HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 05-00452 - 626 Autumn Ct - New SFRZ r
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OF gEXapgC rc CITY of Certificate of Occupancy
~~ 7y _~
° ~~~~ City of Rexburg
`y' Department of Community Development
America's Family Community
19 E. Main St. / Rexburg, ID. 83440
Building Permit No:
Applicable Edition of Code:
Site Address:
Use and Occupancy:
Type of Construction:
Design Occupant Load:
Sprinkler System Required:
05 00452
International Residential Code 2003
626 Autumn Ct
Single Family Residence
Type V-N, Unprotected
Residential
No
Name and Address of Owner: Jensen Brett Etal
P O Box 847
Rexburg, ID 83440
Contractor: Brett Jensen Construction
Special Conditions:
Occupancy: Residential, single family dwellings, lodging houses
This Certificate, issued pursuant to the requirements of Section 109 of the International Building
Code, certifies that, at the time time ofissuance, this building or that portion of the building that
vies inspected on the date listed wes found to be in compliance with the requirements of the code
for the group and division of occupancy and the use for which the proposed occupancy wes
classified.
Date C.O. Issued: August 24,
C.O Issued by:
Building Official
1:31P
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 (208-356-48301:-~
CITY OF REXB URG
050452 ~
• BUILDING PERMIT APPLICATION Pleas 1.
19 E MAIN, REXBURG, ID. 83440 If the q 626 Autumn Ct ale
208-359-3020 X322
PARCEL NUMBER:'~Q~Z~~y ~ b~~j(~ (We will provide this for you)
SUBDIVISION: ~~ ~ {S UNIT# BLOCK# Z. LOT#
(Addressing is based on the informati -must be accurate)
WNER NAME: ,~(~{-~- ~c°Y4~sc1~ CONTACT PHONE # _ ~f.3
PROPERTY ADDRESS: Aw,~u~n~ ~'~,~~--
PHONE #: Home (Zdb)~S'p-9S~3 Work (~) ~(3-(;73~ Cell (1~)~l3'l0?3~
OWNER MA~IILING ADDRESS:~~ ~~7 CITY: ~ Gctt STATE: Sfl ZIP: B3Yy~
EMAIL 6CC fttGfV~ ~6~co AX 3~'q O7(0~
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; ZIP
PHONE #: Home
CITY: (! ~~ C~ ~ (~ ~ a ~y
EMAIL
Work
Cell ( )
CONTRACTOR:
MAILING ADDRESS: S~ryIL.~~ ~~. CITY,
PHONE: Home#
EMAIL
Work#
FAX
FAX
Cell#
STATE ZIP
How many buildings are located on this property? p
Did you recently purchase this property? N~ Yes (If yes give owner's name)
Is this a lot split? ~T YES (Please bring copy of new legal description of property)
PROPOSED USE: __~~! ~ rte,
(i.e., Single Family Residence, Iti Family,
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 o • approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. /
Signature of Owner/Applicant DATE
Do you prefer to be contacted by fax, email or on ?Circle One
WARNING -BUILDING PERM UST 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 Regburg'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 OF
AMERICA'S FAMILY COMMUNffY 19 E. Main (PO Box 280) Phone: 208-359-3020 x326
Rexburg, Idaho 83440 Fax: 208-359-3024
www.rexburg.orp comdevCcarexbura.org
Affidavit of Legal Interest
State of Idaho
County of Madison
__ ,
h ~ ~.~-L
Name -
~~ k ......_. ,
city
Address
-L~~ Lv.:~--..
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 rec own r of e property described on the attached, an~ I grant my
permission to: - _ ~C, 7 ' f~L.~~zs /~~
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 r~" ~ "' ~~ day of , 20 ~s
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing at:
My commission expires:
Please complete the en~re A lication!
PP
,,~ If the question does not apply fill in NA for non applicable
NAME C Y
PROPERTY ADDRESS Z(,~ ~ ~- Permit#
SUBDIVISION ,~~~- cc4lnEZ
Dwelling Units: Parcel Acres:
SETBACKS _ ~ ~
FRONT SU SIDE ~S SIDE ~S~ BACK
Remodeling Your Building/Home (need Estimate) $
__
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area Z 37 g ~ Unfinished Basement area
Second floor/loft area ~~~ Finished basement area Z~7~' ~
Third floor/loft area Garage area /O'S-U
Shed or Barn Carport/Deck (30" above grade)Area
Water Meter Quantity:
~~
************** Water Meter Size: 3~y
Required!!!
PLUMBING
Plumbing Contractor's Name:,~jz~ ~~~~~c Business Name:
Address City State .~ Zip
Contact Phone: ( ) 35~ ~~~ Business Phone: ( 5 ~~ - k ~ 7U
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
1 Water Softener
--- - ~ lDd ~- ~~-- l a5 -___.-
Signature of Licensed Contract License number D e
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
Fax
•
PI~aSe COrilplete t~le eritlrC AppliCatlOri~ If the question does not apply fill in NA for non
applicable
NAME ,gF~ S
PROPERTY ADDRESS (B~Cc ~,i,~-,b~~ ~,~,~,(~- Permit#
SUBDIVISION ~~ rah, S
Required!!!
Mechanical Contractor's Name:
Address
MECHANICAL
~ r
u~ ~Gu•~^-,~. •z- ..Business Name:
City State
Zip
Contact Phone: ( ) 3-s., ' ~~~~ Business Phone: ( ) ,3S(• ;~~ ~ ~
Email Fax
Mechanical Estimate $~ (CommerciaUMulti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) ~'
Furnace ~ ~~~ Exhaust or Vent Ducts ~'~;~ ~
~.. Furnace/Air Conditioner Combc~°'~j~J ~ Dryer Vents ..
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance ~ ~/~
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
Range Hood Vents.;
Cook Stove Vents
.~ Bath Fan Vents ~`°'
other similar vents & ducts:
Fuel Gas Pipe Outlets including stubbed in or future outlets ~ b
Inlet Pressure (Meter Supply) PSI
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.
~ v
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
y •
SUBCONTRACTOR LIST
Excavation & Earthwork: (trI ~ ~- JU ~
Concrete: ~-f- C.
Masonry: ~0~. d ~-O _`G 1~~C~
Roofing: , M~ c,~T-
Insulation: A ,,J~~~~~ j ~t ~,~,
Drywall:
Painting:
Floor
Coverings: C ~~SS~C, ~~~et l`~C S
Plumbing: KfXb~f'c. ~~LUN\{~11L4 'f'
~~
Heating:
Electrical: ~C~~~~ ~~+~t~'
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:~C ~ I ~~, v ,
Siding/ExteriorTrim: ~~- ~ c.ti~d~~
Other: