HomeMy WebLinkAbout0146629-Building CITY OF OSHKOSH No 146629
OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 2211 OREGON ST Owner COYOTE OF WISCONSIN LLC Create Date 06/30/2011
Designer T- Karrels Contractor KOMOROWSKI DRYWALL LLC
Inspector Brian Noe
Category * 140 - Interior Remodeling Plan No Formal REv
Type • Building 0 Sign 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 No Height Permit Not Required
Park Dedication Not Required # Dwelling Units 0 # Structures 0
Use /Nature 12211 Oregon - Unit U - Construct walls for ne toilet room as per tans and demo existing wall and move cabinets as per plan. * *check
of Work #2721
HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $4,000.00 Plan Approval $0.00 Permit Fee Paid $46.00 Park Dedication $0.00
Issued By: ( rY Date 06/30/2011 Final /O.P. 00 /00 /0000
❑ Permit Voided Parcel Id # 1410280000
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 3952 APPLE LN OSHKOSH WI 54902 - 7364 Telephone Number
* 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
To schedule inspections please call the Inspection Request line at 236 -5128 noting the Address, Permit Number, Type of
Inspection (Le. 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) 236-5084 236-5050 O. OJH
Fax: x_ ( 920)236- 506 -5084
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 ri
JOB ADDRESS , a 1 1 U Orion ■4I'e4
OWNER Coy e. � � t I06S P15 c L-
CONTRACTOR OM() O(,.,)Sk(
I am the: ❑ Owner OR 1 18 Contractor
USE CATEGORY
❑Single 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 B Internal Remodeling
❑ Sign/Canopy /Awning ❑ Stair /Handrail ❑ Stove/Fireplace
❑ Swimming Pool ❑ Wrecking Permit
❑ Other
For External Remodeling, Wrecking Permit, and Internal Remodeling please see Chapter NR 447 of the Wisconsin Administrative Code and
Notification Form 4500 -113 on the DNR Asbestos Program website; http: / /dnr.wi.Qov /air /compenf /asbestos /.
For additional information on hazards present in buildings see the Pre -Demolition Environmental Checklist at
http: / /dnr.wixiov /ora/aw/wm/ publications /anewpub/ VA651.pdf.
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: Actol d tA9F1t1 Co( eu) Ma r ' s 4o1 lel roo
moue ft-bi'v t45 , and btiv ex1`at`rt1 toa-t c.s e" p(41-0
Anv work not included in this annlication is not permitted.
Value of the job $ q COO, 00 (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.
RECEIVED Name: �Jf �rl lOfYIOf'CO 1 � r (Please print)
JUN 2 9 2011 Signature:
DEPARTMENT OF Date: ,' k- ' 1 l
COMMUNITY DEVELOPMENT
INSPECTION SERVICES DIVISION 3/02