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Home My WebLink AboutAPPLICATIONS & AFFIDAVIT - 05-00107 - BYUI Heat Plant - Remodel~`~-- CAA- CITY OF REXB URG PERMIT # ~ (9~ BUILDING PERMIT APPLICATI~ 19 E MAIN, REXBURG, ID. 83440 Please complete the entire Application! 208-359-3020 X326 If the question does not apply fill in NA for non applicable PARCEL NUMBER: SUBDIVISION: ~ ! ~ f I~~/~~J UNIT# BLOCK# LOT# OWNER: C~~R~~~ air ~esc~SG~-yb~rs~rcr ,L.,,Q. S~+ CONTACT PHONE # ~9G ` 02~~~ PROPERTY ADDRESS: ~ST G/ °'~ 1lO~~it/fr- /~Q ~b~~ PHONE #: Home Work ~Zl~ -~~i~~ ~y Cell OWNER MAILING ADDRESS: S"~2~5~~~~~i CITY: ~~x8~~~ STATE: I ~ ZIP: 3~(,O --~~2~t' APPLICANT (If other than owner) (If applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) MAILING ADDRESS OF APPLICANT PHONE #: Home ( ) CONTRACTOR: CITY: STATE; Work ( ) Cell PHONE: Home# Work# MAILING ADDRESS: CITY ZIP Cell# STATE ZIP How many houses are located on this property? ~//A Did you recently purchase this property? ~~ Yes (If yes give owner's name) Is this a lot split? NO YES (Please bring copy of new legal description of property) PROPOSED USE: Q (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2000 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Perypit void if work stops for 180 days. ~ _----~rignature of Owner/Applicant DATE D ~ WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE! ~ „ an fees are non-refundable and are paid in full at the time of application beginning January 1, 2005. ~, a City of Regburg's Acceptance of the plan review fee does not constitute plan approval o ~ **Building Permit Fees are due at time of application** c~ ~ **Building Permits are void if you check does not clear** ~-~ 2 ~$ CITY O• ~~r R~:xBUR~ q~~" AMERICA'S FAMILY COMMUNITY n L~ 19 E. Main (PO Box 280) Phone: 208-359-3020 x326 Rexburg, Idaho 83440 Fax: 208-359-3024 www.rexburg.org comdevCcDrexburg.org Affidavit of Legal Interest State of Idaho County of Madison I, , Name Address City State Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) A. That I am the record owner of the property described on the attached, and I grant my permission to: Name Address to submit the accompanying application pertaining to that property. B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any claim or liability resulting from any dispute as to the statements contained herin or as to the ownership of the property which is the subject of the application. Dated this day of , 20 Signature Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: 3 Please complete the en~re Application! ~ Q If the question does not apply fill in NA for non applicable NAME J ~(~~~©~I't4fQ PROPE TR Y ADDRESS ~S'Y___(~(a. -¢- e/ ~ S, Permit# SUBDIVISION Dwelling Units: Parcel Acres: SETBACKS FRONT SI E SIDE BACK Front Footage (if applicable) Storm Water Length SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) First Floor Area Second floor/loft area Third floor/loft area Shed or Barn Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above grade)Area Remodel (Need Estimate) $ ~ ~ © ~~ Water Meter Count: Water Meter Size: PLUMBING ~~ Plumbing Contractor's Name: Address Contact Phone: ( ) FIXTURE COUNT (including roughed fixtures) Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal Hot Tub/Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ (Commercial Only) Zip Sprinklers Tub/Showers Toilet/Urinal Water Heater Water Softener Signature of Licensed Contractor License number Date The City of Rexburg's