HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 06-00140- 778 Poplar Cir - New SFR Z
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4RExsugc
Certificate of occupancy
~; J7 ___ CITY O F
"» ~~~~ City of Rexburg
`y' Department of Community Development
~' Amerita's Famil}~ Community
~~~~MfO ~
19 E. Main St. / Rexburg, ID. 83440
Phone (208) 359-3020 /Fax (208) 359-3022
Building Permit No:
Applicable Edition of Code:
Site Address:
Use and Occupancy:
Type of Construction:
Design Occupant Load:
Sprinkler System Required:
06 00140
International Residential Code 2003
778 Poplar Cir
Residential
Type V-N, Unprotected
Single Family Residence
No
Name and Address of Owner: Walker Marty
836 Engleman
Rexburg, ID 83440
Contractor: Owner
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 of issuance, this building or that portion of the building that
was inspected on the date listed was 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
was classified.
Date C.O. Issued: June 04, 2007~11:57AM)
C.O Issued b `~
Y
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
State of Idaho Electrical Department
C1T~'OFREXBURG
BUILDING PERMIT APPLICATION
19 E ~7AIN, REXBURG, ID. 83440
208-359-3020 X326
PARCEL NUMBER:
PERMIT # •
Please complete the entire Application!
If the question d
~~~d~>L Bao~lo~o
( We wil
SUBDIVISION:~~ ~ rook ~;`~; t ~ ca' 2 UNIT#
(Addressing is based on the information -must be accurate)
06 00140
778 Poplar Cir
OWNER NAME: q * ~ CONTACT PHONE # ~~~~- yz ~
PROPERTY ADDRESS: ~ ~~ ,l"CL7 ~~~ ~~'I~'G. ~~
PHONE #: Home ( ~~~ - `~J~7 Work ~~ ~~q- ~~ 7 Cell ( )
OWNER MAILING ADDRESS: ~'~~~~%~,'; s~; CITY: ~ ~ STATEJ~ZIP:~-=~~j
EMAIL ~----""... FAX -
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner m
APPLICANT INFORMATION: ADDRESS
STATE:
ZIP EMAIL
PHONE #: Home ( )
Work ( )
CONTRACTOR:
MAILING ADDRESS: ~~ ~~ ~~c~ >vrvlq qd ~~; CITY ~ STATF,~I) . ZIP>~'/y~~
PHONE #: Home ~'~) ~ Sri -~z~7 Work ( ) Cell, ~ f9 -y2 g -7
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE C j-/ ~
How many buildings are located on this property? ~jf c~~l ~....
Did you recently purchase this property? No Y ,s? (If yes give owner's name)
Is this a lot split?~ YES (Please bring copy of new legal description of property)
PROPOSED USE: ~~/ ~,
(i.e., Single Family Residence,- ulti 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 or ~roval bras basedy Permi~Jvoid if not started within 180 days. Permit void if work stops for 180 days.
~~~~~
DATE
Do you p~'efer 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 Rexburg'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 your check does not clear**
3
~~ ~ \'!~
U
1 s~
a~
'e~~SHED \0
•
CITY O F
REXBURG
America's Family Community
BUILDING SAFETY DEPARTMENT
19 E. Main (PO Box 280) Phone: 208-359-3020 x326
Rexburg,ldaho 83440 Fax:208-359-3024
www.rexbura.org ianellh@rexburg.org
Affidavit of Legal Interest
State of Idaho
County of Madison
Name Address
1^
City
Being first duly sworn upon oath, depose and say:
A.
~_ ~~
State
(If Applicant is also Owner of Record, skip to B)
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 ~ 7 day of ~ rL , 20 CZ~,
Signature
Subscribed and sworn to before me the day and year first above written.
., ~ ~~ ~» ~ +. 9 ~ n U P 1 U p ~ l i
~?® '~ A`R Y 6.N t ublic of Idaho
~0-'®
AVgV`~ ~~~.~ Residing at:
.~:'
''~~ qTE pF ~ My commission expires:
' I///PPilI11114~
2
'Tease com lete the eire A lication!
p pP
If the question does not apply fill in NA for non applicable
NAME ~~
PROPERTY AD RESS ~: ~/``~ Permit#
SUBDIVISION( ~j~p~, 3~3
Dwelling Units: ~ Parcel Acres: ~~ f ' i ~S ~, t'~~ ~~p~ F f
~~
SETBACKS
FRONT_ , _ ~- SIDE_ lO ~ ~•e5~ SIDE ~.~~ ~Sf"BACK ~
Remodeling Your Building/Home (need Estimate) $
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area ''~~ ~~ Unfinished Basement area ry2~
Second floor/loft area -- Finished basement area -
Third floor/loft area - Garage area yy~i
Shed or Barn - Carport/Deck (30" above grade)Area
Water Meter Quantity:
************** Water Meter Size: ~ yl
Required!!!
PLUMBING
Plumbing Contractor's Name: ~ y ~~ ~,-a~~~ ~r Business Name: ~i ~ ei' ,e~a~~ ~,~~~jo~J
Address ~ X ~c~ 0 City ~~ -~~ ~~;~ State .~ Zip~,3~5'/
Contact Phone: (tag) 7G`9 - ~l 2 "7 Business Phone: ( ) ----
Email _
FIXTURE COUNT (including roughed fractures
Clothes Washing Machine
Dishwasher
~_ Floor Drain
~ Garbage Disposal
.~ Hot Tub/Spa
_~ Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $.
~~
Signature of Lic used Contractor
The City of Rexburg's F
r Jmmercial Only)
Water Softener
License number
fee schedule is the same as
Date
by the State of Idaho
Fax
____ Sprinklers
3 Tub/Showers
~_ Toilet/Urinal
~_ Water Heater
4
please complete the entire Application. If the question does not apply fill in NA for non
applie~ble
NAME ~"
PROPERTY AD SS ~ ~ ~; ,~ ~. Permit#
SUBDIVISIONG~Ju ~rco ~ f ~o
Required!!!
MECHANICAL
Mechanical Contractor's Name: ~~~X ~,~~ Business Name: jCf~ ~~~.,"t`/'i~ ~~
Address ~~ ~ /~,i ~~; ~~ City ~~~~~~State ~ Zip
Contact Phone: (~) ,~,jf ~- ~/~~ Business Phone: ( ) `-'
Email
Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES 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
Dryer Vents
"- Range Hood Vents
"' Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Pool Heater
Similar fixtures or Appliances
2 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
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
ignature of Licensed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
5
.~
SUBCONTRACTOR LIST
Excavation & Earthwork: ~.~~Z~x~.,;~ .~-~.~~
Concrete: ~~, ~ ~ `t~n~~ C ~_~ e ~~ ~ ~
Masonry: ,Cc~r,.,yc~v <;~v-:;,.c
Roofing:
Insulation: ~U-e~..v r,~.~,e
Drywall:~,,~~i
Painting:
Floor
Coverings: ~~ ,t,~ ~~
Plumbing:
c .
Heating:_ m~r.~~G~~ T" ~ ~ ~~a,c,
Cr ~ ~
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses: S~~Dc- ~~ ~~~~ (~,
Floor/Ceiling Joists:
!! ~~
Siding/Exterior Trim:
i~
Other:
r c~
ti
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