HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 05-00479 - 118 S Hidden Valley Rd - New SFRZ
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~~O gEXBUg~,f' `i.rY or Certificate of Occupancy
° ~~jJRG City of Rexburg
~ ~ -
`~' Department of Community Development
America's Fsmily Community
19 E. Main St. / Rexburg, ID. 83440
Building Permit No: 05 00479
Applicable Edition of Code: International Residential Code 2003
Site Address: 118 S Hidden Valley Rd
Use and Occupancy: Single Family Residence
Type of Construction: Type V-N, Unprotected
Design Occupant Load: Residential
Sprinkler System Required: No
Name and Address of Owner: Fillmore Tyler
4178E 550 N
Rigby, ID 83442
Contractor: Fillmore Construction
Special Conditions: Unfinished Basement
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 of issuance, this building or that portion of the building that
vies inspected on the date listed vies found to be in compliance with the requirements ofthe code
for the group and division of occupancy and the use for which the proposed occupancy vies
classified.
Date C.O. Issued
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
•O~TY OF.REXBURG • PERMIT #
BUILDING PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If the qu OS 00479
208-359-3020 X322 (),~
PARCEL NUMBER: ~~ ~ ~ ~ ~~ ( l 18 S Hidden Valley RD
,
SUBDIVISION: ~~ ~ V~L'~~r' UNIT# ~ BLOCK# ,.~ LOT# ~S
(Addressing is based on the information - ust be accurate)
OWNER NAME: ~l c.c.s ~ ~c r CONTACT PHONE # 3 `~c~'-" c~~ ~
PROPERTY ADDRESS: /~a ~c j.S-^ fS/~ 2 ~~ ~/ ~ (,/~-may
PHONE #: Home (~.~) ~ '~'S ` ~.5~-•Work (~:~) 390°` a~3~ Ce11( ) ~'C~ '"~~~/
OWNER MAILING ADDRESS: ~/~~ ~ S`S'~/,~'" CITY: /` ` STATE~1~ ZIP:~'~~~~
EMAIL FAX ~ ~'.S '- ~.~~
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 EMAIL
PHONE #: Home
Work
CONTRACTOR:
MAILING ADDRESS: ~~ 7~~ .~~~ CITY !~~ ~ STATE ZIP ~3~~~
PHONE: Home# ~~5=~~~`~-.Work# Cell# ~~~ ~ ~
EMAIL
How many buildings are located on this property? t)~ ~- _ '~
Did you recently purchase this property? No ~If yes give owner's name) /"~~` '`~`-~ ~~s~ -~ `--,
Is this a lot split? ~`~'" YES (Please bring copy of new legal de ription of property)
PROPOSED USE: ~ r' ~g~~ ~~'```~ 1`J ~~~ t c'~{.._
(i.e., Single Family Residence, Multi
FAX
Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l 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. NOT The building official may revoke a permit on approval issued under the
provisions of the 2000 International bode in,casecase~f any fals ment or misrepresentation of fact in the application or on the plans on which the
Hermit or annroval was based...P1~nit uoj"dif nB{st 180 daus. Permit void if work stops for 180 daus.
Signature of
Do you p
Applicant
)~ ~ ~ 2005
DATE
der 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
**Building Permit Fees are due at time of application** **Building Permits are void if you check does not clear**
~,~
C1TY OF ~ ,...
~;,
RE:~BLIR~
AMERICAS FAMILY COMMUNITY 19 E. Main (PO Box 280) Phone: 208-359-3020 x326
Rexburg, Idaho 83440 Fax: 208-359-3024
www. rexbu rg.orp comdevCcD_rexburg.org
Affidavit of Legal Interest
State of Idaho
County of Madison
!^ ~ /
Name/
~~~ 7
__ ,
City
~~/ 7~s ~ S~~y ~f
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 herein or as to
the ownership of the property which is the subject of the application.
Dated this ~ day of ~~-- , 20 ~ S
~,
O'~ {
.~ / i~~~
Subscribed and sworn to before ~fhe day and year first above written.
,~y iv J. ;;
Q~' 'cin Notary Public of Idaho
~ ~OTARy c~ ,~
-®- Residing at:
~~
AvB~~~ ,
~. ® My commission expires:
,...~~1`orF OF 1U P~''
1
Please complete the ~tire Application!
" ., ~~~ If the que~tio~ees not apply fill in NA for non applicable
NAME ~ °"~~e_. (cis ~ Cr
PROPERTY ADDRESS , -~- %.S-~ ~f ~- 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 l-~~/
Second floor/loft area
Third floor/loft area_
Shed or Barn
Unfinished Basement area
Finished basement area
Garage area
'//
above grade)Area
Water Meter Quantity: 1 * * * * * * * * * * * * * * Water Meter Size: ~ ~
Required!!!
