HomeMy WebLinkAbout2013-Building (fill lot to grade) � CITY OF OSHKOSH No �s�oso
OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1721 S MAIN ST Owner GORDON KARGUS REV TRUST Create Date 08/07/2013
Designer Contractor OWNER
Inspector John Zarate
Category 256-Residential Driveway Plan
Type � Building � Sign � Canopy � Fence � Raze !
Zoning R-4 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 Biock � Post � Treated Wood
Occupancy Permit Occupancy Fee $0.00 Flood Plain Height Permit
Park Dedication #Dwelling Units 0 #Structures 0
Use/Nature SFR/fill lot to grade
of Work
*ck#3411"
I
I
HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $1,000.00 Plan Approval $0.00 Permit Fee Paid $37.00 Park Dedication $0.00
Issued By: jlr- Date 08/07/2013 Final/O.P. 00/00/0000
❑ Permit Voided� Parcel Id# 1400180100
Cautionarv Statement to Owners Obtaininq Buildinq Permits
101.65(1 r)of the Wisconsin Statutes requires municipalities that enforce the Uniform Dwelling Code to provide an owner who applies for a
building permit with a statement advising the owner that
If the owner hires a contractor to perform work under the building permit and the contractor is not bonded or insured as required under
s. 101.654(2)(a),the following consequences might occur:
(a)The Owner may be held liable for any bodily injury to or death of others or for any damage to the property of others that arises out of
the work performed under the building permit or that is caused by any negligence by the contractor that occurs in connection with the
work performed under the building permit.
(b)The Owner may not be able to collect from the contractor damages for any loss sustained by the owner because of a violation by the
contractor of the one and two family dwelling code or an ordinance enacted under sub.(1)(a),because of any bodily injury to or
death of others or damage to the property of others that arise out of the work performed under the building permit or because of any
bodily injury to or death of others of damage to the property of others that is caused by any negligence by the contractor that occurs
in connection with the work performed under the building permit.
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 und stand the aforem tioned information.
Signature ��j,,�,����'�(,{,(�,(�sl � � '7=�,7 Date ^ � '—'
AgenUOwner
Address 1721 S MAIN ST OSHKOSH WI 54902 - 6980 Telephone Number
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
C'lt'y �f OSI��OS� Oshkosh,WI 54903-1130
� Phone:(920)236-5050
Fax:(920)236-5084
Building Permit Application WWWci.oshkosh.w;.us
Project r �
Address ! � (�� � /�����h c7
—�
Applicant Owner Contractor Tenant Other(describe) � �1�t-�nv
Owner/ Name ��'✓6��� ��Q (�� fr�' Phone y��O - O 9� 3
Tenant
Address �a� � °��1" �'( �`l �r Email
Contractor Company Name � � Phone
Contact Email
Address
State Credential#'s , ,
Dwelling Contractor Qualifier# Dwelling Contractor# Building Contractor Registration#
Achitect/ Company Name Phone
Designer
Contact Email
Address
Permit Type Residential Single Family Residential Duplex Commercial Multifamily Industrial :
Catagory New Addition Alteration
Project .�l �,�, � �� � � N Gt-C,��
Description
Mechanical Separate permits will be obtained for the following:
Permits Electrical by Plumbing by Heating by
Value of Job p n�
$ � ,(�D (Value for 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 fro�n the above submitted information may requi�•e additional permits
to be ob ined. I acknowledge and agree to these terms.
Name: ,/� C17 py/ �� (Please print) Date:� r � —< ?j
Signature:���-��
-splupueis juojucjaal
5�P' ulim aauapioaaz to polonrlsuoo pue paluamajdwi oq Begs sainsuau joaluoo uo!so o 11y
T : d,J,V pagsriqulsa sc uorlula90n aouo aauadljjs anoura�j L
-mo.rr,paq.ntlsjp 111,,gojnur pnu pang .9
peoZj 0jjjaxju17 tZ8Z:ssoappV posdol puwdsa7l S
�OhN; 8085 9Zt:auoget Tpf )( r r,,u ) ,rj I Y.e� " n `llyItodutj 17
'0111 r��rtilunuoxg3snoTjdjDf: pudgua)jougjjelsul £
clouslucO d)pols pelu jjosdol dj.TlS Z
'uogoalo.id lajuj puu aouojljjs jjulscg j
�10"l L 9y�jlld r .,... aouan a uajlonxjsuo
urt N 141110S I ZL I',ssag)pv
£560-'9Zt:auotC T satau ZL[' ljos OOS`L a n sn9 u}j uopioO p q iisjp aq of uazV
:.toumo salau Zt• gbs 8S£181 uaxu'aljs p0j,
6L70 SCZ(OM)2NONr3:-1bD
00617S Ursuo)sIM yso)ILISO 2£3Z)ro;l CA d
aNV1 GHif OMR03TM,°`7M
t � t
n
- ���;rl,�t'tuPctrd sl 'N
,Kluopoolo.i�3tolul`"`
YYi'NMy-�,•...
V ad61,uo11oatoiJloluI S,
ped uv�lom.ry 1
qpq pagmlbgQ
6 t'
�e
•sµ'4ara±p-uh4ganYpr aaouj arsnollud ageduaap NJ Sim ulequleru
psilm7,pjjosmulutoorl.I t,Iaanldpul3p)ge.sa3
i w p)Jeuu¢.dp sognlna.ud y,Jr°1¢un 4sya"ap ap£a6d 51111 snta 849.;eloN
�Ia i
S 9016'377"E52
Vi jG' °JAY, W.7t 1S lAr1Ml�7P1C1(}'7 AtUlf10:7
� aN7.41t(I3.J I�2+,'1:131i Jklr .k 1114u"3F1'1lt)
9A91150 7 666
r�r
° t�
a LL
I �' „ � 4;�.L`I3£Id3MflStlIIN�G17C121C1��2121047711N1d����I )�
�i)Uhl � tlA`y 2x�nl vosst sunruraM
aoocaas
�JTYIdSE.I-l
Iu� �y 9a 930�I� c� NUtYUd_Y CtLY I{ W.......,,...�..... ,....m�,.e.,.............. .........�.,....m.,�.....e.,..ti
irmrma.�r,;e:r,ps
L(1�V , —� � GPtY� zc,Iagwar)osli P1S.@�'OA�!Sy(15
� 0 �s3d0bil'3"U�_� � C600Zp6 c7-£r14V V�3A6'9.11illfYO0t3
mCs,Nd9nCFs 00000WO#6 'G;!1£'p'V°1d6N1MWd
.°ausau asd' 'n r Q l t,' � I shunt-AOU srl0arri}3 k3 uoq))o;, N01 u11 ns
CSISNC)JSiN1'AV.q^9GT ;D0O1VG=1!gN1tlfl"i1.44,'jNHSO
JO,UIO'U?JVAA"1,123P.MOA':1tSPJ'NR61'97.H®IU07I.S"pb'NO4A3V�ANJO£101HBNNi1MOO1,HC67@,ar001
VOOHAO SG=-�-D 1 j°O 1-33 H.S19:1M AdN OO O!YVU3N1vI PA DHI NI 001199,L:d'SPIP'IN 1INdtNf1OOCI NI OIONOSZM
sv)'si,AvAhWOml- 60-10-sadkf69NIAA1
._._._....„. ...._.._..._..�......t `6ifS;d�..:HOM:^U.0,11 cMV 111, 11-31n'0C IOl•.Jo 1-Iv,,a 1VH1 eNIJO
L' (£Jo 4 TWd rc; G � . I (