HomeMy WebLinkAbout0157969-Building � CITY OF OSHKOSH No 157696
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OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1333 W BENT AVE Owner LANCE E/ANN M THERN Create Date 09/12/2013
Designer Contractor OWNER
Inspector John Zarate
Category * 140-Interior Remodeling Plan
Type � Building 0 Sign � Canopy � Fence � Raze I
Zoning R-2 Class of Const:
Size
Unfinished/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 $0.00 Flood Plain Height Permit
Park Dedication #Dwelling Units 0 #Structures 0
Use/Nature SFR/kitchen remodel to include all new construction/all work will meet state and local codes/moving an existing window and installing ai
of Work new window in different location header size will be verified 2X10/electrical and plumbing require separate permits/changing from a I
�uplex into a single family
'
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HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuation $3,000.00 Plan Approval $25.00 Permit Fee Paid $51.00 Park Dedication $0.00
Issued By: �� Date 09/12/2013 FinallO.P. 00l00/0000
❑ Permit Voided I Parcei id# 1202470000
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 u erstand the afore m n information.
Signature ����C.�_ ,�'j� Date �—�� ^�
AgenUOwner
Address Oshkosh WI 54901 - 0000 Telephone Number
* 140-Interior Remodeling See Chapter NR 447 of the Wisconsin Administrative Code and Notification Form 4500-313 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 1 li0
Clt'1/ �f OSr��OS� Oshkosh,WI 54903-1130
� .J Phone:(920)236-5050
Faat:(920)236-5084
Building Permit Application W����.oshkosh.wi.us
Project j 3 5 3 �• ti'7 /� �`� �-S!/��O �
Aaaress /SCt sC���,� S Y��' l
Applicant Owner Contractor Tenant Other(describe)
Owner/ Name L �"� �C ��fL�� Phone �u/' 3 �� - 7�"j 7
Tenant
Address �5 �� w /�G�.G�7' �v�` • Email -f".�'/�,r'.t'I Zq��� ,�t�i
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
Addr
Permit Type Residential Single Family Residential Duplex Commercial Multifamily Industrial �
Catagory New Addition Alteration
Project � � 7�G�C.� %Z ��??.�1��� /�IZ�p r z�G ��Z�-L�- �t-/? 715�
Description -�
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Mechanical Separate permits will be obtained for the following:
Permits Electrical by Plumbing by Heating by
Value of Job z /J,q �r1/�
$ J,G`�(f, v V (Value for materials&labor is req.to ensure consistency in accessing permit fees for all applicants.)
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Payment by: Check # Cash Permit Fee Account '
I certify the above information is complete and accurate. Any deviations from the above submitaed information mav requi�•e odditional permirs
to b obtained. I acknowledge and agree to these terms.
Nan]e: � L-�N C� ��1,��/ (Please print) Date: / �CZ^� �
Signature: ��2�'�L� �