HomeMy WebLinkAbout0146376-Building (raze) CITY OF OSHKOSH No 146376
OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1039 W SOUTH PARK AVE Owner CITY OF OSHKOSH Create Date 06/15/2011
Designer Contractor OWNER
Inspector
Category * 161 - Wrecking Residential Dwellings Plan
Type 0 Building 0 Sign 0 Canopy 0 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 0 Floating Slab 0 Pier 0 Other
0 Concrete Block 0 Post 0 Treated Wood -
Occupancy Permit Occupancy Fee $0.00 Flood Plain Height Permit
Park Dedication - # Dwelling Units 0 # Structures 0
Use /Nature Duplex/ Raze structure* Utilities shall be properly abandoned.
of Work
HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $7,500.00 Plan Approval $0.0 Permit Fee Paid $74.00 Park Dedication $0.00
Issued By: N Date 06/15/2011 Final /O.P. 00 /00 /0000
/ Permit Voided Parcel Id # 1307340700
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 understand the afore mentioned information.
Signature Date
Agent/Owner
Address Oshkosh WI 54901 - 0000 Telephone Number
*Raze 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
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
P O Box 1130
Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050
Fax: (920) 236 -5084 Of HKO.IH
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
JOB ADDRESS l.? 7 , to q 1 SC7v Pe (c �c
OWNER Ny U 034 6 : 3 -s 4 1
CONTRACTOR ( : (e ®st, 14j1
I am the: Ill Owner OR ❑ Contractor
USE CATEGORY
DSingle Family PiDuplex DMulti-Family ❑Rental DCommercial ❑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 ez v
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: ett w < (( p Icy ( a e u (S a t pope..
Any work not included in this application is not permitted.
Value of the job $ 7 d (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.
Name: ,51 f l de
(Please print)
Signature: ,% .�
Date: W/S1/
3/02
REQUEST FOR EXCEPTION TO REQUIRED
SEWER AND WATER ABANDONMENT REGULATIONS
Date 6 / g" ///
Address of building / 3 9 /0 4 / 10 9 3 mil t) Par,
Name of Owner C j -L�l O- D l, o .T
Address of owner //
The undersigned Master Plumber requests that the requirement for abandonment of the
sewer and water laterals for this address not be required to meet the ordinance for
abandonment at the property line before raze or removal of the served structure. (Check
one or provide Information)
• The utilities will be reused for new construction at this site within twelve months of
the date of request for exception. If the utilities will not be reused within this time
frame they will be properly abandoned at the property line per ordinance
requirements no later than twelve months from date of this request.
• The utilities will be properly abandoned after the structure is removed to make the
utilities accessible for abandonment. The utilities will be secured against damage
during demolition and until they can be abandoned to meet the requirements of
ordinance. (Not to exceed 60 days)
PA, • Other reasons for the requested exception: �,r-� }/ 40
prn �tba n don a 1 Lik - 6' e.f
f (Continue on the reverse side of form if necessary)
Master Plumber Date
Master Certificate Number
Mailing address
irr ►
Approved: , Date 6)/11/ j
(Plumbing In ctor) /