HomeMy WebLinkAbout2013-Building (kitchen remodel) � CITY OF OSHKOSH No 157123
OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 360 ROSALIA ST Owner SECRETARY OF HOUSING 8�URBAN DEVELOP Create Date 08/08/2013
Designer Contractor HIGH FIVE LLC
Inspector John Zarate
Category * 140-Interior Remodeling Plan
Type � Building � Sign � Canopy � Fence � Raze _J
Zoning R-2 Class of Const: Size
UnFnished/Basement Sq.Ft. Rooms Height Ft. ❑ Projection
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 $�.00 Flood Plain Height Permit
Park Dedication #Dwelling Units 0 #Structures 0
Use/Nature SFR/interior kitchen remodel to include new cabinets,countertops/close in an existing window that is cracked and damaged/electrical '
of Work and plumbing require separate permits/all work will meet state and local codes/reroof house also included in permit
HVAC Contractor _ __ Plumbing Contractor
Electric Contractor
Fees: Valuation $16,000.00 Plan Approval $0.00 Pertnit Fee Paid $136.00 Park Dedication $0.00
Issued By: � .�� Date 08/08/2013 FinallO.P. 00/00/0000
� Permit Voided�I Parcel Id#0203900000
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 wi an easement,the City strongly urges the permit applicant to contact the easement
holder(s)and to secure a,n�necess ap rovals before starting such activity.
I have read arid unde,c�t�nd the af re men'oned information.
Signature —�,sz�� Date U ' �" ��
�,� _ AgenVOwner
Address 1050 VANDERMPZZEN _ GREENVILLE WI 54942 - 0000 Telephone Number 920-841-0114
* 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 236-5728 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 speci�ed 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 OSl L�OS� Oshkosh,Wi 54903-1130
� Phone:(920)236-5050
Fax:(920)236-5084
Building Permit Application wWW���.oshkosh.w�.us
Project �/ � �������,� ��
Address ��
Applicant Owner Contractor Tenant Other(describe)
Owner/ Name � O��'1� �w� C�- Phone
Tenant
Address �.G ��✓��� � � • Email
Contractor Company Name i � J�_ �-� �- � Phone ��6 �`"L � �U��
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State Credential #'s � Z Z s,3�� , 1 2 Z��S� , t �=-��i 5��3
Dwelling Contractor Qualifier# Dwelling Contractor# Building Contractor Registration#
Achitect/ Company Name Phone
Designer
Contact Email
Address __..____. -
Permit Type 12esidential Single Fau�� Resi�iential Duplex Commercial Multifamily Industrial
Catagory New Addition teration,
Project (/vlpvCt. G� l�� > G'1�-fU G f
Description � _
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Mechanical Separate permit�ill be obtained for the following:r_
Permits Electrical by � i � Plumbing by ,,� 6 Heating by
Value of Job }�
$ � , ���/ (Value for materials&labor is req.to ensure consistency in accessing permit fees for all applicants.)
Payment by: Check # Cash Permit Fee Account
1 certify the above informati n is ntplete and accuraie. Any deviateons from the above subntitted information may require addiiional permits
to be obtai �acknowle ge an agree to these terms. �l
Name: �.- (Please print) Date: U � � L ✓
Signature: % C.�� �
Company Information Sheet
All information after bold categories must be provided,if pertaining to your company.
Date: X " �� � �
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Company Name: j T (.�°'�° C�.-L�
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Company Address:_ l_�3'� \ )�� .�c-��°u�n
C�tY� �� `''��V`I. I,�.-C� State:_�� Zip Code: ��,�. ���
M8111�19 AddT@SS(tfdiiferemfrom above):
C�tY� State: Zip Code:
Point of Contact: L�-�. �� Y �' 1��� Title:���j,n..�'(�
Company Telephone Number:_��� �� � {- C� �� `i' Ext.
Company Fax Number:_( ) E�,
E-Mai! Addresses(�faya��an�e):
Name Address
Mobile/Pager Num6ers ��ra�a��ab�e�:
Name IVumber
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State License/Certificate #: Expires:
(8uilding Contractors Only�
State Dwelting Contractor Qualifiert#: Expires:
State Dwelling Contractor Certification#: Expires: