USS 3511 LT 8 EAST SCHOOL - ZCP 2/9/2018,-- Kodiak Island Borough
�u \ Community Development Department
710 Mill Bay Rd. Rm 205
a Kodiak AK 99615
Ph. (907) 486 - 9363 Fax (907) 486 - 9396
http://www.kodiakak.us
Zoning Compliance Permit
Print Form Submit by Email
III (IIIIIIIIIIII
111111 III
16418
Permit No. CZ2018-027
The following information is to be supplied by the Applicant:
Property Owner/ Applicant: Kodiak Island Borough/Matt Gandel
Mailing Address:
Phone Number:
Other Contact email, etc.:
Legal Description:
Street Address:
Use & Size of Existing Structures:
Description of Proposed Action:
No change to building footprint.
710 MITI Bay Rd.
907-486-9211
mgandel@kodiakak.us
Subdv: USS 3511 Block: Lot: 6-12
220 Benny Benson Dr.
East Elementary School and parking lot
Replacement of floor finishes, casework, sinks and associated electrical and mechanical work.
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: 10.1 acres
Front Yard: 25 '
Current Zoning: Public Use KIBC 17.130
Lot Width: 60'
Rear Yard: 10% width b/n >25'
PROP_ID 16418
Bld'g Height: 50'
Side Yard: 10% width b/n >25'
Prk'g Plan Rvw? No # of Req'd Spaces: 39
Staff Compliance Review Notes:
Plat / Subdivision Requirements? See attached asbestos material information. Proposed action will not change parking reqs.
Most current parking plan is provided with this application. Case 87-023 granted parking variance to require only 39 spaces.
There may be an additional issue with conditions of approval from Case 87-023 that required lot lines to be vacated. KIB CDD will followup
with the Borough Manager's Office.
Subd Case No. Plat No. Bld'g Permit No. TBD Bldg Dept
Does the project involve YES
an EPA defined facility?
*Commercial buildings, installations (military bases),
institutions (schools, hospitals) and residences with
more than four (4) dwelling units.
Driveway
Permit?
Septic Plan
Approval:
Fire
Marshall:
N/A
N/A
TBD Bldg Dept
Proof of EPA notification provided (if required)? YES
*Required for all demolitions, for renovations disturbing at least 160 square
feet 260 linear feet, or 35 cubic feet of Regulated Asbestos Containing Material (RACM), and
for renovations that remove a load -supporting structural member.
No permit will be issued for such projects without proof of EPA notification
Applicant Certification: 1 hereby certify that) 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? Other List Other: EPA Notice Documents, parking plan, site plan
F\
Date: Feb 9, 2018 Signature: 1
. F
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.
THIS FORM DOES NOT AUTHORIZE CONSTRUCTION WHEN A BUILDING PERMIT IS REQUIRED.
"EXPIRATION. Any zoning compliance permit issued is subject to the same expiration, suspension, and revocation provisions as a
building permit issued for the same construction permit.** �---•.�
CDD Staff Certification
Date: Feb 9, 2018 CDD Staff:
Payment Verification Zoning Compliance Permit Fee Payable in Cashier's Office Room # 104 - Main floor of Borough Building
Not Applicable
Less than 1.75 acres:
1.76 to 5.00 acres:
5.01 to 40.00 acres:
40.01 acres or more:
❑ $0.00
❑ $30.00
❑ $60.00
❑X $90.00`
❑ $120.00
After -the -Fact 2X the published amount
❑ $0.00
❑ $60.00
❑ $120.00
❑ $180.00
❑ $240.0 OAID
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February 9, 20 IS
Asbestos NFSIIAP Coordinator
U.S. Environmental Protection Agency Region 10
Office of Conipliancc and Luforcenient
1200 Sixth Avenue, Suite 900, OCE -127
Seattle, WA 98101
RE: East Elementary School Renovation Phase If
200 Benny Benson Dr.
Kodiak, Alaska
Contract No. 18002)
(10) EPA Notification EPA Notification of Demolition and Reno% ation
To kvhom it may concern:
Please be advised, Far North Services, shall commence asbestos abatement activities at East
Elementary Schoch, Is'-odiak, :iia aka under the ab,,)%c-rcCcrcnccd contract. A Notifitcation of
Demolition and Renovation been attached for your revic�N .
