DCPZP-2015-00582 - Laserfiche WebLink

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, Call (262) 544-8280 or 1-800-422-5220 PERMIT NO. INDEPENDENT WI UNIFORM PERMIT APPLICATION INSPECTIONS,LTD. • TAX KEY# ISSUING faTOWN 1:VILLAGE ❑CITY PROJECT LOCATION (Building Address) MUNICIPALITY QFcpcm joie ki `' � � I Y ' COUNTY; >ea tie PROJECT DESCRIPTION �K J ❑ COMMERCIAL q ONE&TWO FAMILY Owner's Name Mailing Adpress-.Include City& p Telephone - Include Area Code Lta. ' ,�oT ZIa/ .LOrirdt? _ , /YJjt/iSar t Lt1/�S37i/ Construction Contractor(DC�kIcNo. r� M in A�dr ss,. olude I &Zip Telephone - Include Area Code 6 u0 n O n n i'k i t• �r' ,15 7'�j i G� ' j )/ 5 3�Z tot*-25/ — 7 Dwelling ContractorQualifier(DCQ cNo.) ✓ Dwelling ContractorQualitiershal eanowner, Telephone - Include Area Code CEO,C08,or employee of Dwelling Contractor Plumbing Contractor(Lic No.) Mailing Address- Include City&Zip Telephone - Include Area Code Electrical Contractor(tic No.) Mailing Address-Include City &Zip Telephone - Include Area Code HVAC Contractor(Lic No.) Mailing Address-Include City&Zip Telephone - Include Area Code PROJECT INFORMATION Subdivision Name Lot No. Block No. Zoning District Lot Area N.S.E.W. Front Rear Left Right Qj 0, (i.5 Sq.Ft. Setbacks Ft. Ft. Ft. Ft. 1a.PROJECT 3.TYPE 6.STORIES 9.HVAC EQUIPMENT 12.ENERGY SOURCE lew ['Addition 0 Raze ❑ Single Family ❑ 1 Story El Forced Air Furnace Fuel Nat. L.P. Oil Elec.Solid Solar ❑Alteration❑Repair [Wove El Two Family El Radiant Baseboard or Panel Gas ❑ Multi ❑ 2-Story El El Heat Pump Space Htg ❑ ❑ ❑ ❑ ❑ ❑ DOther El ❑ Boiler 4.CONST.TYPE El Central Air Conditioning Water Htg 999900: 1 b. GARAGE 7.FOUNDATION ❑ Other *fl Dwelling unit will have 3 kilowatt or more ❑Site Constructed ❑Mfd. UDC El 10.PLUMBING installed electric space heater equipment DAttached ❑Detached ❑Mfd. HUD 9 Masonry capacity, 2.AREA 5.ELECTRICAL ❑Treated Wood Sewer 8 ICF ❑Municipal Entrance Panel Other ❑Septic No. 13.HEAT LOSS(Calculated) Basement Sq.Ft. Size:_amp 8.USE Service:_New Rewire Livin g Area Sq.Ft. 11.WATER Total BTU//HR —.—.Phase__Volts ❑Seasonal Garage Sq.Ft. _Underground Permanent Other Sq.Ft, _Underground Di ❑Municipal Utility 14.ESTIMATED COST TOTAL Power Company: [3 Private On-Site Well :.) *2$ apt! A ■ The applicant agrees to comply with the Municipal Ordinances and with the conditions of this permit; understands that the Issuance of the permit created no legal liability, express or implied, of the Department, Municipality, Agency or Inspector; and certifies that all the above information is accurate. Have Permit/Application nu rber and addre-s when requesting inspections. Call (262) 544-8280 or 1-800-422-5220.Give at least 24 hours notice on all inspections, SIGNATURE OF APPLICAN / b /, .. _, PRINT NAME i , . a ATE 7-29-6 kPPROVAL CONDITIONS This permit is issued pursuant to the attached conditions. Failure to comply may result in suspension or revocation of this permit or other penalty. Owner/Builder solely responsible for compliance with all applicable State & Local Building and Zoning codes. NSPECTIONSNEEDED Building ❑Footing ❑ Foundation ❑Rough ❑ Insulation ❑Bsmt. Fl. ❑Final Electric ❑ Rough ❑Service ❑ Final Plumbing ❑ Rough ❑Underfloor ❑ Final HVAC ❑Rough ❑Final FEES: PERMIT(S)ISSUED SEAL NO. Municipality No. _.- - _ _-- Building Fee Bldg. # At to of form RECEIPT PERMIT Zoning Fee g p EXPIRATION: WI Seal Zoning # CK# Permit expires Electric Fee Elec.# two years from Name Plumbing Fee _ Amount$ date issued unless Plmb. # Date HVAC Fee Date municipal Adm. Fee HVAC # From ordinance is Other more restrictive. Certification No. Total Rec By. Jhite-Municipal Files . Yellow - Applicant Pink-Clerk/Assessor