HomeMy WebLinkAbout0143769-Building CITY OF OSHKOSH No 143769
OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1130 N WESTFIELD ST Owner EVERGREEN MANOR INC Create Date 10/14/2010
Designer Contractor DAN V BINDER CONSTRUCTION
Category * 140 - Interior Remodeling Plan 08- 3168 -1010
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 Required Occupancy Fee $0.00 Flood Plain Height Permit
Park Dedication # Dwelling Units 0 # Structures 0
Use /Nature COMM/ Evergreen Manor/ Unit MS1028/ Remodeing the unit to include new kitchen cabinetry, removing one non - bearing wall in the
of Work kitchen and cutting one down to make a half wall. Patching and finishing wall coverings.
HVAC Contractor Plumbing Contractor J RASMUSSEN PLUMBING INC
Electric Contractor BEEZ ELECTRIC INC
Fees: Valuation $5,000.00 Plan Approval $0.00 Permit Fee Paid $53.00 Park Dedication $0.00
Issued By: )2A-- Date 10/22/2010 Final /O.P. 00 /00 /0000
❑ Permit Voided Parcel Id # 1608640000
In the performance of this work I agree to perform all work pursuant to rules goveming 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 l3,,uf, Date j� .- - G O
J -
Agent/Owner
Address 1224 W SOUTH PARK AVE OSHKOSH WI 54902 - 6642 Telephone Number (920) 231 -2114
* 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 (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.
sf4, illy ;,f Oshkosh
?. Inspection Services Division
PO Box 1i30
Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050
Fax: (920) 236 -5084 QJHKOIH
Building Permit Application ON THE WATER
If vQti are a contractor participating in the Permit Fee Account System and have adequate funds, check her
■; • .4 if you want this processed through your account f
.rOB ADDRESS � 1 ' b _- nl tip/a$7 f I L Yn S__/27 —_.. --
OWNER k 1oPeVN
.CONTRACTOR 64.. eu 1 i O.''
I am the: ❑ Owner OR g Contractor
USE CATEGORY
❑Single Family ❑Duplex ❑Rental ' OCommercial ❑Industrial
. Work being done:
0 Addition 0 Deek/PorchjPatio 0 Driveway /Parking
External Remodeling O Fence/Hedge/Kennel 0 Garage /Utility Structure
• O Handicap Ramp 0 Hot Tub /Spa 0 Internal Remodeling •
• 0 SigniCanopy /Awning O Stair/Handrail 0 Stove/Fireplace
0 Swimming Pool 0 Wrecking Permit
O. Other
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. /v>
❖ Full description of work being done: em, C_'4, ,���
C.7' Po , 'I • = &AA tC /AlS# W)4 L [k5
Any work not included in this application is not permitted.
Value of the job $ 5 i".7e) , 00 (Value for materials and tabor is required to ensure consistency in accusing 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 perrnits to be obtained. I acknowledge and agree to these germs.
Name: 1� �.3 .
z �x - _ (Please print)
Nu Signature:
Date: /4 07 c9 /b