HomeMy WebLinkAboutAPPLICATIONS, CO & PLANS - 05-00353 - Futures of Idaho - Office Spaces4~o gEXBURCf7
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~YTY of .Certificate of Occupancy
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America's Family Community
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
359-3022
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:
05 00353
International Building Code 2003
229 S 5th W
Commercial
Type V, 1 Hour
Office Space; 12 Units
No -
Futures Of Idaho
430 W Hwy 26
Blackfoot, ID 83221
Futures Of Idaho
Storage, moderate hazard storage of combustible materials
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
thes inspected on the date listed toes found to be in compliance tMth 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: September 26, 20 (03:41 PM)
C.O Issued by: ~`~ '~'~--~
Building Official
There shall be no further change in the e~asting 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):
. LITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X322
PARCEL NUMBER: `~ ~ ~-1Z`X~'s i
SUBDIVISION:_TQ ~,~t ~ c
(Addressing is based on the information - t
PERMIT #
Please com lete the~entire A lication!
P PP
If the questic - - ~-- ~ -- - -- - -
~y~ ~ _ , (We 0_5 00353
t ~~ UNIT; Contractor Offices - S 5th W
nust be accurate)
~lil 7'~1 R E S mF ! DR H 0 CONTACT PHONE #
OWNER NAME: _ZD9_ L 3~~
PROPERTY ADDRESS:
PHONE #: Home ( )
OWNER MAILING ADDRESS:
EMAIL
TH GJ £S
Work ( ) 78 S- ~ 3 37Cell ( )
CITY: ~/C~'T STATE: ~b ZIP: 8 3 ZZ
FAX ~~~- /3ZL~
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 S/4/1't ~ CITY:
STATE:
ZIP EMAIL
PHONE #: Home ( ) Work
CONTRACTOR:
MAILING ADDRESS:
PHONE: Home#
EMAIL
Work#
FAX
FAX
Cell ( )
-CITY STATE ZIP
Cell#
How many buildings are located on this property? ~--.
Did you recently purchase this property? l~ Yes (If yes give owner's name)
Is this a lot split?~ YES (Please bring copy of new legal description of property)
PROPOSED USE: G ~/rl /~t ~ R G / A-~
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
L'J
SEP 2 Y 2005
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. _ ~ w
~/ ~" ~ /~-
Signature o caner/Applicant DATE
Do you fer to be contacted by fax, em ' o one? 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
3
`~ c1TY c~
RE:~BLIR~
+ AMERICAS fAMg..Y COMMUNITY 19 E. Main (PO Box 280)
Rexburg, Idaho 83440
www.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 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~ t time of application** **Building Permits are if you check does not clear**
Please complete the ire Application!
NAME
PROPERTY ADDRESS
SUBDIVISION
If the question does not apply fill in NA for non applicable
Dwelling Units:
SETBACKS
FRONT
SIDE
Parcel Acres:
SIDE BACK
Remodeling Your Building/Home (need Estimate) $
Permit#
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:
Required!!!
Unfinished Basement area
Finished basement area
Garage area
0" above
,,
Z **************** Water Meter Size• ~
PLUMBING
Plumbing Contractor's Name: ~ Business Name: ~ ~y~
T
Address ~~ ~~' (~~~% City /~/~~~" State ~'/Zip ~3L2
Contact Phone: (~~) `~- - ~~: j~~/~~lf S Business Phone: (~c~) 78.5 -- ~' / ~J
Email
FIXTURE COUNT (including roughed fixtures)
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
Sinks
(Lavatories, kitchens, bar, mop)
Sprinklers
Tub/Showers
Toilet/Urinal
Water Heater
Water Softener
Plumbing Estimate $ ~ ~~ (Commercial Only)
1~7~~ DUB
Required! ignature of Licensed Contractor ~~ License number ate
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
Fax-- ?~ °~/7~/~
4
Plez.se complete the ent~ Application! If the question ao~t apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Required!!!
Mechanical Contractor's Name:
Address
MECHANICAL
City
Zip
Business Name:
State
Contact Phone: ( ) Business Phone: ( )
Email Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
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
Space Heater
Unit Heater
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Signature of Licensed Contractor License number Date
Required!
The City ofRexburQ's permit fee schedule is the same as repuired by the State ofldaho
5
•
d~
4 ~
CITY OF
RE:XBL.IR~
AMERICA'S FAM~.Y COMMUNITY
•
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO
-APPLICANT INFORMATION:
BUSINESS NAME:
OFFICE ADDRESS:
APPROVED BY:
City State Zip
OFFICE PHONE NUMBER: ( )
CONTACT PERSON: CELL PHONE # ( 1
-LOCATION OF WORK TO BE DONE:
STREET ADDRESS WHERE WORK WILL BE DONE:
BUSINESS NAME WHERE WORK WILL BE DONE:
DATES FOR WORK TO BE DONE:
CONTACT PERSON:
TO
PHONE NUMBER: ( ) 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
^ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES
APPLICANTS SIGNATURE DATE
6
SUBCONTRACTOR LIST
Excavation & Earthwork: ~ C ~~ ?'G ~O
Concrete:
N
Masonry: ~~ /fi6 /t/l ~~ .S
Roofing: ~ G ~~ ~ ~N
Insulation:
Drywall:,
Painting: /~ /~ ~ ~A
Floor
Coverings:
Plumbing: ~ ~~
Heating:
Electrical: ~ L /~ /U ~ d $ ~ 1 /(~
Special Construction
J! (Manufacturer or Supplier)
Roof Trusses: (~ ~~ L. ~ /2 O G
Floor/Ceiling Joists:
Siding/Exterior Trim:
Other:
,d r~ u ~ J^~N ~ ~
7
Madison County /City of Rexburg GIS
Page 1 of 1
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---~----~----- DO NOT SCALE S1
SEP 2 1 2005 ;'
SEP 14 2005
205199 CHRISTENSEN PROJECT
TETON REXBURG, IDAHO
STRUCTURAL ENGINEERS P. C. DATE: os/14/o5 BY.• Ev6 SHEET S1 OF 1
136 SDUTH STATE STREET PHONE (208)-357-2420 n~is oRANINC ~s THE PROPERTY of lEtaN siRUCruRa ENaNEER$ P.G iris Nor t0 BE REPRQDUC£D at ro eE usm FoR ANr
SHELLEY, IDAHO 83274 coNSTRUCTlAN EXCEPT AS HEREIN INgCA1ED NITHWT THE EXPRESS MRITTEN O10NSENT aF TE7tFl S7RUCIURAL ENpNEERS P.G
FAX (208)-357-2419 COP)RIGHT 0 TETON STRUCTURAL ENGINEERS P.C. 2005
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