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HomeMy WebLinkAbout2011-Building 40/ CITY OF OSHKOSH No 145751 OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD ON THE WATER Job Address 333 ROSALIA ST Owner FEDERAL NATIONAL MORTGAGE ASSOC Create Date 05/02/2011 Designer. Contractor OWNER Inspector Category * 140 - Interior Remodeling Plan Type • Building 0 Si 0 Canopy 0 Fence 0 Raze Zoning Class of Const: Size Unfinished /Basement Sq. Ft. Rooms Height Ft. ❑ Projection Finished /Living Sq. Ft. Bedrooms Stories Canopies Garage Sq. Ft. Baths Signs Foundation • Poured Concrete 0 Floating Slab 0 Pier 0 Other 0 Concrete Block 0 Post 0 Treated Wood Occupancy Permit Not Required Occupancy Fee $0.00 Flood Plain Height Permit Park Dedication # Dwelling Units 0 # Structures 0 Use /Nature SFR\ Interior Remodel *Removing the lath and plaster on the 1st floor exterior walls to insulated and install new drywall. Remodeling the of Work kitchen, bathroom and laundry room. All work to comply with current code requirements. HVAC Contractor Plumbing Contractor OWNER Electric Contractor HOMEOWNER Fees: Valuation $6,800.00 Plan Approval $0.00 Permit Fee Paid $67.00 Park Dedication $0.00 Issued By: L ` Date 05/05/2011 Final /O.P. 00 /00 /0000 ❑ Permit Voided Parcel Id # 0205150000 Cautionary Statement to Owners Obtaining Building Permits 101.65(1 r) of the Wisconsin Statutes requires municipalities that enforce the Uniform Dwelling Code to provide an owner who applies for a building permit with a statement advising the owner that: If the owner hires a contractor to perform work under the building permit and the contractor is not bonded or insured as required under s. 101.654 (2) (a), the following consequences might occur: (a) The Owner may be held liable for any bodily injury to or death of others or for any damage to the property of others that arises out of the work performed under the building permit or that is caused by any negligence by the contractor that occurs in connection with the work performed under the building permit. (b) The Owner may not be able to collect from the contractor damages for any loss sustained by the owner because of a violation by the contractor of the one and two family dwelling code or an ordinance enacted under sub. (1) (a), because of any bodily injury to or death of others or damage to the property of others that arise out of the work performed under the building permit or because of any bodily injury to or death of others of damage to the property of others that is caused by any negligence by the contractor that occurs in connection with the work performed under the building permit. * 140 - Interior Remodeling See Chapter NR 447 of the Wisconsin Administrative Code and Notification Form 4500 -113 on the DNR Asbestos Program website; http: / /dnr.wi.gov /air /compenf /asbestos /. For additional information on hazards present in buildings see the Pre - Demolition Environmental Checklist at http: / /dnr.wi.gov /org /aw /wm /publications /anewpub /WA651.pdf In the performance of this work I agree to perform all work pursuant to rules governing the described construction. While the City of Oshkosh has no authority to enforce easement restrictions of which it is not a party, if you perform the work described in this permit application within an easement, the City strongly urges the permit applicant to contact the easement holder(s) and to secure any necessary approvals before starting such activity. I have read and underst d t e a d information. Signature e e.7[6y Date S =�� Agent/Owner Address 7105 CORPORATE DR PTX -B -209 PLANO TX 75024 - 0000 Telephone Number To schedule inspections please call the Inspection Request line at 236 -5128 noting the Address, Permit Number, Type of Inspection (i.e. Footing, Service, Final, etc.), Access into Building if Secure (how do we gain entry), your Name and Phone Number. Unless specified otherwise, we will assume the project is ready at the time the request is received. Work may continue if the inspection is not performed within two business days from the time the project is ready. City of Oshkosh Inspection nspection Services Division P O Box 1130 Oshkosh, WI 54903 -1130 Phone: (920) 236 -5050 Fax: (920) 236 -5084 O.IHKOJH Building Permit Application ON THE WATER If you are a contractor participating in the. Permit Fee Account System and have adequate funds, check here if you want this processed through your account n JOB ADDRESS 3 3 120 , „LGGki OWNER ef°' y CONTRACTOR 0/0 I am the: 'Owner OR ❑ Contractor U E CATEGORY ingle Family ❑Duplex ❑Multi - Family ❑Rental ❑Commercial ❑Industrial Work being done: ❑ Addition ❑ Deck/Porch/Patio ❑ Driveway/Parking ❑ External Remodeling ❑ Fence/Hedge/Kennel ❑ Garage/Utility Structure ❑ Handicap Ramp ❑ Hot Tub /Spa Xnternal Remodeling ❑ Sign/Canopy /Awning ❑ Stair/Handrail ❑ Stove/Fireplace ❑ Swimming Pool ❑ Wrecking Permit ❑ Other Additional information, such as plan submittal and approval, may be required before issuance. Fliers, located in the hallway, may be referenced to note if any additional information is necessary. ❖ Full description of work being done: 'maid 4fz w / 6,0,toziyyv it! 4 4.4.1 4111% 1‘ a/•-k- NIA.14- 6 : Azt.),_ 4o AWc Mow llvt�l(.t7� t y `� '' . -F1,■-k 1 Nov\ Any work not included in this application is not permitted. s� p mi l_ Value of the job $ f p OV (Value for materials and labor is required to ensure consistency in accessing permit fees for all applicants.) PLEASE READ, SIGN, & DATE: I cert fy the above information is complete and accurate. Any deviations from the above submitted information may require additional permits to be obtained I acknowledge and agree to these terms. Name: r ev/ �Veirge7Se4•_ (Please print) , Date: 3/02 City of Oshkosh Division of Inspection Services 215 Church Avenue PO Box 1130 �/ K ( Oshkosh WI 54903 -1130 .. H Office (920) 236 -5050 ON THE WATER Fax (920) 236 -5084 Web: www.ci.oshkoch.wi.us AFFIDAVIT FOR PERMIT (Owner Occupied Property) State of Wisconsin, County of Winnebago, City of Oshkosh I, Sh 4j / l)retk05e�t.' , hereby swear and affirm under oath that: (print name) I am the owner of the property listed below, I do currently personally occupy or intend to occupy the property and I will self - perform the work. And do hereby submit an application for a permit pursuant to the Wisconsin Department of Commerce Licensing Act 2 (ss101.147), that does not require me to be licensed by the State of Wisconsin, to perform this work at: STREET ADDRESS � "PREMISES") D S h itos lc)/ , J E f 0/ 9 I UNDERSTAND AND WILL ABIDE BY THE FOLLOWING STIPULATIONS: 1. That I will be personally doing the work as set forth in the Permit Application and no contractor for hire will be performing any work at the Premises. 2. I understand and acknowledge that if any person other than me is determined to be performing work upon the Premises a STOP WORK order may be issued. 3. I understand and acknowledge that if I am unable to complete the work at the Premises I must hire a Wisconsin State Licensed Contractor to complete the work and obtain a permit for the remainder of work to be done. 4. I understand and acknowledge that all work must be performed in strict conformance with all applicable building and zoning codes adopted by the City of Oshkosh. 5. I understand and acknowledge that all work performed will be subject to inspection by the City of Oshkosh. 6. I agree to take full responsibility for all work completed upon and the conditions of the Premises. 7. I am certifying the above under oath and am subject to laws for perjury for any untruthful statements made herein and understand that the permit may be revoked for false statement or misrepresentation as to the material fact in the application on which the permit was based. UPON SUBMISSION, THIS AFFIDAVIT BECOMES PART OF THE ACTUAL PERMIT. Sh ea / Pre M PRINTED NA OF APPLICANT SIGN OF APPLICANT &827 ce r' Lon? !-c>r s.36e -aY STREET ADDRESS OOF PLICANT CITY � ST / ATTE ZIP HOME PHONE NUMBER 7� s "©o ALTERNATE PHONE SWORN and SUBSCRIBED to before me this day of , 20 Al at Oshkosh, County of Winnebago, and State of Wisconsin. NOTARY SEAL HERE NOW .Y PUBLIC &x re pis 7 / (' /aoP/