PORT LIONS BK 15 LT 1 - ZCP 1/19/2018Kodiak Island Borough
Commdnity Development Department
710 Mill Bay Rd. Rm 205
Kodiak AK 99615
Ph. (907) 486 - 9363 Fax (907) 486 - 9396
http://www.kodiakak.us
Zoning Compliance Permit
Print Form Submit by Email
20355
ZZo1? --0 36
Permit No. 8
The following information is to be supplied by the Applicant:
Property Owner / Applicant: Pamela Sullivan-Sumstad
Mailing Address: PO Box 2, Port Lions, AK 99550
Phone Number: (808) 333-2282
Other Contact email, etc.: msgrama@yahoo.com
Legal Description:
Subdv: Port Lions Block: 15 Lot: 1
Street Address: 1510 Main Street, Port Lions, AK 99550
Use & Size of Existing Structures:
Lodge (grandfathered main main lodge building)
Description of Proposed Action:
Demolition of main lodge building
Site Plan to include: Lot boundaries and existing easements, existing buildings, proposed location of new construction, access points,
and vehicular parking areas.
Staff Compliance Review: Current Zoning: Business KIBC 17.90 PROP—ID 20355
Lot Area: 0.41 acres Lot Width: Not Applicable Bld'g Height: 50'
Front Yard: Not Applicable Rear Yard: Not Applicable Side Yard: Not Applicable
Prk'g Plan Rvw? Not Applicable # of Req'd Spaces:
Staff Compliance Review Notes and Specific Plat / Subdivision Requirements:
Subd Case No. Plat No. Bld'g Permit No. N/A
Does the project involve YES
an EPA defined facility?
*Commercial buildings, installations (military bases),
institutions (schools, hospitals) and residences with
more than four (4) dwelling units.
Driveway N/A
Permit?
Septic Plan N/A
Approval:
Fire N/A
Marshall:
Proof of EPA notification provided (if required)?
*Required for all demolitions, for renovations disturbing at least 160 square l
feet 260 linear feet or 35 cubic feet of Regulated Asbestos Containing Material (RACM), and
for renovations that remove a load -supporting structural member.
No permit will be issued for such projects without proof of EPA notification
Applicant Certification: 1 hereby certify that 1 will comply with the provisions of the Kodiak Island Borough Code and that I
have the authority to certify this as the property owner, or as a representative of the property owner. 1 agree to have identifiable
corner markers in place for verification of building setback (yard) requirements.
Attachments? Not Applicable List Other: EPA notification with fax receipt report
Date: Nov 28, 2017
Signature: Pamela Sullivan-Sumstad
This permit is only for the proposed project as described by the applicant. If there are any changes to the
proposed project, including its intended use, prior to or during its siting, construction, or operation, contact
this office immediately to determine if further review and approval of the revised project is necessary.
THIS FORM DOES NOT AUTHORIZE CONSTRUCTION WHEN A BUILDING PERMIT IS REQUIRED.
** EXPIRATION: Any zoning compliance permit issued is subject to the same expiration, suspension, and revocation provisions as a
building permit issued for the same construction permit.** le--- --
CDD Staff Certification
Date: Nov 28, 2017 CDD Staff: Jack Maker
"l
Payment Verification Zoning Compliance Permit Fee Payable in Cashier's Office Room # 104 - Main floor of Borough Building
After -the -Fact 2X the published amount
Not Applicable
$0.00
$0.00
Less than 1.75 acres:
$30.000
$60.00
1.76 to 5.00 acres:
E
$60.00
El
$120.00 1
5.01 to 40.00 acres:
El
$90.00
0
$180.00
40.01 acres or more:
$120.00
E]
$240.00PA'
'ASI C 8
KODIAKiS4t%jj sur�uUGl�,
" IOP.lrr'II'pnEMBINT
Transmission Report
Date/Time 11-28-2017 16:33:42 Transmit Header Text
Local ID 1 9074869385 Local Name 1 KIB - Finance Department
This document: Confirmed
(reduced sample and details below)
Document size : 8.511x111'
U.S. EPA NOTIFICATION OF DEMOLITION AND RENOVATION
Psae) or 1
Operator Projectti 1 Pastmark I.,Witt Received I Nolifiation#
1. Type olNotilleatian(chackone): t6 Original Revised LJ Canceled
Il. Fad6ty Deser(ption
ro
BuildingNa)Jm��e-:-_ S�.7TG.kS CD1li-0��1=
Address: 1!1)5 A),,,.7
city: - Pnf�j:� t� 00r, SMI.: _ Zipcedr. Ej Sli County. 1)$A
Site Location: 1— S ISLV5—
Building Sim (square feet): 2� 00 SO , fr N or Floars: 1 A 6g in Years: a
r
Pmseat use: �?€ (6LL ® Prior Use: _�'A I� 10 �
UL Type ofOpentlab(ebeekoae): mo tj Ordered De Rinovation Lj Emergency Renovation - F1reTralni2
IV, is Asbestos Presenl? (check one): UYes
V. Facility Intra malion
[[��
OxncrName. �A)%Afl-} �V� VA�— 5UMSTA•f)
Address- 4, D hDx o—
city: 1-7 State:Zipcade:.�as5o
Contact: L M-C6ATelephonC ( 1 —=E`) Fax: A
Removal Conln or Name:
Address:
City:
Contact:phot':
Giber Opera -or (demoBilonigeneral:
Address: )CL t212Y Y�
City: th �_—Y 11P -a state: _ Zip Cade: qq sso
Contact: Telephone: (SQZ) a01'17o Fax:
Vt. Pncedure,including amtllleol methods, employed to detect the presence of and to utimalethe quantity orRACM and
Category 1 and Category 11 con-frlabie ACM:
N
V11. ApprnimalcAmauntaf AsbutDshlaledals:
PL: Polled local MP: Mailbox print
No,friable Asbestos Material Non friable Asbestos Material
Nrt
RACM robe Removcd to Le Removed NOT to be Removed
U,.l
Category I Category It Category 1 Category 11
Pipes (llaear feet)
Q N
Surface Area (square feet)
C%
Facility Components (cube: rest)
D, `-J
Vill. Scheduled Dates Demolition or Reaovaliou: Stan: Complete:
IX Dotes for Asbestos Removal (MMrDD.R'Y) Sun: campkk: l i
Doysofthe Week; hlunday I Tuesday I Wednesday TitursJay Friday I Saturday Sundsy
RM ofOperatian:
Total Pages Scanned : 2
Total Pages Confirmed : 2
No.
I Job
Remote Station
Start Time
I Duration
Pages Line
Mode
I Job Type
Results
001
1104
19072713424
16:32:3611-28-2017
00:00:31
2/2 11
1 EC
IHS
ICP33600
Abbreviations:
HS: Host send
PL: Polled local MP: Mailbox print
CP: Completed
TS: Terminated by system
HR: Host receive
PR: Polled remote RP: Report
FA: Fall
G3: Group 3
WS: Waiting send
MS: Mailbox save FF: Fax Forward
TU: Terminated by user
EC: Error Correct
U.S. EPA NOTIFICATION OF DEMOLITION AND RENOVATION
mare t of
Operator Project n
Postmark Date Received
=otification
1. Type of Notification (check one): Original Revised Canceled
tl. Facility Description ^�
BuildingNa/me: S�L�S CLMi,F �Wl�r—
Address: ST (�i51_rT -
City: State: Zip Code: � County: ----
Site Location : F)LUC 5 )
Building Size (square feet): 3 5700 �� f 7�—_ # of Floors: 1 Age in Years: _
Present Use: �-bb? LL LQQi — Prior Use: _ cAPPFU
Ill. Type of Operation (check one): emo LJ Ordered De LJ Renovation Ll Emergency Renovation L Fire Training
IV. Is Asbestos Present? (check one): L Yes LVNG
V. Facility Information
Owner Name: Xk UA)J S U MS -T-
Address:
City: State: A Zip Coder S_ Q
Contact: t� M-C� \Telephone: ( Fax:
Removal Contra for Name:
Address: ---- ---_-.
City: Zi odeL___
Contact:
Other Operator (demolition/general:
Address: u C)
City: a Ki State: Zip Code: qj�
Contact: Telephone: 00) 2 -01' 175L, Fax:
VI. Procedure, including analytical methods, employed to detect the presence of and to estimate the quantity of RACM and
Category and Category 11 non -friable ACM:
1/ /'v -
NIL Approximate Amount of Asbestos Materials:
Non -friable Asbestos Material Non -friable Asbestos Material
h t 1
RACM to be Removed
to be Removed NOT to be Removed
Category I Category Il Category I Category 11
Q
Pipes (linear feet)
O n f
Surface Area (square feet)
cc) )j
Facility Components (cubic feet)
VIII. Scheduled Dates Demolition or Renovation: Start: Complete: /f
IX. Dates for Asbestos Removal (MM/DDfYY) Start: Complete: / iv
Days of the Week:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Hours of Operation:
U.S. EPA NOTIFICATION OF DEMOLITION AND RENOVATION
Page 2 of 2
X.
Description of planned Demolition or Renovation work to be performed and method(s) to be employed, including demolition
or renovation techniques to be used and description of affected facility components:
MCA
XI.
Description of work practices and engineering controls to be used to comply with the requirements, including asbestos
removal and waste handling emission control procedures:
Al
XII.
Wnste Transporter #1
t
Name:
Address:
City: State; Zip Code:
Contact: Telephone, ( )
Waste Transporter #2
Name:
Address:
City: State: Zip Code:
Contact: Telephone: ( )
XIII.
Waste Disposal
Name:
Address:
City: State: Zip Code:
Contact: Telephone: ( )
XIV.
Emergency Demolition (complete Item XIV only if this proj t is an Emergency Demo.)
1. Attach a copy of the Order to lli notice.
2. Name of Authority Issuing Orde : Title:
3. Authority of Order (Cit n f ):
4. Date ofOrder (MM/D Date Ordered to Begin
MI.
Emergency Renovation (Attach separate shet with the f wing information ifproject is Emergency Renovation.)
1. Date and Hour of the Emergency:
2. Description of the Sudden, U xpe t ent:
3. Explanation of how the event ca se s fe conditions or equipment damage or an unreasonable financial burden
XVI.
Description of procedures to be followed in the event that unexpected RACAI is found or non -friable ACNI becme�PD A
to
crumbled, pulverized, or reduced powder.
� D� Ns-
-i
XVII.
1 certify that an individual trained in the provisions of NESHAP (40 CFR PART 61, SUBPART M) will be on-site during the
Demolition or Renovation, and evidence that the required training has been accomplished by this person will be
available during normal business hours.
Signature of Owner/Operator Date Type or Print Name and Title
XVIII.
I acknowledge the existence of laws prohibiting the submission of false or misleading statements, and 1 certify that facts
contained in this notification are true, accurate, and complete.
Signature of Owner/Operator Date Type or Print Name and Title
PAYMENT DATE Kodiak Island Borough
01/08/2018 710 Mill Bay Rd.
COLLECTION STATION Kodiak, AK 99615
CASHIER
RECEIVED FROM
PATRICK OTTOBRE
DESCRIPTION
PAMELA SULLIVAN- SUMSTAD 1510 MAIN ST PORTLIONS
PAYMENT CODE RECEIPT DESCRIPTION
Zoning Compl Zoning Compliance Permit
BZ 2018 036
Payments: Type Detail Amount
Cash $30.00
BATCH NO.
2018-00000345
RECEIPT NO.
2018-00000694
CASHIER
Teresa Medina
Total Amount: $30.00
Customer Copy
Printed hv- Teresa Medina Pane 1 of 1 n1/nR/2n1R 11 -.12-53 AM