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Home My WebLink About0030218-Building (addition for cooler);,. � /� CITY OF OSHKOSH N° 30218 `' PERMIT - APPLICATION AND RECORD � TYPE: BLDG�HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING � FLOOD PLAIN�HEIGHT �� - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - �� B . ADDRESS ��-� � � 9 //`r.� 'L PLAN NO. / OWNER � S °DESIGNER USE/NATURE OF WORK ��5� � � � /r � ��/rD r'� `�B'` – �a�K <<� Cof:l iQ u" BUILDING CON7RACTOR �Z�' � ��`� �' � S • �`� Size ` D q. Ft. # Rooms # Stories � Height i Foundation / ` Class of Const. � Occupancy Permit� /�/o G�`— HEATING CONTRACTOR � Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S ELECTRIC CONTRACTOR�� - � ` ' Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps Fixtures Switches Receptacles Circuits PLUMBING CONTRACTOR —BT _WH —Disp —WSoft —CBasin —Lav —Sh DW —DF —San. Sewer —WC FDr SP —Ur —Storm Sewer —Sink —LTub Eject —SS —Water Other / � �- FEES: Valuation $ �a ^ P it Fee Paid $ � Park Dedication $ ISSUED BY Date � �3 � Final/O.P. � ��QC In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE �^��-` A ENT/OWNER DATE ADDRESS �� , "' C��L�I� S� l`J ` �J��–T�4 `,; TELEPHONE# - i BUILDING/STRUCTURE/HVAC PLANS APPROVAL APPLICATION Wisconsin Department of Industry, -Complete Both Sides- labor&Human Relations Safety&Buildings Division E-File Bureau of Buildings&Structures Scheduling Information-compiete when calhng to schedule review: Plan No. INSTRUCTIONS: Fill in all applicable data. Caution: Failure to complete the form entirely may cause additional delay. Submittal of this Plans Approval Application is required for each building. Submit this form with at least 4 sets of plans which include details and data as required by ILHR 50.12. P�ns may be submitted to any of the plan review offices listed on the reverse side. Projects are scheduled for review. Please call the selected office prior to submittal. Any components submitted independently from the building plans must be submitted to the office which did the project's initial review. 1. Owner Information 2. Project Information 3. Building or Structure Designer Information ame eulldmg Occupanc Chapter(s)And Use: Designer Re istration q ` �' S �.,>0 ��2 TqV� , 11� ,�--y220 t: m any Name Tenant Name(if any) D sign firm ' ✓ c.�. s �o K� ►„��e. A�. Number& treet Building LOCati n(number&sjreet)'C Nyynber&Street S�P �AKE ST• J'�Z7 w• �r��F�7 v c r 4 ��M�( 2-`�43 Gty,State,Z�p Code rty �Vlllage Township Of City,State,Zip Code �,�r. s�� t�s�c ost� c�u osc� cvl s��b..� Contact P rso Count,y Oy�� Co al erso �� G .-�.� � uc `�� Telephone Number Property ID No.(tax parcel no.-contact county) Telephone Number Fax Number c � �33 3 ? � 3-O�OiO HI > 23S-33t Z�-OS�r � fax Number Government Owned ❑Yes No Return Plans To: wner ❑Des�qner � � �� Government Leased Or Operated Q Yes ❑No 0 Other 4. Building History 5. Construction�lass Requested 6. HVAC Designer Information Prev�ous Owner(s)(if any) � 1. fire Resistive Type A �D2s+�e�-- Reg�strat�on# (1 _� ��C D�� ❑ 2. Fire Resistive Type B � ��'} 'F ❑ 3. Metal Frame-Protected �'9+�+� �r n �� ❑ 4. HeavyTimber �K• Prev�us Plan or File No. ❑ 5A. Exterior Masonry-Protected Number&Street - ❑ 58. Extenor Masonry-Unprotected Variance No. Preli��y No. � 6. Metal Frame-Unprotected City,State,Zip Code �ri ❑ 7. Wood Frame-Protected Other Information(previous use,last submission) � 8. Wood Frame-Unprotected Contact Person ; f plans do not show compfiance with requested t � Construction class but are approvable at a lower Tele hone Number Fax Number class,do you wish approval at the lower class? P � ❑ Yes ❑ No ( ) � � � 7. Building Information 8. Submittal Request 9. Supervising Professional Information ❑ Complete Sprinkler- NFPA Proiect Review Requested ❑For auilding �Same As Bu�lding Des�gner ❑ Partial Spnnkler - NFPA ❑New ❑Footing/Foundation �For HVAC �Same As HVAC Designer + 0 Unlimited Area ❑Alteration ❑Building ��r i di ferent rom designer) ❑ Fire Alarm ❑ Emergency Power �Addition ❑Permission To � ❑ Smoke Detection ❑ Hazard Enclosure O Revisions Start ❑Use Change Q HVAC ��'on# ILHR 70 Hizt Code ��`� �� ` Total Number of Stories � ❑ ❑Truss Number&Street ❑Variance ❑Precast Building Footprint Area Q SQ ft Preliminar ❑ y ❑Structural Soil Bearing Capacity Psf ❑Cano City,State,Zip Code py ❑Laminated Wood �Presumed ❑Bleacher ❑Metal 8uilding ❑ Verified ❑ Tower ❑lolst/Girder Te ep one Num er ❑Other 10. Related Business Systems-Please call the respective Program for clarification and plan submittal requirements. ❑ Elevators(608-267-3576)includes: ❑ Flammable/Combustible Liquid(608-267-1379) ❑ Bo�leriPressure Vessel(608-266-1904) ❑ Passenger elevator meeting ILHR 18 req. Will any portion of this building be used for Q Mech�cal Refrigeration/AC(608)266-1904 Q Freight elevator meeting ILHR 18 req. stora9e or dispens�ng of ilammable/ ❑ Plumb�nq(608-266-3615) Q Part 5 lift(residential type) combustible liquids