JURISDICTION : Village of RANDOM LAKE
PROJECT TYPE : New
PERMITS : Construction HVAC Electric Plumbing Erosion
PARCEL NUMBER : 59176746956
NAME : Jake and Carli Reuteler
ADDRESS 408 Franzen St., Random Lake, 53075
CONTACT (262) 424-9486, the.reuteler.1@gmail.com
DWELLING CONTRACTOR
NAME : LEE REALTY OF SHEBOYGAN INC WERNER HOMES
LIC/CERT # : DC-059500769 EXP DATE : 07/31/2023
ADDRESS , ,
CONTACT ,
DWELLING CONTRACTOR QUALIFIER
NAME : ROBERT J WERNER
LIC/CERT # : DCQ-120700217 EXP DATE : 12/12/2023
ADDRESS 4539 S Taylor Dr, Sheboygan, 53081
HVAC CONTRACTOR/QUALIFIER
NAME : WENSINK HEATING SERVICES INC
LIC/CERT # : 5719 EXP DATE : 10/04/2025
ADDRESS , OOSTBURG, 53070
ELECTRICAL CONTRACTOR
NAME : LUEDTKE ELECTRIC INC
LIC/CERT # : 1506 EXP DATE : 06/30/2024
ADDRESS 214 N 10TH ST, OOSTBURG, 53070
ELECTRICAL MASTER ELECTRICIAN
NAME : TODD JAMES LUEDTKE
LIC/CERT # : 1509 EXP DATE : 06/30/2023
ADDRESS W4005 COUNTY ROAD A S, CEDAR GROVE, 53013
MASTER PLUMBER
NAME : LARRY F BOEDECKER
LIC/CERT # : 232200 EXP DATE : 03/31/2027
ADDRESS 1109 S WISCONSIN DR, HOWARDS GROVE, 53083
NAME : Robert Werner
ADDRESS 4539 South Taylor Drive, Sheboygan, 53081
CONTACT (920) 458-4104, aaron@wernerhomes.com
AREA12431.00 SQ. FT.
1 OR MORE ACRES SOIL WILL BE DISTURBED false
LOCATION : Village of RANDOM LAKE
BUILDING
ADDRESS : East Shore Dr. , Random Lake, 53075
COUNTY SUBDIVISON LOT NO. 4 BLOCK NO.
ZONING
DISTRICT : PERMIT NUMBER :
SETBACKS Front ft.: 25.25 Rear ft.: 28.27Left Ft.:9.19Right ft.: 28.11
1. PROJECT TYPE : New
2. AREA :
AREA INVOLVED (SQ FT)
Unit 1
Unit 2
Total
3. OCCUPANCY : One Family
4. CONSTRUCTION TYPE :Site Built
5. STORIES :1-Story Plus Basement
6. ELECTRIC : Entrance Panel Amps 200, Underground
7. WALLS :Wood Frame
8. USE : Permanent
9. HVAC EQUIP : Furnace
10. SEWER :Municipal ,
11. WATER :Municipal
12. ENERGY SOURCE :
13. HEAT LOSS :60206
14. EST. BUILDING COST w/o LAND :350000.00
I understand that I: am subject to all applicable codes, laws, statutes and ordinances, including those described on the reverse side of the last ply of this form; am subject to any conditions of this permit; understand that the issuance of this 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 I 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 Contractor Certification and have read the cautionary statement regarding contractor responsibility on the reverse side of the last ply of this form.
SIGN/PRINT NAME:
DATE 6/11/2023 11:02 AM