HomeMy WebLinkAbout0157173-Building � CITY OF OSHKOSH No 157173
OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 3251 MOCKINGBIRD WAY Owner THEODORE A/PAMELA K MILLER Create Date 08/12/2013
Designer Contrector OWNER '
Inspector Nicole Krahn
Category * 140-Interior Remodeling Plan
Type � Building � Sign � Canopy 0 Fence � Raze �
Zoning R-1 Class of Const:
Size
Unfinished/Basement 713 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 $0.00 Flood Plain Height Permit
Park Dedication #Dwelling Units 0 #Structures 0
Use/Nature ISFR/basement remodel to include new 2X4 walls around perimeter of basemenb egress window was already existing/all work will meet
of Work �State and local codes i
�
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HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $4,900.00 Plan Approval $50.00 PermitFee Paid $128.34 Park Dedication $0.00
issued By: �' �� Date 08/12/2013 Final/O.P. 00/00/0000
❑ Permit Voided� Parcel Id# 1336180000
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 ntioned information.
Signature Date � �� l�
AgenUOwner
Address Oshkosh WI 54901 - 0000 Telephone Number
* 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 specifed 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 Box1130
Clt1J �f Os���s� Oshkosh,WI 54903-1130
� .l Phone:(920)236-5050
Fax:(920)236-5084
Building Permit Application �W���.oshkosh.W�.us
Project � �� r �
Address �� � � � D�, o� Ejr3-(� �} � k�
Applicant Owne Contractor Tenant Other(describe)
Owner/ Name `� 2 C� 1� i"��p� Phone 9 a0 - �7q— �g�
Tenant
Address 3 a'�� I�ac�C�<� pi� (�(�(,� Email� '�/�'(c ��o�J���a�� �y�
Contractor Company Name �W�/l,
�'_� 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 �i�,•SYL ��SPYV�e�'l�� �c�'c� �Id ��q� {� O �jC�s�l�(�1�/�Q�CIO'Sf�
Description
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Mechanical Separate permits will be obtained for the following:
Permits Electrical by F��/h,p�- Plumbin b g y ��t—
g y�,tl/�P�— Heatin b
Value of Job
$�,�Q ��ti (�� (Value for materials&labor is req.to ensure consistency in accessing permit fees for all applicants.)
Payment by: Check #� Cash Permit Fee Account
I cert�the above information is complete and accurate. Any deviations from the above subnaitted information may requir•e additional permits
to be obtained. I acknowledge and agree to these terms.
" � � ta f
Name: r� (Please print) Date: .3
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Signature: