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BUILDING DEPARTMENT - KODIAK ISLAND BOR€
(APPLICANT TO FILL IN ALL INFORMATION WITHIN HEAVY LINES.
SUBDIVISION/SURVEY
LOT NO. BLOCK NO.
,Q.3 C._ oIL
STREET ADDRESS
GH APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
PLEASE PRINT, USE BALL-POINT PEN, AND PRESS FIRMLY.)
BUILDING PERMIT NUMBER DATE ISSUED
CLASS AND SCOPE OF WORK
NEW
DEMOLISH
ALTERATION
REPAIR
ADDITION
MOVE
USE OF BUILDING
•
VALUATION: (BASIS)
SIZE OF BUILDING HGT
NEAREST CROSS STREET
NO. OF ROOMS FLOORS
NO. OF FAMILIES
NAME _
:
NO. OF BUILDINGS NOW ON LOT
USE OF BUILDINGS
MAILING ADDRESS SIZE OF LOT
j i:t ,
CITY, STATE TELPHONE
R• .., 141. 4 r -2
SEWER: PUBLIC PRIVATE
AMOUNT
BLDG PERM$TFEE
2 -?
J
PLAN CHK FEE
TOTAL.
a—
INSPECTION
INSPECTION SCHEDULE
BUILDING
WATER: PUBLIC PRIVATE
SPECIFICATIONS
NAME FOUNDATION
TYPE
ADDRESS
DEPTH IN GND
HGT FIN GRADE
CITY, STATE
EXT
PIERS
FOUNDATION
PLUMBING
ROUGH
FRAME
SEPTIC TANK
PLASTER/BD
SEWER
FLUES
GAS
FINAL
FINISH
ELECTRICAL
ROUGH
FINISH
FIXTURES
MOTORS
FINAL
P.T. PLATE (SILL)
STRUCTURAL
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
ISLAND BOROUGH ENGINEERING DEPARTMENT 486-5736 EXT. 273.
SIZE
SPA.
SPAN
STATE LICENSE NO.
GIRDERS
JOISTS 1ST FLR.
NAME JOISTS 2ND FLR.
JOISTS CLG
ADDRESS
EXT STUDS
INT STUDS
CITY, STATE
ROOF RAFTERS
STATE LICENSE NO.
(FOR OFFICE USE ONLY: CIRCLE)
1. OCCUPANCY GROUP
A BEH I M R
DIVISION 1 2 3 4 5
2. TYPE OF CONSTRUCTION
1 II 1 1 1 IV V
FR 1 -HR. N H.T.
TRUSSES
NOTES:
INSTALLATION OF (MINIMUM) 18 -INCH BV 20 -FOOT CULVERT 15 REQUIRED
AT EACH DRIVEWAY ACCESS TO THE PROPERTY.
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
SANITATION PLAN APPROVAL BV AN ADEC-CERTIFIED INSTALLER IS
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
PLOT PLAN
(A SITE PLAN MAY ALSO BE REQUIRED)
REAR PROPERTY LINE
SIDE PROPERTY LINE
_-
-No– —
FRONT PROPERTY LINE
SIDE PROPERTY LINE
STREET
NOTE: APPLICANT SHALL SHOW BUILDING SETBACKS
FROM PROPERTY LINES, AS PERPENDICULAR DISTANCES
FROM PROPERTY LINES TO BUILDING. DIMENSIONS OF
PRIOR
IOR TTO INSTALLER THE ISSUANCE OF A PERMIT, EITHER THE OWNER OF THE STRUCTURE SHALL BE SHOWN ON THE PLAN.
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) NO. OF ORIES / TO A HGT
ZONING CODE COMPLIANCE
ZONING DISTRICT
TYPE OF OCCUPANC
APPROVED, BUILDING OFFICIAL
AREA • OT
SETBA KS FROM P OPERTY NES
FR NT / RE
SID (L)\ � SI '.E (R)
REQ' ' OFF J$TRtET PARK G
06.
C.U. OR VARIANCE
' T ' 6("--
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APPROVED, ZONING OFFICER �(