PLUMBING 1
Plumbing Contractor's Name: , ~ Business Name: p
Address ~~~ ~ ~ -Zip: ~, _. City '~~ ~~s State ~ ~J Zip 3`~
Contact Phone: (~~) ~(~ ( (~~-{~ Business Phone: (~) -mss ~~ ~~'
Email C,~~„t ~ ~ ~ ~ C c~«~- ~ ca ~~ Fax ~ S t-{~ ~~,
FIXTURE COUNT (including roughed fixtures)
~_ Clothes Washing Machine
Dishwasher
l Floor Drain
~_ Garbage Disposal
Hot Tub/S a
Sinks "~ P~°'""`'~
(Lavatories, ki ens, bar, mop)
Plumbing Estimate $
(Commercial Only)
BACK
Sprinklers
~_ Tub/Showers
~_ Toilet/LTrinal
Z~ Water Heater
~_ Water Softener
~~~
Contractor License number Date
v of Rexburg's permit fee schedule is the same as required by the State of Idaho
Parcel Acres:
12JU112005 48:21 FA% 208524t18U1 B&S BOILER INC C~tjpt7l
.., -
~'~~~5~ COITIp~~I~~ ~~Le ~II I3 #~.~~l~1Cd~.it?1'I t l:f fhe question dam at~t apply fill i$ trTA for n+~n
~tppliGablc
FROPEI~TY ADDRESS 1 ~ ~ '~. Permit#
SLTBDNISIOI~i , . ,~
~t~ui~~t~! C j
~~~~
tvZeehanical Contractor's t«iame: _ tt ~~ H v~ ~~~'S~vt business Name: ~ ~ ~c~ 11 enF t~.f4
.A,ddress~S~~`_ t}.~. ~~vticr~cr City E~ ~S State dip 3~lC3`~,,
Contact Phone: (dog) S"~~ ~ U /S` 7 Business Phone: ( )c~ - t~ ~ ~
Email ~~ ~p ~ ~ev' ~ . Vl-2_.~--- Fa.c ~~ C?~ T ~`c3~ ~ ~1 -- -
R'Xechan~I Estima#e ~ (Camrx~ereiaUMrtiti Fam~y t}aly}
~Fl'TURES BL APPL1A.NG~'S C[7TJR~~' (,S`irtgle Farteily I~wel~ing Chtl.}t}
Furnace ~_ Exhaust or Vent Ducts ~o
_~ _ Furnacel~r Cc}nciitit~rier Cc~tnbo 3 ~ ~... Dryer Vents ~ ~
Heat Pun1p
Air C~rndzticsner
Evaporative Cc~t~Ier
Unit Heater
Space Heater
~. 17ecorative gas-fired appliance 1 S
Rfwge Hood Vents
Cool{ Stove Vents
Bath Fan Vents ~D
other sirailat' vents & ducts:
~, Incinez~atpr System
Boiler
Pool Heater
Similar fixtures or Appliattc~
/1~
~- S
~! Fuel Gas Pipe Outlets including stubbed in ar future outlets /~
~> > ~
~ ,.ss.. Inlet Pressure (Meter Supply) PSI
l-leat (Circle all that al?PIY~ fsas Oil Coal Fireplace Electric
Mechani~tl Suing Calcuiat~iu~as must ~-~ submitted with Plans & ,A..~plication
Paint ~f Delz~very must be shcxwrn o~u puns.
+Conuactrr License number Date
2"he City of'Rr~chur~; 's pe~yt~t fee S~.'hedgtfe is the same us regtsired by the State of Idaho
~ - • ,4 ~"`
SUBCONTRACTOR LIST
Excavation & Earthwork: X~VYy"` ~ ~t,S< ~'fJtCYI`C'~~,..
Concrete: ~G-~-~ ~ ~ ~'~`°"`.~ ' .~'
Masonry: ~ ~ ~.S t3vt N
Roofing: ~ ~ C (,/"~S~
Insulation: ~ ~ ~-~ I~'~S
Drywall:
Painting:__~// ~ C_.
Floor j/~
Coverings: f~ ~`
Plumbing: ~ ~
Heating:_
Electrical:
c_..
~_
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:_
Siding/Exterior Trim:
~-.
~~~
r.~
rf
7"" ~~~
S
p-~- ,~
~---.
Other: