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BUILDING 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.)
SUBDIVI ION/SURV, .
(14 OE k (t} w h 5�
CLASS AND SCOPE OF WORK
NEW
LOT(,,NO.
1
BLOCK NO.
ci
STREET ADDRESS
Q I LI 1 S
T.,1. 7 OL -r ' Cl-"
NEAREST CROSS 5 REET
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MAILING ADD# ESS 00 (l
ALTERATION
ADDITION
DEMOLISH
REPAIR
MOVE
x
USE OF BUILDING d YS
SIZE OF BUILDING 2 &/ ' 30
NO. OF ROOMS
NO. OF FAMILIES
HGT33
3 FLOORS 3
NO. OF BUILDINGS NOW ON LOT
USE OF BUILDINGS p r 5 -
SIZE OFLOT
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CONTRACTOR
CITY, TELEPHmNE
'
NAME
ADDRESS
CITY, STATE
STATE LICENSE NO.
NAME !"-
}61(
WATER: PUBLIC
1'
PR IVATE
SEWER: PUBLIC ✓ PRIVATE
SPECIFICATIONS
BUILDING PERMIT NUMBER
VALUATION: (BASIS)
AMOUNT
DATE ISSUED
BLDG PERMIT FEE
PLAN CHK FEE
TOTAL
INSPECTION SCHEDULE
BUILDING
FOUNDATION
FOUNDATION
TYPE
EXT
PIERS
cc
DEPTH IN GND 4.5 le t.4
HGT FIN GRADE / P.
P.T. PLATE (SILL)
STRUCTURAL
SIZE
SPA.
SPAN
GIRDERS
S'/2x2'q /5acc 30
JOISTS 1ST FLR.
X/D
/6" /2'
JOISTS 2ND FLR.
27( /4
JOISTS CLG
ADDRESS
CITY, STATE
EXT STUDS
z)(fa
INT STUDS
")xy
/6 "
/1
n
FRAME
PLASTER/BD
FLUES
FINAL
PLUMBING
ROUGH
SEPTIC TANK
SEWER
GAS
FINISH
ELECTRICAL
ROUGH
FINISH
FIXTURES
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 BY UBC SECTION 305. FOR EACH
INSPECTION, 24 HOURS NOTICE I5 REQUIRED. TELEPHONE THE KODIAK
ISLAND BOROUGH ENGINEERING DEPARTMENT 486-5736 EXT. 273.
NOTES:
INSTALLATION OF (MINIMUM) 1B -INCH BY 20 -FOOT CULVERT IS REQUIRED
AT EACH DRIVEWAY ACCESS TO THE PROPERTY.
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
INSTALLER
ROOF RAFTERS
STATE LICENSE NO.
(FOR OFFICE USE ONLY: CIRCLE)
1. OCCUPANCY GROUP
A B EH I MR
DIVISION 1 2 3 4 5
2. TYPE OF CONSTRUCTION
I II III IV V
FR 1 -HR. N H.T.
TRUSSES
BEARING WALLS
INSULATION, FNDN
WALLS
(J (q ROOF/CLG p 30
SHEATHING, WALLS/EXT 5/6) 'T//f
ROOF � C"1)X FLOOR 3/4/ r, &,-
FINISH, EXT WALLS
ROOF /1,.:.) , 4,4/
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. Q 4 , `
TAX LOT NO l` 1 S4 0 1 S " a v DATE
PER ISI 1 •-1
OWNER �'V~
OWNERSHIP TRANSFERRED, IN PROCESS, TO:
PER
CLOSING DATE, DEED RECORDED - (BY)
9 /nt/
iv y J, �-- -41 •
APPROVED, BUILDING OFFICIAL
BY -
PLOT ?LAN
(A SITE PLAN MAY ALSO BE REQUIRED)
REAR PROPERTY LINE
SIDE PROPERTY LINE
•
P-1
FRONT PROPERTY LINE
STREET
<..)-- 2 .
1
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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 u Q
TYPE OF OCCUPANCY ' f - /4 u'�
!2
NO. OF STORIES 3 01OTAL HGT
AREA OF LOT (v Iva
SETBACKS FROM PROPERTY LINES:
FRONT p2"; (Iyl/V REAR al S AN
SIDE (L) I Q' /1+ 1 hJ SIDE (R)
REQ'D OFF-STREET PARKING A.
C.U.P. OR VARIANCE Ai A
APPROVED, ZONING OFFICER $ b
BY
BUILDING DEPARTMENT — CITY / BOROUGH OF KODIAK APPLICATION FOR BUILDING PERMIT AND CERTIFICATE
Applicant to fill in between heavy lines.
OF OCCUPANCY
BUILDING ADDRESS
CLASS OF WORK
NEW
DEMOLISH
LOCALITY
ALTERATION
REPAIR
NEAREST CROSS ST.
ADDITION
MOVE_
BUILDING PERMIT NO
'(t
DATE ISSUED
97/10:tp"
USE OF BUILDING
CC
O
NAME
SIZE OF BUILDING HEIGHT
MAIL ADDRESS
NO. OF ROOMS
CITY
1E i. NO.
NO. OF FLOORS
NO. OF BUILDINGS
VALUATION
BLDG. FEE
PLAN CHK. FEE
TOTAL
NAME
NO. OF BUILDINGS NOW ON LOT
BUILDING V'
PLUMBING
ELECTRIC
NO. OF FAMILIES
I OUNDATION
ROUGH
ROUGH
ADDRESS
SIZE OF LOT
1 RAME
SEPTIC TANK
FINISH
CITY
USE OF BLDG. NOW ON LOT
PLASTER
SEWER
FIXTURES
SPECIFICATIONS
FLUES
GAS
MOTORS
STATE LICENSE NO
FOUNDATION
INAL
FINISH
FINAL
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ADDRESS
MATERIAL
EXTERIOR,
PIERS
ID1 OF TOP
WPOTIH OF BOTTOM
CITY
DEPTH IN GROUND
R.W. PLATE (SILL)
STATE LICENSE NO.
S I : I 51'!1.
SPAN
SUBDIVISION
10151 1 1. I I
Il
LOT NO.
13) K
I I IL IN(4
I s i1 RIOR STUDS
DO NOT WRITE BELOW THIS LINE
ID1. Type of Construction
I, II, III, IV(VI
2. Occupancy Group A, B, C, D, E,
F, G, HIVJ Div. 1, 2, 3, 4,
3. Fire Zone 1 6204
TF RIOR STUDS
ROOF RAFTERS
REARING WALLS
COVERING
LXTERIOR WALLS
ROOF
INTERIOR WALLS
REROOFING
FLUES
FIREPLACE FL. FURNACE
KITCHEN WATER HEATER
URNACE
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
13
?A4/5 2'v, PW P
Approved: CHIEF BUILDING OFFICAL
By:
aft ti2ildnk
8-is=7s
3N11 Al2i3dO2Id
A
PLOT PLAN
H
3N11 Al2J3dOiid
STREET
PLANNING & ZONING INFO.
ZONING DISTRICT
TYPE OF OCCUPANCY
NUMBER OF STORIES TOTAL HT.
AREA OF LOT
FRONT YARD SETBACK FROM PROP. LINE
SIDE YARD SETBACK FROM PROP. LINE
REAR YARD
Approved: ZONING ADMINISTRATOR
By•