HomeMy WebLinkAbout0158916-Building � CITY OF OSHKOSH No 158916
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OSHKOSH BUILDING PERMIT -APPLICATION AND RECORD :
ON THE WATER
Job Address 1870 WHITE SWAN DR Owner JEREMY R PROBST/JENNIFER M BURKHOLDER Create Date 11/26/2013
Designer Contractor KRIER'S CONSTRUCTION
Inspector John Zarate :
Category 111 -Single Family Addition Plan
Type � Building � Sign � Canopy � Fence � Raze _J
Zoning R-1 Class of Const: Size
Unfnished/Basement 450 Sq.Ft. Rooms Height Ft. ❑ Projection 'i
Finished/Living 450 Sq.Ft. Bedrooms Stories Canopies
Garage Sq.Ft. Baths Signs
Foundation � Poured Concrete 0 Floating Slab � Pier � Other
� Concrete Block 0 Post � Treated Wood
Occupancy Permit Occupancy Fee $0.00 Flood Plain Height Permit
Park Dedication #Dweliing Units 0 #Structures 0
Use/Nature SFR\Kitchen and family room addition-all work to meet current code.
of Work ;
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HVAC Contractor MCM AIR INC _ Plumbing Contractor KASCADE PLUMBING L.L.C.
Electric Contractor BEEZ ELECTRIC INC
Fees: Valuation $125,000.00 Plan Approval $50.00 PermitFee Paid $187.00 Park Dedication $0.00
Issued By: Date 11/26/2013 Final/O.P. 00/00/0000
❑ Permit Voided�� Parcel Id# 1523630000
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 ne ssary appro als before starting such activity. `
I have read and understand a re m ioned information.
Signature Date
AgenUOwner
Address 3201 COUNTY ROAD F OMRO _WI 54963 - 9464 Telephone Number (920)685-2333
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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0 Check this box if you are a contractor participating in the Permit Fee Account System and you would
like this permit processed through your account.
Project Address: �� �0 Wh��z S���Cu� �f Circle on . Single Famil Duplex
Owner's Name: ._J�r�-m� �r c b�+ Daytime Phone#: �j�0-�85- ( l I 3 :
Contractor's Name:�j{�'I�r��> L��iS�YU�:��,, �-��- Daytime Phone#: ��D `bg5 �3�3
If the contractor is applying for the permit provide the following:
Dwelling Contractor# 15 7 I �-- Contractor Qualifier# 15713
*These two credentials are required by the State of Wisconsin Safety and Buildings Division for any contractors
conducting work on residential property. '
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Value of the project including labor and material costs $ ��`?,ODC�L4 .
*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
from a contractor.
Full description of the work being done:
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Electrical Contractor: a i,c.� �C��i� Hvac Contractor: Yl'1 C m l���
Plumbing Contractor: �,�5 GU,c��, k���in�i nr
Any work not noted on this application will not be included on the permit!
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Please read the following and sign and date this application prior to applying for the building pernut.
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:l/� Date: .�� -��.- �-3
4 L 3`', 9/17/2010