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REXBLIRG
AMERICA5 FAMILY COMMUIvfIY
Building Permit No:
Applicable Edition of Code:
Site Address:
Use and Occupancy:
Type of Construction:
Design Occupant Load:
Sprinkler System Required:
Name and Address of Owner:
Contractor:
Special Conditions:
Occupancy:
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Phone (208) 359-3020 /Fax (208) 359-3022
05 00237
~e,~on G~,t~
155 W Main St
Owner
This Certificate, issued pursuant to the requirements of Section 909 of the International Building
Code, certifies that, at the time time ofissuance, this building or that portion of the building that
vies inspected on the date listed vies found to be in compliance vuth the requirements of the code
for the group and division of occupancy and the use for vihich the proposed occupancy vies
classified.
Date C.O. Issued: October 12, 2005 (01:39PM)
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 Department: Fire
State of Idaho Electrical Department (208-356-4830):
CERTIFICATE OF OCCUPANCY
Cl~'Y OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PARCEL NUMBER:
SUBDIVISION:
(Addressing is based on the information -must be accurate)
LOT#
UWNER: ~; i.~ ` -~-~!, CONTACT PHONE # ~. ;;;ry ~'-
f
PROPERTY ADDRESS:_ / ~ ~ ~« ~ .n "~ ~"t-p N (~ B,~LIE
PHONE #: Home ( ) '~e/S- $ft~~(' Work ( ) Sp~ -,~yyy Cell ( ) ~~~~~- ~3 7
OWNER MAILING ADDRESS:
EMAIL
CITY:
FAX ~`~~ ~- 3 ~'?y
STATE: ZIP:
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 ~p~~ ~ ~ ~~ ~ CITY:
STATE; ZIP~,~ EMAIL FAX
PHONE #: Home
PERMIT #
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
Work
CONTRACTOR: ~~
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
riow many butldmgs are located on this property?
Did you recently purchase this property? ~o 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~ ~ ~~G~~ I
(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 appl' tion 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 day /~
licant
~~ ad ~ o~
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 Tanuary 1.2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
_( We will provide this for you)
UNIT# BLOCK#
Cell
**Building Permit Fees are duyy~~e of application** **Building Permits are v~u check does not clear**
Please complete the erill~e Application!
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Dwelling Units:
SETBACKS
FRONT SIDE
BACK
SIDE
Permit#
Remodeling Your Building/Home (need Estimate) $~ „ p~
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 g
Water Meter Count:
Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name: '~, R Business Name:
Address
Contact Phone: ( )
Email
City
State
Business Phone: ( )
Fax
)Area
Zip
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)
Required! 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:
Sprinklers
Tub/Showers
Toilet/LTrinal
Water Heater
Water Softener
4
' Please complete the entil~pplication! If the question does ~pply fill in NA for non
applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Required!!! MECHANICAL
Mechanical Contractor's Name: Business Name:
Address City State
Contact Phone: ( )
Email
Business Phone:
Fax
Zip,
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL9NCES 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
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
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor License number
Required!
The City of Rexburg's permit fee schedule is the same as
Date
the State of Idaho
5
~~~~~
4 ~p
CITY tJF
R~:XBLiR~
AMERfCA'S FAMILY CQMMUNi`IY
•
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO
-APPLICANT INFOF
BUSINESS NAME:
OFFICE ADDRESS:
APPROVED BY:
City sotdte ~ Zip
OFFICE PHONE NUMBER: )
CONTACT PERSON: CELL PHONE # O ~/- 7C/3]
-LOCATION OF WORK TO BE DONE:
STREET ADDRESS WHERE WORK WILL BE DONE: / ~,/ ~'f«w~ ~
BUSINESS NAME WHERE WORK WILL BE DONE: ~c ~-~
DATES FOR WORK TO BE ONE: ~ ° TO ~ C3 --(7
CONTACT PERSON: ~ ar ~
PHONE NUMBER: ( ) CELL # ( ) S~I~ ~l._3"~
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 EMBRANE STRUCTURES, TENTS, AND CANOPIES
APPLICANT SIGNATURE DATE
6
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete:
Masonry:
Roofing:
Insulation:
Drywall: ~~'-l
Painting: ~~~~
Floor
Coverings: ~ ~~
Plumbing:
Heating:
Electrical: ~ /
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:
Siding/Exterior Trim:
Other:
7
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