HomeMy WebLinkAbout2013-Building (excavate 4 walls) � CITY OF OSHKOSH No 156126
OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1719 ROOSEVELT AVE Owner LORRAINE WOMASKI Create Date 06/12/2013
Designer Contractor AREA WATERPROOFING 8 CONCRETE
Inspector Tom Spierowski
Category * 140-Interior Remodeling Plan
Type � Building � Sign 0 Canopy � Fence � Raze !
Zoning R-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 ,RES!Excavate 4 walls, reinforce walls,seal walls with hydro rubber,add 1"foam,backfill, new drain tile. All construction shall comply
of Work with State and local building codes.
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HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $15,880.00 Plan Approval $0.00 Permit Fee Paid $136.00 Park Dedication $0.00
Issued By: Date 06/12/2013 Final/O.P. 00/00/0000
❑ Permit Voided I Parcel Id# 1212990000
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 enf easement restrictions of which it is not a party,if you perform the work
described in this permit application within ease nt,the City strongly urges the permit applicant to contact the easement
holder(s)and to secu any necessa approval efore starting such activity.
I have read u rstand af� ion .
Signature Date ������� '
i
A enUOwner
Address 4120 SANDPIT RD Oshkosh WI 54904 - 0000 Telephone Number 229-0926
* 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 Environmentai 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
� �'lt � �SlL�OSl� Oshkosh,WI 54903-1130
y ,f Phone:(920)236-5050
� F�: (920)236-5084
Building Permit Application �'�'�'•ci.oshkosh.wi.us
Project
Address
Applicant Owner Contractor Tenant Other(describe)
Owner/ Name6<.�t,JJ ��fiG� `� Phone ��� �l�J -U(S�
Tenant
Address t� �Q Rc�c�S�(��(� S Cg Email
Contractor Company Name � t,�,;h��,v� ,�:� � Phone �i•Z:�--z�`� -vq Z6
Contact q-�,t, -- '�,Lq._c a'ZC Email
Address �/?� ���- � '� �-ri— �t�-,Le3S/� %.t�' .��-�i�'/�Xi�
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 � 1� � o ^ '
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Description " �
Mechanical Separate permits will be obtained for the following:
Permits Electrical by Plumbing by Heating by
Value of Job $ 's, g� �� (Value for materials&labor is req.to ensure consistency in accessing permit fees for all applicants.)
Payment by: Check # '�p� Cash Permit Fee Account
I certify the above information is complete and accurate. Any deviations from the above submitted information may require additional permits
to be obtained. I acknowledge and agree to these terms.
Name: !�-� � / (Please print) Date: C-/zr l3
,
Signature: � il/