HomeMy WebLinkAboutAPPLICATION, BP - 06-00220 - 75 E 2nd N - RemodelZ
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~CIT~1 OFREXBURG ~ ~6 00
BUILDING PERMIT APPLICATION Please ~ 220
19 E MAIN, REXBURG, ID. 83440 If the ques 75 E 2nd N-Jones Remodel
208-359-3020 X326
PARCEL NUMBER: ~ 1 ~' ~>~ ~~ °-3j ('~ -~~ i ' ~ ~' ~--' (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS: ~,j ~ ~.-'1GI nl . 1~~bt,~,v~-c~ ; ~ ~ ~y~C~
PHONE #: Home () ) Work ( )
OWNER MAILING ADD ~' CITY:
EMAIL
1S
APPL' ICANT (If other than owner) ~`(l C
(Applicant if other than owner, a statement authorizing
FAX
to act as agent for
APPLICANT INFORMATION: ADDRESS fr,~p(o ~' Ct r~- CITY:
C ~ etc fMC-~..iQ • c oP-r~~
STATE; rtes ZIP7~3yt(~ EMAIL I'Y1Ci,~ ~G~,peS ~,~ FAX
PHONE #: Home (~) 35to-y ~3 ~ Work
Cell ~ 3 I ~?-S~ l3
CONTRACTOR:
MAILING ADDRESS: 1 ~/ 3(o N, ~~CITY ~(o~.Lw -1'te..(,~4STATE Z- ZIP~L
PHONE #: Home
EMAIL
Work ( ) Cell (Zo~j 52.1 _Sy9`S
FAX52S- 240 ~ IDAHO REGISTRATION # & EXP. DATE ~ ~G~ ° 3(~
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
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 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~Ow~
/ ~ /~
DATE
Do you prefer tb'b~ontacted 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
• ' ~ 3 •
Please complete the e~ire Application!
If the question does not apply fill in NA for non applicable
NAME ~i. C~Q~t~ ~O~t`a. S
PROPERTY ADDRESS '~5 ~ • 2wC( VU • Permit#
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT SIDE SIDE BACK
Remodeling Your Building/Home (need Estimate) $ ~';
SURFACE SQUARE FOOT
First Floor Area
Second floor/loft area_
Third floor/loft area_
Shed or Barn
Water Meter Quantity:
Required!!!
PLUMBING
Plumbing Contractor's Name;
Address
Contact Phone: ( )
Email
~__,
Business Phone:
Fax
State
Zip
FIXTURE COUNT (including roughed fixtures)
Clothes Washing Machine Sprinklers
Dishwasher Tub/Showers
Floor Drain Toilet/[Jrinal
Garbage Disposal Water Heater
Hot Tub/Spa Water Softener
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $
~+u.v~ $ ~ , ooD
UJ;~cf~s(zJ~ I,So~.s2
I~C~,~,Q~CLo~ ~~ba,nc~
_~--
3,30
~ements of the building)
;rade)Area
Meter Size:
ame:
(Commercial Only)
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
4
L
Please COrilplete tale eritlre AjJjlllCatlOri~ If the question does not apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
Mechanical Contractor's Name:
Address
MECHANICAL
Contact Phone: ( )
Email
City
Business Name:
State
Business Phone: ( )
Fax
Zip
Mechanical Estimate $ (CommerciaUMulti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
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.
Signature of Licensed Contractor
The
License number
Date
's permit fee schedule is the same as required by the State of Idaho
5
•
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete:
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Floor
Coverings:
Plumbing:
Heating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:
Siding/Exterior Trim:
Other:
6
~ ~ • •
EXEMPTIONS FROM STATE REGISTRATION
As of January 1, 2006, the City of Rexburg can no longer sell permits without having a copy of your State
registration number or your exemption from the State registration. Please send a copy of your state registration
or fill out this form showing your exemption and send it with your license renewal or your next permit
application.
(This list is a summarization of Idaho Code Title 54 Chapter 5205, for full definitions of these exemptions
please see the State's website at www.ibol.idaho.gov/cont.htm)
^ Currently State licensed pursuant to Title 54 Idaho Code, Chapters:
3 Architects,
10 Electrical Contractors/Journeyman,
12 Engineers/Surveyors,
19 Public Works Contractors (exempt from fee only registration required),
26 Plumbing/Plumbers,
45 Public Works Construction Management Licensing Act (exempt from fee only registration required),
or
50 Installation of heating, ventilation and air conditioning systems
^ Employee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit
charitable activity with no wages or salary
^ Employee of a US Government agency (State, City, County, or other municipality)
^ Public Utility doing construction, maintenance, or development to its own business
^ Involved with gas, oil or mineral operations
^ Supplier doing no installation or fabricating
^ Contracting a project or projects with a total cost less than $2000
^ Operation of a farm or ranch or construction of agriculture buildings exempt from Idaho Building Code
^ Any type of water district operations
^ Work in rural districts for fire prevention purposes
Owner who performs work on own property or contracts with a registered contractor to do work as long
as the property is not for resale within 12 months
^ Owner or lessee of commercial property performing maintenance, repair, alteration or construction on
that property
^ Real estate licensee/property manager acting within Idaho Code
^ Engaging in the logging industry
^ Renter working on the property where they live with the property owners approval
^ Construction of a building used for industrial chemical processing per Idaho Code
^ Construction of a modular building (defined by Idaho Code) to be moved out of state
I hereby certify that the above information is true and correct to the best of my knowledge.
~!1_V_I. _ . ~ l2~ I ~~
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