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APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY - CITY OF KODIAK - KODIAK ISLAND BOROUGH - BUILDING DEPARTMENT
Telephone: 486 -8070 • 486 -8072 Fax: 486 -8600 710 Mill Bay Road, Room 208
(APPLICANT TO FILL IN ALL INFORMATION WITHIN BOLD LINES. PLEASE PRINT. USE A BALLPOINT PEN AND PRESS FIRMLY.)
(OFFICE USE ONLY)
STREET ADDRESS:
iw i .
CLASS AND SCOPE OF WORK:
SPECIFICATIONS:
BUILDING PERMIT NUMBER:
DATE OF APPLICATION:
\
LOT: BLOCK:
/ :)ever,,
NEW
DEMOLITION
FOUNDATION
FOOTINGS
STEM WALL
PIERS
ZONING COMPLIANCE:
DATE ISSUED:
ALTERATION
REPAIR
TYPE
At c
SUBDIVISION / SURVEY/.
I f I On
ADDITION
MOVE
DIMENSIONS
VALUATION BASIS:
BUILDING PERMIT FEE:
L.,:;
DEPTH IN GRND
O
W
N
R
NAME:
r
�'C�•Ii ;,jo r ��i�
USE OF BUILDING AUTHORIZED BY
THIS PERM T:
/.4/ "' G(N
REINFORCEMENT
VALUATION:
PLAN CHECK FEE:
BOLT SPACING
MAILING ADDRESS:
" 1 7 z, -04
CRAWL SPACE HEIGHT INCHES
OCCUPANCY
TOTAL FEE:
GROUP:
CRAWL SPACE VENT SQ. FEET
A B E F H I M R S U
DIV. 1 2 3 4 5 6
CITY & STATE: _
j
i'- ' Lid. tCc. K rs 1 iN '/ q ,/.5
SIZE HEIGHT
STRUCTURAL
SPECIES & GRADE
SIZE
SPACING
SPAN
NO. OF ROOMS STORIES
RECEIPT NO:
TELEPHONE:
W �q 5 Lf
NO. OF FAMILIES
GIRDERS
EACH OF THE FOLLOWING
STAGES OF CONSTRUCTION
REQUIRES INSPECTION BE
REQUESTED & COMPLETED
PRIOR TO PROCEEDING WITH
ANY FURTHER WORK:
FOR INSPECTION CALL 486 -8070
TYPE OF BUSINESS
GIRDERS
A
R
C
H
E
N
G
NAME:
NO. OF BLDGS NOW ON LOT
JOISTS 1ST FLOOR
USE OF EXISTING BLDGS
JOISTS 1ST FLOOR
MAILING ADDRESS:
SIZE OF LOT
JOISTS 2ND FLOOR
WATER: PUBLIC'
I PRIVATE
I
JOISTS 2ND FLOOR
TYPE OF CONSTRUCTION
I II III IV V
N 1 -HR FR H.T.
CITY & STATE:
SEWER: PUBLIC
PRIVATE 1
CEILING JOISTS
INSULATION TYPE & THICKNESS:
EXTERIOR WALLS
14 s`r
TELEPHONE:
FOUNDATION
BEARING WALLS
INTERIOR WALLS
EXCAVATION
STATE LICENSE:
WALLS
ROOF RAFTERS
UNDERGROUND UTILITIES
ROOF / CEILING
TRUSSES
DRIVEWAY PERMIT:
FOUNDATION / SETBACKS
SUBMITTED
FRAMING
U O Z H Q< O F 0 cc t
NAME:
X11+'`s.
j jh'�
' f r`{4' f IL "/1
SHEATHING TYPE & SIZE:
FURNACE TYPE:
FLOOR
APPROVED
ROUGH ELECTRICAL
MAILING DRESS:
LI ' }C Lt (q,
WOOD HEATER YES NO
TYPE
ROUGH PLUMBING
WALLS
ADEC APPLICATION:
FINAL
SUBMITTED
DATE C.O. ISSUED:
CITY &��STATE: qCj/ `
J.` cid la f• f l 6!
ROOF
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION,
THAT IT IS CORRECT AND THAT I AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION
M
APPLICANT: - / (1'4°1014'4 ;4-44---'4- ^ "+ 'f
FINAL APPROVAL
TELEPHONE: /� l� 11i j
J rJ G •
FINISH MATERIAL:
KODIAK FIREMARSHAL REVIEW:
SUBMITTED: APPROVED:
ROOF
STATE LICENSE: `
-
EXTERIOR SIDING
`-
APPROVED - BUILDING OFFICIAL:
INTERIOR WALLS
NOTES:
PRINTED IN KODIAK, ALASKA BY PRINT MASTERS OF KODIAK
THAT BUSINESS IS OPERATED EACH YEAR
TO
OR CERTIFICATE OF REGISTRA
C APPLI ION F(SALES AND SERVICE TAX)
TO: CITY OF KODIAK
P.O.BOX 1397
KODIAK, ALASKA 99615
DATE OF APPLICATION j. o? 7-&.
