HomeMy WebLinkAbout0154733-Building � CITY OF OSHKOSH No 154733
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OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1112 CEAPE AVE _ __ Owner BRANDAN R/LUANNE M DOUGHERTY Create Date 03/18/2013
Designer Contractor OWNER
Inspector John Zarate
Category * 140-Interior Remodeling Plan
Type � Building � Sign � Canopy � Fence � Raze j
Zoning R-2 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 � Floating Slab � Pier � Other
0 Concrete Block � Post � Treated Wood __ _
Occupancy Permit Occupancy Fee $0.00 Flood Pfain Height Permit
Park Dedication _ _ #Dwelling Units 0 #Structures 0
Use/Nature 'SFR/adding a bathroom in attic/adding walls to make a bathroom/all work will meet state and local codes/firestopping will be per
of Work �Icode/separate plumbing and electrical permits are required
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HVAC Contractor _ __ _ Plumbing Contractor
Electric Contractor
Fees: Valuation $500.00 Plan Approval _ $50.00 Permit Fee Paid $37.00 Park Dedication $0.00
Issued By: �'� . Date 03/18/2013 Final/O.P. 00l00/0000
❑ Permit Voided' Parcel Id#0802680000
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 understa d the af entio d i rmation.
Signature Date �^�
AgenUOwner
Address ____ __ _ 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 Checkiist 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 speci�ed 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
� �l�y �f OSlL��SlG Oshkosh,WI 54903-1130
� Phone:(920)236-5050
F�:(920)236-5084
Building Permit Application ����.oshkosh.w�.�s
Project
Address � � � � (�� S � � �
Applicant Owner Contractor Tenant Other(describe)
Owner/ Name �1 ►2, P�✓' Phone �i3 S G '�f�l�
Tenant
Address � � 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 Typ Residential Single Family Residential Duplex Commercial Multifamily Industrial :
Catagory New Addition Alteration
Project i� �,���G 'f— ld� O F �� �'1c� ��o�1f: °���1� • o►�.
Description �
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Mechanical Separate permits will be obtained for the following:
Permits Electrical by Plumbing by Heating by
Value of Job $ �'�,� (Value for materials&labor is req.to ensure consistency in accessing permit fees for all applicants.)
Payment by: Check #��� Cash Permit Fee Account ;
I certify the above information is complete and accurate. Any deviations from the above submitted information may requir�e additional permits
to be obtained. I acknowl e and agree to these terms.
NBITIe: (Please print) Date: � �C/' �(3
Signature: