HomeMy WebLinkAbout0146321-Building (driveway) (.11D CITY OF OSHKOSH No 146321
OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 2367 HAMILTON ST Owner DANIEL J POLISHINSKI Create Date 06/13/2011
Designer Contractor OWNER
Inspector John Zarate
Category 256 - Parking Lots, Driveways Plan
Type • Building ❑ Sign ❑ Canopy ❑ Fence ❑ 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 ❑ Floating Slab ❑ Pier ❑ Other
❑ Concrete Block ❑ Post ❑ Treated Wood
Occupancy Permit Not Required Occupancy Fee $0.00 Flood Plain Height Permit Not Required
Park Dedication Not Required # Dwelling Units 0 # Structures 0
Use /Nature SFR / REPLACE CONCRETE DRIVEWAY AS APPROVED BY THE ZONING DEPARTMENT * *check 4991
of Work
HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valu • n $5,000.00 Plan Approval $0.00 Permit Fee Paid $53.00 Park Dedication $0.00
Issued By: Date 06/13/2011 Final /O.P. 00 /00 /0000
❑ Permit Voided Parcel Id # 1214270000
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.
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 necessry approvals before starting such activity.
I have read and understand the aforementioned information. //
Signature jr - • �, Date / / ✓✓" /
Agent/Owner /
Address 2367 HAMILTON ST OSHKOSH WI 54901 - 1712 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 Services Division
PO Box 1130
Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050
Fax: (920) 236 -5084 OJHKOIH
Building Permit Application ON THE WATER I
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 236 7 N i-mi j T5
OWNER - PI l444 -A 4
CONTRACTOR
I am the: l ,Owner OR ❑ Contractor
U E CATEGORY 111
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 ❑ Internal Remodeling
❑ Sign/Canopy /Awning ❑ Stair/Handrail ❑ Stove/Fireplace
❑ Swimming Pool ❑ Wrecking Permit
Other 41 t iV - re 'u 4Cr Lieu)
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:
S
Any work not included in this application is not permitted.
Value of the job $ fDOO, (Value for materials and labor is required to ensure consistency in accessing permit fees for all
applicants.)
PLEASE READ, SIGN, & DATE:
I certify 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.
, ,x,11 ,' L;
Name: M 4 i
y (Pleas tint) ` ` r
Signature: *0
Date: (A/7,6 `/
3/02