NAME OF FIRM
(Dale or .,y nr
22930
rr
r v1
cOdci 4,/
!T�9l 51 tl 0"
ACCOUNT NO.
n e.
LOCATION ADDRESS 0 (o /� re 3 BUSINESS PHONE ‘-------
MAILING ADDRESS
NAME OF OWNER 61D4
HOME ADDRESS HOME PHONE 3(0 3 3 6 3 `%
STREET CITY
TYPE OF BUSINESS IS 1-7 -- r-Y.-L-o �/ ) to L<T aJ
(9C z`' / / q g' 5� �-c- a 113LK s 1 F -r tJ
STREET
•
CITY STATE
AIL
ZIP CODE
STATE ZIP CODE
DATE BUSINESS STARTED
ALASKA BUSINESS LICENSE NUMBER n
TYPE OF ORGANIZATION: INDIVIDUAL t 1 PARTNERSHIP
IS BUSINESS SEASONAL IF YS, APPROXIMATE DATES
EG. L. I5 ft/2-A t-C.Tt. Rt2W LQQ FROM
I n3rccO.
CORPORATION
OTHER (EXPLAIN BELOW)
te'd
NO. OF MONTHS
SIGNATURE & TITLE OF APPLICANT
NAME TITLE
MAILING ADDRESS: HOME ADDRESS: PHONE:
NAME TITLE
MAILING ADDRESS: HOME ADDRESS: PHONE:
NAME TITLE
MAILING ADDRESS: HOME ADDRESS: PHONE:
NAME TITLE
MAILING ADDRESS: HOME ADDRESS: PHONE:
REVENUE OFFICE
BUILDING DEPARTMENT — CITY OF KODIAK
Applicant to fill in between heavy lines. OF OCCUPANCY
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE
BUILDING ADDRESS
CLASS OF WORK
NEW I DEMOLISH
LOCALITY
ALTERATION I I REPAIR
ADDITION I I MOVE
NEAREST CROSS ST.
USE OF BUILDING
PERM ITTEE
NAME
SIZE OF BUILDING HEIGHT
NO. OF ROOMS
MAIL ADDRESS
NO. OF FLOORS
CITY TEL. NO.
NO. OF BUILDINGS NOW ON LOT
NO. OF FAMILIES
ARCHITECT
ENGINEER
NAME
SIZE OF LOT
ADDRESS
USE OF BLDG. NOW ON LOT
CITY
SPECIFICATIONS
FOUNDATION
STATE LICENSE NO.
MATERIAL I EXTERIOR i PIERS
CONTRACTOR
NAME
WIDTH OF TOP I I
WIDTH OF BOTTOM I I
ADDRESS
DEPTH IN GROUND I
CITY
R.W. PLATE (SILL)
SIZE I
SPA.
SPAN
STATE LICENSE NO.
GIRDERS
LEGAL
DESCRIPTION
SUBDIVISION
JOIST 1ST FL.
JOIST 2ND FL.
LOT NO. BLK.
JOIST CEILING
EXTERIOR STUDS
1. District
p. Type of Construction
I, II, III, IV, V, VI
3. Occupancy Group A, B, C, D, E,
F, G, H, I, J Div. 1, 2, 3, 4,
4. Use Zone;
5. Fire Zone 1 2 3 4
INTERIOR STUDS
ROOF RAFTERS
BEARING WALLS
COVERING
EXTERIOR WALLS
ROOF
INTERIOR WALLS
REROOFING
FLUES
FIREPLACE FL. FURNACE
KITCHEN WATER HEATER
FURNACE GAS OIL
I hereby acknowledge that I have read
this application and state that the
above is correct and agree to comply
with all City Ordinances and State
Laws regulating building construction
Applicant
BUILDING PERMIT NO.
7i
VALUATION
DATE ISSUED
BLDG. FEE S
PLAN CHK. FEE
TOTAL
BUILDING
FOUNDATION
FRAME
PLASTER
PLUMBING
ROUGH
SEPTIC TANK
ELECTRIC
FLUES
FINAL
SEWER
GAS
FINISH
ROUGH
FINISH
FIXTURES
MOTORS
FINAL
3NI1 A11:13dO2id
PLOT PLAN
H
A
SETBACK
3N11 A.M dO21d
STREET
MAP NUMBER
NO. ASSIGNED BY
FIELD CHECK BY
DATF
PLANNING & ZONING INFO
TYPE OF OCCUPANCY
TOTAL FLOOR AREA
NUMBER OF STORIES TOTAL HT.
AREA OF LOT
FRONT YARD SETBACK FROM PROP. LINE
SIDE YARD SETBACK FROM PROP. LINE
REAR YARD
NEW CONSTRUCTION ALTER
CHANGE OF OCCUPANCY FROM
By: To
Approved: CHIEF BUILDING OFFICIAL
Bv: