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� CITY OF OSHKOSH No 157486
OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 805 W PACKER AVE Owner JENNIFER L DALY IRREV TRUST Create Date 08/30/2013
Designer Contractor BRU NICK BUILDERS
Inspector John Zarate
Category * 140-Interior Remodeling Plan
Type � Building � Sign � Canopy � Fence 0 Raze
Zoning R-2 Class of Const:
Size
Unfinished/Basement _ Sq.Ft. Rooms Height Ft. � Projection j
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 SFR/frame walls for new bathroom in basement
of Work
"'ck#1702"
i
HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $1,400.00 Plan Approval $50.00 Permit Fee Paid $37.00 Park Dedication $0.00
Issued By: ���� Date 08/30/2013 Final/O.P. 00/00/0000
❑ Permit Voided� Parcel Id# 1219742200
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 an necessary approvals before starting such activity.
I have read and ders n the afo tion rmation.
Signature - Date '- ��'
genUOwner
Address 1335 WINNEBAGO AVE OSHKOSH WI 54901 - 5334 Telephone Number (920)426-4359
* 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.
P O Box 1130
� City of O.S���S!L Oshkosh,WI 54903-1130
� Phone:(920)236-5050
Fax:(920)236-5084
Building Permit Application w����.oshkosh.W;.�s
Project ���� ��) ���_ �i��
Address l�r� ���
Applicant Owner Contractor Tenant Other(describe)
Owner/ Name Phone
Tenant
Address Email
Contractor Company Name � � C� �� Phone�v� �lC� - l�a�
Contact 'l Email f����j�lly��i���" �t
Address ��� /2�r � - l�, �'f � � :
State Credential#'s ���
� ,
Dwelling Contractor Qualifier# Dwelling Contractor# Building Contractor Registration#
Achitect/ Company Name Phone
Designer
Contact Email �
Addr
Permit Type Residential Single Family Residential Duplex Commercial Multifamily Industrial ,
Catagory New Addition Iteration
Project ;
Description
Mechanical Separate permits will be obtained far the following:
Permits Electrical by � Plumbing by ��t�'l���2 Heating by
Value of Job
$ �y� (Value far materials&labor is req.to ensure consistency in accessing permit fees for all applicants.)
Payment by: Check # Cash Permit Fee Account
I certify the above information is complete and accurate. Any deviations from the above subn:itted information may require additional perrnits
to be obt ' ed. I ac wl nd agree to these terms. �
Nanle: ease print) Date: � �l �
Signature: �