HOSPITAL BK 1 LT 2A-1 - ZCP 12/23/2014Kodiak Island Borough
Community Development Department
4 710 Mill Bay Rd. Rm 205
Kodiak AK 99615
Ph. (907) 486 - 9363 Fax (907) 486 - 9396
http://www.kodiakak.us
Zoning Compliance Permit
Property Owner/ Applicant:
Mailing Address:
Phone Number:
Other Contact email, etc.:
Legal Description:
Street Address:
Use & Size of Existing Structures:
Print For Submit by Email
23656
Permit No. CZ2015 -045
The following information is to be supplied by the Applicant:
PROVIDENCE KODIAK ISLAND MEDICAL CENTER
1915 E REZANOF DR, KODIAK, AK 99615
907 486 3281
C/O STAN THOMPSON 907 486 9525
Subdv: HOSPITAL SUB Block: 1 Lot: 2A -1
1915 E REZANOF DR
HOSPITAL/ HEALT CARE
Description of Proposed Action: CONVERT EXISTING LONG -TERM CARE SQFTG TO REHAB THERAPY USE
( -10 CLIENTS & 10 EMPLOYEES AT ANY ONE TIME)
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:
Lot Area: 11.82
Front Yard: 25 '
Prk'g Plan Rvw?
Staff Compliance Review Notes:
Plat/ Subdivision Requirements?
Current Zoning: Public Use
Lot Width: 60
Rear Yard: 25'
# of Req'd Spaces:
KIBC 17.130
PROP-11D 23656
Bld'g Height: 50'
Side Yard: 25 '
TOTAL OCCUPANCY AND PARKING REQUIREMENTS REMAIN UNCHANGED
Subd Case No. Plat No. Bld'g Permit No.
Does the project involve
an EPA defined facility?
Driveway
Permit?
Septic Plan
Approval:
Fire
Marshall:
YES —i / If YES, do you have an EPA Return Receipt of �� �(VZ
i Notification? �i
"Permit will not be issued until receipt is submitted to
Applicant Certification: 1 hereby certify that I will comply with the provisions of the Kodiak Island Borough Code and that 1
have the authority to certify this as the property owner, or as a representative of the property owner. I agree to have identifiable
corner markers in place for verification of building setback (yard) requirements.
Attachments? Site Plan List Other:
Date: Dec 23, 2014
Signature: KEN KNOWLES (for STAN THOMPSON)
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: A zoning compliance permit will become null and void if the building or use authorized by such permit is not
commenced within 180 days from the date of issuance, or if the building construction or use is abandoned at any time, after the
work is commenced, for a period of 180 days. Before such work can be recommenced, a new permit must first be obtained. (Sec.
106.4.4 Expiration. 1997 UBC) per KIBC 17.15.060 A. **
CDD Staff Certification
Date: Dec 23, 2014 CDD Staff. Martin Lyd kl
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
r
$0.00
Less than 1.75 acres:
r
$30.00
I—
$60.00
1.76 to 5.00 acres:
(—
$60.00 ��
F—
$120.00
5.01 to 40.00 acres:
r
$90.00-' � `
F
$180.00
40.01 acres or more:
F—
$120.00 ' A I D
(—
$240.00
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Kodiak Island Borough Pun all
+ ! Community 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 -- No. ��,�j.
The following information is to be supplied by the Applicant:
Property Owner/ Applicant: ��� �! /�� f �► him • l,& / 14 Alb /,2L
Mailing Address: 1r, —() R
Phone Number: 90 ;7 302 "? i
Other Contact email, etc.: Cla 7- 5l�G ._ 2 61,2-5-
Legal Description: ,....
Subdv: Qu !( (- Block: Lot: 26-
Street Address: rc�/ -- , yhro 4D
Use &Size of Existing Structures: A(G,
Description of Proposed Action:
raj
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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: PROP ID vi c
Lot Area: Lot Width:
Front Yard: Rear Yard:
Prk'g Plan Rvw?
Staff Compliance Review Notes:
Plat/ Subdivision Requirements?
# of Req'd Spaces:
Bld'g Height:
Side Yard:
Subd Case No. Plat No. Bld'g Permit No.
Does the project involve
an EPA defined facility?
Driveway
Permit?
Septic Plan
Approval:
Fire
Marshall:
If YES, do you have an EPA Return Receipt of
Notification?
"Permit will not be issued until receipt is submitted to
Applicant Certification: I hereby certify that 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? List Other:
Date: Signature:
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: A zoning compliance permit will become null and void if the building or use authorized by such permit is not
commenced within 180 days from the date of issuance, or if the building construction or use is abandoned at any time, after the
work is commenced, for a period of 180 days. Before such work can be recommenced, a new permit must first be obtained. (Sec.
106.4.4 Expiration. 1997 UBC) per KIBC 17.15.060 A. **
CDD Staff Certification
Date: CDD Staff:
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
r
$0.00
Less than 1.75 acres:
r
$30.00
r;
$60.00
1.76 to 5.00 acres:
r
$60.00
r
$120.00
5.01 to 40.00 acres:
90.00
r
$180.00
40.01 acres or more:
r
$120.00
j—
$240.00