HomeMy WebLinkAbout0015549-Building � f
� CITY OF OSHKOSH N°_ 15549
` PERMIT - APPLICATION AND RECORD
TYPE: BLD�HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING � FLOOD PLAIN HEIGHT
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ADDRESS �� � S I I r t1�� � � PLAN NO.
OWNER �V 1—Y—t�'C� /`t'� WlP �
DESIGNER
USE/NATURE OF WORK �
/�t�9�' f\ /pCOP� t�h�flf�'S/l�
BUILDING CONTRACTOR °
Size Sq. Ft. � �Z� # Rooms # Stories � Height
Foundation Class of Const. � Occupancy Permit J��
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR � ` /L
�
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits t
�
PIUMBING 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: Valuatio $ � P ' Fee Paid $ T �� Park Dedication ${���
ISSUED BY Date � Final/O.P. �� r� "�v
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE �I � ( �� ��
? AGENT/OWNE DATE
1 � `, � �
ADDRESS y v `�
TELEPHONE#
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stateotwisconsin WISCONSIN UNIFORM *
Department of Industry, APPLICATION N0. ��
LaborB Human Relations BUILDING PERMIT
Division of Safety&Buildings
Mad s�on,WI 53707 APPLICATION
Wisconsin Statutes 101.63,101.73 See/nsf� ons On beCk ol Ink Co PARCEL NO.
�E������������ TRUCTURE ❑ HVAC ❑ ELEC ❑ PLUMBING
O ner's Na ai g Address Telephone
w. '�� `v ' � `— 7
Contractor's Name Mailing Address Telephone
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��OJEG"��.�CA"1`�i�N
; '/a, '/a,SECTION ,T N,R E or W
_. _ _.
Building Address Subdiv'�ion Name / Lot No.� Block No.
2� �� 4 � �'-
ZoningDistrict LotArea Fron Rear Left � Right
� Qc��n. Setbacks �v n. Z3 g' tt. �S n. S` n. :
___ _ ___ _
_ __ _ ______ __
1a. PROJEGT'` 9. 'f'YP� �. !��.E�'��1tCAL : 9�. Hitl4C�Q1�EIE�M'�N�' 12:' EH�RGY SQL�flCE ``
_ _ __ _ _ _ _
ew ❑Addition ❑ Raze ingle Family Entrance Panel orced Air Furnace Fuel Nat. L.P. Oil Elec.Solid lar
Alteration ❑Repair ❑ Move ❑Two family Size:�amp Radiant Baseboard or Panel C s *
❑Other Ser �ce: ❑ Heat Pump Space Htg. ❑ ❑ ❑ ❑ ❑
❑Other nderground ❑ Boiler WaterHtg. ❑ ❑ ❑ ❑ ❑
Overhead entral Air Conditioning
�b. �`aA�AGE : > � C�7.�1fE�E 7. :F�3�lr1DA�IC�N>'� Other ' ❑Dwellin unit will have 3 kilowatt or
_............. .............. more installed electric space heating equip.
it2 cO�St�UCted oncrete 'lE�. PLUI1A�fNC� ' �nfiltration control option is:❑Full sealing
ttaChed ❑ DetaChed Masonry Sewer of joints. ❑Blower door test. ❑Exterior
, ❑Manufactured
air infiltration barrier.
'�, ��, ❑Treated Wood unicipal
� S 5 S'�!�Ft�ES! ❑otner septic i3.: N�A�'!LO$S;Gafculaiies�)
Basements q.ft. Permit No.
❑1-Story � ��� Envelope BTU/HR
Living Area��Sq.ft. 2_Story ❑ Seasonal 1f. �����;:i ' Infiltration BTU/HR
ther ermanent unici al Utilit 14�> �S71MA'C��I CO3'�'f
Garage �� Sq.ft. �� Other P y
r Private on-site Well �„_ �
$ �"�
The applicant agrees to comply with the Wisconsin Uniform Dwelling o and other Municipai Ordinances and with the conditions of this permit;understands
that the issuance of the permit creates no leg liability,express or i pli ,on the Department or Municipality;and certifies that all the above information is
accurate. � � � �
SIGNATURE OF APPLICANT � oArE � �
CONDITIONS OF APPROVAL This permit is issu p u t to the following conditions. Failure to comply may result in suspension or
revocation of this perm o her penalty.
�������. ❑TOWN ❑VILLAGE ITY ❑ COUNTY Municipality Number ot Municipality Number of Dwelling
❑STATE ❑ Iy,DEPEN EN Inspection Authority Location,if different
JURI�D�T1�N '; oF: k o ��-�-� -— — —
F�S: B�RM�Sj' Vlt[S.ilN�t�RM��RMIT PEAId[I'F ISStJED 8Y:
; ' >FS�U�.._; SEAL NO.
�/� Construction
Plan Review . . . $ �LL.- � HVAC rti!•t. ��
Inspection . . . . $ NAMF
❑ Electrical �!� C � �i�
Wis.PermitSeal(s) $ � ❑ Plumbing DATE T ls
Other . . . . . . $ ❑ Other .� i/'�,��
TOTAL . . $
CERT.NO. �7�
56D5823(R.04/87) WHITE—IssuingJurisdiction YELLOW—DILHR GREEN—Inspector PINK—Owner/Agent
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Tt�t Plarirtiag Ddsec�or, az �pzop�iate dasigrus� mat appzov� aLL plari,�, �t
tt� �olla+oa�g: (1) 81l�at�,aa�s a� int�+o� work wi�n th� tss� it aoe�o� and
� s�o cbar� o� u� is ptopoa�d. (2) � itm. �q:,. ad'd3�s#g. ai�3owa,
' s�c., � th� us� is coato�r�g and � m d� cLR� is pmoQat�
� � ao�c e�].i�s aath tht abot+e crit�o�a, ttas pe�a,t dtn b! z�evi�ned
bY � Htstldfs�q 2c�c�o� adthomt r�l to � Plas�ais�g Disa�.�bor. � :
�AFQPDVID D10T ApPi�VID
Plaa �'��;^�+ 14�3�On g�quired
vas3ancels)
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REVg3� HY: DAZ; — —
City of Oshkosh 1/1/85+ ,
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PARKLAND DEDICATION FEE COLLECTION RECORD
Address � � �.�. �
Owner's Name �,�ti--��--t�
Name of Subdivision �� (�`
Lot # � 61 dg. Permi t # ��.�''� /�
No. of Units �
Fee Required
�
Fee Paid Q
Owner's signature � Date
InsF�ector's signature Date
Parks ubdi ision
� Improvement
Accts. Rec. : 362-041
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NA��IE
�� A�DRESS `�>'�� � �vNP-cu r�l�
LOT � BLOCK 'dARD
SUBDIV. ��� I C��"I ZONE
STREET N0. ���� (�<`���-�� _�Z�Q LOT D I MENS I ONS
SIDEWALK EXISTING YES � NO �
BU I LDI NG GRADE ELEVAT I ONS STAKES SET AT S I TE r'�.,� �� � , I 9 P� y BY �. �>^ �� � i
,
FEE: $1� .Q0 '
�'J
DEPARTMENT OF PUBLIC WORKS
I , the undersigned, owner or agent of the above d cribed prope ty agree to have the
grade established before excavation has commenced
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STRUCTOMATIC TEL No . 1 312 804 0905 Jan 12 ,90 4 �21 P .02 E
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