Building Permit #32591 Application - Attachment 2

CAPITAL REGIONAL DISTRICT, Building Inspection Department.

I Phil Alcock ADDRESS 1641 HAUKTAIN, being the owner or acting with the consent of the owner, hereby make application to: ERECT, CONSTRUCT, ALTER, REPAIR, ADD TO, MOVE, DEMOLISH (CIRCLE ONE)

LOCATED AT #14 HELMCKEN Rd HOUSE NUMBER STREET

(Use of building or structure): SFD

ASSESSMENT ROLL NUMBER: 11.83.E (88) 32591

• LOT: 4
• SECTION: 1
• BLOCK: [blank]
• RANGE: [blank]
• PLAN NO.: 31416
• DISTRICT: Esqu Dist.
• OWNER: Phil Alcock
• ADDRESS: 1641 HAUKTAIN
• POSTAL CODE: V8R-2K8
• ARCHITECT: [blank]
• ADDRESS: [blank]
• POSTAL CODE: [blank]
• BUILDER: [blank]
• ADDRESS: [blank]
• POSTAL CODE: [blank]

THIS APPLICATION FORM MUST BE ACCOMPANIED BY THE FOLLOWING INFORMATION:-

1. Copy of ASSESSMENT NOTICE (Tax Notice). New properties must submit "CERTIFICATE OF TITLE".
2. Evidence of Access Permit application and location (obtained from Dept. of Highways, #103-4475 Viewmont Rd., Victoria, B. C., V8Z 5K8).
3. Sewage Disposal application and proof of potable water supply.
4. Site plan drawn to scale showing:-(2 or 3 copies for building inspection: 3 copies for health department) (a) Dimensions of land on which proposed building is to be located. (b) Location of Septic Tank and Disposal Field. (c) Location of proposed building. (d) Ground elevations. (e) Location of existing building/s showing horizontal and vertical dimensions. (f) Details of site drainage.
5. Include copies in duplicate (triplicate for PENDER, SATURNA & OTHER GULF ISLANDS) of the following and scale drawings of the building with respect to which the work is to be carried out, showing:- (a) Foundation Plan. (with overall dimensions) (b) Floor plan of each level, fully dimensioned. (c) Elevations of all sides of the building. (d) Proposed and/or existing uses of all rooms shown on floor plans. (e) Overall, actual cross sections showing all structural details and finishes. (Partial cross sections are not acceptable) - Preferred Scales: - Imperial 1/4" = 1'; Metric - 1:50.
6. State intended use of building, including use of existing buildings.
7. Any other information required pertaining to the application.

OCCUPANCY CERTIFICATES - A Certificate of Occupancy must be applied for and obtained prior to the occupancy of any building.

WAIVER OF INDEMNITY

I agree to conform to all the said regulations and all other statutes and Bylaws in force in the Capital Regional District. The undersigned, applicant, developer, contractor, or owner, assumes all risks or hazards incidental to building inspection services and agrees to release, dissolve, save harmless and keep indemnified the Capital Regional District and its officials, agents, servants and representatives, from and against all claims, actions, costs, expenses and demands in respect to death, injury, loss or damage to the person or property of the applicant, developer, contractor or owner, howsoever caused, arising out of or in connection with the building inspection services, notwithstanding that the same may have been contributed to, caused or occasioned by the negligence of the Capital Regional District, its officers, employees, officials, agents, servants and representatives. It is understood that no warranty is implied for building inspection services of the Capital Regional District and that this agreement is to be binding on myself, my heirs, executors and assigns.

Phone Number: 592-8291 Date: Nov 24/88

FOR OFFICE USE ONLY

Handwritten note: *Building Permit #32591 Application with CRD for third story.