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HomeMy WebLinkAboutAPPLICATIONS, BP - 05-00323 - 255 Nez Perce Ave - RemodelZ ~ ~ _ o ~ o c~ -i ~~:~ _ ~ ~, ~ W S v W p W ~ ~ •~ 3 ' Q S _ O c ~1 m v; ^.~ g z ~ v ~ Q. ~ 3 a r- c ~ ~ ~ ~ y C f Z cdi ~ ~ a ~ C . "F3 ~ y H! 0 0~~ i o ~ ~ O T C ~ ~ ~° m m ~ a z ~ . C7 ~ a I D d a a v v o;Q~.~ ;~ ~ ~ ~~~ .rte n .p. ~~~ ° _ ~ _ p0 m _ ~ y ~ ~ m y cfl m a °~ ~' o ~ ~ O n ~ S C1 3 tD pl O fl. ~ ~ ~ a ~ ~ ° _ ~ 7 . a v a c o~ v Z p ~ ~p p' ~ ~~ ~? o o' ~ O ~ y ,C vi ~ N ~ v s o m ~ <D ~D 3 7 v a ~ W y ,~~~. ~ ~ ~ C ~ f A ~ C1 .:_ ~ ~- 3 ~ ~ C. ~D y 'a p W ~. ~ ~ ~ ~ c m T !/~ -I ~ 3 W Cf tD 3 ~ 0 3 C Q. O , W ~ ~ ~~a < a m Z p D ~ ~ ~ O1 a1 p c~ ~ ~ `~ o. ;~=~Z a = `~ ~~~ ~ ~ ~ ~• ~ ~~ y ~. F .~ ...~ W 3 7 3 n n~ ~ ~ (Q S ~ '11 C ~ - ~ /~ Q d 0 0 ~ 3 p ~D ~a m X~D F o O' ~D ~ ~ N o ~ ~ ~.(~ 7 0 0 ~, ~: ~ ~ ~ ~ ~ .~T ~oo~ ~ m ~,`° ~. ~a a ~ c~ 0 z ~ m n o ° z z ~ y ~ ~ a ~ n C '.~ n Z ~ O ~ ~ v ~ ~ N 3 m C - ~ ~ N ~ ~ ~. n ~ o ~ .~- `~ 3 C ~ ~ O ~ L g m N CJ7 Z NT V m n D m ~ ~ C ~ N rn ~.. ~ ~ ~ ~~ ~' Q ~ ~ ~ ~ O m ~ z -=i ~ ~k 0 o ~o o~ w~ W M ~ ~+ ~{ a -~ ~ W ~ w N z n H ~ -gyp ~ 7 ~ v ~ N ~ n _ o m _ c~$ > > ~ ~ ~ m O ao 0 o n m =: ~" = ~ ~ r c W C7 vpcvi W ~ 3 ~ o 0 3 ~ yT~ ~ ~~ Z ~~ T W z v m~~ io o.~ 0 v ~ m v G7 m n ' ° c rF ~ ~ pmt ~ ~ ~. z n ° n ~ ~ g o y - ~ Z N ~ < fD /D a ~ CO 00 V ~ Vl .A W N -~ 7 O N n ~ ~ v ~ ~ ~' ~ ~ ~ = h ~ O o N ~ ~ O 7 n v O ~ ~ ~ ~ ~ O CITY 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: 1~-~-~,~~, l~ ~ ~ ~ ~~ l~ ~(S UNIT# BLOCK# L( LOT# (Addressing is based on the information -must be accurate) OWNER: ~u S Se V1 (~ ~ +~c ~ CONTACT PHONE # ,~ ,S ~ - ~ 7 ~ ~ PROPERTY ADDRESS: Z S S -NeZ ~~ ;~~~ ~ r c PHONE #: Home (Za8) 3 ~~ - ~ ~d ~ Work OWNER MAILING ADDRESS: EMAIL FAX Cell CITY: ~.~tbr~ STATE: ~. ZIP: ~ 3 yc,~ APPLICANT (If other than owner)_ (Applicant if other than owner, a statement APPLICANT INFORMATION: ADDRESS ~S~ `e.r ~ V~'S~t ~~ CITY: 2e1~ h.-~y STATE; ~ ~.G-~o ZIP ~3~f o/A EMAIL t~S (~ ~,f},1 ~ w.~n. f ~`yFAX 3 S~ ~ a4Z Y PHONE #: Home (7~~) 356-SZS2 Work ( ) 1"a~ .356-bY~y Cell ( ) 351- ~ ~~~/ CONTRACTOR: V~`G~c. (Zw~,~.LVS Se ~ C~ ~,~ fi / ~ _fi a~ L ~: c, MAILING ADDRESS: ~.O j3o~ (~ (~ ~ CITY 2 ~ ~~ry STATE X ZIP ~ ~ ~ y0 PHONE: Home# 3~6~ n~S2- Work# 3~d"~~t2y EMAIL '- FAX °- How many buildings are located on this property? 4 h Did you recently purchase this property? No ~ (If yes give owner's name) 2~ S~e~! G~ 1heS Is this a lot split? ~ YES (Please bring 11copy of new legal description of property) PROPOSED USE: ~~~ 4~ (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 Owner/ O ~~~ ~~ V DATE Do you prefer to belcontacted by fax, email or honey 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 **Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear** applicant to act as agent for owner must accompany this application.) 