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� CITY OF OSHKOSH No 159781 �
�
OSHKOSH COMMERCIAL BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 500 S OAKWOOD RD Create Date 03/07/2014
Project PEDIATRIC RELOCATION Project Number 20140765
Owner MERCY MEDICAL CENTER OSH INC Plan 688-3970-0314
Contractor GREENWOOD PROJECT MANAGEMENT f
Inspector Nicole Krahn
Designer
Category 220-Alteration Hospitals&Institutions Type of Plan
Zoning C-1 PD Square Footage
Major Occ Const Class
Fire Protection 0 Sprinkled 0 Unsprinkled � Sprinkler Design
Occupancy Permit Not Required Flood Plain Height Permit Not Required
Park Dedication Not Required #Dwelling Units 0 #Structures 0
� Projection � Canopies Signs
Use/Nature
of Work
OMM/MERCY MEDICAU Interior remodeling for the pediatric clinic relocation. DHS-DQA#8748-13777 '*check#2204 i
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HVAC Contractor BASSETT MECHANICAI Plumbing Contractor AUGUST WINTERS CO
Electric Contractor PIEPER ELECTRIC INC
Fees: Valuation $ 75,000.00 Plan Approval $0.00 Permit Fee Paid $1,052.50 Park Dedication $0.00
Issued By: ��� Date 03/14/2014 Final/O.P. 00/00/0000
❑ Permit Voided I Parcel Id#0613660000
In the performan is wo agree to perform all w pursuant to rules governing the described construction.
While the Ci of Oshkosh has n authority to enfor easeme t restrictions of which it is not a party, if you perform the work
described in his permit application within an ease nt,th it strongly urges the permit applicant to contact the easement
holder(s)an to secure any neces ry p ov efore arti such activity.
I have read an u erstand the af re e io inform tion
Signature Date � �'
gent/Owner
Address W URES WAY DR SHERWOOD WI 54169 - 0000 Telephone Number 920-358-3917
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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� City o �,SYL/G�S� Oshkosh,WI 54903-1130
� Phone:(920)236-5050
� Fax:(920)236-5084
Building Permit Application ��•ci.oshkosh.W�.�s
Project � CJ� /� �
Address (�
Applicant Owner - ontractor Tenant Other(describe)
Owner/ N�e � ^ e i Phone MAR
Tenant
Address 22 2 � � 3A � � Email ��:�'.�:�T���:'s oF
Contractor Com an ame � �v,�c Ti ,ti���1� S Di�'eSio.
P Y �o��:l��r,n ��� G'�' �A � - %t)6n►�one a'�lJ' ���i'c��/�
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Contact � � Email�an�,u��'�!'eenc.rr;c�pm. .,�
Address V J���j� �I?��'C�� ��.lQ��je
State Credential #'s , ,
Dwelling Conu-actor Qualifier# Dwelling Contractor# Building Contractor Registration#
Achitect/ Company Name f,'�G A �h,�¢�{ S Phone � o Z7E�3�
Designer
Contact C7��-f f 1 n 2 ,/' Email
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Address 333 ' �e- clI/�P?
Permit Type Residential Single Family Residential Duplex Commercial Multifamily Industrial
Catagory New Addition lteration
Project
Description
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S- Q -� �- 37 �]
Mechanical Separate permits ill be obtained for the following:
Permits Electrical by �e ^ � Plumbing by � �!` Heating by
Value of Job 'f �,�`� �
$ �/S, (/�J (Value for materials&labor is req.to ensure consistency in accessing permit fees for all appiicants.) .
Payment by: Check # Cash Permit Fee Account
I •tify the above information is c �:plete and accw� te. Any deviations fi•om the above submitted infor•mation may requi�•e additional pernsits
t be t ' . owled e agre to the rms.
Name: Q, f' s (Please print) Date: g �
Signature: