HomeMy WebLinkAbout0148763-Building0 CITY OF OSHKOSH No 148763
OSHKOSH
ON THE WATER
Job Address 2163 W 9TH AVE
Designer
Inspector Brian Noe
BUILDING PERMIT - APPLICATION AND RECORD
Owner THOMAS O /PATRICIA HALLQUIST REV TRUST Create Date _ 12/19/2.0.11
Contractor LEGACY BUILDERS INC
Category 223 - Alteration Offices, Banks, Professional Plan W5- 3457 -1211 _
Type 10 Building O Sign O Canopy ❑ Fence O Raze
Zoning _ _ Class of Const: Size
Unfinished /Basement Sq. Ft. Rooms Height Ft. ❑ Projection
Finished /Living Sq. Ft.
Garage Sq. Ft.
Foundation 0 Poured Concrete O Floating Slab
O Concrete Block O Post
Occupancy Permit
Park Dedication
Use /Nature FDental Clinic /
of Work
HVAC Contractor
Electric Contractor
Fees: Valuation
Issued By:
Bedrooms Stories Canopies
Baths Signs
O Pier O Other
O Treated Wood
Occupancy Fee $0.00 Flood Plain
# Dwelling Units 0
x 26' addition to
g. Check #1
Height Permit
# Structures 0
Plumbing Contractor
$104,000.00 Plan Approval $0.00 Permit Fee Paid
❑ Permit Voided
$400.00 Park Dedication $0.00
Date 12/19/2011 Final /O.P. 00/00/0000
Parcel Id # 1311840000
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 under a d the afore parMoned information.
Signature .14,441 � Date
Address 5676 COUNTY ROAD II
Agent/Owner
LARSEN
WI 54947 - 9672 Telephone Number 426- 0745/836 -1801
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
Building Permit Application
P 0 Box 1130
Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050
Fax: (920) 236-5084
www.ci.oshkosh.wi.us
Project
Address
A L 11�
o to �' - C- ! - /� y C_.' 0 � k t? 1 -k 19 0-A7
Applicant
❑ Owner Contractor ❑ Tenant ❑ Other (describe)
Owner /
Tenant
Name I>C- . V M a S t\t' kA u �'* Phone
Address A de- 4��Ot OA- Email ` o rvt , k w l a .sN Q qj
Contractor
Company Name i C
P Y �'C c-c v Qa �. \ �t r5 mac.- Phone �(• z� 'C7.7 � l to 1
Contact �A 1 k Email �GC�A���uiVe(S
Address d24-W-5 L1%j1 t e- `i'A f .� C' S �a k 4 ti r_ W S
State Credential #'s 9 \ "� % -1
Dwelling Contractor Qualifier # Dwelling Contractor # Building Contractor Registration #
Achitect /
Designer
Company Name h'c Ly t t 0 /h 0"t Phone Z0, 5�S. a (b?,
�-'
Contact 1 i m �GQ n`f Email +It -CnVP Ate- t 'rC_c.� s t n
l n (''1-'n Est 0A to
Address A/ -7 ®i (,o �«n ic. V it W Of , ie to h e ,.c U �t , k/.r
Permit Type
❑ Residential Single Family ❑ Residential Duplex Commercial ❑ Multifamily [I Industrial
Catagory
❑ New ;1Addition ❑ Alteration
Project
r
P5 tkX 3 (, x Zto �o(dl ('A
Description
Mechanical
Permits
Separate permits will be obtained for the following:
❑ Electrical ❑ Plumbing b y ❑ Heatinb tr by 01C M A` t^
Value of Job
S (Value for materials & labor is req. to ensure consistency in accessing permit fees for all applicants.)
Payment by: ❑ Check # ZD S 3 ❑ Cash ❑ Permit Fee Account
I certify the above information is complete and accurate. Any deviations from the above submitted information may require additional permits
to be o tained. I acknowledge and agree to these terms.
Name: (Please print) Date: j Z 1 G7
Signature: Al-244 -