permit fee schedule is the same as required by the State of Idaho Business Name: State Business Phone: ( ) 4 • Please complete the en~re Application! If the question does not apply fill in NA for non applicable NAME Q yU~ ~ ~ ~~~a PROPERTY ADDRESS /~ j,U . ~ ~ -~ S. Permit# SUBDIVISION MECHANICAL Mechanical Contractor's Name: Address Contact Phone: ( ) Business Name: _ State Zip Business Phone: ( ) Mechanical Estimate $ (Commercial/Multi Family Only) FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas-fired appliance Incinerator System ? Boiler Pool Heater Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: Similar fixtures or Appliances Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure (Meter Supply) PSI Heat (Circle all that apply) Ga Oil Coa Fireplace Electric Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. Signature of Licensed Contractor License number Date The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 5 ti ' d` ~' a ~ ~ ~~ • CITY OF REXBLIR~ AMERICA'S FAMILY CQMMUIVITY 19 E. Main St. Rexburg, Idaho 83440 www. rexburg. org APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO APPROVED BY: -APPLICANT INFORMATION: BUSINESS NAME: Je yG'- /~~1~ OFFICE ADDRESS: sus- ~ GE~/rC~' , /.~-x8/~- ~ /a 8'~~ 6D ~'.~~s~"" City State Zip OFFICE PHONE NUMBER: ( ~o ) ~9~- a~~.~~ CONTACT PERSON: /1v.~o,v f~icrs~.v CELL PHONE # ( ) -LOCATION OF WORK TO BE DONE: STREET ADDRESS WHERE WORK WILL BE DONE: /s7-~/, ~ ~~ ~. BUSINESS NAME WHERE WORK WILL BE DONE: !~ yu -/9g~a~ ~~« A~~' DATES FOR WORK TO BE DONE: ~°~<< ~~~" TO ~rc~ll~.~.~~o~ CONTACT PERSON: .LLayd (~ h/S~~/ PHONE NUMBER: (~~) 49(- :~4~ ~ CELL # ( ) PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR: ~~ . ~.~.~ ^ AUTOMATIC FIRE-EXTINGUISHING SYSTEMS ^ COMPRESSED GASES ^ FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT ^ FIRE PUMPS AND RELATED EQUIPMENT ^ FLAMMABLE AND COMMBUSTIBLE LIQUIDS ^ HAZARDOUS MATERIALS ^ INDUSTRIAL OVENS ^ LP-GAS ^ PRIVATE FIRE HYDRANTS ^ SPRAYING OR DIPPING ^ STANDPIPE SYSTEMS ^ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES APPLICAN SIGNATURE DATE 6 ~~ . ~// ~ SUBCONTRACTOR LIST Excavation & Earthwork: Concrete: Masonry: Roofing: Insulation: Drywall: Painting: Floor Coverings: Plumbing: Heating: Electrical: Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists: Siding/Exterior Trim: Other: 7 gun. ~. ~00~ ~:4~~M CI?'Y OF ~B URCr BUILDING PERMIT APPLICATT©N 19 E 11JIAIN, REXBURG, ID. 834~t1 208-359-320 X322 PERMIT # Na.0762 P. Please complete, he enti.r~e Application ~ -- If the ques3ion does aol< ~pPly fill in NA for non applicabfle PARCEL NUMBER: (We wi11 provide #his for you} SUBDIVISION: _ LINIT# BLOCK# (.A.ddz~essing is based on the inf'armation - must be acctuate} LOT# O~YNE,R: BYU-Idaho C©NTACT PHONE # 496-6456 PRC}pERTY ADDRESS: 525 S. Center, PHONE #: Home ( } Work ( ) Coll ( ) OWNER MAILL~IG ADDRESS: 525 S. Center EMAIL FAX 496-6456 A-P~~ICA.N7': {If ether thalt owner) Lewis Corporation (A,pp.iicatzt ~f'otlxer tttaz~ ow.uer, a statezaent sutbarzzlzzg applicazxt to act as agent for owner mast accompany APPLICANfi INFORMATIdN: ADDRESS 15136 W. Hunziker CITY; Pocatello ST.gTE; Idaho ~p 83202 EMAIL. kenyan@Icorp.com FAX..208-237-1343 PHONE #: Home Work (20i~ 238-1202 Cell C~1V7RA~T't~R: Lewis Corporation IvIAIL-ING ADDRESS: CITY F'Ha:NE: Hvme# CI'T`Y: Rexburg STATE: ID 7~p; 83460 EMAIL FAX How many buildings are located on this praperh-? Cell# STATE_ ZIP Did yatr recently purchase this property? NQ Yes (If yes ~ ve owner's name) Is this a let split? NO YES (Please bring copy of new legal descr.'ption of property) PROPOSED USE: Existing heat plant--commercial {i.c., Single Family liesitience, Nlultx Family, Agarmrtents, Retnotie3, Garage, CammexeisJ, Additiozt, Etc.