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� /� t CITY OF OSHKOSH N° 28532
,
`' PERMIT - APPLICATION AND RECORD
TYPE: BLDG� HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING ��� FLOOD PLAIN HEIGHT
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ADDRESS I7 �3 ✓':7.F.�4/'/'�/"(.�L�J7'I PLAN NO.� � ��D J�l Z /2-
OWNER �.L�- � �G���ic� l/GL��/v.G�2 �.�f.d-��-
DESIGNER '
USE/NATURE OF WORK o /-c=>-a./ ,��� L�[-L�-,�ct.�- �
BUILDING CONTRACTOR /J��'�-' �_�t�u�t��-�� � C'_ �
Size � Sq. Ft.��1�. # Rooms a =3� # Stories Z' Height �% �
Foundation ��'�-' Class of Const � Occupancy Permit_��
HEATING CONTRACTOR
Heat�❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
—BT WH _Disp —WSoft —CBasin
—Lav _Sh _DW —DF —San. Sewer
WC —FDr SP Ur _Storm Sewer
Sink _LTub Eject SS —Water
Other
FEES: Valuation $ �Q�. �O O. O c� Permit Fee Paid $ 53 e . � n Park Dedication $ ���• � c�
ISSUED BY n Date 5/�Z��Z-� Final/O.P.
� �
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE `'�� I � � ��
AGENT/O NER DATE �
�
ADDRESS
TELEPHONE Jf
� i b8� as-'Sz � .
Depart entofindustry, WISCONSIN UNIFORM '
Labor 8 Human Relations APPLICATION NO.
DivisionofSafety&Buildings BUILDING PERMIT S Z
Mad s9on,WI 53707 APPLICATION '
Wisconsin Statutes 101 63,101 73 Ses MstruCNoi►S on baCk o/ lnk co PARCEL NO. `� �!
PERMIT REQ�iE�� �oNSTRUCT�orv ❑ HVAC ❑ ELEC ❑ PLUMBING ❑ OTHER:
Owner's Name Mailing Address Telephone
��C' b � �i�,
ontractor's Na e Mailing Address ele hone
'ei° �tll�lIXPP"' � � ( 1'�ftX L° ��� P �� �G �a
•--
�� ���,����� Lot Area
' '' �•n• '/a, '/s,SECTION ,T N,R E or W
Building Add ess Subdivision Name Lot No. Block No.
3 � ec w� � 9S
Zoning D�r�t(s) 2oning Permit No. Front Rear Left Righ �
Setbacks .� �rc n � �� S
_. ;
ft ft.
�' ' >�. ,:; +�: �L�A�..:`� #11�`,�4GE�tl��' 1�. �I!IERQYSaURCE >
ew ❑ Repair Single Family Entran Panel Forced Air Furnace Fuel N . L.P. Oil Elec. lid lar
❑Alteration ❑ Raze ❑Two family Size: G� amp Radiant Baseboard or Panel G s *
❑Addition ❑ Move ❑Garage Ser ' e: � Heat Pump SPace Htg. ❑ ❑ ❑ ❑ ❑
❑Other nderground ❑ B iler Water Htg. � � � � �
❑Overhead Central Air Conditioning
" " "'' *�Dwellin unit will have 3 kilowatt or
❑Other ;���YR� �' .,, �NI���I�I�°; Other more installe electric space heating equip.
ite constructe COnCfete ;'�� .��;;�����j ;; ;:: Infiltration control option is:❑Fuil sealing
�:;i A�EA:1�11�,�p ; ❑ anufactured � Masonry Sewe of joints. ❑Blower door test. ❑Exterior
❑Trested Wood uniClpal air infiltration barrier.
❑Other ❑ Septic
untinisned sasement�q.ft. ;�•:&T'�1�:'::: 7� ;:;��Tl�:O�� �atculatec##
� �� Permrt No
❑ tory Envelope 7' � BTU/HR
Living Area ��Sq.ft. - _Story asonal 17 ����� !: :; Infiltration ��3 3 Z• 7BTU/HR
Garage 2 gq h Other Permanent unicipal Utility '�� ::�$� ��[�,Q�G�$�
Other
Private on-site Well �
❑Plus basement $ Zpd �
The applicant agrees to comply with all applicable codes,statutes and ordinances and with the conditions of this permit;understands that the issuance of the
permit creates no legal liability,express or impl'ed,on the Department or Municipality;and certifies that all the above information is accurate.
