HomeMy WebLinkAboutBP & APPLICATION - 06-00240 - 120 N 1st W - GarageZ
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1
CITY OF REXBURG j
PERMIT # M
,BUILDING PERMIT APPLICATION Please '`"""'-_'~~*" *i"' ^"+""' A ~.~,llin~>finr 1
19 E MAIN, REXBURG, ID. 83440 If the que
208-359-3020 X326 06 00240
PARCEL NUMBER: R.P~C~-X~ ~ D2'~'1'l C7 (~ 120 N 1st W-Garage Addition
SUBDIVISION: LT1Vr ~+~ „L~,~.nfr Lam, i,~
(Addressing is based on the information -must be accurate)
CONTACT PHONE # `~,Z
PROPERTY ADDRESS: ~ Z (~~ (~.~)tk1r~ ~ S I (,(,~~-
PHONE #: Home (zC?~) 1~ . ' (~' Work ( ) Cell ~~ n`~"J_ ' Z
OWNER MAILING ADDRESS: ~~~ [~~[ ~'l~ CITY: ~ "~„>; (~STATE~n ZIP: ~i~tt-Id
EMAIL C9L~Gf YY1 ~' ~C'[~ ~~ r~ ~~~ ~ (~~~ FAX ~S~l ' l Z ~~
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 ( ) ~~ ~ ;A- Cell ( ) ~;~ ~~
CONTRACTOR: ~ -CV ~~1C
MAILING ADDRESS: ~~ ~>< ~~} CITY }~f~,Ir~STATE~_ZIP S~~K1C~
PHONE #: Home ( ) Work (~~'~) ,7~3 - ~lQ(~ Cell ( )
EMAIL
FAX
IDAHO REGISTRATION # & EXP. DATE, '~5~0~ ~I p
How many buildings are located on this property?
Did you recently purchase this property? o'' Yes (If yes give owner's name)
Is this a lot split?~~ YES (Please bring copy of new legal description of property)
PROPOSED USE: ~ (~ r° C (C~LrtF~ ,
(i.e., Single Family Residence, Multi Famt y, Apartmer
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 abov -mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the
provisions o e 2000 International Code in cases of any false statement or misrepresentation of ~aplalicatien.c~.ou~k ich the
permit or a ov as sed. Permit void if not started within 180 days. Permit void if work sty d~. ~ ~ M~~
/~~
Signacfure of Owner/Applicant U ~ M AY D~~ ~~
Do you prefer to be contacted by fax, email 'phone? Circle One
WARNING -BUILDING PE ST BE POSTED ON C NST UCTION SITE!
Plan fees are non-refundable and are paid in full at the time of applicat on be
City of Rexburg's Acceptance of the plan review fee does not c nst t~ e n o
**Building Permit Fees are due at time of application** **Building Permits a
CITY O F
T~?~I3I.TRG
----- cy, ---------
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.rexbura.org ianellhCcDrexburg.org
Affidavit of Legal Interest
State of Idaho
County of Madison
Name Address
~~~~bcti ~~~, ,
city
Being first duly sworn upon oath, depose and say:
h®
State
(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 I CJ' ~ day of ~ ~ , 200
Signature
Subscribed and sworn to before me the day and year first above written.
`\\\`\\\1\11V1I i I I Illll///~~i/
\~~ ~ ~„» S T~~~~~~/Notary Public of Idaho
...,, ~
0 ~' `'
N OTARY ~ ~ =_
* PUBLIC
ice,, ..... ,,~~
Residing at: /i?c'~,~Gr rq ~c~
My commission expires: ~ ~ /~ - D g
2
Please com lete the a ire A lication!
. ~ P PP
If t e question does not apply fill in NA for non applicable
NAME ~ 1M ~(A"C.i ~~
PROPERTY ADDRESS 'i r Srfi Permit#
SUBDIVISION
Dwelling Units:
Parcel Acres: ~ ~~
SETBACKS
FRONT SIDE SIDE ~ ~ BACK ~~ ~
Remodeling Your Building/Home (need Estimate) $ ~ ~ U Oo
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area
Second floor/loft arf
Third floor/loft area
Shed or Barn
Water Meter Quantity:
Required!!!
PLUMBING
Plumbing Contractor's Name:
Unfinished Basement area _~~ 1 ~t
Finished basement area j~; ~
Garage area ~ ~(~r;C~ .~} ,
Carport/Deck (30" above grade)Area
************** Water Meter Size:
Address
Contact Phone: ( )
Email
FIXTURE COUNT (including roughed fixtures)
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
Sinks
(Lavatories,
Plumbing Estigriite $
(Commercial Only)
Sprinklers
Tub/Showers
Toilet/Urinal
Water Heater
mater 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
bar, mop)
Business N e:
City State
Business P e: ( )
Fax
Zip
4
Please COlriplete the eritlre AppllCatlOri~ If the question does not apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION..
Required l ~!!
MECHANICAL
Permit#
Mechanical Contractot's Name: Business Name:
Address
(Commercial/Multi Family Only)
State
Zip.
Contact Phone: ( ) Business Phone:
Email Fax
Mechanical Estimate $
FIXTURES & APPLL9IVCES
Furnace
Furnace/Air Conditioner
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Similar fixtures or Annli~nces
City
(Single Family Dwelling Only)
. `Exhaust or Vent Ducts
,,,~
T Dryer Vents
'~ Range Hood Vents
•~,
Cook Stove Vents
Bath Fan Vents
' \,,~ other similar vents & ducts:
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
Mechani~¢al Sizing Calculations must be submitted with P
~~ Point of Delivery must be shown on plans.
,~
Signature of Licensed Contractor
The
License number
's permit fee schedule is the same as
& Application
Date
the State of Idaho
5
..
SUBCONTRACTOR LIST
Excavation & Earthwork:
t.,
Concrete:
Masonry:
Drywall:-
Painting:-
Floor
Coverings:
Plumbing:_
Heating:-
Electrical:
Roof Trusses:
Floor/Ceiling Joists:
Siding/Exterior Trim:
Other:
~~
Special Construction ~"~,,
(Manufacturer or Supplier
6
t
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 yo state registration
or fill out this form showing your exemption and send it with your license renewal or yo 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,
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 Licen$ing 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, aheration or construction on
that property ``~
^ Real estate licensee/property manager acting within Idaho Code '~i
^ Engaging inthe logging industry ~`
^ Renter working on the property where they live with the property owners approval,
^ Constructibn~ 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.
Signature
Print Name
Date
7