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09-18-'08 08,51 FROM-Town of Verona 6088457143 T-362 P004/007 F-772
<br /> /! ,consin•Division S1' JONSXN UNIFORM BUILDING ^ Application No.
<br /> ...7f Safety and Buildings PERMIT APPLICATION Of
<br /> Wisconsin Stats.101.63,101.73 Instructions on back of second ply.The information you provide may be Parcel No.
<br /> used by other government agency programs[(Privacy Law,a,15.04(1)(m)]m A040,aq'/ O!O-4 , t
<br /> - ��� a_. ; Erosion Control Other:
<br /> �.�'����13 t��!;.?���'�a���t�;a�,�4�i Constr. HVAC Electric Plumbin:
<br /> Owner':Name s G Mai ing,A3 9 s l�H+L E,U e.) krrrrt, GJZ Tel.
<br /> g' y`
<br /> R0 tz � .to�'ill.� goo .. ,� 0 f,
<br /> 3. ,. ter� ...,t� � m�'AyYr 'i� {',_ ,Ni. ��• �,a.,....: ia��ya 5,:::i!.`�"�, ( i � 'i: ,
<br /> ~Dwelling Co.,•' tor(Constr.) 6t? y /ASS
<br /> 1, 72F : ;. of '
<br /> Dwelling Contr.Qualifier The Dwelling Contr.Qualifier shall be an owner,
<br /> CEO,COB or employee of the Dwelling Contr. u i ;
<br /> HVAC
<br /> Electrical P.o (3ou.362_ get yr [e t 6a-376 O 9 o
<br /> Sfgg�o/�1LGCT
<br /> Plum b AL 1114 AAD 6 6 $ 22 65 /z 31 1 Gcnei nrei-cpi/evt..i2 U -r a-
<br /> ° j Lot errs �i.e acre or more o ` d �j /
<br /> 'l i i. ,d 410 0 Sq.tt, soil will be dislur._+
<br /> /V 114, 5-6 1/4. of Section .2 ,T �r hl,R 8 E Corr*.
<br /> wilding Ad} Lot NOV Block No.
<br /> Building Address Subdivision Name
<br /> ' g i.t1 1-1-A-t.- el le,D Right
<br /> Zoning District(s) Zoning Permit No. Setbacks: Front ft.
<br /> -fir� ���� 7 �� g ;c eft;. �,
<br /> ..e_. _��..F grin c.rn ' yisiyo .site--7-7. .f51.3. .MEA tx,S:.1Vi,v'A{ ri'Ml .Siye',`', M� %fl2• ''I'f`'4Z ''iJ,_% �R
<br /> �'� `' �� f' Oil Solid Solar
<br /> ,�4 Repair Single Family Entrance Panel Furnace Fuel
<br /> fir :lion Raze Two Family : 40 Radiant Basebd Space Hug 0 ❑ 0 0 0 ❑
<br /> Addition Move Garage it nd•;,v o .. Heat Pump Water lag 0 0 0 0 '0 0
<br /> Other: Other: Overhead Dwelling unit has 3 kilowatt or more in electric space
<br /> PE EA V zr Co Al OS 4 46 13lli(.QS t- :i. to '` 4l AC heating equipment capacity,
<br /> ■ r2 r. r M;g1Miaat Wood Frame OFireplace
<br /> Unit 1 Unit 2 Total de-Built Steel Other: fq....., ;!,c-',Ja..e,.!.,ila4^t _�i`ta ' ? , �'`-ly � �''`'
<br /> Unfn. Mid per WI UDC (3 CF B fU/tHt Total Calculated
<br /> Bsmt 050¢D Mfd.per US 0 Timber/Pole 1&� `f,,.+,;. -t.;,:
<br /> HUD 0 Other: Municipal• Envelope and Infiltration Losses("Maximum Allowable
<br /> Living f�.Y' -),:.,` '� r v ei "�a� # Sanitary Permit# Heating Equipment Output"on Energy Worksheet;
<br /> Area f_`s:F ' " � ea al Total Building Healing Load"on Reacheck report)
<br /> Garage " Seasonal
<br /> T.T ; POW.,7t'';'
<br /> Y r i a^+ ' tl + f 67,7 r'""4 r071 g.'∎NA�t'ts 4P3 .� !.
<br /> -Story •�Yi� _ �gyack.T"r.'•`•9 js J J�_.F'�: ,q,*V.�.w :.r . '�KJ»�.ter j 04�. 4
<br /> Deck `
<br /> Other: Other: M�� ___l S ,O 0 (2 0
<br /> Totals Li 4 0 ti Plus Basement �n t� Y ■
<br /> I agree to comply with all applicable codes,statutes and ordinances and with the conditions of this pertnifi understand that the issuance of the permit creates no legal liability,
<br /> 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
<br /> project is subject to cli.NR 151 regarding additional erosion control and stormwater management and the owner shall sign the statement on the back of the permit if not
<br /> 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
<br /> hours and for any proper purpose to inspect the work which is being done.
<br /> I vouch that 1 am or will be an owner-occupant of this dwelling for which I am applying for an erosion control or construction permit without a Dwelling .
<br /> Contractor Certification and have read the cautionary statement regarding contractor responsibility on the reveres side of the last ply.
<br /> APPLICANT'S SIGNATURE
<br /> / • - p ' DATE SIGNED -too S
<br /> CONDITIONS . permit is issued pursuant to the following conditions. Failure to comply may result in susp • ••or revocation of this
<br /> APPROVAL
<br /> _ or other. al . See attached for conditions of e•.royal.
<br /> F .6.41,4, V70.' i4Vy4C. ' I2'S _..a O441 3 A
<br /> MAR 2.0 7008 Sae. a4o- P b - 12.1' .•a.?•.4 . . .
<br /> "i! ty u aF'•r sj! *.t . AV lingo of City of Lp$gQ tery State-Contracted • .action Municipality Number of Dwelling Location
<br /> Fe g e r TOW DI O . t iN1Z g yk A) /9.'
<br /> t
<br /> / �j D 6 ..7---)•
<br /> %•51"'A,' ' `3a-" . : a� li ,.l _ 'Dd i ti:a'1Tlfi °r•`,l_i_.4,1 - 0:1.11: T,3 . , ;&,,,,',/ ;• .,. ,'w
<br /> . Plan Review $ , ° t 'f r o■1.c 1., ( tam
<br /> Inspection $ frIv AC N. . , •
<br /> Wis.Permit Seal $ _ 1/Electrical r O TeL `7
<br /> Other $ Plumbing )Da
<br /> .� Erosion Control
<br /> Total $ _ L art
<br /> SBD-5823(R.01/08)Distribute: Ply 1-Issuing Jurisdiction; Ply 2-Issuer forwards to State vv/in 30•,ys; •ly 3-Inspector; Ply 4-Applicant
<br /> MAY I ,'i:r'
<br /> TOWN OF VERONA
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