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Home My WebLink AboutCO & APPLICATION - 05-00177 - 325 W Main St - Remodel~~`°~ CITY°F CERTIFICATE OF OCCUPANCY a a REXBLIRG City of Rexburg ~ AMERICA'5 FAMILY COMMUNITY Department of Community Development 19 E. Main St. / Rexburg, ID. 83440 Phone (208) 359-3020 /Fax (208) 359-3022 Building Permit No: 05 00177 Applicable Edition of Code: Site Address: 325 W Main St Use and Occupancy: Type of Construction: r~d~\ Design Occupant Load: Sprinkler System Required: Name and Address of Owner: Gardner Marjorie B 325 W Main Rexburg, ID 83440 Contractor: Owner Special Conditions: Occupancy: This Certificate, issued pursuant to the requirements of Section 109 of the International Building Code, certifies that, at the time time of issuance, this building or that portion of the building that vies inspected on the date listed Ities found to be in compliance with the requirements ofthe code for the group and division of occupancy and the use for v~hich the proposed occupancy vies classified. Date C.O. Issued C.O Issued by: Building Official There shall be no further change in the e~asfing occupancy classification of the building nor shall any structural changes, modifications or additions be made to the building or any portion thereof until the Building Official has reviewed and approved said future changes. Water Departmentr,~}Tis~~C.~! ~o Fire Depa~p~nt: State of Idaho Electrical Department CITY OF REXB URG i BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 208-359-3020 X322 PARCEL NUMBER: ( We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information -must be accurate) OWNER: ~ i X20 ~~rL CONTACT PHONE # Zd~~ ~S~-5ZZ ~ PROPERTY ADDRESS: ,~ZS l~ • M f~- / /`1 ~~'~~-~ rat , ~ . ~ 3 µ-~t-~ PHONE #: Home (Z~ 3~ - ~2Z~ Work ( ) Cell (~ ~~ 7 - S ~ 3~ OWNER MAILING ADDRESS: 32-5 W~ mA..~ CITY: ~L- c~;,~-c-~ STATE: ZIP:~3 3~~~ EMAIL FAX APPLICANT (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS CITY: STATE; ZIP EMAIL FAX PHONE #: Home ( ) Work ( ) Cell ( ) CONTRACTOR: ~/'G.N/r f'ytc~, r" k e C MAILING ADDRESS: ~3Y //~i~~ ~.ve CITY cif ie STATF,~~ZIP 3 1 PHONE: Home# egg 7g -1g7~Jork# Cell# ~c~$ - ~p - I ~ ,Z I EMAIL FAX How many buildings are located on this property? 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: .R C /~-~ o D ~ 1-- ~ A-~2-r-; C~~~ I STD ~C~~oar~-, Gtr/ [~-i 1~ (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. Permit void if work stops for 180 days. Signature of ner/Applicant ~ DATE Do you prefer to be contacted by fax, email o Circle One 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** PERMIT # Please complete the entire Application! If the question does not apply fill in NA for non applicable Please complete the en~e Application! If th question does not apply fill in NA for non applicable NAME ~/(, A- r~~{ p r i ~ j j ~ ~,~2 !~~ ~i2 PROPERTY ADDRESS 3 ZS u) , -~'~ r3, ,J Permit# SUBDIVISION Dwelling Units: Parcel Acres: SETBACKS ~ '-~ ~~ f~ FRONT Z~ Z SIDE ~~ SIDE 7 BACK Remodeling Your Building/Home (need Estimate) $ ZOO Q , 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 ~. 5 Carport/Deck (30" above grade)Area Water Meter Count: Water Meter Size: Required!!! PLUMBING Plumbing Contractor's Name: ~ Business Name: Address City State Zip Contact Phone: ( ) Business Phone: ( ) Email Fax FIXTURE COUNT (including roug hed 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) 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 Please com lete the entire lication! if the uestion does nova 1 fill in NA for non p pp q PP Y applicable NAME /~ ~~, j ~ r i C. ~ . ~ /~2 r~ N~r~. PROPERTY ADDRESS 3 z ~ ~- m ~ ~ ,J Permit# SUBDIVISION Required!!! MECHANICAL Mechanical Contractor's Name: ~.~;~~~ Business Name: Address City State, Contact Phone: ( ) Business Phone: ( ) Email Fax Zip Mechanical Estimate $ (CommerciaUMulti 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 (Q,Lj 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 The License number 's permit fee schedule is the same as ~~~~ Date the State of Idaho Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: . ~ ~ • 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: SidingBxterior Trim: Other: ~~ CITY OF • _ __ _ _~_F _~ _ _ RE:~BLIR~ ~ _ _ AMERICA'S FAMILY COMMUNITY 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 City Being first duly sworn upon oath, depose and say: A. Address State (If Applicant is also Owner of Record, skip to B) 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 herein 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: N mot' Y U O J m m r ~ W J O O ~ ap ~ ~ ~ ~ O ~ Z w N Q~ O ~ O ~~ m ~' ~~~ m 0~ ~ O M CD N M m X M N~ ~ O~ M X ~ C~ M M~ N N N N~ Ef3 N O EA ~ O~ ~ ~ R ~.i = 3 ~_~ ~ O ~ N ~ m ~ y ~ N ~ v ~ 4k ~ v O ~ O v ~ ; L C i a H_ ~ ' d~a ~Q ~ 1 dQ a ~ d Z~~ aaa~ 0 wR~~ 5~~t~ ~ ~'d v c9.~