HomeMy WebLinkAbout0154807-Building (raze home) � CITY OF OSHKOSH No 154807
OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1717 W 7TH AVE ____ Owner 9TH AND 7TH STREET LLC _ _ _ Create Date 03/21/2013
Designer _ _ _ _ Contractor EGBERT EXCAVATING INC
Inspector Nicole Krahn
Category * 161 -Residential Raze ___ _ __ _ _ Plan
Type � Building � Sign � Canopy � Fence � Raze i
Zoning R-1 __ Class of Consh
____ 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
� Concrete Block � Post � Treated Wood ___ ___
Occupancy Permit _ _ Occupancy Fee $0.00 Flood Plain Height Permit
Park Dedication #Dwelling Units __ 0 #Structures 0
Use/Nature SFR/razing building --- -—---- --- ---
of Work
i 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: �t^– � Date 03/21/2013
_ Final/O.P. 00/00/0000
❑ Permit Voided Parcel Id#0613040000
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 pertorm 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 a rovals before starting such activity.
I have read and u r and the af ntion nformation.
Signature Date � � [ �
AgenUOwner
Address PO BOX 462 _ GREEN LAKE WI 54941 - 0000 Telephone Number 920-294-6668
* 161-Residential Raze 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
City of OS���S� Oshkosh,WI 54903-1130
� Phone: (920)236-5050
Fax: (920)236-5084
Building Permit Application ��ci.oshkosh.wi.�s
Project
Address
Applicant Owner Contractor Tenant Other(describe)
Owner/ Name C (� S ��( ti� Phone
Tenant �s'
Address�� j � (,�• � 1'f} iQ�J� Email
Contractor Company Name ., Phone G� �f'- ����
Contact Email ��lQ� 6,CG„� CZE�� �7� :
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Address�l.3 �J J� ,��/J C.✓\- �it.f�t°� �r��-� �t,/p
State Credential#'s , ,
Dwelling Contractor Qualifier# Dwelling Contractor# Building Contractor Registration#
Achitect/ Company Name Phone
Designer
Contact Email
Address
Permit Type esidential Single Family Residential Duplex Commercial Multifamily Industrial
Catagory New Addition Alteration :
Project ��, � _ C
Description � �'
Mechanical Separate permits will be obtained for the following:
Permits Electrical by Plumbing by Heating by
Value of Job $ �PO O �G alue for materials&labor is re to ensure consistenc in accessin
N q• y g permit fees for all applicants.)
Payment by: Check # Cash Permit Fee Account
I certify the above inforn:atiaz is con:plete and accu�•ate. Any deviations from the above submitted infornsation may requir�e additional pernaits
to be obtained. I acxnowledge and agree to these terms.
Name: ,�/�j(���� ��� �`�, � (Please print) Date: �� � `-� l�
Signature: � �