HomeMy WebLinkAbout0154815-Building � � CITY OF OSHKOSH No 154815
OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1013 EVANS ST Owner SONJA A SIMONSON Create Date 03/22/2013
Designer Contractor LEACH BROS.
Inspector John Zarate
Category * 140-Interior Remodeling Ptan
Type � Building � Sign � Canopy � Fence 0 Raze I
Zoning R-1 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 0 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 ,RES/Remodeling the kitchen to include removing a wall and closet. Header specs will be provided at rough-in. Will be using the—�
of Work lexisting cabinets. New countertops and dishwasher. All construction shall comply with State and local codes. i
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HVAC Contractor Plumbing Contractor UNKNOWN
Electric Contractor SECKAR ELECTRIC CO INC
Fees: Valuation $4,0 .00 Plan Approval _ $0.00 Permit Fee Paid _ $58.00 Park Dedication $0.00
Issued By: - Date 03/22/2013 Final/O.P. 00/00/0000
❑ Permit Voided, Parcel Id# 1108480000
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 derstand the afore menf ed information.
Signature � Date 3`" —'��
AgenbOwner
Address 2883 RUSCHFIELD DR _ OSHKOSH WI 54904 - 7404 Telephone Number 235-2225
* 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 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 specifed 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
� �ll,y �f OS G��S G Oshkosh,WI 54903-1130
� �� �L Phone:(920)236-5050
Fax:(920)236-5084
Building Permit Application ����.oshkosh.w�.�s
Project ��13 ,�U�{'�� �
Address
Applicant Owner ontractor Tenant Other(describe)
Owner/ Name���'j �,1.� �i i'1�GYI .so � Phone
Tenant
Address l� �3 � U�h S ,S� Email
Contractor Company Name L�'j CLi ��S C�k � �� Phone �� 7�_��_�
Contact��� ' � !�r`�'-i C� Email ������ro s ���4,.� C�� ;
Address '
State Credential#'s , ,
Dwelling Contractor Qualifier# Dwelling Contractor# Building Contractor Registration#
Achitect/ Company Name Phone
Designer
Contact Email
Address
Permit Type si entia ing e Residential Duplex Commercial Multifamily Industrial
Catagory New Addition Alteration
Project �f�'I� � l/�'r�l � ��7�vF��T� ,� 4� � 1 ✓��i �� �I o Ji d k S f� )
Description
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Mechanical Separate permits will be obtained for the following:
Permits Electrical by S�C�' ✓' Plumbing by ? Heating by `�e.so1-�
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 accu�•ate. Any deviations from the above submitted information may require additional permits
be obtained. 1 acknowledge and agree to these terms.
Name \ L� (Please print) Date: � `p�� � l �
r
Signature: