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� CITY OF OSHKOSH No 156283
�
OSHKOSH COMMERCIAL BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1130 N WESTFIELD ST Create Date 06/18/2013
Project Addition _ Project Number 20130499
Owner EVERGREEN MANOR INC Plan AA3-3794-0613
Contractor MIRON CONSTRUCTION CO INC
Inspector Nicole Krahn
Designer
Category 219-Addition Hospitals&Institutions Type of Plan Alt. Level 2
Zoning R-1 Square Footage 3376
Major Occ 1-2 Nursing Home Const Class Type VA
Fire Protection � Sprinkled 0 Unsprinkled � Sprinkler Design NFPA 13
Occupancy Permit Not Required Flood Plain No Height Permit Not Required
Park Dedication Not Required #Dwelling Units 0 #Structures 0
❑ Projection � Canopies Signs
Use/Nature
of Work
OMM/Evergreen Retirement Community/The addition of two resident rooms and general interior remodeling of Creekview South households 5 and �
. "check#388690 '
HVAC Contractor UNKNOWN??? Plumbing Contractor JIM'S PLUMBING&HEATING INC
Electric Contractor BEEZ ELECTRIC INC
Fees: Valuation $512,293.00 Plan Approval $0.00 Permit Fee Paid $1,886.00 Park Dedication $0.00
Issued By: ��� Date 06/19/2013 Final/O.P. 00/00/0000
❑ Permit Voided � Parcel Id# 1608640000
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.
1 have read and understand th afore mentioned information.
Signature Date (O � �/�3
AgenUOwner
Address PO BOX 509 NEENAH WI 54957 - 0509 Telephone Number 920-969-7000
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
� Cit,of Oshkosh Oshkosh,WI 54903-1130
� Phone:(920)236-5050
Fax:(920)236-5084
Building Permit Application w�•ci.oshkosh.W�.�s
Project
Address 1130 N. Westfield Street, Oshkosh, WI 54902
Applicant Owner Contractor Tenant Other(describe)
Owner/ Name Evergreen Retirement Community Phone 920.233.2340
Tenant
Address 1130 N. Westfield Street, Oshkosh, WI 54902 Email
Contractor Company Name Mlt'Ot1 COnStfUCtlOn CO, InC. Phone 920.969.7086
Contact Jen Mason Email len.mason�a miron-construction
Address 1471 McMahon Drive, PO Box 509, Neenah, WI 54957
State Credential#'s , ,
Dwelling Contractor Qualifier# Dwelling Contractor# Building Contractor Registration#
Achitect/ Company Name a J AI'ChlteCtUr2 Phone 414.431.3131
Designer
Contact Steve Ketterhagen Email spkett@agarch.com
Address 1414 Underwood Ave, Suite 301, Wauwatosa, WI 53213-2653
Permit Type Residential Single Family Residential Duplex ommercia Multifamily Industrial
Catagory New Addition teratio�
Project Addition of two resident rooms and general interior renovation of Creekview South
vescriPtion ouse o s a vergreen e iremen ommuni y.
Mechanical Separate permits will be obtained for the following:
Permits Electrical b TBD
y Beez Electric Plumbing by Jims Plumbing Heating by
Value of dob 512,293
$ (Value for materials&labor is req.to ensure consistency in accessing permit fees for all applicants.)
Payment by: Check # ,38$(o� Cash Permit Fee Account
I certify the above rnformation is complete nnd accurate. Any deviatrons from the�bove si�bmitted inf'ormation may regi�rre ac/ditrona!perrnrts �
�o be obtained. I acknowledge and ngree ro these terms. ��
Name: Jen Mason, Miron Construction (Pleaseprint) Date: 6/�g/2013
Signatur :