} APPLICAt~iT' S SIGNA~~TRE, CERTIFICATION AND AUTHORIZATION: under peachy of pcrltay, I hereby Gerrity that I have read this application and stare that the inftumatYOn herein is correct and 1 swear that any informatiat which may hereafter be gives by Ise in hearings before the Planning and Zaatmg Commission or the City Council*vr the City of Rexburg shall be tttulifit! and eoatct. ! egret to comply with at! City rcgulatioas and State laws relating to the sabjcct m~ of ttus applicatiotl and baeby autbaavcd rcptcseptatvq of tftC City to enter upon cite abov~mcntiottcd property fo< iasporxions purp6scs. NOTE: 71te buildrsrg o revoke a permit nm apprornl issued under the provisions of the 20D0 ]ntetnatiotttsll CodC in CBSe•S Of any rise Staterttttit of misrepirsea of is the app or on the plans on which the permit ur approval was based. Permit void if not startEd withia 180 days. Permit void if t+vark stops fot~I BO d 3 /June / 2005 DATE yau.~fref~rCo be contacted by fax, email yr pllvne? Circle One WARlYING - BUILDIlYG PERMI`.t MUST ~E POSTED ON CUNSTRiJCTION SITE'. Plan fses are non-refnndalsle and sre paid In fall at the time of application heginniag lot~rrrarp 1. ?AOS~ City otR,pciJt~rg's Arfitptance oftise plan review tee does sot constitute g1aA approval Work# dun: 2: X005 3:41 PM ~ ~ No.07b2 P. 4 > **Bailding Permit Fees are dQe at titoe of eppllcat~on" * •*BalW1n~ Perml~ ere void iSyon cltecic does aot clear** Please complete the entire Application! ~f'the quesfion does not apply fill in lYA fox taon $pplicable NAME Lewis Corporation PRGPER.T'YADDRESS 525 S. Center, Rexburg, ID p~i~ SUBDIVISION Dwelling Units:. SETBACKS FRONT Parcel Acres: SIDE SIDE BACK Remodeling Your Buildingl~om~ (need Estimate) S N/A SU~tFACESQUAI,`.EFGIO.TAGE: (Shall include the exterior wall measurements of the building) First Floor Area Unfinished Basement area Second floor/loft area ~ Finished basement area - - - Thizd ftaorlloft area Garage azea - Shed or Barn Carpaz~t/Deck (3fl" above grade)Area mater Meter Connt: -Wa#er Meter Size: - - Rewired r r ~ ~'~L U1V.11~ING Plumbing Contractor's Name: N/A Address City State Zip Caz~tact Phone: ( ) Business Phone: ( ) Email FIXTURE Cd UN"I' furctuding roughed f~xluresl Clothes gashing Machine Dishwasher Floor Drain Garbage Disposal Hot Tub/Spa Sinks {Lavatories, kitchens, bare map) Plnmbi~og Fax Sprinklers Tub/Showers Toilet/Urinal Water Fleater Water Softener (Commercial oi~-) Business Name: fLicensed Contractor License natnber Date The Clry of Rexburg's permit fee schedule Is the same as required by the Strrt2 of Idaho ,un. ~. 2~~~ 3:41PM • ~ No.O%b2 P. ~ P~e~3C COD1p~ete the eII~e App~1CS~l0II ~ If the question does not apply .fill in NA for non apglicable NAME Lewis Corporation PROPERTY ADDRESS 525 S. Center; Rexburg, D pe~~ SL'BD1VlSION 12equired!!! mechanical Contractor's Name: Kenyan Lewis Business Name: Lewis Corporation Address 15136 W. Hunziker Cit Pocatello y State I D Zip 83202 Contact Phone: ( ~ 238-1202 Busi~zess Phone: Email ken an Icorp.com Fax 237-1343 ,.,, ~ y0 Mechanical Estmnate ~ 400 (Cp~erciaUMulti Family Only) FIXTURES' & APPI1A11~CL~',S' COU.N'T (~'i~tgle Family ,Dwelling Only} Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Aecozative gas-fired appliance Incinerator System ~____, Boiler Pool Heater Dryer Vents Range Hood Vents ___ Coak Stove Vents Bath Fan Vents 3 other similar vents & ducts: Boiler Stacks 1 Boiler Fan Similar fixtures or Appliances ,~ Fuei Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure {Meter Supply} PSI Heat (Circle all that apply) Gas pit Coal Fireplace Electrzc Mechanical Sizing Calculations must be submitted with Plans & Application Po3'tnt of Delivery mast be shown on plans. 10391-AAA-4(2,5,12, License number 24,30,31,34,35,36,37,40,46) 3 June 2005 Date The Ciry ofRex 's ermirfee sclrerh~rle u the s~mte us required by the Stote ofldaho sin, ~, IuO~ ~.41?M ! C_.#~'Y ~7F /\MfRICAS friMll.Y C~~MMIlNfT7 ~ No. 0762 ~, 6 nexeurg, to&na 13;3440 Far_ 208-g5&3024 www.r® ura.aro cdd~raxburg.org APPLICATION: `CONSTRUCTION PERMIT" CONSTRUC~'ION PERNII~' #: PER'VII'I' APPRUVED; YES1 NU SSOAO FEE PAID: YES/NO APPROVED BY: -APPLICANT INFORMATION: BUSINESS NAME: Lewis Corporation OFFICE ADDRESS: 15136 W. Hunziker, Pocate o, a o ~~ state ~~ OFFICE PHONE NUMBER; 2os ~ 238-1202 CONTACT PERSON. Ken an Lewis CELL PHONE # ~_) -LOCATION OF WORK TO BE DONE: STREET ADDRESS WHERE WORK WILL 8E DONE: 525 s. center BUSINESS NAME WHERE WORK WILL BE DONE; BYU-Idaho DATES FOR WORK TO BE DONE: TO CONTACT PERSON; Wayne Clark PHONE NUMBER: ~~ 496-2431 CELL # PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR: ^ AUTOMATIC FIRE-EXTINGUISHING SYSTEMS ^ COMPRESSED GASES ^ FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT ^ FIRE PUMPS AND RELATED EQUIPMENT ^ FLAMMABLE AND COMMBUSTIBLE LIQUIDS ^ HAZARDOUS MATERIALS ~ INDUSTRIAL OVENS Boiler Stack Replacement ^ LP-GAS ^ PRIVATE FIRE HYDRANTS ^ SPRAYING OR DiPP1NC ^ STANDPIPE SYSTEMS ^ T PO EMBRANE STRUCTURES, TENTS, AND CANOPIES 3 June 2005 TS GNATURE DATE i~rr~iasa^^s^^^a^^^•r~~~rs~~~~~aas~si~a~~~s~~~~~~ata~yr^rr~aar::^^^^sr^•^~*~~~~~~~~~~isassts~ Jug. ~. 200 3:41PM ~ ~ Nc, 0762 P. 7 ~, ~C~NT~2AC'~`OR LISA' Excavation & Earthwork: Concrete: Pour It Concrete Masonry: N/A Roo~g: Clarks Roofing In.SUlation: Mountain States Insulation Dryw~l; N/A Painting Sunrise Enterprise Floor N~s~oatings Silver Crest or United Painting Plumbing: N/A Heating: Lewis Corporation Electrical: Portneuf Electrical Special COII3t7'uCt10n (Manufacturer or Supplier) Roof Trusses• N/A Floor/Ceiling Joists: N/A Siding/Exterior Trim: N/A Other: Structural Steel Support: Sunrise Enterprise JUN-03-05 X8:15 FROM-LEWIS~C~O p~ATION ' GfT~F o a° ~~~ ~+~ FAA+si~.r cavu++twnir~r Affidavit of Leg~~ Interes# State of ~'daha ~Co ty oP1V~ciison i' ,~ xame .~- Cfty ~~~ ~ C~.~ti~ ~ .. Address State Being first duly swarm upon oath, depose and say: (If Applie~t is also r of ord, aldp to fit) A. 't'hat T am the Cf~oCl o the arty described on the attache , amd I gran y permission ta: ' ' ~~, ~,~,,~- e A~ddrQSS ~-~~.:~ to submit the acoompanying application, pertng to that property. B. Z agree to inder~anify, defend anal hold Rexburg City sad xts employees harmless from auy csaiZr- a~ liability resulting .from auy dispute as to the statements oantainec3 herin or as to the owneYShip afthe praparty which iS the subject of the appl%oation. Dated this ~ ~~ - ,-- i~, ~ day of Sub:gcribed and sworn to before trio the day and year first above wxittea. \~\\\\!A It t l i Ult~j~i ~~~~~~~ P A' K fi` ~~*r, a ~: ~pT A R y • • ' j~o~ Public afIdahn _, p ~ e ~ ~ ~ ro ~ Residing at; ~ - :- n .•' •~ i .• ',r,/`~~~ l 1;1~~!i;1o~\\\~ My cammt$sion expires (,Z -y7 l~C~