HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 06-00186 - 264 S 3rd W - Remodel Z
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Q~EXtiUk~ Certificate of Occupancy
`,~ ~7 CITY ar
G ~
~~ ~~~G City of Rexburg
- ~
M"~`,:xEw ,,.~, America'tFamllyCc~mmunity Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Building Permit No: 06 00186
Applicable. Edition of Code: International Residential Code 2003
Site Address: 264 S 3rd W
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: Willis Blake D Etux
268S 3W
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
wes 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: June 06, 201.0-(SOP
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 De artment: 1 "
N
State of Idaho Electrical
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___._._.._.__C,__I 1AY._t) ~ _.____.__..
I~VT~~"~('t BUILDING SAFETY DEPARTMENT
1~.1~ / 1~~._..i 19 E. Main (PO Box 280) Phone: 208-359-3020 x326
Rexburg,ldaho 83440 Fax:208-359-3024
America's Family Cvmnnmity www.rexburp.orp janellhCa2rexburp.orq
Affidavit of I
State of Idaho
County of Madison
I, ~ (~. I~ ~ ~, I 1 r~ ,
Name
" "~-
City
Being first duly sworn upon oath, depose and say:
A.
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 /~0~ i ( , 20~~
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing at:
My commission expires:
06 00186
264 S 3rd w-Stairway
Address
~~
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:
2
CITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
PERMIT# ~ ~~'`~~. ~~~
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: UNIT# BLOCK#
(Addressing is based on the information -must be accurate)
LOT#
OWNER NAME: CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Home ( )
OWNER MAILING ADDRESS:
EMAIL
AX
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 CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR:
MAILING ADDRESS:
PHONE #: Home ( )
EMAIL FAX,
Work ( ) Cell ( ) ~ t ~ ~~"'~
CITY: STATE: ZIP:
Work ( )
Cell ( )
IDAHO REGISTRATION # & EXP. DATE
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Aparhnents, 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 infonnation 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 2003 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.
/ /_
Signature of Owner/Applicant DATE
Do you prefer 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**
CITY
STATE ZIP
3
' ~.
Please complete the entlre Appllcatlon!
If the question does not apply fill in NA for non applicable
NAME ~,~ ~` `, ~\if
PROPERTY ADDRESS Z fo `f ~ . ~` ~t,J Permit#
SUBDIVISION
Dwelling Units: ~ Parcel Acres:
(s'
SETBACKS
FRONT SIDE SIDE BACK
Remodeling Your Building/Home (need Estimate) $ LSD ~ J
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area 15 a o f f z
Second floor/loft area
~, Third floor/loft area
'' Shed or Barn
above
Water Meter Quantity:
Unfinished Basement area
Finished basement area
Garage area
************** Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name:
Address
Contact Phone: ( )
Email
City
Business Phone:
Fax
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
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
Zip
Business Name:
State
4