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� CITY OF OSHKOSH No 157810
OSHKOSH B ING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 1240 MARICOPA DR Owner MICHAEL K/KATHLEEN M DEBEHNKE Create Date 09/18/2013
Designer Contractor OWNER
Inspector Nicole Krahn
Category 251 -Fences Plan
Type � Building � Sign � Canopy � Fence � Raze I
Zoning R-1 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 � Pier � Other
0 Concrete Block � Post � Treated Wood
Occupancy Permit Not Required Occupancy Fee $0.00 Flood Plain Height Permit
Park Dedication #Dwelling Units 0 #Structures 0
Use/Nature SFR/FENCE/Installing a 6'high cedar fence per the site plan submitted. Ellis fence is doing the work but is not licensed.
of Work
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HVAC Contractor Plumbing Contractor
Electric Contractor
Fees: Valuati $7,632.00 Plan Approvai $0.00 Permit Fee Paid $107.00 Park Dedication $0.00
Issued By: Date 09/18/2013 Final/O.P. 00/00/0000
❑ Permit Voided�� Parcel Id# 1313030000
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 derstand the aforementio d information.
Signature �.. Date —/�� ( f
Agent/Owner
Address 1240 MARICOPA DR OSHKOSH WI 54904 - 8121 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.
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❑ Check this box if you aze a contractor participating in the Permit Fee Account System and you would
like this permit processed through your account.
Project Address: /'��0 TY1�t,.T �cD� 't`. Circle on : Single Family Duplex
Owner's Name: /��Ke.�-�a1'h4 ���,n nl�t Daytime Phone#: 9�D ^�3(s- 9/Ia
Contractor's Name: £(1.,�' S ��r,� L'� . LLC Daytime Phone#: �'2D- 3�4- �?�/�2
If the contractor is applying for the permit provide the following:
Dwelling Contractor# Contractor Qualifier#
*These two credentials are required by the State of Wisconsin Safery and Buildings Division for any contractors
conducting work on residential property.
Value of the project including labor and material costs $ '7� (0 3a. D a
*The value for both materials and labor is required to ensure consistency in assessing permit fees for all applicants
even if you're doing your own work. A general rule of thumb is to double the material cost or provide an estimate '
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from a contractor.
Full description of work being done:
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Any work not noted on this application will not be included on the permit!
T'he'£Q�a��.�qcuments are attached ta tlus�pplicat�on � "��� k � � r;{�� � �
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' � o Site pia� �❑ �,pphcable�ees
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Please read the following and sign and date this application prior to applying for the building permit.
I certify the above information is complete and accurate. Any deviations from the above submitted
information may require additional reviews and permits to be obtained. I acknowledge and agree to these
terms.
Signature: Date:
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