KODIAK TWNST BK 19 LT 16 - ZCPKodiak Island •ugh Community
Development Department
710 Mill Bay Rd. Rm 205
Kodiak AK 99615
Ph. (907) 486 - 9362 Fax (907) 486 - 9396
http://www.kib.co.kodiak.ak.us
Zoning Compliance Permit
•Print Form Submit by Email
III IIIIIIIIIIIIIIIIIIIIIIYIIII IIIIIIIIIill
R1340190160
Permit No. CZ2009-031
Property Owner / Applicant:
Mailing Address:
Phone Number:
Other Contact email, etc.:
Legal Description:
Street Address:
The following information is to be supplied by the Applicant:
DOWNING, VICTOR & CONSTANCE
217 W HILLCREST ST, KODIAK, AK. 99615
486
3343
KODIAK TWNST BK 19 LT 16
217 W HILLCREST ST
Use & Size of Existing Structures: SFR
Description of Proposed Action: REPLACE WINDOWS
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: 3919.00 S
ZONING: R-2 Parcel No. R1340190160
Lot Width: 60'
Bldg Height: 35 '
Front Yard: 25 ' Rear Yard: 10' Side Yard: 5 '
Prk'g Plan Rvw? No # of Req'd Spaces: 3
Plat / Subdivision
Requirements?
Other
Requirements?
_i ,J al
k Island Borough
lce Department
Coastal Policy Residential •onsistent? Yes •chment?
Subd Case No.
Driveway
Permit?
Septic Plan
Approval:
Fire
Marshall:
Plat No. Bld'g Permit No.
Applicant Certification: 1 hereby certify that 1 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? List Other:
Date: Sep 5, 2008
Signature: Michael Hoffman for Dow
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.
** 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 17.03.060. **
CDD Staff Certification
Date: Sep 5, 2008
CDD Staff: Martin Lydi
Payment Verification
Zoning Compliance Permit Fee
Payable in Cashier's Office
doom # 104
°�a"6' �-
r. r.. N
-11
.r d .112 C7
' Fe'e Schedulg a
fiZ42P.7"-.
F�0 *
*
Less than 1.75 acres $30.00
t, -
Construction Disposal Deposit
Payable in Cashier's Office
Room # 104
Fee Schedule
Less than 250 sq ft $250.00
Kodia
Fina
4 ZONING COMPLIANV PERIIIT(pagelof3)
• Permit # C
Kodiak Island Borough, Community Development Department, 710 Mill Bay Road (Rm. 205), Kodiak, AK 99615
PH(907)486-9362 Fax(907)486-9396 http://www.kib.co.kodiak.ak.us
Required Applicant Information:
1. Property Owner/Applicant: M 2 t Vel es �d w 144
Mailing Address: 21 7
f-{ 1(L c2 EST ST_
2. Legal Description: A/4
TO w .a Siz
Street Address: 2 1 -1 w
c
Phone: Yei-33Y3
/Lo 1 q / L6 j / (r
3. Description of proposed action: EP1 n -c F .- ' 4 (JS
4. Site Plan (page 3 of 3 of this application): to include: Lot boundaries & existing easements, proposed
location of all buildings, access points &vehicular parking areas.
STAFF WILL PROVIDE YOU WITH A COPY OF THE APPLICABLE CODE SECTIONS THAT APPLIES TO YOUR
DEVELOPMENT ACTIVITY
Zoning District 0 Parking Requirements 0 Solid Waste Removal Requirements 0
STAFF COMPLIANCE REVIEW Parcel No. R
Current Zoning: Required Lot Area:
Required Setbacks: Front: Side: Rear Building Height:
(Setbacks other than zoninz district standards to be noted on the attached site plan)
5. Number & size of parking spaces required:
6. Off-street loading requirements:
Plat/subdivision related requirements (e.g. plat notes, easements, subdivision conditions, drainage plan review,
etc.)
Other Requirements (e.g. zero lot line, additional setbacks, projections into yards, screening, etc.
ACMP Policies: Res. 0 Bus. 0 Ind. 0 Other 0 Consistent with KIB CMP: Yes❑ No❑ Attachment: Yes❑ No❑
Zoning Compliance Permit Fee
Payable in Cashier's Office
Room # 104
Fee Schedule:
(per MB Assembly Resolution
Eff. July 1, 2005)
Less than 1.75 acres
1.76 to 5.00 acres
5.01 to 40.00 acres
40.01 acres or more
$30.00
S60.00
$90.00
$120.00
Cflfl Trmnlatec/Fnrmc/7nnino (mmnlianrn Annliratinn
Construction Disposal Deposit
Payable in Cashier's Office
Room # 104
Fee Schedule:
(per MB Assembly Resolution
Eff. July 1, 2005)
Less than 250 sq. ft. $250.00
251 to 500 sq. ft. $500.00
501 or greater sq. ft. $1000.00
PP OP i of
PeC. e3cPC07-C.,`7
Op-bik-es5(se P i
/Nat) 8(c pao
✓1"oc-5Z ipt0-k&7 sp'5
SERINE BROTHERS
ROOFING, SIDING, WINDOWS, DECKS
FIRE & WATER RESTORATION
c res St.
Lot 16, Block 19
5
\\A
Parking Easement
for Lot 15A, Block 19
(Book 77, Page 200)
15A
s
17
8' 0"
5' 2" —
14
Scale: 1 "=20'
P.O.Box3855 • Kodiak,AK99615 • Tel:(907)481-3900 Fax:(907)481-3922
BERN1E 8R0TIIERS
Roofing • Siding • Windows • Decks
�iFire and �nd Water Restoration
'
NAME .;'( L f [[" 11( 2S b o J N r
ADDRESS 1 -7 14 1 LL C/2 -e--5
CITY, STATE AND ZIP CODE
Bernie Stallard • Owner
P.O. Box 3855 • Kodiak, AK 99615
Office: 481-3900 • Fax: 481-3922
DATE
/ 8 \Ju./ of
PHONE (HOME) 2tP G 3 3 Y 3
JOB LOCATION IF DIFFERENT
TEAR OFF:
NO TEAR OFF REQUIRED
TOP LAYER(S)
IRE ROOF TO DECKING AND INSTALL NEW # FELT
T LATION:
WI RGAURD THREE FEET ABOVE G
WINTE AURD ALONG WALLS AND SKY
WINTERG URD IN VALUES
INSTALL N 3 -TABS • ARCHITECT RAL • SHAKES • STEEL
MANUFACTUR-'S WARRANTY • YEARS
COLOR -
INSTALL
DESCRIPTION OF WORK
g ET 0 /J JM TVi i 4--t$
S
GHTS
AirC
PLUM c G VENT FLASHING
R • • VENTS `
REPLACE BAD DECKING AT $ PER SHEET OF
PLYWOOD EXTRA
❑ NO WARRANTY APPLIES
WORKMANSHIP WARRANTY OF 1 YEARS
7v CLEAN UP & HAUL AWAY ALL TRASH
O CLEAN GUTTERS
O RUN NAIL MAGNET
PRICE INCLUDES ALL LABOR, MATERIALS & TAX
We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
dollars ($
VPa") P/E.-7an/
MI calculis guaranteed to be as specified. Ag work to be completed in a workman Oro manner
mooning to standard practices. Any a1ra6on or deviation from above specifications involving
eta cents will be stewed ordy upon written orders, and wig become an extra charge over and
above the esdwle. All agreements conbnge t upon strikes, accidents or delays beyond our
oadrd. Owner to carry fire, tornado and other necessary insurance. Ow waken are turfy
covered by Workman's Compensation Insurance.
Aec.rieettance
of Proposal- The above prices, specifications and
are sabstactory and are hereby accepted. You are authorized to
do the work as specified. Payment will be made as outlined above. This
proposal becomes a legal and bigding contract after 72 hours of acceptance.
Date of Acceptance: L. 1 1 cj t
Signature
Signature
1
ZOWN G CUMl'LlAN ,E 1 LI(IVII,tPagelof3)
Per # C. Z- 26)0 �- — (04—
Kodiak Island Borough, Community Development Department, 710 Mill Bay Road (Rm. 205), Kodiak, AK 99615
PH(907)486-9362 Fax(907)486-9396 http://www.kib.co.kodiak.ak.us
Required Applicant Information:
1. Property Owner/Applicant: Vi bo N Nl/
Mailing Address:
2(7 f-( 'tic T_
lJ Orn/e../ Z/C7/4 76-
2. Legal Description: ko)f4,C TE `aLocK /7
ill Street Address: N < < c c CS
i-
LOT /C.=
Phone: 546 -33 y3
3. Description of proposed action: kc DEt_ / s' r < '
KD o m i 811,i6)
f� N� 4 /771 AD?,71',4'-
4. Site Plan (page 3 of 3 of this application): to include: Lot boundaries & existing easements, proposed
location of all buildings, access points &vehicular parking areas.