SIGNATURE OF APPLICANT � � . DATE S— �� � ��
CONDITIONS OF APPROVAL This permit is issued pursu t to the foilowing conditions. Failure to comply may result in suspension or
revocation of this permit or other penalty.
e ' ,�
' �c.�t_ �� '
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__ __ _
������ ; ❑TOWN ❑VILLAGE ITY ❑ COUNTY Municipality Number of Municipality Number of Dwelling :
❑STAT��NyDEPENpENT Inspection Authoriry � Location,if different
d��iSD�G'��?N ! OF: _ �l1C.OSGI z�_� (
���� s� w�.u��c�����tt —— — — —
I�S � PEl���1��i�flf
< 1 ` t59�E >:ST�AL:Nt�k i; ! >
_.. ...__ _. .:
Pian Review . . . $ �.O� Construction .
HVAC n NAME ��
inspection . . . . $ ❑ Electrical /�9' X(..�L1 � Z
Wis.PermitSeal, , $ 30.0 0 � plumbing U � DATE � l �
Other . . . . . . $ ❑ Other
TOTAL . . . $ �'�a CERT.NO. •� � S C
SBD5823(H.8/90) WHITE—IssuingJurisdiction YELLOW—DIIHR GREEN—Inspector PINK—Owner/Agent
� R,�V152d: S��
� y ZONING/LANO USE COMPLIANCE CHEC.<LIST
JOB LOCATION: 17f�3 �c�a--r` ��c� v�_ ZONING: � f
PROPERTY OWNER/CONTRACTOR: � .��,,,,,����,�.� J�c.-e .
CONSTRUCTION OATA: ✓NEY1 CONSTRUCtI{N AOOITION ALTERATION PARKING LOT '
TYPE OF PROPOSED CONSTRUCTION: (i.e. fe e, pool , sign, de�k, etc.)
��.c7 �" i� L� � � �� x� � � �Y
COMP�IANCE CHECICLIST (Check only those applicab'le}
COMPLIES DEFICIENT DEFICIENCY/COMME�TS
USe
Lot Width
Lot Area
Floodplain
Front Yard �
Side Stre�t (fi�rnt yard)
� Rear Yard
Side Yard (R)
Side Yard (L)
Par�ing Spaces
Building Area "
Lct Area Per Family
Carner Lot
Landscaping
Transitional Yard
Off-Street Loading
Vision Clearance
Height �
REV 1 E1J AUTHOR ITY: �� �Gd :
The Director of Cortmunity Development, or de gnee, must approve all plans, except the
following: (1 ) Alterations or interior work when the use is conforming and when no change
in use is proposed. (2) Maintenance items,� e.g. siding, windows, etc. , when the use is
conforming and when no ct�ange is proposed. :
Instances where woric complies with t�e above criteria, the permit can be reviewed by t�e
Building Inspector without referral to the Director of CortQnunity Oevelopment, or designee.
�L APPROVED OENIED
Plan Commission Action Required
Variance(s) Requir d
REVIEIJED BY: DATE: � Z
City Of Oshkosh �/�/85
PARKLAND DEDICATION FEE COLLECTION RECOP.D
Address �7 �{�3 ��h�„���-t
Owner�s Name .��:,c.�.e, .� /�,,.�c,c�'�.v���
Name of Subdi vi si on ��=-k- ����-�_-
Lot � 9 �� Bldg. Permit # � �' �3�Z
No. of Units �
Fee Requi red /G�O • c? �'
Fee Pai d /c � . 0 7
Owner's sign�ture C `, Date � - 1� - �Ia
Inspector's signature � �2-,� �C�'�.��n Oate 5�1�z- %�
Parks Subdivision
Improvement
Accts. Rec. : 362-041
. C,4TE 1'— /i��
� ►vAr�E�Q ��Pv- ��,�l..j„�,-- �`�� AODRESS
LOT �-S� nICCK — T� ��
S u80 I�r. �� C`,� f�� ZGN E
STREET N0.���3
-- ►�-- �� LOT 0 t�ENS I GrdS
S I DE4rA�K EX I S T(NG ���� ! ��� a
YES �p ��
BUILDIUG GRADE ELE`/ATIONS STAKES SET AT SITE
, 19 [ �Y _
FEE: $�}�-@@. �
�/5;� �/
.� �����
DE°AR i P•'E`dT OF �1;8 L i C wCRK� .
� , the undersigned, owner or agent oT the abcve dascrioed property agree to �ave tn�
grade estafliished befora excavation has commenced.
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