HomeMy WebLinkAbout0154198 - Building (remodel bathroom) CITY OF OSHKOSH No 154198
OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 809 GRACELAND DR Owner BARBARA E SITTER/L M REPENSHEK Create Date 01/17/2013
Designer Contractor CLOSE CONSTRUCTION
Inspector Nicole Krahn
Category * 140-Interior Remodeling - _ —___ _._ Plan —_
Type • Building O Sign O Canopy 0 Fence 0 Raze
Zoning R-1 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 O Floating Slab O Pier 0 Other
O Concrete Block 0 Post O Treated Wood -- _
Occupancy Permit Occupancy Fee $0.00 Flood Plain Height Permit
Park Dedication #Dwelling Units 0 #Structures 0
Use/Nature ISFR/remodeling bathroom/no structural work being done/tearing some drywall out just for removal of bathtub/no electrical work being-I
of Work done/new flooring/all work will meet state and local codes
HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $2,000.00 Plan Approval $0.00 Permit Fee Paid $44.00 Park Dedication $0.00
Date 01/17/2013 Final/O.P. 00/00/0000
Issued By: - -
D Permit Voided' Parcel Id#0617270000
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 ai ndersta mentioned information.
Signature Date l / 7 /3
Agent/Owner
Address 5411 FUERST RD. NEW LONDON WI 54961 - 0000 Telephone Number 920-982-3041
* 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
n City of Osr�j kos` j� Oshkosh,WI 54903-1130
Phone:(920)236-5050
Fax:(920)236-5084
Building Permit Application i.oshkosh.wi.ns
Project
Address
Applicant Owner Contractor Tenant Other(describe)
Owner/ Name 3 h 6 :5 i TM-R. Phone - 3 3 -/-5.5-0
Tenant
Address r3 0 6.-R RC Lij - DR. Email
Contractor Company Name CL c' c c / -'n-' 5/-u.e TIC'n Phone .2 2 47S",2- S0 9.I
Contact J A-1 C C 0✓L Email
Address /V.!, `> / ,, 5.,;1 tp 5 7- R 17 v ELV Le ro•a o n., w
/
State Credential#'s (7/ q 7
Dwelling Contractor Qualifier# Dwelling Contractor 4 Building Contractor Registration 4
Achitect/ Company Name Phone
Designer
Contact Email
Address
Permit Type("Residential Single Fami Residential Duplex Commercial Multifamily Industrial
Catagory New Addition • teration
Project
Description
k En•ca e 4`11-1eod/1
Mechanical Separate permits will be obtained for the following:
Permits Electrical by Plumbing by SC'9 TT F1 LI-n 5 Heating by
Value of Job $ j ct''Q (Value for materials&labor is req.to ensure consistency in accessing permit fees for all applicants.)
Payment by: Check # g 6 et\ 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�7 obtained.
C
b�tained. I acknowledge and agree to these terms. r�
Name: /' . t (Please print) Date: / 7/ )3
Signature: ,(t y., -'