HomeMy WebLinkAbout0151658 - Building (remodel interior) CITY OF OSHKOSH No 151658
OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 3773 GLENBROOK LN Owner JEFFREY BEYER/DANENE KIMMEL BEYER Create Date 08/13/2012
Designer Contractor OWNER
Inspector Nicole Krahn
Category * 140-Interior Remodeling Plan
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 Occupancy Fee $0.00 Flood Plain Height Permit
Park Dedication #Dwelling Units 0 #Structures 0
Use/Nature SFR/remodeling of interior of mobile home
of Work
HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $2,000.00 Plan Approval $0.00 Permit Fee Paid $32.00 Park Dedication $0.00
Issued By: LTC: Date 08/13/2012 Final/O.P. 00/00/0000
❑ Permit Voided I Parcel Id#
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 a ' •erstand the afore entioned informs•Signature j M , I (•-R p�Date O —13H
Agent/Owner
Address 4Q)., GO. \0-O` PcV( Oshkosh WI 54901 - 0000 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(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.
P O Box 1130
City of Oshkosh kos/G L Oshkosh,WI 54903-1130
�'j, Phone: (920)236-5050
Fax: (920)236-5084
Building Permit Application www.ci.oshkosh.wi.ns
Project
Address 3.i-73 C. bcc.c o\L L-• D.5-, 05 h W�
Applicant 1wner> Contractor Tenant Other(describe)
Owner/ Name DC1.tttr-�_ Vl lty-ry l Phone ()kcat)-30=3--cp`114-7
Tenant �/,��
Address HO), 0. tD ' DSh k Email
Contractor Company Name Phone
Contact Email
Address
State Credential #'s ,
Dwelling Contractor Qualifier# Dwelling Contractor# Building Contractor Registration#
Achitect/ Company Name Phone
Designer
Contact Email
Address
Permit Type Residential Single Family Residential Duplex Commercial Multifamily Industrial
Catagory New Addition 1 'Alteration
Project IZ OM l.0 iL i- a uaul 1,0 l i'1 aret LO.11,(
Description 1 '
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Mechanical Separate permits will be obtained for the following:
Permits Electrical by Plumbing by Heating by
Value of Job $ aim) . CO (Value for materials&labor is req.to ensure consistency in accessing permit fees for all applicants.)
Payment by: Check # Cash x 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 obtained. I acknow edge and agree to these terms.
Name: ,LJ , ' '1'111., A.l'mr(\e_.,` (Please print) Date: j' j - i-.D.i
Signature: 4 ■ \(i{