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HomeMy WebLinkAbout029913 - Foundation (07/28/92) 4 9 // 3 0292 , _ State of Wisconsin WISCONSIN UNIFORM Department of Industry,Labor Human Relations Division n of Safety&Buildings BUILDING PERMIT APPLICATION NO. ,.J so Box 79 Mad n,WI 53707 APPLICATION Wisconsin Statutes 101.63,101.73 (See Instructions on back of pink copy) PARCEL NO. ....................................................... .. ....................................................................... PERMIT REf UESTED 2.V.nr.1 CONSTRUCTION HVAC I I ELEC PLUMBING OTHER: Owner's Name Mailing Address Telephone C tractor's Na M.51-ling Address Telephone �- 2 '3 (-33 Y9 Lot Area PROJIz t:OC ►T ON Sq.ft. 14, 1/4,SECTION T N,R E(or)W Building Address Su (vision Name Lot No. Block No. Zoning District(s) Zoning Permit No. Front Rear Left Right ��r Setbacks S ' ft. ft. :7' -• 3r ft. /0 ft. 1. PROJECT :,3::::.0t640.660: B ELECTRICAL_ aR <HVACEQUIPMENT 12. ENERGY SOURCE New ❑ Repair Single Family Entrancc Pa el Forced Air Furnace Fuel Nat. L.P. Oil Elec.SolidSolar * ❑Alteration ❑ Raze Two family Size: �r/ amp Radiant Baseboard or Panel Gas ❑Addition ❑ Move ❑Garage Service: ❑ Heat Pump Space Htg. O D O O D ❑Other ❑Underground ❑ Boiler Water Htg. D O O D D Overhead ❑ Central Air Conditioning CON, ST.. i: Ft uNO411c.N ❑ Other ` ❑Dwelling unit will have 3 kilowatt or ❑Other more installed electric space heating equip. Site constructed Concrete 1p. ;PLUMBING Infiltration control option is:❑Full sealing 2 AREA INVOLVED Manufactured ❑ Masonry Sewer — of joints. ❑Blower door test. ❑Exterior �4 ❑Treated Wood Municipal air infiltration barrier. �y Unfinished Basement/ Sq.ft. � STORIEL ❑Other ❑ Septic 13.:41EATLtySS Catculatec�} %, Permit No. w / ,' 3 �1` /�©� gr 1-Story :.k.`�'� Envelope W BTU/HR Living Area Sq.ft. ❑2-Story ❑ Seasonal 11. WATEt Infiltration_70 9 Se BTU/HR Garage Sq.ft. ❑Other Permanent Municipal Utility 'I4. EST.;BUILDING COST ❑ Other Private on-site Well ❑Plus basement $ 1 OM, V 4) 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 th- :-.artmentor Municipalit • :certifies that all the above information is accurate. SIGNATURE OF APPLIC . , . 40...,.r /�-'--` '' DATE CONDITIONS OF APPROVAL This permit is is . •ursuant to the following conditions. Failure to comply may result in suspension or revocation of .ermit or other penalty. fC t✓c+r(-- eG-f zA€ / c.i,+t oct„ z;,-- tO-t"—fit. ' ,ik r/ll.-$-oc,,,,c..,1' -r..,%/ C.4.4.--n". I ,-SUIN ❑TOWN ❑VILLAGE f CITY ❑ COUNTY Municipality Number of Municipality Number of Dwelling • ❑STATE ❑I DEP 1 Inspection Authority, Location,if different JURISDICTION OF: 4.1. ` - d -�-� h - 6EE$ PE Mn(S:) WISr UNIFORM PERMIT PEt�itltlT 155UE©BY ISSUE SEAL NO. '.c e Construction Plan Review $ ] HVAC NAME ` Z4°<' /4.4..,6/4.4 " Inspection . . . . $ ❑ Electrical i N t/ ® Wis.Permit Seal, , $ -- 'o U ❑ Plumbing T DATE ��z' Other $ ❑ Other TOTAL . . . $ _7©•pv CERT.NO. 9—..r-S-0 SBD 5823(R.8/90) 3.s—cf WHITE—Issuing Jurisdiction YELLOW—DILHR GREEN—Inspector PINK—Owner/Agent