as covered by ILNR 10? Sewer: ❑ Part 201rft(wheelthair hft) ❑ Yes ❑ No ❑ Muniupal ❑ Pnvate Sewage System se�-t t8(R.o5�9z> -CONTINUE ON REVERSE SIDE- i £ 11. Calculation of Fees � Area: The area of a floor is the area bounded by the exterior surface of the building walls or the outside face of � columns where there is no wall. Area includes all floor levels such as subbasements, basements,ground floors, mezzanines, balconies,lofts,all stories and all roofed areas including porches and garages,except for cantilevered canopies on the building wall. Use the roof area for free standing canopies. Total area is the summation of all floor areas. Attach a separate sheet if necessary for the calculations below: Floor Level (s ecify) Length X Width3 = Area 5� _ !��O X �[D - - (� X - X = X = X = j Total Area = ��(� �roject NOT located in certified municipality(go to Fee Schedule Table 2.31-1). ` roject located in certified municipality(go to Fee Schedule Table 2.31-2). (See Fee Schedule for list of certified municipalities.) � ❑ Building and HVAC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee $ _ uildingOnly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee $ VACOnly . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee $° `z Revision To Previously Approved Plan .. . . . . . . . .. . . . .. . . . . . . . . . . . .. $ , `_ Permission To Start . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . .. . . . Fee $ �: ❑ Pre-July 1992 Building Components � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee $ ❑ Other . . . . . . . . . . . . . . . . . . . . . . . . Fee $ ': Total Fee = $ � I 12. OWNER'S STATEMENT: I request that plans be reviewed for compliance with the code requirements set forth in � Chapters ILHR SO-64 of the rules of the department. I recognize that I am responsible for compliance with all code requuirPments and any conditions of plan approval. If this building exceeds 50,000 cubic feet in total volume, I will retain a supervisinc�professional as required by ILHR 50.10 throughout construction to project completion and the filing of a Completion Statement by the supervising professional. �� L� � Owner's Signature: � me&Title �,¢� — Original Pnnt 13. DESIGNER'S STATEMENT: DESIGN AND SUPERVISION(ILHR 50.07-50.10)if this building,following construction of this ; project,contains more than 50,000 cubic feet in total volume, plans are required to be prepared,signed,sealed and dated by a Wisconsin registered engineer or architect(ILHR 50.07(2)). Signatures and seals shall be original. The department expects,and requires,that the project designer review individual component submittals for compliance with the general design concept. The project designer,and department,will rely on the seal of the component designers for compliance with the codes as they apply to their d signs. Total cubic foot volume of the building upon completion of this project: Less Than 50,000 ❑ 50,000 or Greater t Design loads have been indicated on the plans. . . . . . . . . . . . . . . . . . . . . . .�es ❑ N/A 4: Firewall schematic plan has been included. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes �/A All applicable items required by ILHR 50.12 have been included. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �es ❑ N/A I certify that the submitted plans were prepareii under my supervision,are accurate,and to the best of my now e comply �th the applicable codes of the Depa�tment of Industry, Labor and Human Relations. nginal Slgnature f B ildin signer Date Signed Onginal Signature of HVAC Designer Date Signed ��2�� — �.� IJ 14. SUPERV SI G OF SIONAL'S STATEMENT: I have been retained by the owner as the supervising professional per � ILHR 50 1 for t e pe formance or supervision of reasonable on-the-site observations to determine if the construction ' is in sub ntial c liance with the approved plans and specifications. Upon completion of construction, I will file a � written statement with the department certifying that,to the best of my knowledge and belief,construction has or has not been performed in substantial compliance with the approved plans and specifications. Onginal Signature of Professional Supervising The Building Date Signed Onginal Signature of Professional Supervising The HVAC Date Signed nIOT f2.�� D Hayward Off�ce La Crosse Office Madison Off�ce Shawano Office Waukesha Off�ce ; 209 W tst Street 2226 Rose Street 201 E.Wash�ngton Ave. 1053A E.Green Bay Street 401 Pilot Court,Su�te C Rt 8,Box 8072 La Crosse,WI 54603 P.O.Boz 7969 P.O Box 434 Waukesha,WI 53188 Hayward,WI 54843 Phone(608)785-9334 Madison,WI 53707 Shawano,WI 54166 Phone(414)548-8600 ; Phone(715)634-4870 Fax(608)785-9330 Phone(608)266-8735 Phone(715)524-3626 Fax(414)548-8614 Fax(715)634-5150 Fax(608)267-0592 Fax(7t5)524-3633 `�'� _y..�� / f BY__J_�-�___ DATE.________ SUBJECT__�C��-�r_��!��..-]_1�``��I_..11.._�:� _ SHEET NO..___l_____OF ,_j_ __ CHKD. 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