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: v Please complete th~ntire A lication! pP If the question does not apply fill in NA for non applicable NAME Q11.~'~ C In (Jr.~,~'1~e~ PROPERTY ADDRESS 2 ~ S INe 2 ~~erc~ (~/'~ Permit# SUBDIVISION Dwelling Units: Parcel Acres: SETBACKS FRONT SIDE SIDE BACK Remodeling Your Building/Home (need Estimate) $ ' C, ©~ C) l~U uJ 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 (30" above grade)Area Water Meter Count: (~ fl Water Meter Size: (~~ 6/,h~ Required!!! ~`'~ ~ ~ PLUMBING ,~ ~, Plumbing Contractor's Name: ~ Af w~ h ~~~ ~ Business Name: ~''( ~ t ~~~~- h- nt ~ ~ ~ !, Address City ~( State '~~ Zip ~ 3 ~l ~l0 I, Contact Phone: ( ) ~ ~ S - d 3 ~ Business Phone: ( ) ~U ~ - ~-(, l / S I' Email FIXTURE COUNT (including roughed fixtures) Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal Fax Hot Tub/Spa ~ Sinks (Lavatories, kitchens, bar, mop) o~ Plumbing Estimate $ 2 S®~ (Commercial Only) Unfinished Basement area S~ ~~° Finished basement area_ _ 19 O Q Garage area Sprinklers i Tub/Showers ~ Toilet/LJrinal ~~-~~ 1~q5 ~L Water Heater Water Softener 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 complete the e~e Application! If the question ~ not apply fill in NA for non applicable NAME ~5~~-~~ ~~~~ PROPERTY ADDRESS 2 S~ ~ e Z he rCC ~~ Permit# SUBDIVISION ~4..~ ~Z '~~~,G~ (-~,l(S Required!!! MECHANICAL Mechanical Contractor's Name: ~l ~`~ PIS ~ ~~ ~ ~~us~iness Name: {~l ~t ~t ~"~~`'y S~ ~"``n Address City ~j ~ b , State ~ d ~ ~"~ Zip Contact Phone: (2~~) ~ ~ ~' 03 ~ b Business Phone: (?~ ~7~°~--~1 ~ 1 Email Fax Mechanical Estimate $ (CommerciaUMulti Family Only) FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only) Air Conditioner f Bath Fan Vents Range Hood Vents Boiler Cook Stove Vents Decorative Gas Fireplaces Dryer Vents Evaporative Cooler ~ Exhaust or vent ducts Fuel (gas) piping fixtures or appliance outlets Furnace Furnace/Air Conditioner Combo Heat Pump Incinerator Pool Heater Heat (Circle all that apply) ~~ Oil Coal Fireplace Electric ~ ~'"°'`~ Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. Space Heater Unit Heater Signature of Licensed Contractor License number Date Required! The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 5 r ~ SUBCONTRACTOR LIST Excavation & Earthwork: Concrete: Masonry: Roofing: Insulation: Drywall: ~ i ~ h, ~.~ ~- ~ ~ `~ W~ u, Z Painting: ~ ~ 4-~ ~ ~J Vh,iJ~e ~ - ~~ v`^-~ ~ w v~C ~ c J Floor Coverings: s~~ ~y~ C~~~ ~ ~ '~ ~ J ~~ r~ Plumbing: ~ ~ ~ ~. '~ ~ ~ w. ~ ~~ ""t ¢ l~ `'~ ~`~ `t ~- Heating: l~ i ~ e ~ y v~ 5+ ti~ ¢ ~'~ e-~ ~ c `I ~'~1 Electrical: hC ~ ~ ~ w~ ~ ~ _ ~c L~~ c2 ~ C©~~ ~ ~ U - 3 3 0 ~ Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists:_ Siding/Exterior Trim: Other: