HomeMy WebLinkAboutBP & APPLICATION - 05-00266 - 54 Mill Race Rd - New SFRZ
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CI~'Y OF REXB URG • PERMIT #•
BUILDING PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
208-359-3020 X322
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: ~ i d~N'' ~ fi`~,~t-iJ UNIT# BLOCK# ~ LOT# ~J
(Addressing is based on the information - t~tst be accurate)
OWNER: ~~;~~,,~r.~,. -~'~.v~ ~~r-- CONTACT PHONE # 3 5~~ --`~ ZQ
PROPERTY ADDRESS: ~,~ YYl ~ ~ f ~~ es~ .
PHONE #: Home (2®~) '~ 5 (a -h Z`I Z Work (?ra$) (~' ~P~ -`~3(,~ ~ Cell ( ) ,5~1 - q ~ (`7
OWNER MAILING ADDRESS: ~(~ /~i. ~~ i C;((~+ U~lley CITY:. ~~~ STATE:T~ ZIP: S ~ ~~~
EMAIL bhr.I~~ S5~'T'~=h,CernFAX ~-
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
Work ( ) Cell
FAX
CONTRACTOR: 5'~ h,~,
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this pro>7ertv? ~!o n~~ N ~ - ~f- ~u d ~~-+~' l l ~/
Did you recently purchase this property? No ~(If yes give owner's name) ~~ Patr~e~- - y~u~ (~1I~ uK~lc
Is this a lot split?~ YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi amily, A
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
p can__ nr:T al was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signatur of Owner/Applicant c 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 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**
CITY:
ZIP EMAIL
,~~ CI~OF •- -~, ----- -
~_ - --- - -
qs~ +- AMERICA'S FAMILY CQMMUNffY 19 E. Main (PO Box 280) Phone: 208-359-3020 x326
Rexburg, Idaho 83440 Fax: 208-359-3024
www.rexburq.orq comdevCc~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 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:
Please complete th~ntire Application!
If the question does not apply fill in NA for non applicable
NAME ~ ~^ ~ r.~~ C~.r-
PROPERTY ADDRESS Permit#
SUBDIVISION . C~ ~ l
Dwelling Units:
SETBACKS
FRONT /~
Parcel Acres: .~ ~~
S~I~ E J'~ ~ S DE
BACK 2
Remodeling Your Building/Home (need Estimate) $ ~ D0~
Boa
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area Unfinished Basement area
Second floor/loft area '~ Finished basement area -
Third floor/loft rea Garage area ~ d D °'~0- t 15.2
Shed or Barn W I~ l my -s a~ Sid Carport/Deck (30" above grade)Area
Water Meter Count:
Water Meter Size: . ~ `~
Required!!!
PLUMBING
Plumbing Contractor's iN~me:p ~ r~.~,r~ Business Name:
Address ~ ("~ ~ ~ 1ti C~c3(er~ ~ I ~ City ~,,- State LOj
Zip ~~ Y~
Contact Phone: (~~)~,~ C'6 -,SLQ' ~. Business Phone: ~~) ~(p~ j ~ ~ ~a~
Email b rU C2C~ sS p`f 2c)., , La i---~ Fax
FIXTURE COUNT (including roughed fixtures)
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $ ~(9d ~ (Commercial Only)
Signature of Licensed Contractor License number Date
The Ciry of Rexburg's permit fee schedule is the same as required by the State of Idaho
Sprinklers
Tub/Showers
f Toilet/LTrinal
9D~
Water Heater
Water Softener
Please complete the ere Application! If the question c1Ses not apply fill in NA for non
applicable
NAME ~ Y` I.l. G~ U~,Y-~i1~
PROPERTY ADD SS 71'1 i ~ c~c~ R ~{. Permit#
SUBDIVISION In
Required!!!
MECHANICAL
Mechanical Contrac4tror's Nacame: V fst~ ~. Business Name:
Address ~ U /~! , `tti G~w Uel~~ 1~1 City ~.~r State ~~ Zip ~~ (~
Contact Phone: (gyp ~) ~ S 6 ~ S ~~ Z- Business Phone: ( ) (p ~ ~ ` ~ `~ 6~
Email ~Y'~tCA(d ~S (,~ ~~:`.. CD v-~ Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace 2, Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
evaporative Cooler
a- ~ 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) ~ Oil Coal Firephace Electric
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
r Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
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
•
SUBCONTRACTOR LIST
Excavation & Earthwork: (~ 1.t9 YlQ/Y' -+ ~ c~ y y~.Q ~ctir,~ i rS m.-._
Concrete
Masonry
Roofing:-
Insulation:
Drywall:
Painting:
Floor
Coverings
(J W ~e~r
~Wy~~
d~~~
D ~~W-
Plumbing: ~ u1 'v~.P~a~
Heating: _ Cy -Wr4AC- - G ~ S 1. ; re s b ~ f'j ~ ~ ~ ~(r c.,~, ~~ h ~ ~ l-
Electrical: (~ ~~ ~
Special Construction
(Manufacturer or Supplier)
Roof Trusses: ~ o t ~-e CG s c~~
Floor/Ceiling Joists: ~o~ ~ ~ ~ s cc1
Siding/Exterior Trim: L t~(,re~ `I~ ~ zs~ ~r,c~
Other:
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