HomeMy WebLinkAboutAPPLICATIONS, CO - 05-00352 - City of Rexburg - Animal ShelterCertificate of Occupancy
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~oF ~•i~ CI"CY O F
~„ o ~~~G City of Rexburg
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Department of Community Development
America's Family Community
19 E. Main St. / Rexburg, ID. 83440
Building Permit No: 05 00352
Applicable Edition of Code: International Building Code 2003
Site Address: 490 W 4th N
Use and Occupancy: City Animal Shelter
Type of Construction: Type V-N, Unprotected
Design Occupant Load: Commercial
Sprinkler System Required: No
Name and Address of Owner: City Of Rexburg
12 North Center
Rexburg, ID 83440
Contractor: Harris, Harold Construction
Special Conditions:
Occupancy: Business, professional or service, restaurants less than 50
This Certificate, issued pursuant to the requirements of Section 109 of the International Building
Code, certifies that, at the time time of issuance, this building or that portion of the building that
vies inspected on the date listed vties found to be in compliance vtiith the requirements of the code
for the group and division of occupancy and the use for v~hich the proposed occupancy vies
classified.
Date C.O. Issued: April 23, 20 :49PM
C.O Issued by:
~~~~
Building Official
There shall be no further change in the existing 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 D
State of Idaho Electrical De
CITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PARCEL NUMBER:
SUBDIVISION:
PERMIT #
Please com lete t~e entire 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#
(Addressing is based on the information -must be accurate)
OWNER: (~~~ ~?P,,Ybu ~ CONTACT PHONE # 3~-3fJo~fl
PROPERTY ADDRESS: ,
PHONE #: Home ( ) il/~,~ Work ( ) ~$~ 3ya~ Cell ( ) /Y~,¢
OWNER MAILING ADDRESS: ~9F /7~~ CITY: ~(' STATE:f~ZIP:~
EMAIL ~~(x1~C~~,Ol9 FAX~~- 390~~-
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:
CITY:
ZIP EMAIL
PHONE #: Home ( ) Work
Cell
CONTRACTOR: -~ ~ v ~ ~'
MAILING ADDRESS: CITY STATE ZIP
PHONE: Home# Work# Cell#
EMAIL FAX
How many buildings are located on this property? ~e(O
Did you recently purchase this property~~Yes (If yes give owner's name)
Is this a lot split? ~ YES (Please bring copy of new legal description of property)
PROPOSED USE: ~~,t bllG !/138
(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: T e building official may revoke a permit on approval issued under the provisions of the 2000 International Code in cases of any false statement or
misrep se ation of fact in the~g~fi~ation 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 r 18 dpys. /
Signature
Do you
~ izz- , oS
DATE
to b~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
FAX
3
Affidavit of Legal Interest
State of Idaho
County of Madison
I, _
Name
City
Address
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 ar at time of application** **Building Permits ar~oid if you check does not clear**
Please complete thetire Application! ~
If the question does not apply fill in NA for non applicable
NAME Gl n~»7orr Shy _~('
PROPERTY A~RESS Permit#
SUBDIVISION
Dwelling Units:
SETBACKS
FRONT
SIDE
SIDE
Remodeling Your Building/Home (need Estimate) $
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
BACK
0" above grade)Area
Water Meter Count: t
Water Meter Size: 2
Required!!!
PLUMBING
Plumbing Contractor's Name: ~~- Business Name:
Address
Contact Phone:
Email
City
Business Phone: ( )
Fax
State
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)
Sprinklers
Tub/Showers
Toilet/Urinal
~_ 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
Parcel Acres:
4
Please complete the ei~e Application! If the question a~not apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Required!!!
MECHANICAL
Mechanical Contractor's Name: /~A- Business Name:
Address City State
Contact Phone: ( ) Business Phone: ( )
Email
Fax
Mechanical Estimate $^~~~ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES 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
Required!
The
License number
Date
's permit fee schedule is the same as required by the State of Idaho
Zip
5
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CITY OF
RE:XBC..IR~
AMERICA'S FAMILY COMMUNITY
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO
APPROVED BY:
-APPLICANT INFORMATION:
BUSINESS NAME: (~,~ ~ ~~ RE~1(~i~
OFFICE ADDRESS: l~ ~T~G~~ S~, ll~ 8' 3Y~
City State Zip
OFFICE PHONE NUMBER: (,~Dg ) 35'~~30~-3~f`!~
CONTACT PERSON: ~t~?%ve ~ CELL PHONE #
k
-LOCA~'ION OF WORK TO BE DONE:
STR'EET' ADDRESS WHERE WORK WILL BE DONE: /1~ 5d, ln~ ~, v/' ytti /Y
BUSINESS NAME WHERE WORK WILL BE DONE: G/TT~~~j~~SJ~ELTE,~
DATES FOR WORK TO BE DONE: /g-05 TO.OGT-05
CONTACT PERSON: ,,~Y ,~
PHONE:NUMBER: ( ) CELL # ( )
~,
PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR:
^ AUTOMATIC FIRE-EXTINGUISHI~dG SYSTEMS
^ COMPRESSED GASES
^ FIRE AL° ARM 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
GNATURE DA~/~/Os
...........................................................................................
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Excavation & Earthwork:
Concrete:
SUBCONTRACTOR LIST
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Floor
Coverings:
Plumbing:
Heating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:
Siding/Exterior Trim:
Other:
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