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APPLICANT- PLEASE DO NOT SEPARATE THIS FORM. Your copy will be returned to you with your permit. <br /> ---_._ —JOANSON113'SrPECTION LLC _ it No: <br /> UNIFORM APPLICATION Perm <br /> Po Box 127 BUILDING PERMIT <br /> Arena,WI 53503 <br /> Phone:608-444-0372 Wisconsin Statutes 101.63, 101.73 Project Description: <br /> The information you provide may be used by other government <br /> Johnsoninspection @ gmail.com agency programs.I(Pdvacy Law,S.15.04(1)(m)1 <br /> PERMIT REQUESTED I "Construction "HVAC "Electric "Plumbing "Erosion Control "Other. <br /> Owner's Nome: Moiling Address: <br /> Andrew J. Stokes 505 Pine Tree Rd, Kohler WI 53044 Tel.and Email <br /> 920-2264922 roickesefwtmai.com <br /> Contractor Name I.Type Uc/Ced# Mailing Address el.a Fax <br /> Dwelling Contractor(Constr.) <br /> Dwelling Contr.Qualifier The Dwelling Contractor Quatier shall be on Owner, <br /> CEO.COB or Employee of the Dweling Contractor <br /> HVAC Contractor's Nome: <br /> Electrical Contractor's Nome: <br /> Plumbing Contractor's Nome: <br /> PROJECT tot area <br /> 10,000 N• One acre or more of <br /> , <br /> LOCATION soil will be disturbed SE 1/4, SE 1/4.of Section 21 ,T 09 N.R 05 E(or)W <br /> Site Address: Subdivision Name: lot No. Block No, <br /> 10434 Law's Drive J Town of Mazomanie,Dane County Wi 1 I <br /> Zoning District(s) I Zoning Permit No. Setbacks: 1 Front Rear r left I Right <br /> A-1EX ft. ft. ft. ft. <br /> 1.PROJECT ( 3.OCCUPANCY 16.ELECTRICAL f. HVAC EQUIPMENT 12.ENERGY SOURCE <br /> -New 'angle Family Entrance Panel -Forced Air Furnace Fuel Not Gas i LP Dec Sob Solar <br /> -Alterotion 'Repair X Two Fomity Amps: 'Radiant oo,•eeororron•i �e Nly II ( ❑ ❑ i ❑ 0 a <br /> 'Addition 'Raze 'Commercial -Underground X -Heat Pump WoterNtn ❑ 1 IT ❑ I ❑ ❑ , <br /> -Other -Move "Garage -Overheod -Boller <br /> -Other. X 7.WALLS -Central Air Cond. <br /> 2.AREA INVOLVED ] 4.CONST.TYPE I -Wood Frame X -o a <br /> -Other: 13.HEAT LOSS <br /> other: <br /> -Slle-Built 'Timber/Pole <br /> 8smt n/a -sq Ft -Mid: -WI UDC -Steel 'ICF 10.SEWER BTU/HR Total Calculated <br /> Uving Area 500 'U.S.HUD -Other• -Municipal Envelope and Infiltration Losses("Maximum Arowoble <br /> 5q Ft 5.STORIES 8.USE -Sanitary Permit No.: Heating Equipment Outpur on Energy Worksheet; <br /> Garage n/a Sq H -I-Story X "Seasonal X 'Total Building Heating Lood'on WlScheck report) <br /> -2-Story "Permanent 11,WATER 14.EST.BUILDING COST w/o LAND <br /> Other n/a Sq Ft -Other. 'Other Municipal Utility <br /> Total 500 Sq Ft -P,us Basement •Private On•Site Wet $ 1500.00 <br /> I understand that for subject to of applicable codes.statutes and ordinances and with the conditions of this perm):understand that the Issuance of the permit <br /> creotes no legal iabiity.express or impied,on the state or municipally:and certify that all the above Information Is accurate_I one acre or more of soil will be <br /> 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 <br /> statement on the back of the permit If not signing below.I expressly grant the budding Inspector,or the Inspector's outhortzed agent,permission to enter the premises <br /> for which this permit is sought at al reasonable hours and for any proper purpose to Inspect the work which is being done. <br /> I vouch that!am or will be on owner-occupant of this dwelling for which I am applying for an erosion control at conskuctbn permit without a Dwelling <br /> Contractor CergicaDon and have read the cautloaary slat' grant regarding contractor responsibility on the reverse side of the lost ply. <br /> APPLICANT'S SIGNATURE_ S DATE SIGNED August 2nd,2017 <br /> APPROVAL CONDITIONS This permit Is Issued pursuant to the following conditions.Follure to comply may result in suspension or revocation <br /> of this permit or other penalty."See attached for conddons of approval. <br /> "Town of -Woge of -City of "Comfy of -State r Stole Contracted inspecaon `Municipally Number of Dweling Location <br /> ISSUING JURISDICTION Agency I <br /> FEES: INSPECTIONS REQUIRED WI PERMIT SEAL B PERMIT ISSUED BY: <br /> Plan Review$ "Footing -Underfloor Plumbing/test <br /> Inspection ti :Footing -05 Sewer Lateral/test Nome <br /> "Rough Construction "Electric Service <br /> WI Seol $ -Rough Electrical 'insulation Date Tel. <br /> Other $ _ -Rough HVAC -Final Cert No. <br /> TOTAL S -Rough Plumbing/lest <br /> RECEIPT: I Check P: From: Rec'd by: Dote: <br /> Distribution "while:Fite "Yellow:Deportment of Commerce "Pink:Municipally 'Gold:Applicant Rev. 11-08 <br />