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HomeMy WebLinkAbout0158859-Building � CITY OF OSHKOSH No �ssa59 � OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD ON THE WATER Job Address 965 967 ALPINE CT Owner JEFFREY M/DIANE GROFF Create Date 11/18/2013 Designer Contractor REBATH OF CENTRAL WISCONSIN Inspector John Zarate Category * 140-Interior Remodeling Plan Type � Building � Sign __ � Canopy __ 0 Fence � Raze _� Zoning R-2 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 � Concrete Block � Post � Treated Wood — Occupancy Permit Occupancy Fee $0.00 Flood Plain Height Permit Park Dedication #Dwelling Units 0 #Structures 0 Use/Nature 'DUPLEX/remove exising fiberglass tub and install new one of Work i I*"debit acct" ��, I i �I , � ------- —----- ---- HVAC Contractor Plumbing Contractor Electric Contractor Fees: Valuation $4,450.00 Plan Approval $0.00 Permit Fee Paid $65.00 Park Dedication $0.00 Issued By: � Date 11/21/2013 Final/O.P. 00/00/0000 ❑ Permit Voided', Parcel Id# 1525380000 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 mentioned information. Signature Date Agent/Owner Address 230 N KOELLER ST OSHKOSH WI 54902 -4109 Telephone Number (920)303-5797 * 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 additionai 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. ..Nov, 18 2013 10: 32AM ,.�REBATH CENTRAL WI 9203035935 � � . . No, 4770 •..P. 1/2� :•. _. . . . . . ;. . . , . . . , . .: . . ... .. . . . . . � . . . ,:. .... . . : .. . ::: ..: . .' - . . . . .'. . � :.. .. , : . . ` . P O Box 1130. �I . � . �Lt� � �_O . .�5�'L�OS�'L � �. . . � , �, : . :.ost�osi�,w�sa9o3-ii3o .' �. .�: ' . Phone:(920)236-5050 ' ' '.,., . > .. ' Fax:�(920)�6-5084 . - �. � - . .: Bui�ding Per�zt A.pp�icatzo�a, _ .�.ci.oshkosh.wi:;� Project�'. . [� ' , c�,�, ' :-�iddress � 7�i ��� '�. . �'"�; —� l� � t Appiicant Owncr Contrac[or � Tenant Otl�er(describe) ;f::: r �,+ 2 �Owger:=/ .. Name���'F� �" �1 Q.�le, �Ir���' Phone /ZD" J� I ��(0 ( ( `Te�iamt: . Address Email . Con�ractor �onipariy Name��'C-L' T�(�/l/1(6 '� � �` �1Yl T��hone i1.!'� � .1 d� �.. `'7�i� ��r'�i `.'����� _ � Contact��_. , _ Email Z l�� 7�'} '1 .'l,�'�/Yl Address��� N: �� ����y �l�/P-Cl ��� �.�rl��,51'l � I ��Q� � State Credential#'s��a a�� � ,1���d 9� , ' . Uwelling Cunlraotor Qualificr�! Dwelling Contractor# Buildi�g Convactor Regisrn►tion# Acliytect/. Coinpany Name� < Pfione . � Dcsea�ner �. . � � ���. � ..����-} . � Contact Email . . Address � ' . . � �Pe��TYPe` , . Residential Du l . . Commcrcial Multifamily Tndustrial Catabory New . AddiDion �' Alteratiou . . �. �P�ojecf�:� � . . . . . . - ,. =�•Description'' �.. . . I��/ . r o.�c �C is}�i'(1 �C�X -�-�b . .- -- . .: _... .. _� S�� ��� �= � 1 %� � �ul � � . . . . .. . . . . ...._._ .� - l . � . .� � � � � � : � i : _; _ ,. ._.. ____ , . . . -.-_- IR4ecliaprr.�i _ Seg'tr�t��c�iits_zvillbe_obtaii�ed_for_.#ne�fol.IeiwiA.g:-:..— ----..'__:.—.-_--.---.--..--.-:---.--'—.-.--._.._.._::_. �_._...._..__ Pcrmits: . _. ::......... ........:.: ` . .. _.__,-..._. .. . .�:���fxic�al:b,,,�.,. . _ . • �:Pfim�iilla o . � Heatll�a by . .. . . . . . X �.... .. �b3' � - ��%al.ue'ofJab� $ 'l�,,p�.. - ( . (Value for m�(�rial�dt Ixbor is rcq.to eosure coosiste " ' rmit fees,For ali applir$nts.) , - � Paym�nf,by_ , � �h�ck.# Cash. � .permit Fee Account .. ..: ...;.':l.ce.lify#he above ir formation:lr cDniplete and occr�a[e: i�,ry deviationsfron�the abov'e slibmitred infarmatio�may require:additionolpermit,P : 'obtained l ock.,oivledg:mrd qgrse io�hese rernis .- ... '� . �8ID@: ! ' ' . • �r � `... .. . . , ;,;. .. ., .. . .' .: � (�'lcsse?'u't) "I•�.� ,} _ � Date:.. � . . s ' Signaun-e:: .. . _ . . : .. . . . . . :. ,