If you have any questions or comments regarding this matter, please contact me tit your earliest
Convenience.
Sincerely,
VIAmir BerezvLd
Project Manager
PO Box 210483, Anchoraqe, Alaska 99521
Phones: 907-250-271.21 Fax: 907-631-0653
EmaM fri-services,4yal
1 ,00 50h Avfen:]E',()i3O-1!077
Operator Project # Postmark
Date Received Notification #
1, TYPE OF NOTIFICATION (check one): Revised Canceled
11. FACILITY DESCRIPTION
Building Name,
LAST ELEMENTARY SCHOOL
Address:
200 BENNY BENSON DR
City.
J{`ODIAK
State,
IAL ASKY
t cuntr
Site Location:
200 BENNY BENSON DR,
Building Size (square feet}:
:%_ ,3CICi
> of >= lo,)rs
Age in Years_
Present Use,
Pura' Use
111. TYPE OF OPERATION (check one): ...._; Deeno 7 Ordered Dern:,El Reno'nCi ^t1 ElEmertltnr_y Rencrvaticn [ Fire Training
IV, IS ASBESTOS PRESENT? (check one) Yes [.7 No
V, FACILITY INFORMATION
OWNER NAME:
ttia [)iAK JSLAND i Ol.tRC.)LJGH
Address
,10 MILL BAY ROAD#02,"i.
City:
KODIAK
State:
J 1. ',
Zip:
99615
Contact.
MAT LAND L.
Tel:
(907i 86-9_'rn )
ASBESTOS CONTRACTOR:
i,01 NORTH SERVIGIES I
Address:
PO BOX 210483
City
ANCHORAGE
ataiF;
Zip:
Contact
VLAD(MIR BERE YUK
Tel:
;f' 2 ,.. ,r,'
OTHER OPERATOR (Abaternent/Remediation): REMOVAL CONTRACTOR
Address
City
stag
zip
Contact
Tel
PROCEDURE, INCLUDING ANALYTICAL METHOD, EMPLOYED TO DETECT THE PRESENCE OF AND TO ESTIMATE THE. QUANTITY OF RACM
VL AND CATEGORY I AND CATEGORY 11 NON -FRIABLE ACM;
CL)ha1L11...ATIVF INSPECTION$ FROM ACCREDITED INSPECTORS F04 -1-t: A ING THE RRQUIR' f><EW OF THE EPA At, 11
VII, APPROXIMATE AMOUNT OF ASBESTOS MATERIAL:
GWB WITH JOINT CCMPOUNI 5t}OSF
ACM '1 D SRINWA 'TIC 20,OOOSF
Nonfnable Asbestos tvtaterial Nonfr.abie Asbestos Material
t %e Removed NOT Iu ba Removed
Gawgary I Category If Category i Category 11
GVI,18;JOINT COT01POUND
500SF I
ACM PiLOORING"MASTIC
20.000SF
VIII, SCHEDULED DATES ASBESTOS REMOVAL (MMIDDIYY) Start £°. r Complete: (a.2
IX. SCHEDULED DATES RENOVATION (MMIDDIYY') Stari Complete,
DAYS OF THE WEEK: MONDAY I TUESDAY I WEDNESDAY THURSDAY FRIDAY SATURDAYSUNDAY
HOURS OF OPERATIOW -
X.
DESCRIPTION OF PLANNED DEM OLII ONOR RENCIVAT017'WORK,AND METHOD(S) TOSE EMPLOYED. INCLUDING DEMOLITION OR RE—N-6-MW
TECHNIQUES TO BE USED AND DESCRIPTION OF AFFECTED FACILITY COMPONENTS!
COMFLFTF ABATF.MiN' ;— P1 k CONTRA. tAWAOSURL
X1,
DESCRIPTION OF WORK PRACTICES AND ENGINEERING CONTROLS TO BE USED TO COMPLY WITH THE REQUIREMENTS, INCLUDING ASBESTOS
REMOVAL AND WASTE HANDLING EMISSION CONTROL PROCEDURES:
NGINEERIW,CON'i,
X11.
WASTE TRANSPORTER fl' ASBESTOS ABATEMENTISELECTIVE DEMOLITION
Name
FAR NORTH SERViCIE'., L.:-t,
Address
PO BOX 210483
City'
States
Zip
ANCHORAGE
IAASKA
995-21
Contact Person
Tel-
VLADOAIR BEREZYUK
907-250-2712
WASTE TRANSPORTER #2: REMOVAL CONTRACTOR
Name
SAME
Address;
City
state
Zip
Contact Person
X111,
WASTE DISPOSAL SITES REMOVAL CONTRACTOR
Name
KGUAK ISLAND 130-RIJU.::H LANf i
Local!=
'203 NIONAS1 iKA BAY RD
City,
State
z3r,
KODIAK
A,'-, Ki`,
9441 9
Contact Person,
Tel
(90 486-9345
WASTE DISPOSAL SITE: REMOVAL CONTRACTOR
Name.
KODIAK ISLAND BOROt.iGH I A,*,CJF ILL,
Location
1203 MONASHKA BAY RD
City
zip
iKODIAK
"KA
Conlacipersow
XIV.
EMERGENCY DEMOLITION (Complete item x1v only it this project is an Emergency Demolition.)
I Attach a copy of the Order to this notice
2. Name of Authority Issuing Order Title
3. Authority of Order {Citation of Code,
4. Date of Order (Mk1;DDiYY) Date Ordee to Begin
XV,
EMERGENCY RENOVATIONS (Attach separate sheet with the following information if project is Emergency Renovation)
1. Date and Hour of the Emergency
2 Description of the Sudden, Unexpected Ever-i
3 Explanation othovthe evenicaused unsafe or an unreasonablefinam,,ial burden.
XVI,
DESCRIPTION OF PROCEDURES TO BE FOLLOWED IN THE EVENT THAT UNEXPECTED ASBESTOS IS FOUND OR PREVIOUSLY NONFRIABLE
ASBESTOS MATERIAL BECOMES CRUMBLED, PULVERIZED. OR REDUCED TO POWDER
FIBER RELEASE WILL BE CONTROLLED USING WET METHODS & HEPA VACUMING
I CERTIFY THAT AN INDIVIDUAL TRAINED IN THE PROVISIONS OF THIS REGULATION (40 CFR PART 61. SUBPART M) WILL BE ON-SITE DURING THE
XVII.
DEMOLITION OR RENOVA-PdN, AND EVIDENCE THAT THE REQUIRED TRAINING HAS BEEN ACCOMPLISHED BY THIS PERSON WILL BE AVAILABLE
FOR INSPECTIOr"UR NORM Bt1SINESS HOURS.
Sidnature of Ownei/OKiator Dale Type or Print Name and Title
XVIII.
I CERTIFY THAT THErABQVF WrORMATION IS CORRECT:
S I q n Zito t -,T Dam, Tynlc of Print Name and Title
UNDERGROUND • '
ADEC NOTICEOF • CLOSE OR
The ADEC notice of Intent-to-Close or Change-in-Service (Form 18-0504) is required when decommissioning an underground storage tank
(UST) system, or changing its use to a non-regulated substance (i.e., heating oil), in accordance with Title 18 Alaska Administrative Code
(AAC) 78, Underground Storage Tanks. Notification is due at least 15 days, but no more than 60 days, prior to beginning the closure, site
assessment and release investigation work. (18AAC78.085(a)).
1. ADEC FACILITY
INFORMATION
UST SYSTEM OWNER:
EXPECTED DATE
of CLOSURE:
ADEC FACILITY #:
UST CLASS A/B OPERATOR:
FACILITY NAME:
OPERATOR CONTACT:
PHYSICAL ADDRESS:
PHONE/EMAIL
IF A CHANGE-IN-SERVICE, NEW USE:
CITY:
ZIP:
2. CLOSURE OR CHANGE-IN-SERVICE FOR UST SYSTEMS:
ADEC
OWNER
1,'CLOSURE FOR:
TANK &
TANK
PIPING
TANK #
TANK #
PRODUCT STORED
VOLUME (GAL)
LAST DATE USED
PIPING
ONLY
ONLY
3. CERTIFIED UST WORKER AND QUALIFIED ENVIRONMENTAL
PROFESSIONAL:
Anyone who supervises or performs closure or change-in-service of a UST system is required to be a state-licensed UST worker certified in
Closure (18AAC78.455). An owner or operator may not allow a person to conduct any part of a UST system closure unless the person is a
licensed UST worker certified in closure (18AAC78.400(a)). An owner or operator shall ensure a qualified environmental professional (QEP)
performs the site assessment and release investigation (18AAC78.088).