STAFF WILL PROVIDE YOU WITH A COPY OF THE APPLICABLE CODE SECTIONS THAT APPLIES TO YOUR
DEVELOPMENT ACTIVITY
Zoning District Parking Requirements J Solid Waste Removal Requirements
STAFF COMPLIANCE REVIEW Parcel No. R ) 3q O / of ) (p 0
Current Zoning: R 2 _ T \ Required Lot Area: 2° 3 S 4
Required Setbacks: Front: 9---Cs/ Side: S� ( Rear l U / Building Height: `3S f jai g�
(Setbacks other than zonin,4 district standards to be noted on the attached site plan)
5. Number & size of parking spaces required: `l i)C
6. Off-street loading requirements: p / j A--
Plat/subdivision related requirements (e.g. plat notes, easements, subdivision conditions, drainage plan review,
etc.) S-44,-4-4.- ori P�:✓c-� p�.�7� 2�
Other Requirements (e.g. zero lot line, additional setbacks, projections into yards, screening, etc.
iv 4
ACMP Policies: Res.
Bus. 0 Ind. 0 Other 0 Consistent with KIB CMP: Ye
Zoning Compliance Permit Fee
Payable in Cashier's Office
Room # 104
Fee Schedule:
(per MB Assembly Resolution
Eff. July 1, 2005)
Less than 1.75 acres $30.00
1.76 to 5.00 acres Fno.11t1-
5.01 to 40.00 acres $90.00
40.01 acres or more $120.00
r'nn TP.nnlntpc/Pnrmcr7nnino n.,rrntinn
Attachment: Yes❑ N9
Construction Disposal Deposit
Pay. * e in Cashier's Office
Room # 104
Fee Schedule:
(per Kill Assembly Resolution
Eff. July 1, 2005)
AMER t1ACCT2
/12/2867 14:87:87
80133'74 toning Cep
PAID
38.00
*** Paid in Full ***
Kodiak Island Bi roup
Kodiak AK 95615
(i01) 486-9324
PTI OP l „f
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 b
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 17.03.060.
1. Subd. Case #: Plat #: A Ai Bldg Permit #:
2. Driveway Permit (State, Borough, City) by/date:
3. Applicant Certification: I hereby certify that I 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. I agree to have identifiable corner markers in place in the field for
verification of setbacks.
By:.
Date:
/?
X4'2 /< U %
Supporting documents attached (check one): Site Plan:
Title:
(s e 7v i / 67-c, 777:
As -Built Survey: ❑
Other (List):
4. Communi Develo
By:
5. Fire Marshal (UFC) by/date:
Department
Title: - C i
N��
d7-
6. Septic System Plan Approved by/date: 11'
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 uses
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.
'Jnl Tpmnlatrc/Fnrmcl7nnino rmmnlianrr Annliratin• • Nos." of 1
ED and LIP -1)141E0, ro -JULY /.9.9e.
l4IEL =Mk # DECKS)
L091 -
P
/ .o'
'C
FX PK"NG E.�SE�MSNT
1cGQ
LC"?' /ffA, 13LoC-C /9
(BDc1eT7. PelalS 200)
r3_
• f
BURIED FIrEL
LDIDER
1
A'
;r
c4t9
CiIL
rvir P
All
misuse 110+ Atf1P6Q/F'0)
BERNIE BROT/IERS
Roofing • Siding • Windows • Decks
Fire and Water Restoration
NAME V J' 1 l / 1 ,e7s `ipLAM
111
ADDRESS g.'
