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� CITY OF OSHKOSH No 156127
OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 353 W SOUTH PARK AVE Owner THOMAS J BAIER Create Date O6/12/2013
Designer Contractor REBATH OF CENTRAL WISCONSIN
Inspector John Zarate
Category * 140-Interior Remodeling Plan
Type � Building � Sign � Canopy � Fence � Raze I
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 0 Pier � Other
0 Concrete Block � Post � Treated Wood —
Occupancy Permit Occupancy Fee $0.00 Fiood Plain Height Permit
Park Dedication #Dwelling Units 0 #Structures 0
Use/Nature SFR/Remove and dispose of fiberglass tub and wall. Install showerbase. '
of Work '
""**Debit account*"" °
I
�
HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $6,094.00 Plan Approval $0.00 Permit Fee Paid $79.00 Park Dedication $0.00
Issued By: �� Date 06l12/2013 Final/O.P. 00/00/0000
❑ Permit Voided�� Parcel id#0904140000
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 and understand the afore mentioned information.
Signature Date
AgenUOwner
Address 230 N KOELLER ST OSHKOSH WI 54902 - 4109 Telephone Number (920)303-5797
* 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 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.
Jun, 11, 2013 3: 52PM . . REBATH CENTRAL WI 9203035935 No. 4273 P. 1/1
' "P O�ox 1130
� l..'lty 0�Os•�l�G�s•� Oslilcosh,WT 54903-1130
� Phone:(920)236-5050
Fax:(920)236-5084
�. �uilding Permit Applicataon "'"ry"�"•°snk°9h.,�.°S
�°,���=: 3 5 3 W �-� �a;�1� �� . ���o_.s'h, �1 a D�
Adar�s
Applicant Owner . Conlraclor Tenant Other(describe)
Owoer! Name � ` Z�- Z�J J� �
��rYl �CXI n l.� �G�,I �1� k'hone � �' �J� -
�Tenaat �� � w. �l-1 �W � �1V�.� ��`Email `5 `' . �
Address
5� y a
Contractor Compa�iy Nazne �,( � � '. � � Phone � - � �
Contact �(7_ „ , Email � z �te �'1 (' IY�
Address �0 1J. K e � � ee .o � ►
Staie Credential#'s��a b(p�j � ,1a� �r�9 I ,
Uwelling Coniraaor QualiTier# Dwclling Cono�actor it Building Cunhactor Ite�ictration�l
Achitcct/ Company Name Phone
Designer
Contact Email
Address
Permit Type Residential Single Fanaily Residential Duplex Commercial Mullifamily induslrial
Catagory New Addirion � Alteratipd •
Project . .
Description.'
cU � �� o� �-f I��X {�..�J vv� .,
� �7�� ���I��%�S� .
Mechanical Separate permits wi I I.be obiained for the following: �`c-+-���n (��
. . . . � ��,��•..,
Permits �lectricalby. . � •,Pl�imbingby° d1'?�H�eaiingby
; ;�alae ox Job� $ � O�y � �� �ue for materiaLs&lat�or is
(V req.to ensurc wnsist rmit fees for all applicants.)
Paymeut by: Check �i Cash Permit Fee Account
I certifv the above i,rformaeion is comple�re and accurate. Arry rlevra[in►zc fr�m 11�e above:submiued infor�nation may regun-e vddiuonol permi��
do b iried 1 acbrowle e and agree fo�hese�erms.
Naiue: 1� � (p�ea,�pr;r�t) Date: U�/ I I �
Signature_