HomeMy WebLinkAbout0019806-Building � �
� CITY OF OSHKOSH N° 19806
`' PERMIT - APPLICATION AND RECORD
TYPE: BLDG� HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING '� FLOOD PLAIN HEIGHT
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ADDRESS �'��� � �/� PLAN NO. �����9QjC-
OWNER
DESIGNER
USE/NATURE OF WORK �/��� ,��� ����i�
BUILDING CONTRACTOR
/�S� 3l3�IS � �
Size Sq. Ft. # Rooms # Stories Height
Foundation ��Z- Class of Const. � Occupancy Permit,�
HEATING CONTRACTOR ��.!•CLI�C�f.•l/
Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR C��
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR ���'�/.L/
_BT _WH —Disp WSoft —CBasin
—Lav —Sh —DW _DF San. Sewer
—WC FDr SP —Ur —Storm Sewer
—Sink LTub Eject —SS —Water
Other
FEES: Valuation $ ��l���� pd Permit Fee Paid $ /°0"�d Park Dedication $ f a�•��
ISSUED BY�`��l.�.`r.�-'G�'s�"��-� Date��D Final/O.P.
In the performanc of this work I a r perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT� ER D TE
ADDRESS \ ��� �,��'�-----�'�
TELEPHONE#
}�!o/Z� �7�� /c�
State of Wisconsin
Departmentoflndustry, WISCONSIN UNIFORM • ��
LaborBHumanRelations BUILDING PERMIT APPLICATIONNO.
Division of Safety 8�Buildings
Mad s�on,w� ss�o� APPLICATION
Wisconsin Statutes 101.63,101.73 See lnStruCNons on beCk o/ InkCO PARCEL NO.
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TR T RE HVA EL
�
S UC U ❑ C ❑ EC ❑ PLUMBING
Owner's Name Mailing Address Telephone
Contractor's Name Mailing Address Telephone
�O 2� �� `�?-to /y'73
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, ,
k /a SECTION T N R E or W
Building Address Subdiv'si n Name Lot No. Block No.
��s�s' ����� .l - �a
Zoning District Lot Area , Front Rear Left Right
� `"' � � .ft. S@tb8Ck8 ft. ft. ft. ft.
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_..._._......_.....................................____..........._...._...._....________ __............_......_............_......._..................._.._....______..................._....._........._......................................................__._.._..
ew ❑Addition ❑ Raze �Single Family Entrance Pa�el � Forced Air Furnace Fuel Nat. L.P. Oil Elec. lid lar
❑Alteration ❑Repair ❑ Move Two family Size: �B'� amp Radiant Baseboard or Panel Gas '
❑Other Service: ❑ Heat Pump �9• ❑ ❑ ❑ ❑ ❑
❑Other �Underground ❑ Boiler Water Htg. ❑ ❑ ❑ ❑ ❑
❑Overhead ❑ Central Air Conditioning
,:,.:... .::_.:.:..:..:.:::::.::::.:...::::::::.::....::.::::..:: :::: .::. ...:.::: .::::::::...:..:::::..::.::.:.:::.:::.::::. *�Dwelling unit will have 3 kilowatt or
�� #i/E�A�`'a� :; : <:�:';�€::'�Y#� 7.`:��i�11lJk�`iQI��.:: ❑ Other
more installed electric space heating equip.
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Attached ❑ Detached Siteconstructed Concrete ;'�#t;;;;[��;;���I�"'«"'.!:j!:;;:«j;j<;;<j::;::::;r:::;;: Infiltration control option is:❑Full sealing
�Manufactured
Masonry Sewer of joints. ❑Blower door test. ❑Exterior
;�, � i ': ;; ❑Treated Wood � Mwicipal �
air infiltration barrier
❑Othef SB tiC
i �::�`��� ::;
P a�::�'�':Lt�S;.cai��lat�
Basements ��Sq.ft. ...................... '
Permit No.
3
� D .3
�Q��Q/ ❑1-Sto � BTU/HR
ry $::::;�$�:»»:»»»»»:::»:>:>:: Envelope
Livin Area�S .ft. �'
9 U �
S
::' �a�i� : :::::::::::::;: ; : :
lG 9
e sonal >7::�.. Infiltration BTU/HR
�2-Story ❑S a __.._..........._..._....................................
��� 7j Other Permanent
� � Munici al Utili <'��:'>::�TK':���:��:':;:;:;:':ii<;:
Garage Sq.ft. �Other P tY
❑ Private on-site Well
a d�+a
The applicant agrees to comply with the Wisco sin Uniform Dwelling d other Municipal Ordinances and with the conditions of this permit;understands ,
that the issuance of the permit creates n le I lia ''ry, xpress or' lied, the Department or Municipality;and certifies that all the above information is
accurate.
SIGNATURE OF APPLICAN - oATe
CONDITIONS OF APPROVAL This permit is issued p the following conditions. Failure to comply may result in suspension or
revocation of this permit o penalty.
i:;i;:i ❑TOWN ❑VILLAGE CITY ❑ COUNTY Municipality Number of Municipaliry Number of Dwelling
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:.;>;.<::.:««««««:«««:.<:>:>:;.«<:<:>.>; ❑STATE ❑ N EPEND NT InspectionAuthority Location,ifdifferent
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Plan Review . . . $ � Construction
�HVAC NAME '�/Z�•y✓
Inspection . . . . $ ❑ Electrical � �s�
Wis.Permit Seal(s) $ 3� ❑ Plumbing �� � DATE
Other . . . . . . $ ❑ Other �S'j�
TOTAL . . . S � CERT.N0.
SBD5823(R.M88) / � r.� WHITE-IssuingJurisdiction YELLOW-DILHR GREEN-Inspector PiNK-Owner/Agent
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