HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 06-00227 - 643 Meadowbrook St - New SFRZ
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o4¢~X~~kr, Certificate of Occupancy
,.o CITY O F
~~ a ~~~G City of Rexburg
- ~ Department of Community Development
.+,~ HfD e, Americn'sFnmityCommunity
19 E. Main St. / Rexburg, ID. 83440
oa,,.,e i~nQ~ ~~a_3n9n ~ Fax (2081 359-3022
Building Permit No: 06 00227
Applicable Edition of Code: International Residential Code 2003
Site Address: 643 Meadowbrook St
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: Romrell Danae
523 Troy Drive #2
San Jose, CA 95117
Contractor: Don Romrell
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
vas inspected on the date listed vas found to be in compliance tMth the requirements of the code
for the group and division of occupancy and the use for v~hich the proposed occupancy vties
classified.
Date C.O. Issued: December 08, 2006 (10:21A
C.O Issued by:
. ,`'' //
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
CITY OF REXB URG
BUILDING PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If the que~
208-359-3020 X326
PARCEL NUMBER:~~~<<~~ d ~1 ~ L ~(~""~ ~ (` >~ ( ~
PERMIT # (~ OU~a
os 00227
643 Meadowbrook ST
SUBDIVISION:~"~,~`gt-~~s~ ~ ( UNIT#~BLOCK# ~ LOT#~
(Addressing is based on the information must be accurate)
OWNER
CONTACT PHONE #
PROPERTY ADDRESS: ~'~'7j l d !~'~~t~`C~,,`.~J:~,t~:~%~ j a-o6'~90-2'11tf -
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: 109 ~- ~ ~ ~ ~ CITY: S u~~r STATE:~ZIP: ~ 3yS~
EMAIL FAX ~ ~ (~, - ~ 3 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
CITY:
STATE; ZIP EMAIL
FAX
PHONE #: Home ( ) Work ( )
Cell ( )
CONTRACTOR:
MAILING ADDRESS: ~~~ I~ `~~~'~' ~ CITY S u qot~ STATE ~ ZIP ~y
PHONE #: Home (ao~ ~S (o- ~(35g Work ( ) 35 (o 'S7 77 Cell ( ) ~~ o - a ~ ~ y
EMAIL~c,~IQ eug~v ~olM~ ~'AX ~Sq~ l~~~i IDAHO REGISTRATION # & EXP. DATE~~= ~jp(oI ~~~3/
~-
How many buildings are located on this property? ~
Did you recently purchase this property? No es f yes give owner's name) ~qs'~ • it., ~ s
Is this a lot split? NO ES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence,
Family, Apartments, Remodel, Garag~','Commercial, Additib~?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 con•ect 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 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**
3
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SNED
CITY O F
REXI3URG
America's Family Community
BUILDING SAFETY DEPARTMENT
19 E. Main (PO Box 280) Phone: 208-359-3020 x326
Rexburg, Idaho 83440 Fax: 208-359-3024
www. rexburg.org janellhCa2rexburg.org
Affidavit of Legal Interest
State of Idaho
County of Madison
Name Address
S y~sc~,~ SC~ P~ ~-c~
City 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
Signature
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing at:
My commission expires:
2
05/10/2006 1x:54 FAX
••~~r• i v. LUVU I I ~ 7UNIYI
I~j002
No. 2085 P, 2
Please complete the entire Applic~bon!
If t gnesHo oes not apply fill in NA- for non applicable
NAME
PROPERTX ADDRE S ~} Pec~it#
SUBDIVISION r„
Dwelling Units:_,__~__ Parcel Acres: ~ ~
SETBACKS
FRONT ~ ~ SIDE 3 D SIDE tj Br'~CK
Remod~tin~ Your Badldi~glHome (need Bscimate) $
SURFACE SQUARE FOOTAGE: (Shall iac]ude the exterior wail nneasuraaents of the building)
Fast Floor Azea 5~ Unf~ished Basement area ~(
Second floorlloft area Finished basement asee
Third floor/laft area Garage area ~
Shed or Baca C ort/Deck (30" above grade)Azea
Water Meter Quantity: &~~~*~~*~.*
ReQz~r~ed~!
FLTT1t~BZNG
'stet Meter Size: ~~
Plumbing Contractor's Name • ~ ~ r~ ~ 1 µ,~.„, (n ~~~ess Nanne: ~
.Address City ~~c,~~L ^ A State ~ip~~C~~
Ca~atact Pone: ( ~-
F.mail
Business Phone; ( )
~'I~CTURE CO r~clud~ie~ roupl&~d rtrer+es)
:~ Clothes Washing Machine
~„•,_ Dishwasher
Floor Drain
1 Garbage Disposal
_ I~ot Tub/Spa
.`~, Sinks
(L•avatnxies, ketchens, bar, m-op)
Fax
~_ Sprinklers
-~ ~wsho,~ 3
~,~ Toilet/Urinal
^~ water xcater
1 water Softener
klnmbing l~.stimate $ (Commercial Only}
~ ~ fo
Slgnat~,tre of L9ernsed Contractor License number D ~
The Ciry o Rerburg's errn~ fee sehedr~le is the same as requbed 8y the State pfldalra
~~
4
Please com lete the eire A lication!
p PP
If t questio oes not apply fill in NA for non applicable
NAME
PROPERTY ADDRE S ~3 Permit#
SUBDIVISION c-o-
Dwelling Units
SETBACKS
FRONT ~ ~ SIDE 3 ~ SIDE 3 y BACK 3
Remodeling Your Building/Home (need Estimate) $
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area ~JC~ ~ Unfinished Basement area I,~]
Second floor/loft area Finished basement area
Third floor/loft area Garage area ~ y ~
Shed or Barn Carport/Deck (30" above grade)Area
Water Meter Quantity:
Required!!!
**************' Water Meter Size:
PLUMBING
Plumbing Contractor's Name: ~ e.~t~ ~ ~ ~ (,.~.N)t ~, ~ usiness Name: ~~,4iYt Wl p 0~
Address City ~. u r State Zip~;~y~c
Contact Phone:
Email
FIXTURE COUNT (including roughed fixtures)
C Clothes Washing Machine
~_ Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
~~~ Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $
(Commercial Only)
~_ Sprinklers
~_ Tub/Showers
o~ Toilet/LJrinal
Water Heater
Water Softener
Signature of Licensed Contractor License number
The City of Rexburg's permit fee schedule is the same as
Parcel Acres: ~ ~-
Business Phone:
Fax
Date
the State of Idaho
4
May 15 06 06:O1a 208-529-6846 p.2
M
Please complete the en4re Application: l~rei+e gratlo. aes.oe aprlq- >gu ~, ~~ ro~.~ >ApphaRbk
PR PO EItTx ann]~ss P ~1:~ O~k~~'7
SUBDIVXSION
Required
11IEC~~~1vICAL
Mecbanicat Coabnctar's Name: i ~ ~~ Busit~,ess Name:
Addr~q City State Lip
Contact Phone: ( ) . , Btesznoss Phone: ( ) ~o7Ca " ~D~•
Email Fax ~ o'~-°ti ~ `9 ~t'-~ ~O
Mec>4anical Fatimatc S (CotemerchtUMttlbi Ir>rmBy ~~Y)
FIX771RJic,S dr APPLIANCES COiIIVT (,Sfagle Fpnrr7y 8 ~Y1
Fw~nacc _ Exhaust or Vast Dltcts ~ ~~
~ ~ ur»acc/Air Conditionex Combo ~ ~ ___. I Dryer Vents S
Heat Pump
Air CondiOOUeK
Evapoxative Cooler
Unit I-Ieat~
_,. , Spncc Hcactcr
__~ Docotative has-fired appliance I S
I.o~cincratot System
Boiler
.,,,_ Pool Heater
-_~ Fuel Gas Pipe Outlets including stubbed im ar firiurc outt]]ets 30
_-- • ..__ Inlet Pressure (Meter Supply) PSI
ILb
Hera (Circle al] that apply) Gas Oil Coal F"it+cplaoc Electric Hydronic
Mechanical Sixin~Calculationa ~nst be sobmitted with Plsars & A>DDlic~ttion
Pant o~ Detiverv mast be sh ,,, oa,~,~I,ns.
._--
-_ ec~e of 1_ Incense n~bes Dame
Range Hood Vents
._ Cook Stove Vaats
~T Barb Fang Yetns ! o ..
other similar vents 8t ducts:
The Clry o~RexhurR's pewmil fee achedbrle t's'the scone ~ n+q~rirad by rlie Slrats
-.
;~ ,
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
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~,
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
is true and correct to the best of my knowledge.
Signature "
N ~o~~e,
Print Name
Date
7