HomeMy WebLinkAbout0159772-Building � CITY OF OSHKOSH No �s9��2
l.
OSHKOSH COMMERCIAL BUILDING PERMIT -APPLICATION AND RECORD
ON THE WATER
Job Address 500 S OAKWOOD RD Create Date 03/13/2014
Project 3rd Floor Remodel _ _ _ _ Project Number 20140764
Owner MERCY MEDICAL CENTER OSH INC Plan BB8-3976-0314
Contractor BOLDT OSCAR CONSTRUCTION
Inspector Nicole Krahn
Designer
Category 220-Alteration Hospitals&Institutions _____ Type of Plan Alt.Level 2
Zoning C-1 PD Square Footage
Major Occ Institutional-12_ _ Const Class Type IIB
Fire Protection 0 Sprinkled 0 Unsprinkled � Sprinkler Design
Occupancy Permit Not Required Flood Plain Height Permit
Park Dedication #Dweliing Units 0 #Structures 0 '
� Projection Canopies _ Signs
Use/Nature
of Work
ICOMM/MERCY MEDICAU Remodeling the 3rd floor to provide a pharmacy, medical records area and clean supply room per the plans submitted.
(DHS approved plans) I
I
-- - �
HVAC Contractor _ Plumbing Contractor
Electric Contractor
Fees: Valuation $130,108.00 Plan Approval $0.00 Permit Fee Paid $548.50 Park Dedication $0.00
Issued By: ��J"� Date 03/14/2014 Final/O.P. 00/00/0000 •
❑ Permit Voided ' Parcel Id#0613660000
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
AgenUOwner
Address PO BOX 419 __ APPLETON __ WI 54912 - 0000 Telephone Number 739-6321
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.
�,y P O Box 1130
� ���1�f�SII��S� Oshkosh,WI 54903-1130
� Phone:{920)236-5050
Fax:(920}236-SQ84
Building Permit Application �•�oshkoah.�.u�
Aaar�� Soo � U.�.�� �
Applicant Qwaer ontractor Tenant Other(describe}
Ovrner I Name /�tE-;�.`�� e.�,'c.�� �iwD Phone �o�lJ - �2'�— O!'�
Tenant
Address �`oD _S. f1���,,o� t'4� Email Q,
Contractor Company Naznc /� �td+ �N,,pa,•,.�1 Phone Q,'it�- .225- G1G 9
Contact ��tJ�. �.'«+..!' Emai11'.o�r�l.t�+��'l�..l'G� �1c��.Go••�
Address �.Sa'?S �• /�os.w,at" /4�.d. /111�, �a l .�g/o7
State Credential#'s , ,
Dwelling Cantiactor Qualifier# Dwelling Contractor# Building Contractor Registratioa#
Achitect! Company Name �1� Phone___�j�-�'7� - 33 a q
Designer
Contact M�c.�n.a�� C�o�sa.ti��,.�. Email 4LiC�na�vaW...�„� o �nn,c�..�c..•�.
Address 333 �s..b� �/`i� �e��. /�:�e�t�ec, ! l� S3��oZ
Permit Type Residential Single Family Residendal Duplex omtn �al Multifamily Industrial
Catagory New Addirion AIte `
Pro�ect � ,,,.�,. 3 JS� 'ti
Description �
�.,. � . 3� ��.:�..1
' _ ��4-•-, ...ar� �.� ��,�,,��,�.. .
5,�1�__ ����.
Mechanical Separate permits will be obtained for the foltowing:
Perraits Electrical by � t,t' Plumbing by�� �„rra'1'" Heating by '��
Value of Job $ �3O� �+�� .i�{� (Value for materials&Iabor is mq,w cnsure cansistency in accasing permit fces for all app6canis.)
Payment by: Ci�eck # Cash Permit Fee Account
I certify 1he above infornranon Ls caniplete and accurate. Any deviationsJrom the above submttted infornrctfon s�►ay require additional permits
to be obtained. 1 acknowledge and agree to thue lernrs.
Name: '��s� (Ploase Print) Date: � 1e :
Signature: