HomeMy WebLinkAboutBP & APPLICATION - 06-00264 - Main Street Diamonds - RemodelZ
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CITY OF AEXB UI~G
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
• PERMIT #
Please ~-~~---'_~_ ~,_
If the ques
06 00264
PARCEL NUMBER: ~`~ F-~~~~r I (,~1~C~~.J` (~ Main Street Diamonds-Remodel
SUBDIVISION: UN~
Is based on the information -must be
OWNER NAME: l~i ~ i.,lc -vl~c r.-~.l( CONTACT PHONE # '35b' SS:S 1
PROPERTY ADDRESS: ~I ~ ~ ~ f AAA ~ ~^
PHONE #: Home (z~ ~~ ~ ~' ~ ~~ ~ ~' Work (tQt;) 3~ 4 ~~ ~ Cell ( )
OWNER MAILING ADDRESS: I ~ ~S S ~b ~ ~ CITY:~~STATE: ~ ZIP: ~ 3~ ~ o
EMAIL F
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,
PHONE #: Home
EMAIL F
Work ( ) Cell
CONTRACTOR:
MAILING ADDRESS: -1~- ~S ~`O~~ ~t~t ~ CITY ~~ STATE ZIP ~3~~'W
PHONE: Home# ~ ~`~ ~ Work# ~ ~ ~ ~ ~ 3~ Cell# ~ S b `t~l 3 ~ Fax#
EMAIL IDAHO REGISTRATION # & EXPIRATION DATE ~ LT °3(A6 3 6~- ~ -~Z
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? ~ YES (Please bring copy of new legal description of property)
PROPOSED USE: C6l~.t.... V~ i~
(i.e., Single Family Residence, Multi Family, Apartments, 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 Corrunission 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 pernut 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 o emut or approval was based. Pemut void if not started within 180 days. Pemut void if work stops for 180 days.
`~ / 30 /~
Signature of Owner/App nt 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, anaaty 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 Petmits are void if your check does not clear*'k
2
O~ pBXB U/pC
~~ r9 C Y O F •
~ BUILDING SAFETY DEPARTMENT
U~ IZEXI3IJRG
N' 19 E. Main (PO Box 280) Phone: 208-359-3020 x326
America's Family Community Rexburg, Idaho 83440 Fax: 208-359-3024
'e~~SHED X00,
www.rexburg.o~e janellh e,rexb~Q.orQ
Affidavit of Legal Interest
State of Idaho
County of Madison
I,
Name Address
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 herin 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:
3
Please complete the ent~ Applications If the question do~ot apply fill in NA for non
applicable
NAME CX-~
PROPERTY ADDRESS ~GGtS~' YY1G~ Permit# Q ~Q (~(~'
SUBDIVISION
RequYred!-~
MECHANICAL
Mechanical Contractor's Name: K-4>l~ti.ti- ~L~`~~"~Business Name: `
Address City State Zip
Contact Phone: ( ) Business Phone:
Mechanical Estimate $~ (Commercial/Multi Family Only)
0
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
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similax vents & ducts:
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Ayylication
Point of DeliverX must be shown on flans.
Required) Signature of Incensed Contractor License number Date
The City of Kexburg's permit fee schedule is the same as required by the State of Idaho
5
05/30/2006 11:16 FAX f~001
~~MI• ~u• tvvu IV~J/niri N0. 2214 P. 2
Plegse complete the en~ A l~eat10t7t1 If me uestion •
applics~ble ~ 9 apply SD ie NA 5~r aoo
NAML '~
PROPERTY ADDRESS ~S~- ,j Permiit# ~ ~ ~~
SUBAIVISION
.Requit~ed!1!
1~EC~~ANICA~
,M'echanical Contractor's Name: ~~•~ ~'~`r~~~~''"usiuess Name: `~ r'`'''
Address City State Zip
Contact Pboae; ( ) Business Phone:
Eza~- ~~~.~.~ Fax
Mecha~aical Estuouate $ (Com~aercial/Mule Fam~ilq Ou13')
i
1~XT ZIRES & APPLIANCES LbUN7' (Single P~mily Dwelling On11')
~-, Furnace Exhaust or'Vcut Ducts
Furnace/Air Conditioner Combo
Heat Pump
~~ Ass Conditioner
Evapox~atzve Cooler
U»it .Heater
Space Heater
Deaa~rative gas-fired appliance
Incinerator System
Boiler
Pool HcAtcr
Drper Vents
Range Hood Vmts
Cools Stove Ventre
Bath Fan Vents
other simulaz vents & ducts:
Fuel Gas Pipe Outlets including stubbed in ox future outlets
_.~, Islet Pressure {112enet Supply) PSI
Heat (Circle all that apply) Gas Oil Coax Fireplace F.lect<ic Hpdxonic
,~
~ e ~av ul st be shown en t~ 9r~~
~ ~ of ~o~a coaszaaas
~~
!Wl~
Y.iewee samba
rcbea~ik it 11n .raw„ gr
e M o
Sao s~
5
•
Please complete the entire Application!
I the question does not apply fill in NA for non applicable
NAME ~~+ ~ •` S~` pi ao*o~.-~ S
PROPERTY ADDRESS ~< < ,e~si- rn~h - ~? Permit#
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT SIDE SIDE BACK
Remodeling Your Building/Home (need Estimate) $~ I byo ~ ~
SURFACE SQUARE FOOTAGE.• (Shall include the exterior wall measurements of the building)
First Floor Area Unfinished Basement area
Second floor/loft area Finished basement area
Third floor/loft area Garage area
Shed or Barn Carport/Deck (30" above ~rade)Area
Water Meter Quantity:
Required!~~
PLUMBING ~Q, D~~
Plumbing Contractor's Name: (~Y'~~ ~~i,. ~a(~ Business Name: f ~~,.,~ 1 ~-,~
Address ~~~ III (~v~ ~ (.,'C~ City ~~~State -(-~ ' Zip ~~~ b
Contact Phone: (2~,) ~ ~ b0 Business Phone: ( ) 3¢! d" ~~ 6 ~
Fax
FIXTURE COUNT (including roughed frxtures~
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
Sinks
(Lavatories, kitchens, bar, mop)
`' ' ' ' ~"'' ' ` `~'°" Water Meter Size:
Sprinklers
Tub/Showers
Toilet/Urinal
Water Heater
Water Softener
Plumbing Estimate $ ~D~b (Commercial Only)
Required! Signature of Licensed Contractor License number Date
The City of Aexburg's permit fee schedule is the .came as required by the State of Idaho
4
• •
o~ 4ExsURc
U,~ r~ CITY OF
o j?L`vT?Tm(~? BUILDING SAFETY DEPARTMENT
~~ I~LilV~ V 1\y
~ 19 E. Main St. Phone: 208-359-3020 x326
' America's Family Community Rexburg, Idaho 83440 Fax: 208-359-3024
e~~SHED ~eOA
www.rex ~bure.ore ianellh a rexb,~Q.or~e
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO
APPROVED BY:
-APPLICANT INFORMAT//~~ION: //~~
BUSINESS NAME: l'7~ 4u r ~.0~~
OFFICE ADDRESS: ~a~ ~~ ~e~ YVcr~ ~u .~• `~t(L(o
City State Zip
OFFICE PHONE NUMBER: (~ ~~ )_ ~Sb a S~ ~ `~
CONTACT PERSON:
--~ CELL PHONE # (~- ~) 39 a- (1 1
STREET ADDRESS WHERE WORK WILL BE DONE: ~{ (- e°S ~ Gu4 ,a
BUSINESS NAME WHERE WORK WILL BE DONE: c/IO~~I~ S~~ ~'~~~r
DATES FOR WORK TO BE DONE: TO
CONTACT PERSON: ~ ~ ~~- V1n~ r ~
PHONE NUMBER: ( ) 3ab ~SS~' ( CELL # ( )
PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR:
^ AUTOMATIC FIRE-EXTINGUISHING SYSTEMS
^ COMPRESSED GASES
^ FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT
^ FIRE PUMPS AND RELATED EQUIPMENT
^ FLAMMABLE AND COMMBUSTIBLE LIQUIDS
^ HAZARDOUS MATERIALS
^ INDUSTRIAL OVENS
^ LP-GAS
^ PRIVATE FIRE HYDRANTS
^ SPRAYING OR DIPPING
^ STANDPIPE SYSTEMS
^ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES
k, ~o ®L
APPLICAN S SIGNATURE DAT
6
• •
SUBCONTRACTOR LIST
Excavation & Earthwork: (V
Concrete: YU
Masonry:
Roofing: ~°U 1~
Insulation: ~1! ~-
Drywall: ~ ~~' ~ ~
.~:~ ~~c-t F-.;
Floor
Coverings: ~~ ~'~w Sb~
Plumbing:_ ~ u~ Sow
Heating:
~,~, t,;
Electrical: T~-'q 1-i ~:... Sow E ~p~~,,.~~
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:
W ~-
Siding/Exterior Trim: W
~~ I~
7
•
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.
Signature ~/ ~
V} r~ ct~
Print Name
~o a~