KODIAK TWNST BK 1 LT 17B - Supplemental InformationBUILDING DEPARTMENT - KODIAK ISLAND BOROUGH APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
(APPLICANT TO FILL IN ALL INFORMATION WITHIN HEAVY LINES. PLEASE PRINT, USE BALL-POINT PEN, AND PRESS FIRMLY.)
SUBDIVISION/SURVEY
LOT NO. BLOCK NO.
STREET ADDRESS
NEAREST CROSS STREET
NAME
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O
1-
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Z
S (7
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MAILING ADDRESS
CLASS AND SCOPE OF WORK
NEW
ALTERATION
ADDITION
DEMOLISH
REPAIR
MOVE
USE OF BUILDING /../ 5-10. L.
SIZE OF BUILDING . )3,HGT
NO. OF ROOMS
BUILDING PERMIT NUMBER
DATE ISSUED /
.76
VALUATION: (BASIS)
BLDG PERMIT FEE
FLOORS
NO. OF FAMILIES
2-
NO. OF BUILDINGS NOW ON LOT
USE OF BUILDINGS
SIZE OF LOT
i
AMOUNT
PLAN CHK FEE
TOTAL
INSPECTION SCHEDULE
BUILDING
PLUMBING
ELECTRICAL
CITY, STATE TELEPHONE
NAME
ADDRESS
CITY, STATE
STATE LICENSE NO.
NAME
-1,75--'3.:.----••••••.r.
WATER: PUBLIC PRIVATE
SEWER: PUBLIC PRIVATE
SPECIFICATIONS
FOUNDATION
ROUGH
ROUGH
FRAME
SEPTIC TANK
PLASTER/BD
SEWER
FINISH
FIXTURES
FOUNDATION
TYPE
EXT
PIERS
DEPTH IN GND
HGT FIN GRADE
P.T. PLATE (SILL)
STRUCTURAL
GIRDERS
JOISTS 1ST FLR.
SIZE
SPA.
SPAN
ADDRES
‘at -Tatxx‘s ,
JOISTS 2ND FLR.
JOISTS CLG
EXT STUDS
INT STUDS
FLUES
FINAL
GAS
FIN ISH
MOTORS
FINAL
EACH OF THE ABOVE INSPECTIONS MUST BE REQUESTED AND THAT
WORK APPROVED PRIOR TO ANY ADDITIONAL WORK PROGRESSING
BEYOND THAT POINT, AS REQUIRED BV UBC SECTION 305. FOR EACH
INSPECTION, 24 HOURS NOTICE IS REQUIRED. TELEPHONE THE KODIAK
Icl ANO' BOROUGH ENGINEERING DEPARTMENT. 486-5736. EXT. 273.
NOTES:
INSTALLATION OF (MINIMUM) 18 -INCH BY 20 -FOOT CULVERT 15 REQUIRED
AT EACH DRIVEWAY ACCESS TO THE PROPERTY.
SANITATION PLAN APPROVAL BY AN ADEC-CERTIFIED INSTALLER 15
REQUIRED PRIOR TO ISSUANCE OF A BUILDING PERMIT WHERE PUBLIC
WATER AND/OR SEWER 15 NOT AVAILABLE FROM A CERTIFICATED
MUNICIPAL SYSTEM.
INSTALLER'S PLAN APPROVAL RECEIVED
INSTALLER
CITY, STATE
ROOF RAFTERS
STATE LICENSE NO.
(FOR OFFJE USE ONLY: CIRCLE)
1. OCCUPANCY GROUP
A B EH I MR
DIVISION 1 2 3 4 5
2. TYPE OF CONSTRUCTION
1 II III IV V
FR 1 -HR. N H.T.
TRUSSES
BEARING WALLS
INSULATION, FNDN
WALLS ROOF/CLG
SHEATHING, WALLS/EXT
ROOF FLOOR
FINISH, EXT WALLS
ROOF
FLUES, FIREPL WOOD HTR
KITCHEN WATER HTR
FURNACE, TYPE
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.
APPLICANT
PRIOR TO THE ISSUANCE OF A PERMIT, EITHER THE OWNER OF THE
PROPERTY OR HIS AUTHORIZED AGENT MUST SIGN THIS APPLICATION OR
GRANT OTHER WRITTEN PERMISSION FOR THE DESCRIBED WORK TO BE
PERFORMED.
TAX LOT NO DATE
OWNER PER
OWNERSHIP TRANSFERRED, IN PROCESS, TO:
PER
CLOSING DATE, DEED RECORDED (BY)
APPROVED, BUILDING OFFICIAL
PLOT PLAN
(A SITE PLAN MAY ALSO BE REQUIRED)
REAR PROPERTY LINE
SIDE PROPERTY LINE
FRONT PROPERTY LINE
STREET
1
SIDE PROPERTY LINE
NOTE: APPLICANT SHALL SHOW BUILDING SETBACKS
FROM PROPERTY LINES, AS PERPENDICULAR DISTANCES
FROM PROPERTY LINES TO BUILDING. DIMENSIONS OF
STRUCTURE SHALL BE SHOWN ON THE PLAN.
ZONING CODE COMPLIANCE
ZONING DISTRICT
TYPE OF OCCUPANCY
NO. OF STORIES
TOTAL HGT
AREA OF LOT
SETBACKS FROM PROPERTY LINES:
FRONT REAR
SIDE (L) SIDE (R)
REQ'D OFF-STREET PARKING
C.U.P. OR VARIANCE
APPROVED, ZONING OFFICER
BY BY
BUILDING DEPARTMENT — CITY / BOROUGH OF KODIAK
Applicant to fill in between heavy lines.
CLASS OF WORK
BUILDING ADDRESS
1-A Utiel
LOCALITY
NEAREST CROSS ST.
trv
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0
NAME
MAIL ADDRESS
CITY
91A tif L NO.
NEW
DEMOLISH
ALTERATION
REPAIR
z
0
J
a
'Li,
J N
Lai
0
STATE LICENSE NO.
NAME
ADDRESS
CITU
STATE LICENSE NO.
SUBDIVISION
LOT NO.
BLK.
DO NOT WRITE BELOW THIS LINE
1. Type of Construction
I, II, III, IV, V, VI
2. Occupancy Group A, B, C, D, E,
F, G, H, I, J Div. 1, 2, 3, 4,
3. Fire Zone 1 2 3 4
ADDITION
MOVE
USE OF BUILDING
SIZE OF BUILDING HEIGHT
NO. OF ROOMS
NO. OF FLOORS
NO. OF BUILDINGS
NO. OF BUILDINGS NOW ON LOT
NO. OF FAMILIES
SIZE OF LOT
USE OF BLDG. NOW ON LOT
SPECIFICATIONS
FOUNDATION
MATERIAL EXTERIOR,
PIERS
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE
OF OCCUPANCY
BUILDING PERMIT NO.
VALUATION
BUILDING
I OUNDATION
FRAME
DATE ISSUED
BLDG. FEE
PLAN CHK. FEE
TOTAL
PLUMBING
ROUGH
SEPTIC TANK
ELECTRIC
ROUGH
FINISH
PLASTER
SEWER
FIXTURES
WIDTH OF TOP
WIDTH OF BOTTOM
DEPTH IN GROUND
R.W. PLATE (SILL)
SIZE
SPA.,
SPAN
GIRDERS
JOIST 1st. FL.
JOIST 2nd. FL.
JOIST CEILING
EXTERIOR STUDS
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
F LUI 5
1
GAS
FINISH
MOTORS
FINAL
3N11 AJ J3dO8d
PLOT PLAN
Y
H H
3N11 Ala3dO2id
SETBACK
STREET
PLANNING & ZONING INFO.
ZONING DISTRICT
TYPE OF OCCUPANCY
NUMBER OF STORIES TOTAL 111.
AREA OF LOT
FRONT YARD SETBACK FROM PROP. LINE
SIDE YARD SETBACK FROM PROP. LINE
REAR YARD
Approved: CHIEF BUILDING OFFICAL Approved: ZONING ADMINISTRATOR
By:
By•
BUILDING DEPARTMENT — CITY OF KODIAK
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE
Applicant to fill in between heavy lines. OF OCCUPANCY
BUILDING ADDRESS
CLASS OF WORK
NEW I I DEMOLISH
LOCALITY
ALTERATION I I REPAIR
ADDITION I I MOVE I
NEAREST CROSS ST.
USE OF BUILDING
PERM ITTEE
NAME
SIZE OF BUILDING HEIGHT
NO. OF ROOMS
MAIL ADDRESS
NO. OF FLOORS i
CITY TEL. NO.
NO. OF BUILDINGS NOW ON LOT
NO. OF FAMILIES
RC IT ECT
ENGINEER
NAME
SIZE OF LOT
ADDRESS
USE OF BLDG. NOW ON LOT
CITY
SPECIFICATIONS
FOUNDATION
STATE LICENSE NO.
MATERIAL
EXTERIOR i PIERS
CONTRACTOR
NAME
WIDTH OF TOP
I
WIDTH OF BOTTOM
I
ADDRESS
DEPTH IN GROUND I
CITY
R.W. PLATE (SILL)
SIZE 1
SPA.
SPAN
STATE LICENSE NO.
GIRDERS
LEGAL
DESCRIPTION
SUBDIVISION
JOIST !sr FL.
JOIST 2ND FL.
LOT NO. BLK.
JOIST CEILING
EXTERIOR STUDS
1. District
0
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
[ 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.
-
VALUATION
DATE ISSUED
BLDG. FEE S
PLAN CHK.
TOTAL
BUILDING 1 PLUMBING
1
FEE
ELECTRIC
FOUNDATION
FRAME
PLASTER
ROUGH
1 I SEPTIC TANK
SEWER
ROUGH
FINISH
FIXTURES
FLUES
FINAL
GAS
FINISH
MOTORS
FINAL
3NI1 .112i3dO2id
PLOT PLAN
A
r
SETBACK
3N1'1 Al?:13dOJId
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
By: