HomeMy WebLinkAbout0154978 - Building CITY OF OSHKOSH No 154978
OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD
ON THE WATER
Job Address 1218 WINNEBAGO AVE Owner HABITAT FOR HUMANITY OF OSHKOSH Create Date 04/04/2013
Designer Contractor HABITAT FOR HUMANITY OF OSHKOSH INC
Inspector John Zarate
Category 110-New Single Family Plan
Type • Building 0 Sign 0 Canopy 0 Fence 0 Raze
Zoning R-2 Class of Const: 8
Size
Unfinished/Basement 640 Sq.Ft. Rooms 6 Height 24 Ft. ❑ Projection
Finished/Living 1280 Sq.Ft. Bedrooms 4 Stories 2 Canopies
Garage 0 Sq.Ft. Baths 2 Signs
Foundation • Poured Concrete 0 Floating Slab 0 Pier 0 Other
0 Concrete Block 0 Post 0 Treated Wood
Occupancy Permit Required Occupancy Fee $0.00 Flood Plain Height Permit
Park Dedication Not Required #Dwelling Units 1 #Structures 1
Use/Nature FNSFR/New Single Family*2 story home,parking area and concrete driveway.
of Work
HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation$92 95.00 Plan Approval $75.00 Permit Fee Paid $420.60 Park Dedication $0.00
Issued By: �,,,,,,_ Date 04/08/2013 Final/O.P. 00/00/0000
❑ Permit Voided i Parcel Id#0203570000
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 ph ation within n easement,the City strongly urges the permit applicant to contact the easement
holder(s)and to s cure any necessary a royals before starting such activity.
I have read and urrierstnd the afore m tioned information.
/
Signature ( I /- / Date y(/i / /3
1 / Agent/Owner
r
Address PO BOX 2692 OSHKOSH WI 54903 - 0000 Telephone Number 235-3535
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.
Wisconsin Department of Industry, WISCONSIN UNIFORM Application No.
Labor and Human Relations
Safety and Buildings Division BUILDING PERMIT 0154978
P.O. Box 2509 APPLICATION Parcel No.
Madison,WI 53701-2509
Wisconsin Statues 101.63, 101.73
AOtAmilfirtEcgiEsTED,g ❑ Constr ❑ HVAC ❑ Elec ❑ Plbg Q Erosion ❑ Other:
Owner's Name Mailing Address Telephone No
HABITAT FOR HUMANITY OF OSH PO BOX 2692 OSHKOSH WI 54903- 2692
Contractor:U Con❑ Elec❑ HVAC Li Plbg Lic/Cert# Mailing Address Telephone No.
HABITAT FOR HUMANITY OF OSHKOSH INC 1050156 PO BOX 2692 OSHKOSH WI 54903- 0 235-3535
Dwelling Contr.Qualifier Lic/Cert# The Dwelling Contr. Qualifier shall be an owner,CEO,COB or employee of
DAVID NACZEK 1107976 Dwelling Contr.
Contractor: ❑ Con ❑ Elec❑ HVAC❑ Plbg Lic/Cert# Mailing Address Telephone No.
Contractor: Li Con Li ElecH HVAC U Plbg Lic/Cert# Mailing Address Telephone No.
Contractor:H Con H Elec U HVAC Li Plbg Lic/Cert# Mailing Address Telephone No.
4 Lot Area
,Ft3 :>'�®C1TI0N Sq.ft. 1/4, 1/4,Section ,T N,R E(or)W
Building Address Subdivision Name Lot No. Block No
1218 WINNEBAGO AVE
Zoning District(s) Zoning Permit No. Front Rear Left Right
I I i
s - ' 424 e. i 21C+1 IV CLAMMY ,;el+ • ;ELEICTRIcAL II;' 9:NY•C'EQUIPMENT '',ONO'',2 ENERGY''MACE . '
Q New . �s®a
❑ Repair Q Single Family Entrance Panel Q Forced Air Furnace Nat. L.P. Oil Elec. Solid Sola
❑ Alteration Two Family Fuel
Altti ❑ Raze — T Fil y Size: amp❑ Radiant Baseboard or Panel Gas
❑ Addition Garage Service: ❑ Heat Pump Space Htg Q ❑ ❑ ❑ ❑ ❑
❑ Move ❑ Other(print): Q Overhead
❑ Boiler Water Htg Q ❑ ❑ ❑ ❑ ❑
Other: ❑ Underground
❑ Q Central Air Conditioning •U Dwelling; g unit will have 3 kilowatt or
,4:GONS`T�1T1(PE 7 'FQUNDAT►QN°' Other more installed electric space heating equip.
r' 9:4 m I>t/sI vo' i Q Site Constructed 12 Concrete d-RAJA/7B1NG ;�:' Infiltration control o tion•is:Q •Full sealin
Unfinished ❑ Manufactured ❑ Masonry Sewer of joints. option sealing
❑ Treated Wood 1 ❑ Blower door test. ❑ Exterior
Basement 640 Sq.ft. -:STORIES; , Q Municipal air infiltration barrier.
❑ Other
Living Area 1280 Sq.ft. 1-Story El Septic
$.'.HST LOSS Calculated :
❑✓ 2-Story ' .A. Permit No Envelope 22299 BTU/HR
Garage 0 Sq.ft. ❑ Other ❑ Seasonal 4 WATER v S'Siss+ t Infiltration 11750 BTU/HR
0 Permanent 0 Municipal Utility ...14:EST.:SUILOINGOOST
Q Plus Basement ❑ Other ❑ Private On-Site Well 113000
I agree to comply with all applicable codes,statutes and ordinances and with the conditions of this permit;understand that the issuance of the permit creates no legal liability,
express or implied,on the state or municipality;and certify that all the above information is accurate.If one acre or more soil will be disturbeb,I understand that this
project is subject to ch.NR 151 regarding additional erosion control and stormwater management.I expressly grant the building inspector,or the inspector's authorized agent,
permission to enter the premises for which this permit is ou ht at all reasonabl'hours and for any proper purpose to inspect the work which is being done.
❑ I vouch that I am or will be an owner-oc pan of tlIis dwelling for ich I am applying for an erosion control or construction permit without a Dwelling
Contractor Certification and have read the cauti na atment regarding ••ntr- r responsibility on the Building Permit Application. / /
APPLICANTS SIGNATURE p 'II DATE SIGNED `f( Y.( I,
APPROVAL CONDITIONS This p rmit is issued pursuant t. • e following conditions. Failure to comply may result in suspension or
revocation f this permit or other penalty
See attached signed and dated"Standard Conditions of Approval"sheet
N *'004 ❑ Town Village City County Municipality Number of Dwelling Location:
� � * ❑ 9 0 Y ❑ Y ❑ State of: p ty 9
alb City Of Oshkosh 7 0 - 2 6 6
Plan Review $75.00 0 Construction
Inspection ❑ HVAC Name JOHN ZARATE
❑ Electrical
Wis. Permit Seal $35.00 ❑ Plumbing Date 4/4/2013
Other Q Erosion
Total $110.00 ❑ 425875 Cert.No. 70330
SBD-5823(R.07/92)