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HomeMy WebLinkAboutAPPLICATIONS - 05-00336 - LDS Church - RampCITY 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 - 1 PERMIT # Please com lete th• ntire A lication! P PP If the question does not apply fill in NA for non applicable ( We will provide this for you) UNIT# BLOCK# LOT# nust be accurate) OWNER NAME: ~, ~ ,S C~(u~C l-f CONTACT PHONE # ~~ ~ - 7/ 8`/ PROPERTY ADDRESS: /~ ~ /~~ ~ ~C-.~'~~' 17)/J~ ~,~~/5~~ PHONE #: Home ( ) - Work ( ) Cell ( ) OWNER MAILING ADDRESS: ~- CITY: STATE: -ZIP: -- 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: STATE; ZIP PHONE #: Home ADDRESS CITY: E I FAX Work ( ) Cell ( )_ -- CONTRACTOR: ~, ~itJ ~- ~~~ CllitiST2G~~I70N MAILING ADDRESS:~7.31 ~- ~-lt.~L~ 2dR-Q CITY l~-~1d ~~CS STATE .l"!~ ZIP ~~3 y~ / PHONE: Home# .~-,3 -~ '7 Work# Ski - ~-3a-~ Cell# 5~t -~~ ~ EMAIL-S AILS®~Q4 . ~y~= J" FAX ~`~.3 -~5~~ How many buildings are located on this property? p~/t' Did you recently purchase this property? To Yes (If yes give owner's name), Is this a lot split? ~ YES (Please bring copy of new legal description of property) PROPOSED USE: ~~L-!Gt l~l~ S /'~C~77~cJG~ .~a~S~" (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 herea8er 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. ~ ~ s ~ .~ ~"/..5/ v~ 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 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 herin 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: 2 **Building Permit Fees are d at time of application** **Building Permits are v~d if you check does not clear** Please complete the ire Application! ~ tie cxuesti~ dog e~ not apply fill in NA for non applicable NAME ~ ~,~ ~, s (~,, S .~~,,... PROPERTY ADDRESS /`~ ~-/ ~%~=" ~~~,1.~P.~f Permit# T SUBDIVISION Dwelling Units: ~/ Parcel Acres: ti~A- SETBACKS ~~{'lS7`/~Gr ~ ~~~D~"U~ FRONT SIDE SIDE BACK Remodeling Your Building/Home (need Estimate) $ ~~, voy `~ 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 Water Meter Quantity: Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above grade **************** Water Meter Size• Required!!! PLUMBING Plumbing Contractor's Name: ~ Business Name: Address City Contact Phone: ( ) Email 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) Sprinklers Tub/Showers Toilet/LJrinal Water Heater Water Softener 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 Zip Business Phone: Fax State 4 ' Please complete the ent~ AppllcatlOn ~ If the question doe~t apply fill in NA for non applicable NAME PROPERTY ADDRESS Permit# SUBDIVISION Required!!! Mechanical Contractor's Name: Address Contact Phone: ( ) Email Business Name: _City State, Business Phone: ( ) Fax MECHANICAL Zip Mechanical Estimate $ (Commercial/Multi Family Only) FIXTURES & APPLL4NCES COUNT (Single Famil Dwelling Only) r, Air Conditioner ' 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) 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 Required! The License number Space Heater Unit Heater Date 's permit fee schedule is the same as required by the State of Idaho 5 ~~` .. CITY OF RE:~.BLIR~ AMERICAS FAM{LY CQMMUNFfY APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO APPROVED BY: -APPLICANT INFORMATION: , / BUSINESS NAME: ~©rlJ ,S ~~~~ ~~~~~~ OFFICE ADDRESS: ~ y3~ ~~ ~~~° 10~ ~3~01 City State Zip OFFICE PHONE NUMBER: (a- os' ) ~a~r-a3 ~s~ CONTACT PERSON: ~.o./ CELL PHONE # ( ) ~ ~~- ~-3a ~ -LOCATION OF WORK TO BE DONE: STREET ADDRESS WHERE WORK WILL BE DONE: G -~a~~ /~'~ ~s ~ --~~ ~--5 BUSINESS NAME WHERE WORK WILL BE DONE: ~ex~~ Y~ ~~~' Cpl DATES FOR WORK TO BE DONE: /s s-~, ~ os TO ~so~ d s CONTACT PERSON: PHONE NUMBER: ( )s~~° ~ ~~r~~= CELL # 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 ~~ ~--~~ c~ ~ ^ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES ~ ~~ S U '~ APPLICANTS SIGNATURE DATE 6 r ` + • SUBCONTRACTOR LIST t"'"gym <~G'' s +~ ~i.t/~~6-~ ~ ~,t~ ~5. ~t LS ~~5'`"/lri~- Y7 D~c~ Excavati Concrete Masonry Roofing: Insulatio Drywall: Painting Floor Covering Plumbin Heating: Electrical: Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists: Siding/Exterior Trim: Other: 7