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Home My WebLink About0158818-Building (pellet stove) � CITY OF OSHKOSH No 158818 OSHKOSH BUILDING PERMIT - APPLICATION AND RECORD ON THE WATER Job Address 1021 KANSAS ST Owner JUDITH L BERNA Create Date 11/19/2013 Designer Contractor OWNER Inspector Nicole Krahn Category 144-Fireplaces/Stoves Plan Type � Building � 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 0 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/installing a pellet stove to the basemenU all work will meet state and local codes for installation � of Work i � j I� -- -- - - HVAC Contractor Plumbing Contractor -- Electric Contractor Fees: Valuation $4,139.00 Plan Approval _ $0.00 Permit Fee Paid $65.00 Park Dedication $0.00 Issued By: '��,�, Date 11/19/2013 FinaUO.P. 00/00/0000 ❑ Permit Voided''� Parcel Id# 1305440000 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 activiry. I have read an ersta d the aforementioned information. Signature Date '( [ ' AgenUOwner Address 1021 KANSAS ST _OSHKOSH WI 54902 - 6240 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 � �'lty �f OSl��S� Oshkosh,WI 54903-1130 � Phone:(920)236-5050 Fax: (920)236-5084 Building Permit Application ��.oshkosh.W�.us Project _t � � � T V.1 l'��Q � �� ►'1 l\��)� W� V�'7�� Address � Applicant Owner Contractar Tenant Other(describe) Owner/ Name �j,l�� 1�Q� Phone 921� ' 3710—�Z?T Tenant Address /Ua � �Q1��QS ��`'�� mail /' � u� Contractor Company Name �ft� ��S.Q, �11 fl�►'y'c51�$�m�Phone 9zv a�-ao� �— Contact Email Address �o ��J �' f,�a� �� D� s�'7�� State Gedential#'s , , Dwelling Contractor Qualifier# Dwelling Contractor# Building Contractor RegisVation# Achitect/ Company Name Phone Designer Contact Email Address Permit Type esidential Single Family Residential Duplex Commercial Multifamily Industrial Catagory New Addition teration Project ' � �f f � �e Description Mec6anical Separate permits will be obtained for the following: Permits Electrical by Plumbing by Heating by Value of Job $ �J 3� �L}� (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 information is complete and accurate. Any deviations from the above submitted information may requi�•e additiona!permits to be obtained. 1 acknowledge and agree to these terms. i Name: �j,(, �./ n Q� (Please print) Date: f�' �g ' ��j Signature: �.�'//�✓�/�/