Bernie Stallard • Owner
P.O. Box 3855 • Kodiak, AK 99615
Office: 481-3900 • Fax: 481-3922
CITY, STATE AND ZIP CODE
JOB LOCATION IF DIFFERENT
TEAR OFF:
❑ NO TEAR OFF REQUIRED
O TOP LAYER(S)
O ENTIRE ROOF TO DECKING AND INSTALL NEW # FELT
INSTALLATION:
❑ WINTERGAURD THREE FEET ABOVE GUTTERS
❑ WINTERGAURD ALONG WALLS AND SKYLIGHTS
O WINTERGAURD IN VALLIES
❑ INSTALL NEW 3 -TABS • ARCHITECTURAL • SHAKES • STEEL
O MANUFACTURERS WARRANTY OF YEARS
❑ COLOR.
O INSTALL.
DATE 2-1-10.—
PHONE (HOME) lD 3 31-13
O PLUMBING VENT FLASHING
O ROOF VENTS
O REPLACE BAD DECKING AT $ PER SHEET OF
PLYWOOD EXTRA
O NO WARRANTY APPLIES
®'WORKMANSHIP WARRANTY OF 1 YEARS
CLEAN UP & HAUL AWAY ALL TRASH
O CLEAN GUTTERS
❑Rpl NAIL MAGNET
PRICE INCLUDES ALL LABOR, MATERIALS & TAX
We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
dollars ($
All material is guaranteed to be as specified. All work to be completed in a workman like manner
according to standard practices. Any alteration or deviation from above specifications involving
extra costs will be executed only upon written orders, and will become an extra charge over and
above the estimate. All agreements contingent upon strikes, accidents or delays beyond our
control. Owner to carry fire, tomado and other necessary insurance. Our workers are fully
covered by Workman's Compensation Insurance.
Authorized Signature
Acceptance of Proposal- The above prices, specifications and
conditions are satisfactory and are hereby accepted. You are authorized to
do the work as specified. Payment will be made as outlined above. This
proposal becomes a legal and binding contract after 72 hours of acceptance.
Date of Acceptance: ~ 1 0 T -7
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANY - CITY OF KODIAK - KODIAK ISLAND BOROUGH - BUILDING DEPARTMENT
Telephone: 486-3224 700 Mill Bay Road
L INFORMATION WITHIN BOLD LINES. PLEASE PRINT. USE A BALLPOINT PEN AND PRESS FIRMLY.)
(OFFICE USE ONLY)
STREET ADDRESS:
CLASS AND SCOPE OF WORK:
SPECIFICATIONS:
BUILDING PERMIT NUMBER: ,
DATE OF APPLICATION:
LOT BLOCK
NEW
DEMOLITION
FOUNDATION
FOOTINGS
STEM WALL
PIERS
ZONING COMPLIANCE :
DATE ISSUED:
ALTERATION
REPAIR
TYPE
SUBDIVISION / SURVEY:
ADDITION
MOVE
DIMENSIONS
VALUATION BASIS:
BUILDING PERMIT FEE:
,
DEPTH IN GRND
NAME:
USE OF BUILDING AUTHORIZED BY THIS
REINFORCEMENT
VALUATION:
PLAN CHECK FEE:
PERMIT:
BOLT SPACING
O
MAILING ADDRESS:
CRAWL SPACE HEIGHT INCHES
OCCUPANCY GROUP:
TOTAL FEE:,�
0
CRAWL SPACE
VENT SQ. FEET
A B E H I M R
RECEIPT NO.:
N CITY & STATE:
SIZE HEIGHT
SPECIES
DIV. 1 2 3 4 5 6
EACH OF THE FOLLOWING STAGES OF
CONSTRUCTION REQUIRES INSPECTION
BE REQUESTED PRIOR
E ,/1 if - 1 -
R
NO. OF ROOMS STORIES
STRUCTURAL
& GRADE
SIZE
SPACING
SPAN
TELEPHONE :
NO. OF FAMILIES
GIRDERS
TYPE OF BUSINESS
GIRDERS
NAME:
NO. OF BLDGS NOW ON LOT
JOISTS 1ST FLOOR
A
USE OF EXISTING BLDGS
JOISTS 1ST FLOOR
TYPE OF CONSTRUCTION
& COMPLETED TO
R
SIZE OF LOT
JOISTS 2ND FLOOR
PROCEEDING WITH ANY FURTHER WORK:
FOR INSPECTION CALL 486-3224
C
WATER: PUBLIC ,
PRIVATE
JOISTS 2ND FLOOR
H CITY & STATE:
SEWER: PUBLIC
PRIVATE
CEILING JOISTS
/
INSULATION TYPE & THICKNESS:
EXTERIOR WALLS
N 1 -HR FR H.T.