NAME OF LICENSED UST WORKER LICENSE #:
CERTIFIED IN CLOSURE: EXPIRATION DATE:
NAME OF QUALIFIED COMPANY:
ENVIRONMENTAL PROFESSIONAL:
(defined in 18 AA 78. o88) PHONE:
4. CHECKLIST
NOTE: CLOSURE means to remove, or make inert, any part of a UST system, so that it can no longer receive, store or issue
petroleum products (18AAC78.o85(c)). CHANGE-IN-SERVICE means to remove all products, and fully clean the UST system,
to continue to use it for a non-regulated substance (18 AAC78.085(d)). /CERTIFYTHE FOLLOWING15 TRUEAND CORRECT.
YES
NO
NOTIFIED LOCAL FIRE DEPARTMENT OF INTENT TO CLOSE OR CHANGE-IN-SERVICE?
THERE IS EVIDENCE OF A RELEASE, LEAK OR SPILL AT THIS SITE?
METHOD OF CLOSURE: [ ] REMOVAL [ ] INERT-IN-PLACE [ ] CHANGE —IN-SERVICE
DISPOSAL OF TANK: [ ] RECYCLE COMPANY:
[ ] LANDFILL LOCATION:
DISPOSAL OF PIPING AND EQUIPMENT: [ ] RECYCLE [ ] LANDFILL LOCATION:
DISPOSAL OF FREE FLUIDS, PETROLEUM
PRODUCTS AND/OR SLUDGES:
The UST Worker and Owner/Operator are required to complete and sign the Notice of Post-Closure (ADEC Form 18-0505) within
30 days of the tank pull. The Owner must submit the Site Assessment and Release Investigation Report within 60 days to ADEC.
CERTIFIED BY: [ ] OWNER [ ] OPERATOR [ ] OTHER TITLE: PHONE:
PRINT NAME:
SIGNATURE: DATE: FAX:
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION UNDERGROUND STORAGE TANKS OFFICE
555 CORDOVA STREET ANCHORAGE, ALASKA 99501-2617 PHONE 907-269-7679 FAX269-7687 www.dec.alasi7a.gov
ADEC FORM 18-0504, REVISED AUGUST 2016
- ----------- - --------- -----------------------------
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I /WEJ HEREBY CERTIFY TNAT / (WEI AM /ARE) ill OWNER(5I � TIME
PROPERTY SHOWN d/N DESCRIBED HEREON. I (W£I MERE SITDFD/Cd TE
TO T- PLAiLK. ALL EASEMENTS FOR PUSL�C UTA.ITl3,
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NOTARY'S ACKNOWLEDGEMENTS
SUBSCRIBED AND SWORN TO BEFORE ME THIS
DAY OF 1989
PLAT APPROVAL
KODIAK ISLAND PLANNING AND ZONING COMMISSION
RECEIVED; APPROVED:
CHAIRMAN• DATE:
THIS IS TO CERTIFY THAT THE WITHIN PLAT 15 DULY
APPROVEO I1 ACCORDANCE WITH THE KODIAK ISLAND
BOROUGH CODE THIS--
t989
HIS D1989
CLERK DATE
BOROUGH ENGINEER DATE
TAX CERTIFICATE
I HEREBY CERTIFY THAT ACCORDING TO THE RECORDS
OF THE KODIAK ISLAND BOROUGH ALL TAXES ASSESS-
ED AND DUE AGAINST SAID LAND AND IN FAVOR OF
THE KODIAK ISLAND BOROUGH ARE PAID IN FULL.
