HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 06-00362 - 1092 Arctic Willow Dr - New SFRZ
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America's Family Community
Certificate of Occupancy
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Phone (208) 359-3020 /Fax (208) 359-3024
Building Permit No: 06 00362
Applicable Edition of Code: International Residential Code 2003
Site Address: 1092 Arctic Willow Dr
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: Lewis Chris
440E 2nd S
Rexburg, ID 83440
Contractor: Same As Owner
Special Conditions: Unfinished Basement
Occupancy: Residential, single family dwellings, lodging houses
This Certificate, issued pursuant to the requirements of Section 109 of the International Building
Code, certifies that, atthe time time ofissuance, this building orthat portion ofthe building that
tees inspected on the date listed vies found to be in compliance v-ith the requirements ofthe code
for the group and division of occupancy and the use for v-hich the proposed occupancy sties
classified.
Date C.O. Issued: November 14 7
C.O Issued by:
~~
Building Official
There shall be no further change in the e>asfing 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.
Plumbing Inspector:
Electrical Inspector:
Fire Inspector: 1 ---Illy
P~ZAdministrator: ~ I~
• Cl 1 `~ OF KEXB UI~G
BUILDING PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If the qua
;~ 08 X359-3020 X326
r PARCEL NUMBER:
(
06 00362
1092 Artic Willow Dr
99 ~ r
SUBDIVISION:~f. `~jl l v W I~Y~B~ U~rr~ ~ K#
(Addressing is based on the information -must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS:
PHONE #: Home '~~ *I ~(p ~~ S 7~Work ( ) ~LI/Lt~~ Cell ( )
OWNER MAILING ADDRESS: l~- G~~ ~i . a-1'I'`{' Sl~(~ 1~ITY: ~~"ATE:c~~LIP:~
EMAIL FAX J
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 ( ) Work
Cell
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE
How many buildings are located on this property? ~~
Did you recently purchase this property? No l~(If yes give owner's
Is this a lot split? TO YES (Please brin opy of new le 1 desc~i tion of property)
Single Family Residence,~ulti Family, Apartments, Remodel, C~rage, Commercial, Addition, Etc.)
AI~CANT'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 of ~ ~ ~ued under the provisions of the 2003
Inte ati Cod in ases of any false statement or misrepresentation n a ~c 'an U o hewn ~ch the permit or approval was
b -ed. P rr it vo~i jot started within 180 days. Permit void if works )~ ~u LL'~~
of Ov~ner/Applicant
/~~/0~
DATE
Do you prefe~jto be contacted by fax, email or pho C' le One
WARNING -BUILDING PERMIT S~ CTI N SITE!
Plan fees are non-refundable and ate paid in ul ~ g anu 1 200 .
City of Rexburg's Acceptance of the e n a proval
**Building Permit Fees are due at time of application** **Building Permits are void if your check does not clear**
PERMIT # (~(~ ~ ~ (~
CITY STATE ZIP,
2
Please com lets the entire A lication!
p PP
If the question does not apply fill in NA for non applicabk
w NAME ~ if't ~ L~~~
PROPERTY ADDRESS D W ~ ~ ~ R I~~ ~ `~~~~rniit#
SUBDIVISIONo~j~~~~ t~~ .
Dwelling Units: ~ Parcel Acres:
SETBACKS ~!
FRONT SIDE I DT-~- SIDE I~~ ~-- BACK 6
Remodeling Yout Building/Home (need Estimate) $
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area t (O(y~ Unfinished Basement area ~ ~~
Second floor/loft area N ~~ Finished basement area
Third floor/loft area ~~r fa' Garage area DD
Shed or Barn ~ ~" Carport/Deck (30" above grade)Area
~~
Water Meter Quantity:
**************Water Meter Size:
~ /~ r.
Required ~~!
PL U~VIBING ,
y~
Plumbing Contractor's Name: ~ Y~~ S(~CI/lC~' Business Na e: s ({-~ I~ci~~ ~ '~~
Address _ ~ ~ 5~~ ~~ : ~ h, i ~~~ ~ i ~;~(~ ~~~ City ~ ~SState Zip~~~_~~
Contact Phone: (~) 'fib ~ ~ ~ ~S S Business Phone: ( ) ~- -%'~~ £'
Email
FIXTU COUNT includin rou hed fixtures
Clothes Washing Machine
l Dishwasher
~ Floor Drain
Garbage Disposal
Sprinklers
i~~ Tub/Showers
/Y "~ Toilet/Urinal
~ 'W Water Heater
Water Softens
Plumbing Estimate $ ~ (Commercial Only)
n~~[~~d~
V
u u JUL 1 9 2006
CIiY 0~ REXBUR
G~ ~ ' ~ /~l ~ ~~
Signature of Lic ' sed Contractor License Number& Expiration Date Date
The City of I~exburg's permit fee schedule is the same as required by the State of Idaho
Sinks (Lavatories, kitchens, bar, mop)
4
Please com lete the entir•A licatlOn~ If the question does apply fill in NA for non
P pp
applicable
~~v ~ S l,~c.,,a ti 5
NAME
PROPERTY ADDRESS
SUBDIVISION ~t7 ~ (,~ ~ P1 Ya 0 K-
(Single Family Dwelling Only)
Exhaust or Vent Ducts
Required.!!
MECHANICAL
Mechanical Contractor's Name: ~~n.Vl~ d ~ Business Name: cl o ~ yl5[~n 't'1'~~-~ ~ 1
J
City State Zip
Contact Phone: (,2D~() 3q4 Q S'a-S Business Phone: ( )
Email Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT
Furnace
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
~_ Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
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 Co Fireplac Electric Hydronic
mechanical Sizinv Calculations must be submitted with Plans & Avvlication
Point of Delivery must be shown on laps.
~ s
Si tune of Licensed Contractor
The City of Rexburg's
Dryer Vents
Permit#
Range Hood Vents
Cook Stove Vents
2- Bath Fan Vents
~ ~ a-
License number
`fee schedule is the .came as
~~ o
Date
the State of Idaho
5
•
~~ • ; !~9
~~ ,
0a,
9 B~~ S M E D ~
CITY O F
REXBURG
~1v
America's Family Community
BUILDING SAFETY DEPARTMENT
19 E. Main (PO Box 280)
Rexburg, Idaho 83440
~wx~.rexbure.ore
Phone: 208-359-3020 x326
Fax:208-359-3024
janellh a(~rexburQ.ore
Affidavit of Legal Interest
State of Idaho
County of Madison
I, ~~,,.~5 L~l 5 ~ ~ ~ ~~ ~ ~ ~ c~~-lo~ brrv~
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 herein or as to the
ownership of the property which is the subject of the application.
Dated this ~ oZ 1 S-~ day of ~ , 20~_
Signature
Subscribed and sworn to before me the day and year first above written.
~/" ` Notary Public o daho
n p~ ,~
~ypTARY ~+ ~ "
~ - Residing at: { v' I~ I S ~' ~_ ~~~. I I, L(~1
... ~-
p~~,tG ::o ~~ My commission expires: ~ ~ ~ ~ <
~q~ OF ~~~~`°~\`\\
2