUCTIONS: Fill In all applicable data. Submittal of Plan Approval Application lo►m Is tuqubud with each plan submittal. Examineuon and
inspection foes, as indicated on back of form, are required to be submitted with a minimum of four sets of plans. Date required on plans is described
in code section Ind. 50.12.
Codes can be purchased from the Department of Administration, Document Sales, 202 S. Thornton Ave., Madison, 53702 ..��
/�tt41F
Name of Owner Build ng Occupancy or Use Desig or Design f m of
KILSS�.(�. Yovy' .U.�11fi1T.yF..,H3 - -1//407- . TDGK 44b406*E - .�.-
Company Tenant Name, if any Street & No.
.QZ/( Y v sh lac. /990 l ..44.50Ae e
Street & No. r Buildin locau n Street & No. City State & �2'I?
o 3 t�A . id q.LIN ,.2/vE /3 oA61.4y _
n fi r.¢ .‘ 0 . 6-6 ; 1( r .‘ 0 . 6-6 ; 1( dr kJ..43o ?- -oa97
City State & Zip City County Phone ,/q
OW, Village ❑ aHOil/ 1441416 (► -III - -1,g - ass
Sf/KOS/4< G1! /. J Town ❑ !
Previous Owner, if any Return Plans to Owner ❑Designer ❑Other •
THIS APPLICATION IS FOR: Type of Construction (Ind 51.03) ❑ Sprinkler System Provided FOR OFFICE USE ONLY
❑ Building Plan Approval ❑ Fire Resistive —Type A #1 ❑ Fire Alarm Provided
❑ HVAC•Plan Approval ❑ Fire Resistive —Type 8 #2 ❑ Other Detection System Provided Amt. Rec'd.
❑ Other ❑ Metal Frame Protected #3 0 Emergency Power Provided
PLANS FOR: ❑ Heavy Timber #4 Mechanical Information:
❑ New Building ❑ Exterior Masonry #5A Type of Heating Rept. No.
❑ Addition ❑ Exterior Masonry #5B
❑ Alteration ❑ Metal Frame Unprotected #6 DETERMINATION OF FEES
❑ Revision to previously approved plans ❑ Wood Frame Protected #7 ' (See back of form)
• "(Structural ❑ Wood Frame Unprotected #8 Area Height Volume
❑ Footing & Foundation SOIL BEARINGS CAPACITY
o Other Method used ❑Verified X cu. ft.
Check one: ❑Presumptive X
- cu.ft.
Value used: PSF Total Volume or
Total Area of Alteration
COMPONENTS INCLUDED WITH THIS SUBMITTAL ' Total Vol. /1000 (Building) Minimum Fee $75.00
NOTE: Must be submitted by budding designer X 1.10 $
Designer Name 1 Reg. No. , Vol. /1000 IHVAC) Minimum Fee $70.00
METAL X .81 • = $
BUILDING Supplier Alt. Area Minimum Fee 670.00
X .02 - $
Designer Name Re . No.
TRUSSES 1���$ N I \ � f XStructural ❑Exhaust ❑Illumination D p0
Supplier ❑Ftg &Found ❑Revision $
<SirOCX 2,04766. ❑ PRIORITY PLAN REVIEW.
Designer Name • 'Reg. No. FEE IS EQUAL TO THE TOTAL PLAN
PRECAST EXAMINATION FEES ABOVE. $
CONCRETE Supplier
❑ Permit to start $81.00 $
Designer Name 'Reg. No. PUBLIC RECORDS: Inspection Fee
LAMINATED
WOOD Supplier This p /an, and re /aced documents, may be
subject to public inspection and copying, $
Designer Name !Reg. No. See Ind. 69.09(8) for additional informa- Total
OTHER
(SPEC /FY) Supplier - lion regarding public record&
. $
DESIGN AND SUPERVISION (Ind. 50.07 - 50.10) Wisconsin Registered Professional required for buildings, containi}tg more than 50,000 cu.ft.,
total volume. This project has been prepared under my supervision. Individual components, submitted herein, may have been designed and sealed
by others. 1 have reviewed those component documents for conformance with the general design concept. 1 have relied on the seal of the component
designers for compliance with codes as they apply to their design.
If this submittal includes building, or building components, the designer and supervising professional below must be that of the building. If submittal
is for HVAC, only, blocks below may be completed by HVAC designer and supervisor. ,
Name ABLDG " - 111 AC - Designer Type or Print Reg. No. Si • . 're o '- BLDG �. Designer Dec id
Plana for buildings over 60,000 cu. ft. will not be approved until the name of the supervising professional is known and the signature provided below.
Na nt�.g f Supervising Prof ' nal (Type or Print) 1 No. Address.,
j/ -5-1,y..?
Z•.y. ,Z. ( I.�' D.( 4'J a. �O.ti''.C.
wing Profess Date ; , /29 .� �p[1. oE,((I!/E , tl /T,�6�0
�� �� �.. . l� — _ - _. , 1,�'I.,ETO.(; hke • .5-121/