DATED AT KODIAK ALASKA , THIS_ DAY OF
1989
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AWNARES, PARKS 4M] OTHER PURLC AREAS
NOTARY'S ACKNOWLEDGEMENTS
SUBSCRIBED AND SWORN TO BEFORE ME THIS
DAY OF 1989
PLAT APPROVAL
KODIAK ISLAND PLANNING AND ZONING COMMISSION
RECEIVED; APPROVED:
CHAIRMAN• DATE:
THIS IS TO CERTIFY THAT THE WITHIN PLAT 15 DULY
APPROVEO I1 ACCORDANCE WITH THE KODIAK ISLAND
BOROUGH CODE THIS--
t989
HIS D1989
CLERK DATE
BOROUGH ENGINEER DATE
TAX CERTIFICATE
I HEREBY CERTIFY THAT ACCORDING TO THE RECORDS
OF THE KODIAK ISLAND BOROUGH ALL TAXES ASSESS-
ED AND DUE AGAINST SAID LAND AND IN FAVOR OF
THE KODIAK ISLAND BOROUGH ARE PAID IN FULL.
DATED AT KODIAK ALASKA , THIS_ DAY OF
1989
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TO T- PLAiLK. ALL EASEMENTS FOR PUSL�C UTA.ITl3,
AWNARES, PARKS 4M] OTHER PURLC AREAS
NOTARY'S ACKNOWLEDGEMENTS
SUBSCRIBED AND SWORN TO BEFORE ME THIS
DAY OF 1989
PLAT APPROVAL
KODIAK ISLAND PLANNING AND ZONING COMMISSION
RECEIVED; APPROVED:
CHAIRMAN• DATE:
THIS IS TO CERTIFY THAT THE WITHIN PLAT 15 DULY
APPROVEO I1 ACCORDANCE WITH THE KODIAK ISLAND
BOROUGH CODE THIS--
t989
HIS D1989
CLERK DATE
BOROUGH ENGINEER DATE
TAX CERTIFICATE
I HEREBY CERTIFY THAT ACCORDING TO THE RECORDS
OF THE KODIAK ISLAND BOROUGH ALL TAXES ASSESS-
ED AND DUE AGAINST SAID LAND AND IN FAVOR OF
THE KODIAK ISLAND BOROUGH ARE PAID IN FULL.
DATED AT KODIAK ALASKA , THIS_ DAY OF
1989
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FOUND 6"X6" CONC. : 5 i KODAK. ALASKA 99615
HIGHWAY MON. ,J' �-ALE
DATE570. 92.ODl _ - ,MINE 3011 1989 HORIZON LAND SURVEYING INC.G.B.BO' LEFT KODIAK ALASKA 99615 BOX 194 SNEE I OF I( 907) 486-6506 : 50'
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SURVEYORS CERTIFICATE
AK:LICENSED
\`
m•IOp iIY PbtTTAM PROPERLY REGIS JERED
W iNE STATE OF ALASK.i, AND
/A5
TOM.YCER
TO PRACTICE LAND SURVfYUG
REPRESENTS A SURVEY MADE b y M_ OR UAOER
M.T4
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THAT TN15 PLA i
MY DIRECT SU°ERVMAY( AND THAI ill MONUMENTS AMT
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I.G. BERGfE _ RfGt3TERED
U.S.S. 35117
.5$
FOIRN B.C. AK]W\Z59\
/ _ /
/
/ACCORDING
VACATION OF LOTS 6, 7,8, 9, 10, ANDI,U.S.S.
6 THE ORIGINAL PLAT THEREOF ANO
LOT i2 OF PLAT 67-8 EXCEPT RIGMT-OF-WAY GRANTED
ALL
OZ
`V
O •od
TO THE STATE OF ALASKA PER BOOK N, PAGE 82,
THE KODAK RECORDII, DISTRICT, KODAK ALASKA
X65 _ P 9g9 / WITHIN
55' 28113
A696 5? _ / TO TRACT 6-A
3 REPEAT
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$ / 7KU UPPER MILL BAY ROAD
FOUND 6"X6" CONC. : 5 i KODAK. ALASKA 99615
HIGHWAY MON. ,J' �-ALE
DATE570. 92.ODl _ - ,MINE 3011 1989 HORIZON LAND SURVEYING INC.G.B.BO' LEFT KODIAK ALASKA 99615 BOX 194 SNEE I OF I( 907) 486-6506 : 50'
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