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� CITY OF OSHKOSH No 156230 �
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OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER -
Job Address 403 W 15TH AVE Owner KELLI N KOSSEL Create Date 06/17/2013 `
Designer Contractor HICKEY ROOFING
Inspector John Zarate �
Category 041 -Residential Roofing 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 � Pier 0 Other
� Concrete Block 0 Post 0 Treated Wood ---
Occupancy Permit Occupancy Fee $0.00 Flood Plain Height Permit
Park Dedication #Dwelling Units 0 #Structures 0
UselNature SFR/tear off and re-roof house �
of Work ; ;
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HVAC Contractor Plumbing Contractor
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Electric Contractor
Fees: Valuation $11,250.00 Plan Approval $0.00 Permit Fee Paid $112.00 Park Dedication $0.00
Issued By: �f�►. Date O6/17/2013 Final/O.P. 00/00/0000 ;
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� Permit Voided I� Parcel Id#0907600000 �
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
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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 E
AgenUOwner
Address 1427 BROAD ST OSHKOSH WI 54901 - 3047 Telephone Number (920)426-4008 g
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 1713 08:21a Hickey Roofing Inc 920-232-0354 p.2 �
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Cin•of Oshkosh �
Inspection Services Division �
P O Box 1130
Oshkosh,R�I 549U3-1130 O "HKa H
Phone:(920)236-5050
Fax:(920)236-5084 0�r�.=l•.�nTFR
Roofing & Siding Permit Application
• Application(s}and fee(s)can be brought to City Hall,Room 205 or mailed to Inspection Services;PO Box l 128,
Oshkosh Wl 54903-1128. Commencing work without permit(s)will result in fees being doub�ed or�i00.00 plus the
normal permii fee. which ever is greater.
OR
1 ou are cr contractor artici atire in !he Pernri ee Account S stem and hdve ade uate unds. check here
i ou want this roce�sed throu h vour accouni
JOB.4DDRESS �6 3 G�-�� fS�� k��
OR'NER U'S���
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CO�TIt4CTOR Cr I �
I am the: O Owner OR C�ntractor
�1SE CATEGORY
�ingle Famih� ❑Duplex ❑Multi-Family ❑Rental ❑Commeroial ❑]ndustrial
Work being done:
ROOFING
�Tesr ot7and replace existing roofing ony�house,�garage
❑Repiane wood decking
❑Add l layer of roofing to Ehe existing layer(s)on D house,0 eaz�c
This wor�is being dos�e due to O Hail Damage ❑Other
SIDL'�1G
❑install siding on ❑house. ❑�araSe
❑Replacing vinyl with vinyl
❑Repfacing sbeel or aluminum�vith vinyl(circle steel or aluminum)
�Replacing with
This work is being done due to❑Hait Damage ❑Other
When siding is done,one of the boxes below must be checked:
1) ❑E1eGric—E�tisring Electric h9eter,receptacle,fighting and Elecuic Service entrance alterations'modi Fcations are being perf'ormed
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AND �Elecaic fr�stallation Veri6cadon form is attached OR ❑Separate Elect Qermit wi[t be requestc�
2) ❑Electric—Not Applicable because: '_l J Blocks previously installed. '�No oWside lights. ,-Other
O Iustall new or O Replace gidters
❑Insisll new or O Replace downspouts
Otber related v��ork being done: (please note)
Value of the job $ I� �� � _ (include fair market price for labor e��en ifyou are not paying for labor) 03/02