HomeMy WebLinkAboutBP & APPLICATION - 05-00227 - Diamond Gallery - Tenant FinishZ
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"-CITY OF REXB URG
BUILDING PERMIT APPLIf,~ION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PARCEL NUMBER:
SUBDIVISION:
PERMIT #
Please co-
If the questio O ~ 0 O ~ ~ 7
CONTACT PHONE #
(Addressing is based on the information -must be accurate)
Q
PROPERTY ADDRESS: M~.1~ sTIZ'~~~ ~~yG(~~(,t-' ~L`I14~ ~
PHONE #: Home ( ) Work ( ) Cell ( > 39a- 3'J/ '~
OWNER MAILING ADDRESS: lt~~ A~IJku~1, CITY: Q>c.~t4rieP_u STATF,:Ip 7,TP_cF.~S~S~~
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
STATE:
PHONE #: Home
CONTRACTOR:
Work ( )
_(We~
UNIT#
Diamond Gallery
CITY:
FAX
Cell ( )
MAILING ADDRESS: ~ ~ (~o~L. ~ 3 ~ CITY ~~pt~ STATE~ZI 3 S~~
PHONE: Home# y~`y`~5"ZWork# 7a' -4~IS~ Cell# 313-- Low
EMAILaefo~~4~ ~_ ~l'E~EI ,c~Ax y ~8~~`-f~ Z ~'
How many buildings are located on this property?
Did you recently purchase this property? ~T Yes (If yes give owner's name)
Is this a lot split? ~~ YES
ZIP EMAIL
(Please bring copy of new legal description of property)
PROPOSED USE: ~~~kK-~ SIV~(KO(J~~r~'
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage,
tl, 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 Owner/Applicant DATE
Do you prefer to be contacted by fax, email or phone? 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 Rezburg's Acceptance of the plan review fee does not constitute plan approval
Please complete the er~j~ Application!
applicable /'( ~
NAME l~ U~ t~t,~ ~.1~,~,.. ~a~-- ~,s, ~
PROPERTY ADDRESS ~l.lk~K. *,~t~o2~-~
SUBDIVISION ~ut,Q~j~ {~{~,~.~.
Permit#
Required!!! MECHANICAL
Mechanical Contractor's Name: ~ 1 I`Y~ ~~ ~ Business Name:
Address ~t(~,vu,~ ~ {~„V~ City Zc~rtlls ~~.~(,,~ State ~ Zip~3y4~ Z..
Contact Phone: ( )
Email
Business Phone:
Fax
If the question ~t apply fill in NA for non
Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
k'urnace 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
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
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
' Point of Delivery must be shown on plans.
~ `' Signature of ~ ec Contractor License number
Required!
The City of Rexburg's permit fee schedule is the same as
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
7 / v
Date
the State ofldaho
5
' r
~ CITY OF
+ AMERICAS FAMILY CQMMUNI'17
NA •
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO
BUSINESS NAME: F~_
OFFICE ADDRESS: O Rojo I b I
INFORMATION:
APPROVED BY:
~K t~1,~i-co rti
~ 3 ~fS
City State Zip
OFFICE PHONE NUMBER: (ac~~) ~ ~ ~ 4~S Z-
CONTACT PERSON: ~20,,~ C~er,~_dEc~~.`CELL PHONE # (~) 3l3 "~~~
-LOCATION OF WORK TO BE DONE:
STREET ADDRESS WHERE WORK WILL BE DONE: d'i~ A ~ ~ S rG~~-
BUSINESS NAME WHERE WORK WILL BE DONE: l~ur~re~4,!-a a ~l-ra-L~
DATES FOR WORK TO BE DONE: Z l ylo~ TO ~ H/4S~
CONTACT PERSON: i~ G~.d ~o~.
PHONE NUMBER: (~) y~' --y~S1- CELL # (~~8 )~~
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
APPLICANTS SIGNATURE DA E
...........................................................................................
6
• r
Excavation & Earthwork: ~ ~~`-
Concrete:
Masonry:
Roofing:
Insulation: ~ ~ t! lAr nC~/~ x -~S u,~, ~~~.
Drywall:
Painting: Cam- /~~ ~ C~ pa.~fi.~ ~u'' ~u-",J
SUBCONTRACTOR LIST
Floor
Coverings: ~ ~ ~ ~~
Plumbing:
Heating: ~~ `I'V! ~G~~~~C~-L-
Electrical: ~~ ~ ~ ~. ~L~C~,TQ,.L{~
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
1~-
Floor/Ceiling Joists: ~ ~~
Siding/Exterior Trim:
Other: ~~~~
**Building Permit Fees are due at time of application** **Building Permits ~d if you check does not clear**
Please complete the~ire Application!
If the question does not apply fill in NA for non applicable
NAME ~~ i< ~
K
PROPER~ADDRESS NI ~ ~ K 5r ~,E~-~ Permit#
SUBDIVISION ~~ ~'Ly4 z.I~-
Dwelling Units: /~ ~-- Parcel Acres: Jl~~'
SETBACKS
FRONT_~ f ~~ SIDE ~ 1~{- SIDE /I~ BACK /IG ~--
Remodeling Your Building/Home (need Estimate) $ 0 ~
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building
First Floor Area / 7 DO ~%~' S4u~lIl.F
Second floor/loft area
Third floor/loft area
Shed or Barn
0" above
Water Meter Count: 1~(1~--
Water Meter Size: ~fj~--
Required!!!
PLUMBING
Plumbing Contractor's Name: ~o~' S~o ~' T~~.cwl1 ~ ~'~Business Name: ~' S~~- ~~~i 6'~/~
Address ¢~(~ ~~a~ g City -~~ ~~ State ~ Zip~S
Contact Phone: ( ) Business Phone: ~) ~~.3 - ~ 7~~
Email Fax
FIXTURE COUNT (including roughed fixtures
~~- Clothes Washing Machine J~ ~ Spririlclers
6~ ~ Dishwasher -~~ Tub/Showers
_~ Floor Drain ~ Toilet/LJrinal
(~- Garbage Disposal ( Water Heater
Hot Tub/Spa ~ Water Softener
Sinks
(Lavatories, kitchens, bar, mop)
$ '~~ ~•~ (C~ mercial Only)
ii. ~ ~ ~dh~v~
The
's
Unfinished Basement area
Finished basement area
Garage area
License number Da
schedule is the same as required by t e State of Idaho
4
Affidavit of Legal Interest
State of Idaho
County of Madison
I, ~.s~~ y~~ ~ia~~ l_ar,.~~~~ ~Q, ~a ~f~S~~
Name Address
~%la~~
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: Ga~.l~smil !~~ .F C,~~f~ %,~~.-, ~~e~~~
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 ~ u ~ ~( , 20 e ~
a~~~ ~ ~ ~~
Signature
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing at:
My commission expires:
~~
2