HomeMy WebLinkAbout0156304-Building (bathroom remodel) �
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� CITY OF OSHKOSH No 156304 �
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OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 919 EVANS ST Owner DAVID/NANCY TOMASCHEFSKI Create Date 06/20/2013
Designer Contractor REBATH OF CENTRAL WISCONSIN
Inspector John Zarate �
Category * 140-Interior Remodeling Plan
Type � Building 0 Sign � Canopy � Fence � Raze j
Zoning R-1 Class of Const: Size
Un£nished/Basement Sq.Ft. Rooms Height Ft. ❑ Projection ��
Finished/Living Sq.Ft. Bedrooms Stories Canopies
Garage Sq.Ft. Baths Signs
Foundation � Poured Concrete � Floating Slab 0 Pier � Other
� Concrete Block � Post 0 Treated Wood
Occupancy Permit Occupancy Fee $0.00 Flood Plain Height Permit
Park Dedication #Dwelling Units 0 #Structures 0
Use/Nature SFR/removal of tub to install shower
of Work
"'debit accY"'
HVAC Contractor Plumbing Contractor
Electric Contractor
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Fees: Valuation $6,728.00 Plan Approval $0.00 Permit Fee Paid $79.00 Park Dedication $0.00
issued By: �TLy, Date 06/20/2013 Final/O.P. 00/00l0000
❑ Permit Voided i� Parcel Id# 1106610000
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 Checkiist at http://dnr.wi.gov/org/aw/wm/publications/anewpub/WA651.pdf
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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. 19. 2013 5: 06PM REBATH CENTRAL WI 9203035935 No, 4295 P, 2/3 � �
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, /. • • • ' 1'O Box 1130
:. � CZ� . O , O.S��Q.S� • : . � Oshkosh,WI.54903-1130 .
� � , Phone:(920)?36-5050
� • • . Fax: 3
(9 0)236-5084
Building Per�it A,pplication� �.«.°��°5�,�'��
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�A�c3dress. .
Applicant Owner Contractor 7'enant Other(describe)
Owner-1 '� c{��t �
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State Credeniisl#'s i�a_(�(p,� � � , o� �
• DwcllingContractorQualifier# AvJelli�gContractor# BWId[T]g(„Q[]U$CEOCjZCpLSIfy�l011�
Achitect/ Company Name Phone
Desibner
Contact ' �m��
Address
Permit x'ype Resideniial Si»gle Family Residential Duplex Commercial Mul.tifamiIy Industrial
Catagory New Addition ' Alteration �
�roject
Ae�cripfion.` -
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�Sf�lt��� :� ( ; � � laCe�� _
Mechaaicai Sep�ate�crnuts will'be'obtained for ihe foIlowing: ' '
Permits .: ,. ' �
El��i�a1 liy.� . Pl�bing.by HeatinD by ;
` �;Value=of,�o6; $ �. v�
(Valuc for materials&labor is req,to ens�consist rmii fccs for all applicauts)
� Payment by: Check �! Cash Permit Fee Account
I co2ify the above i,�ormatlon is complele ared accurate_ A►ry rleviatiorrsfrom 1he above submilred 1►ijormatio mcry r guve addi[iona/pernrils
to be ' ed. !r�cknowle ge arrd agree io these�erms. •
Name� �� (Picasc print) .. . Date•, � �� � .
Signatwe: � .
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