HomeMy WebLinkAbout0154803-Building (raze duplex) � CITY OF OSHKOSH No 154803
OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1728 W 9TH AVE Owner 9TH AND 7TH STREET LLC Create Date 03/21/2013
Designer _ Contractor EGBERT EXCAVATING INC
Inspector I�I Nicole Krahn , ,
Category *z''@�-Raze Structure(s)-Oen�re� _ Plan
Type � Building � Sign � Canopy � Fence � Raze ,
Zoning C-1 Class of Const:
Size
Unfinished/Basement __ Sq.Ft. Rooms Height Ft. � Projection I
Finished/Living __ Sq.Ft. Bedrooms Stories Canopies
Garage _ Sq.Ft. Baths _ Signs
Foundation � Poured Concrete � Floating Slab � Pier � Other
� Concrete Block � Post � Treated Wood
Occupancy Permit _ Occupancy Fee _ $0.00 Flood Plain Height Permit
Park Dedication _ #Dwelling Units 0 #Structures 0
Use/Nature !@6faTfttl/raze building — -- —
of Work �ple x
i
,
HVAC Contractor _ ___ Plumbing Contractor
Electric Contractor
Fees: Valuation _ $5,000.00 Plan Approval _ $0.00 Permit Fee Paid $65.00 Park Dedication $0.00 :
Issued By: �� Date 03/21/2013 Final/O.P. 00/00/0000
❑ Permit Voided Parcel Id#0613020000
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 and u rstand the afore ntion information.
Signature Date �'�`' �
AgenUOwner :
Address PO BOX 462 _ _ GREEN LAKE WI 54941 - 0000 Telephone Number 920-294-6668
* 285-Raze Structure(s)-Commercial 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 additio�al 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
C'lty Of OS!L��S!L Oshkosh,WI 54903-1130
� Phone: (920)236-5050
Fax: (920)236-5084
Building Permit Application ���I.oshkosh.wi.us
Project
Address
Applicant Owner Contractor Tenant Other(describe)
Owner/ N�e � f� � Phone
Tenant
Address j �).C 6 ' /i di � (�-�. � j"f l, A jj� Email
Contractor Company Name � �- Phone .� C� lf -���g"
Contact Email��(Q _!P � (' ���F���j'u
Address
C�r,�oa ,�� �.�t�.��1�;��, ��o,,,�j�a, "��. ,�E r
�
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 Alteration
Project � �, `�
Description
Mechanical Separate permits will be obtained far the following:
Permits Electrical by Plumbing by Heating by
Value of Job o'�
$_ �(� �� (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 require additiona!permits
to be obtained. I acknowledge and agree to these terms.
Name: (,� ,�7 �CJ (Please print) Date: � Z l^'�
Signature: � ,/