HomeMy WebLinkAbout0031223-BuildingCITY OF OSHKOSH N°_ 31223
PERMIT - APPLICATION AND RECORD
TYPE: BLDG V HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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J - - e-0
ADDRESS
OWNER
DESIGNER /
USE /NATURE OF WORK r � �/ � g &' &1gq
PLAN NO. 132- 1 Y6 lo9Zi2.
BUILDING CONTRACTOR 4�. ,/�
�
Size Sq. Ft # Rooms � 3rJ # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR /3xz u,�
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR &,I le;iq
Electric Serv. New ❑ Change ❑ Teml
Fixtures Switches
PLUMBING CONTRACTOR T
BT
WH
Lav
Sh
WC
FDr
Sink
LTub
❑ Type
Receptacles
Disp
DW
—SP
Eject
Volts Amps
WSoft
DF
Ur
SS
Circuits
CBasin
San. Sewer_
Storm Sewer
_ Water
Other
FEES: Valuation $ 3o, Ooo • o 0 , Permit Fee Paid $ 0 S `O d Park Dedication $ a 0 v
ISSUED BY Date 0 L-9 I C1 Z Final /O.P. 13
In the performance of this work I a ree to perform all work pursuant to rules governing the described construction.
SIGNATURE G'J
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
State of Wisconsin
Department of Industry,
WISCONSIN UNIFORM
-
Labor& Human Relations
BUILDING PERMIT
APPLICATION NO. I ZZ 3
Division of Safety & Buildings
Box 7969
Madison, WI 53707
APPLICATION
Wisconsin Statutes 101. 63,101.73
See Instructions on back o/ ink co
PARCEL NO.
,::PERMIT RE -S
CONSTRUCTION ❑HVAC ❑ ELEC ❑PLUMBING
❑OTHER:
Owner's Name f
Mailing Address
Telephone
Contractor's Name
G'm c aZZZ7._
Mailing Address
2� too &0.1,
T e hone
5-JY --3333
���
Lot Area
Sq. ft.
' /., '/. SECTION
T N, R E (or )W
Building Address
Subdivision Name
Lot No(..
Block No.
L$�
a9J'r/1
I 0
Zoning District(s )
Zoninwpermit No.
rout
Rear
Left
Right
rp —1
1
Setbacks
ft.
ft.
ft.
ft.
p JET ° :
.....:.
ELE "MML::::
$:' H. -A E tCl�itEt�.:.: ;
.
42. `; EM�ERQY
SOURCE»
New ❑ Repair
Single Family
Entrance�^ an�e,l
Forced Air Furnace
Fuel
Nat.
L.P.
Oil
Elec.
Solid
lar
Alteration ❑ Raze
Two family
lo
Size: � amp
adiant Baseboard or Panel
gas
❑
Addition ❑ Move
❑ Garage
Service:
❑ Heat Pump
Space Htg•
❑
❑
❑
❑
❑
❑ Other
Underground
❑ Boiler
WaterHtg.
111
❑
I ❑
❑
❑
❑ Other
!
Overhead
"'
❑ Central Air Conditioning
❑Other
x Dwelling unit will have 3 kilowatt r
❑ g tto
more installed electric s ace heatin a ui
P 9 equip.
ite constructed
Concrete
'i;_::'; >?; ;; ;;;
Infiltration control option is: ❑Full sealing
!..j
❑ Manufactured
Masonry
......... ..............
er
of joints. Blower door test. Exterior
❑
❑
Treated Wood
Other
unicipal
air infiltration barrier.
Unfinished Basement S ft..S:.:S1►#IER:
Sq.
❑ Septic
LOSS Calclsla #ecf
Living Area �+� Sq. ft.
❑ 1 -Story
--
St E<<<> << ««
Permit No.
Z Z..
Envelope 20 BTU /HR
f�
❑ 2 -Story
er
❑Seasonal..
anent
2
Infiltration BTU /HR
Garage v Sq. ft,
E3 ahe
Municipal Utility
❑ Plus basement
Private on -site Well
$ t�o�ci. Q (D
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 implied, on the Departrpwt or Municipality; and certifies that all the above information is ac urate.
SIGNATURE OF APPLICANT
L' DATE
�6
CONDITIONS OF APPROVAL This permit is issued pursuant to the following conditions. Failure to
comply may result in suspension or
revocation of this permit or other penalty.
❑TOWN ❑VILLAGE
CITY ❑COUNTY
Municipality Number of
Municipality Number of Dwelling
❑ STAT El
Inspection Authority
Location, if different
URISDtCT..ON
.
OF:
-
— —
.
t+�RAlt .Srj::;; :If[t:aJl�EiR�ki:>P!RM1T
.............
<..
:
. :.
Plan Review $
Const ruction
.
HVAC
NAME
Inspection . . . . $
❑ Electrical
I � / q 7� C�
i -1 J J
Wis. Permit Seal, $ O.Q O
❑ Plumbing
q �
DATE
Other . . . . . $
❑ Other
SS"c�
TOTAL . . . $ -0 0
CERT. NO. e9-
SBD 5823 (R. 8/90) 30 WHITE - Issuing Jurisdiction YELLOW -DILHR GREEN - Inspector PINK- Owner /Agent