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Home My WebLink AboutAPPLICATION & PLANS - 05-00115 - Speed Shop - Tenant Finish~~TY OF REXB URG BUILDING PERMIT APPLICATION PERMIT # 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: ~ P'CZR.x,g:~ O3 2~ 3 3 SUBDIVISION~"v~ ~~.~,~.J UNIT# BLOCK# LOT# OWNER: ~~~ ~~~~ CONTACT PHONE # ~. ~°~ -~ `~'.(~ ~ ~. Q PROPERTY ADDRESS: PHONE #: Home () 3~ -1~„~,Work (l,~ ) Cell (dp~l l.~ r ~, - ~~"~,v OIL OWNER MAILING ADDRESS: ~ CITY: .~ ~ STATE:~~~ ZIP:~~p 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 CITY: CONTRACTOR: MAILING ADDRESS: How many houses are located on this property? CITY Did you recently purchase this property? No 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: - (i.e., Single Family Residence, Work STA ~3 L~ `C Cell PHONE: Home# Work# FamilyvApartments, 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 ' ion or on the plans on which the permit or approval was based. Permit void if not started within 18 Permit vo~stops ftor 180 days. Owner/Applicant DATE WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE! Plan fees are non-refundable and are paid in full at the time of application beginning January 1, 2005. City of Rexburg's Acceptance of the plan review fee does not constitute plan approval **Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear** ZIP Cell# STATE ZIP 2 ~~'`~ CITY OF ~-- - ~ ~ R~XBLIR~ ~2 ~i ___.:_ _ _ _ ~___ _ _ _ _ . _ ~ - - - _..:::~ ?ggt1~` AMERICAS FAMILY COMMUNffY 19 E. Main (PO Box 280) Phone: 208-359-3020 x326 Rexburg, Idaho 83440 Fax: 208-359-3024 www.rexburg.org comdev(a)rexburg.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 entire Application! NAME If the question does not apply fill in NA for non applicable PROPERTY ADDRESS SUBDIVISION Dwelling Units: SETBACKS FRONT SIDE Front Footage (if applicable) Storm Water Length Permit# 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 .'Remodel (Need Estimate) $ 1 ~~ ~ Water Meter Count: Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above grade)Area Water Meter Size: PLUMBING Plumbing Contractor's Name: // ! E~~d / Business Name: Address State Zip Contact Phone: ~~~ Business Phone: ~) ~(7-,~~ l ~1~s FIXTURE COUNT (including roughed frxtures) Clothes Washing Machine Sprinklers Dishwasher Tub/Showers Floor Drain Toilet/LTrinal Garbage Disposal Water Heater Hot Tub/Spa Water Softener Sinks (Lavatories, kitchens, bar, mop) ~~ Plumbing Estimate $ ~~ (Commercial Only) 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 Parcel Acres: SIDE BACK 4 Please complete the entire Application! If the question does not apply fill in NA for non applicable NAME PROPERTY ADDRESS SUBDIVISION Contac Permit# CHANICAL iical Contractor's Na e: ~ ~i~`y~q Q~CC, ~ Business Name: ~~ ~ G~ State al~J Zip t P e: ( ) Business Phone: ( ) d~ Mechanical Esti to $ dr D y (CommerciaUMulti Family Only) FIXTURES & APPLLgl~ Furnace Furnace/Air Conditi Heat Pump Air Conditioner Evaporative Cooler Unit Heater COUNT (Single Family Dwelling Only) Exhaust or Vent Ducts Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: Space Heater Decorative gas-fired appliance Incinerator System Boiler Pool Heater Similar fixtures or Appliances \ Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure (Meter Supply) PSI Heat (Circle all that apply) Gas Oil Coal 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 ~~~'°t°"'"~e CITY QF RE:~Bt..,IR~ q~, AMERICA'S FAMELY COMMUNITY APPLICATION: "CONSTRUCTION CONS7 -APPLICANT INFORMATION: BUSINESS NAME: OFFICE ADDRESS: city OFFICE PHONE NUMBER: (_ CONTACT PERSON: ERMIT" UCTION PERMIT #:_ APPROVED: YES/ NO APPROVED BY: $50.00 FEE PAID: YES/NO State CELL PHONE # Zip -LOCATION OF WORK TO BE DONE: STREET ADDRESS WHERE WORK WILL BE DO BUSINESS NAME WHERE WORK WILL BE DONE: DATES FOR WORK TO BE DONE: CONTACT PERSON: PHONE NUMBER: O 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 FIRE PUMPS AND RELATED EQUIPMENT FLAMMABLE AND COMMBUSTIBLE LIQUIDS HAZARDOUS MATERIALS INDUSTRIAL OVENS LP-GAS PRIVATE FIRE HYDRANTS SPRAYING ORDIPPING / STANDPIPE SYSTEMS PMENT TEMPORARY MEMBRANE STRUCTURES, TENTS, ND CANOPIE APPLICANTS 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 ,;ease complete the entire Application! If the question does not apply fill in NA for non applicable rTAME ' PROPERTY ADDRESS SUBDIVISION Dwelling Units: SETBACKS FRONT Front Footage (if applicable) Storm Water Length Parcel Acres: SIDE BACK Permit# 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 ('Remodel (Need Estimate) $ j &(~ ~ Water Meter Count: Water Meter Size: PLUMBING / Plumbing Contractor's Name: `~s/l d % Business Name: Address State Zip Contact Phone: ~0~ Business Phone: ~) ~t ~-,/~ l ~ ,~~ FIXTURE COUNT (including roughed fixtures) Clothes Washing Machine Sprinklers Dishwasher Tub/Showers Floor Drain Toilet/LTrinal Garbage Disposal Water Heater Hot Tub/Spa Water Softener Sinks (Lavatories, kitchens, bar, mop) ~~ Plum g Estimate $ ~~ (Commercial Only) Sign e of Licensed Contractor License number Date The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 4 SIDE Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above grade)Area 3s ~- ~/~~ Rpr,l3. 2005 12~41PM ALPHR NIECHANICRL No~5201 P. 1 APk ~..~,~uu~ uy:5ss r~arzer Insurance zo83598148 Page ~. .~ ,,.~ ~ ,.., .._..o_ ~~~ ,ease complete the entire Application! , . ~~~~ ~~-~ ~` ~a~~ If t6o quostion does not apply fill in NA for non applicable Nr1ME PROPERTY A 1.)1) K f ? SS _ Pertttit# SUBDIVISION -~ .~.~~_ , ~-~-,... .ECHA11rICAL Me apical Contra~r'~ N,~1tc: -'~, - ~I~C',t,~ Busiacss Name; Addrea ~~'1 l~j, li„~ _ ...___ St,au; ~~ Y.iI, Conlacl P c; ( ) '''' _~> (o ~C z,~_~_Busincss Phono: ( ) _ Nlcchanical Esti r $ D~ (Coxaa~erciaVMu1N FAmi1y Only) - FIX~CIR~S di APPL S COUNT (Sitagle Fant>'!y lr-we/lin~ Only) Furnace Exl~alrst or Vcnt Ducts . Fumc~cc/Ai>• C.~nditioner 'rnnbo pzycr Vcnts _. _.._ .. Hent P~wp \ Air Conditioner ' Evaport~.iiivc Cooler Unit Hct~tcr ,,, Spacc Hc;t~tcr ,_,,, Di;oorativc gas-fl.red Appii4nce Inoincrator System Builcr Pool Hcetcr \ .S1IT111QJ' 1•IXtltl'e5 or AI7p1i~1GeS Fool Gas Pine Outlets including Stubbed in or furore outlots In1Ct Pressure (Meter Sup}~ly) PSI Rang~c Hood Ve~tats Couk Stove Vents Bat11 FQn Vents otlwr similar. vents & ducts: Heat (Circle all that apply) Cit-,~ pil Cnatl Firepl:3.er Elcctric~ MechAnlCOI Sizing Calculations roust be submitted with Plans Application Polo,! ol'De ive ust be s own on plans. \ r~`'~ C ` _ _ ~-~~--G-13 ~~ ~l l3 aS Signature of Licensed C:rntt~•actor ~ Liwnsc; nuuuber Da c 7%e C'i/y <,f k~~zFn~rg's perntil fee schvdul~s is [Mr, ynm:u as reyteirN~(hy [lrr ti1u1e ~ jldabn 5