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576'- , 7 C . L AZSCO Co oXI(' 73 9 9,e7170 ?.0/ � Division WISCONSIN UNIFORM BUILDING Application No. Wisconsin D WISCO of Safety and Buildings PERMIT APPLICATION /s-., 6 S` Wisconsin Stats.101.63,101.73 Instructions on back of second ply.The information you provide may be Parcel No. used byptifeigovemment a ency pro [(Privacy __ s.15.04(1)(T)] PERMIT:REQUESTED 6-Constr. ❑ AC ❑ ectric ❑ umbing 6-Elosion Control 0 Other: O is Name D Mailin Address 0, /J,_S 37J1 Te c_gcsy � s � vccc+�. Con tot's Name: on ❑Elec OHVAC 0 Plbg Ltc/C Mailing Address 1,}4,../AA A.€e Telg5J. 64e-50,0 e�/ ( o l l� 114c I o p 33/ F, mew- Ste" 6J / FAX#mod- des'9 ✓`e Tel. Q (� Contra is Name: OCon ❑Elec t'FIVAC 0 Plbg Lic/Cert# Mailing Address /� U'3?- I �5C5 !� Iy 5-1,,,), / C.� FAX# c Si i Tel. F 47.3 "6- Contractor's Ni. e: OCon BEfec AC ❑Plbg Lic/Cett# �+ Mail g Address rdyQ F 1 Y cLitryk r FAX# Contractor's Name: °Con ❑Elec OHVAC lfgg Lic/Cert## Mailing Address Tel. Fr 3)_ (F.r6, 3 57 �l_ �7eY0 K we. c h-..2.....„ FAX# PRO CT_ Lot area (/��, ❑One or mot. .. 4417 P Sq.R Ismiwh be disu• d 1/4, 1/4, of Section ,T N,R E(or)W LOCATION Building Add a Qk nI Su} ✓ision Name R s. Lot No. . Block No. 7-.3 ' ' ' r(Y CY Right, Zoning Districts) �Vry ✓ Zoning Permit No. Setbacks: FrQ 1 $ 1 5.0 Left ft 3.,O ft. 1.P>103 CT 3,,0 ANCY 6.ELECTRIC 9.HV.0 EQUIP. 12.ENERGY SOURCE 4544ew 0 Repair &Single Family E c.A Pr5,1, ILIPtimace Fuel Nat Gas LP Oil Mac Solid Solar 0 Alteration 0 Raze 0 Two Family Amps. °Radiant Basebd Space Htg 8 0 0 0 ❑ ❑ 0 Addition 0 Move 0 Garage ` nderground ❑Heat Pump Water Htg lir 0 0 _ 0 ❑ ❑ 0 Other: 0 Other. 0 Overhead °Boiler 0 Dwelling unit has 3 kilowatt or more in electric space 7,WALLS 41rEentral AC heating equipment capacity. 2.AREA INVOLVED(sq ft) 4.CST.TYPE d Frame DFireplace Unit 1 Unit 2 Total rte-Built 0 Steel °Other: 13.HEAT LOSS Unfin. OMfd.per WI UDC 0 ICF . Bsmt 3 OMfd per US 0 Timber/Pole 10.SEWER BTU/HR Total Calculated Living HUD 0 Other °Municipal Envelope and Infiltration Losses("Maximum Allowable Area 2 7 63 5.STORIES 8.USE RI Sanitary Permit# Heating Equipment Output'on Energy Worksheet; Gage ❑ I-Story 0 Seasonal "Total Building Heating Load"on Rescheck report) DDeckk 4I g rnr ry tl- anent 11.WATER 14.EST.BUILDING COST w/o LAND 5 ❑Other. 0 Other 0 Municipal $ CC Totals 5L`if( ❑Plus Basement p.6n-Site Well 7 �j 0 c.5-' I agree to comply with all applicable codes,statutes and ordinances and with the conditions of this permit understand that the issuance of the permit creates no legal liability, express or implied,on the state or municipality;and certify that all the above information is accurate.If one acre or more of soil will be disturbed,I understand that this project is subject to ch.NR 151 regarding additional erosion control and stormwater management and the owner shall sign the statement on the back of the permit if not signing below. I expressly grant the building inspector,or the inspector's authorized agent,permission to enter the premises for which this permit is sought at all reasonable hours and for any proper purpose to inspect the work which is being done. ❑I vouch that lam or will be an owner-occupant of this dwelling for which I am applying for an erosion control or construction permit without a Dwelling Contractor Financial Responsibility Certification an have read the cautio s ent regarding contractor responsibility on the reverse side o th st y. APPLICANT'S SIGNATURE DATE SIGNED l This permit' issued pursuant to the following conditions. Failure to comply may result in suspension or revocation of this APPROVAL CONDITION S permit or other penalty. 0 See attached for conditions of approval. z P z° - 00 95/2- .x-41, # Villf°City of 0 County of°State—■ r — Municipality Number of Dwelling Location ISSUING °Town of ° age of JURISDICTION 1 4/35/9 l 3 - O FEES: 54/V/ c6f y IG i2.,r _ PERMIT ISSUED BY: 'soi4-O s a. Z e,ceof ,�.ao 33 i c- i Lox.• S 7�- s .OO 6/tls Joe.,op � Name / �� D,47L v S-is G L a c/3 s 2SZ G..51 PN v s 2 GS/ / Y l 59 .SV Date 4 S ice' Tel. 800- 90 2 �Z I J C, Faron 404.3'2, D Total s /598-BY KAZD 53c� Cert No. , SBD-5823(R.05/07)Distribute:0 Ply 1-Issuing Jurisdiction;0 Ply 2-Issuer forwards to State w/in 30 days;0 Ply 3-Inspector;0 Ply 4-Applicant