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� CITY OF OSHKOSH No 154848 `
� j
OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 126 W 12TH AVE Owner 126 W 12TH LLC Create Date 03/26/2013
Designer Contractor SUSTAINABUILD LLC
Inspector Nicole Krahn
Category 041 -Residential Roofing Plan
Type � Building � Sign � Canopy � Fence � Raze �
Zoning R-2 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 0 Treated Wood —
Occupancy Permit Not Required Occupancy Fee $0.00 Flood Plain Height Permit Not Required
Park Dedication Not Required #Dwelling Units 2 #Structures 0
, Use/Nature ear off and re-roof house only. No structrual changes. --�
of Work
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HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $7,200.00 Plan Approval _$0.00 Permit Fee Paid $86.00 Park Dedication $0.00
Issued By: �' Date 03/26/2013 Final/O.P. 00/00/0000
❑ Permit Voided� Parcel Id#0302960000
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 ar�nders nd�e afor� ntionec�information.
Signature �j� � � Date � r� �U/3
AgenUOwner
;
Address 540 E BLACKWOLF AVE OSHKOSH WI 54902 - 9185 Telephone Number 920-420-5020
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
Clty �f OS��OS!L Oshkosh,WI 54903-1130
� Phone: (920)236-5050
Fax: (920)236-5084
Building Permit Application ����.oshkosh.W�.�s
Project �� � (�+„�
Address
Applicant Owner ntractor Tenant Other(describe)
Owner/ N�e ��,�,/ �,t��� r/ Phone ��z�� Z7ti Z�6 E
Tenant
Address 2��� New ►�v��if" �i�� Email
Contractor Company Name �J-5���^� gµ. (iX , �� Phone���� Y ZC'U S�Z�
Contact ���� -����-�� Email
Address ��U � �j/}c�(vv i,�' �Q-✓� ��t�/�v-�l� �✓L S y�id Z
State Credential#'s v��� 3 �� l����s5
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Dwelling Contractor Qualifier# Dwelling Contractor# Building ConVactor Registration#
Achitect/ Company Name Phone '
Designer
Contact Email
Address
Permit Type Residential Single Family esidential Duplex Commercial Multifamily Industrial
Catagory New Addition Alteration
Project R� -���r=��`-�� i /►G�v�, �Z,� � ec�/' c��- v� C'k ,S �. :, �
Description
Mechanical Separate permits will be obtained for the following:
Permits Electrical by Plumbing by Heating by
Value of Job $ 7 2 vU `v� (Value for materials&labor is re .c�to ensure consistency in accessing permit fees for all applicants.)
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Payment by: Check # Cash Permit Fee Account
I certify the above information is complete and accurate. Any deviations from Ihe above submiited information may require additional pennits
to be obtained. I acknowledge and agree to these terms. �
Name: �n_/i� -�L1nE'�� (Pleaseprint) Date: ����Z�/�
Signature: �� � ��L'��