EXCAVATION
E TELEPHONE :
BEARING WALLS
UNDERGROUND UTILITIES
N
G
FOUNDATION
INTERIOR WALLS
DRIVEWAY PERMIT:
FOUNDATION / SETBACKS
SUBMITTED
FRAMING
STATE LICENSE :
WALLS
ROOF RAFTERS
ROOF / CEILING
TRUSSES
4
APPROVED
F
ROUGH ELECTRICAL
C NAME:
SHEATHING TYPE & SIZE:
FURNACE TYPE:
ROUGH PLUMBING
ADEC APPLICATION:
FINAL
SUBMITTED •
DATE C.O. ISSUED:
MAILING ADDRESS:
FLOOR
WOOD HEATER YES NO
FINAL APPROVAL
T
WALLS
ALASKAFIREMARSHALLREVIEW:
SUBMITTED: APPROVED:
ROOF
TYPE
:
FINISH MATERIAL:
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT IT ISEPHONE
LY&STATE:
ROOFCORRECT
AND THAT I AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS
BUILDING CONSTRUCTION
APPROVED—BUILDING OFFICAL:
TE LICENSE
EXTERIOR SIDING
REGULATING
INTERIOR WALLS
APPLICANT:
NOTES:
KODIAK ISLAND BOROUGH Community Development
710 Mill Bay Road (Room 204), Kodiak, Alaska 99615-S341) - Phone: (907) 4865736, extension 255 or 254 ZONING COMPLIANCE
PERMIT Permit #: C Z- 7' - //61
1.
2.
3.
Property Owner/Applicant: r'a-d Ste valA f/ 7&.i. / t 4A
Number and size of parking spaces required (onsite ids oro d perking spaces is required -Yes: No:
� / n p�/ /
Mailing Address: -, - 1 q 3i u0CL k 9Y4/'r Phone: I/ In c/3oS
' / � _ r
,Ak ('(77'1w6'�-
1
Legal Description: Lo 4-' 8/cc K / y kt Gr4 Tow.)44;i 17e.
cif -street loading requirement: Xi/fei
�/¢6
Street Address: �1 /1 CI.e J7 Tam Code x: 1.' 3 Li a 1 IO r 6 C)
P131 relatedirements (e. )
sego g., plat notes, easements, subdivision conditions, etc
Description of Existing Propertycurrentzoning: A 2
)XJ( (2
i
Minimum Required Lot Area: 7 v2 o D 6 wet 60
Other requirements (e.g., zero lot line, additional setbacks, projections into yards, saeening, etc.):
Actual Lot Area: 3 q / sr) (fr Width: ��'
60/L%P
57
Minimum Required Setbacks: Sides:
Front: 2 `) Rear.
Coastal Management Program Applicable Polices (check appropriate category) - Residential: Business:
Maxinum Building Height:
industr'ai: Other (list):
Use and size of existing structures on the bt a 72S �O
Is the proposed action consistent with the KIB Coastal Management Program? - Yes: — No:
v
If the proposed action conflicts with the Coastal Management Program policies, attach a sheet that notes the poiiry(ies), describes the
conflict(s), and specifies conditions In mitigate the cantiions). Attachment - Yes: No: ._
4.
/o'' 7 r0
Description of proposed action (ai,acr,>;iee plan): .4 S t >Z +�'�L / � � / h L G� v�•rl� to / � Q < < � �
'.. 0 k, " '..AI
S - ' , .f , £ -. ACA- !tio 6 A- 6, ... s .
A , .�.. ,or- ,��
•
A M.S ,ZA n S w Gee 412rffile.e.Ge 4. Gee.Cleic, OA
A/ F r S W ..�.c(4,-ai; .u.,..7k, / AK. -4,.,.•P
e4,7c.4u D ik` 1)15N)oc. Afro ie6Quive6m R%Al2-4 stpelmb cog 1
SW 1.d Pru , --- - /1..ea.4 a ,(6).„,) Dr -de / 57)17 i?$ crin)
5.
Applicant Certification: I hereby certify that I will comply with the provisions of the Kodiak Island Borough Code and that I have the authority
I agree to have identifiable comer markers in place in the field for verification of setbacks.
to certify the as the property owner, or as a representative of the property owner.
/
Date: ,/2-V(0 Title 0 LA) "-Q-•'•
By: 1 c G""^ii�/ _ - /`��
Supportfrng documents attached (check): Site plan: V As -bunt survey: I. Other (list):
6.
Community Development stet forzoning, by: oe `�(1i .-" Date: q 0 Title: r_ �/
%-
Fire Chief [City of Kodiak, Firs District 11 (Bayside), women* Bay Fire District] approval for UFC (Sections 10.207 and 10.301C) by: Date:
8•
Driveway Permit (state, ctty of Kodiak, Borough) issued by: Date:
9. Septic system PLAN upprov d by: Dale:
Dstrib,to,: File /BuiidingOfficial /Applicant THIS FORM DOES NOT AUTHORIZE CONSTRUCTION WHEN A BUILDING PERMIT IS REQUIRED
July 1990
ti 1 A
T
P.�i'r.A/G sE,.+iaN7
--c,/"Z• A, f3Lca-- /9
(c 77, P)4G6 Zoe)
'T
A9
eV. b;,x
" �
V
Stf-
„De
AS - DU1LT SWIVEY
1 hereby certify that 1 have urveycd the following,described property:
6/ /9, /-1oc ick
Towns/7-5zrrr� .
U. S. 5 i/-kt y 2'_37- t3.
and that the improvements situated tkereon are within the property lines
and do not overlap or encroach on the property Tying adjacent thereto,
that no improvements on property lying adjacent thereto encroach on
the premises In question and that there are no roadways, transmit•
lion lines or other visible easements on said property except as indi•
cated hereon.
Dated this 1-7 day `=CIO—=7S` 19 f'7
RO°A. ��t%
Registered Land Surveyor
Scale: /"r �t7 TZTo f
i
Drawn Irv: At/ -5
f /17 ' Date: /P-rl.>%.rr- /9R'7
BUILDING DEPARTMENT—CITY / BOROUGH OF KODIAK
Applicant to fill in between heavy lines.
CLASS OF WORK
BUILDING ADDRESS
LOCALITY
NEAREST CROSS ST.
cc
Z
0
Z
0
a
L_°1
J
0
NAME
ADDRESS
CITY
STATE LICENSE NO.
NEW
DEMOLISH
ALTERATION
REPAIR
ADDITION
MOVE
USE OF BUILDING ci .t;> „Li: //-
/
SIZE OF BUILDING.D4 V36, 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
WIDTH OF TOP
CITY
WI DTH OF BOTTOM
DEPTH IN GROUND
R.W. PLATE (SILL)
I
SPA.
SI' \N
LOT NO
ELK.
Ir.
GIRDERS
JOIST 1st. FL
JOIST 2nd. FL
JOIST CEILING
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE
OF OCCUPANCY
BUILDING PERMIT NO
VALUATION
BUILDING
FOUNDATION
FRAME
PLASTER
FLUES
FINAL
EXTERIOR STUDS
DO NOT WRITE BELOW THIS LINE
O. Type of Construction
I, II, 111, 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
INTERIOR STUDS
ROOF RAFTERS
BEARING WALLS
COVERING
EXTERIOR WALLS
ROO(1'r
INTERIOR WALLS REROOFIN
FLUES
FIREPLACE
FL. FURNACE8,
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 b ilding constr ction.
Applicant
DATE ISSUED
BLDG. FEE
PLAN CHK. FEE
TOTAL
PLUMBING
ROUGH
SEPTIC TANK
SEWER
GAS
FINISH
ELECTRIC
ROUGH
FINISH
FIXTURES
MOTORS
FINAL
7"-/o /47,4,. 77 .�/Y/('(� 8x20' U/ d..
/7-57t'z
Approved: CHIEF BUILDING OFFICAL
By•
/7 16/7/6
3N11 A183dOHd
PLOT PLAN
A
r
I
SETBACK
3N11 AiL dO2id
STREET
PLANNING & ZONING INFO.
ZONING DISTRICT
TYPE OF OCCUPANCY
NUMBER OF STORIES 1OTAL HT.
AREA OF LOT 3' /9 ,
J
FRONT YARD SETBACK FROM PROP. LINE ,..72,
SIDE YARD SETBACK FROM PROP. LINE ,,,'�. —7
REAR YARD
Approved: ZONING ADMINISTRATOR
By.