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HomeMy WebLinkAboutAPPLICATION, BP - 06-00422 - 1732 N 5000 E - New SFR MechanicalZ rn .~ F•o ~ 3~ n ~ ~ ~ m ~ v o w n ~• 3 0 o ~ ~ ~. ~, - ~ ~ a w ~ m o. C N C7 ~ ~ o c 3 d ~ ~ ~ ~ 0 0 ~, N ~. a= v o 0 n O j ~ s c m ~ < a ~ o o w x ~ N ~ S fl- 01 < Q M O 3 3 ~ 3 n m vv;;.Z ~ v ~ o ~~ ~ a~ o ~ ~ __. o ~ N N L]. x ~ Zc~ico ~ ~o~~o~ ,N.. 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N, ~• ~A m n ° W N ~ v,~ S ~ ~ IV ~ m ~ m ~On ~ ~ ~ v v v ~ 3~ m y y~ • 0 v ~ v Z 00 o O T -- ° ~ T _ ~ Z I ~' N ,.. z ~ ~ CD ~ C °" N H ~ ~ 3 ~ _ N ~ ~ v o T ~ ~ Z ~ ~ z nag o ro o ~ ~ O O m G) ~ m n p t ~ c ~ ~ rF io m Zug ~ °- ~. 3 N ~ n 2 N O ~O ~ a City~of Rexbu~g/ Madis~'ounty 'BUILDING PERMIT APPLICATION 1=~lts~>€ 19 E MAIN, REXBURG, ID. 83440 ~~' ~#~~= af~ 208-359-3020 X322 PARCEL NUMBER:`~~~ ~ ~J;y~'1 ~ ~ ~ ,`~~"G~7_ ~~. ~ SUBDIVISION: U (Addressine is based on the information -must be accurate) PERMIT # • 06 00422 1732 N 5000 E-Cnty Mech . ,... -, l+~~ fl(o IU~t 1C la~dvo ~~ ~ CONTACT PHONE # ~ ~ `~ ' ..~ -~ ~ PROPERTY ADDRESS: ~~~~\~Y~a`'`' - `~ ~= ~: ~' _ .-~~ `%~ /N_, ,~ ~ ;~4 -,_- t~ c "E-'1 13~3a ~ ~ PHONE #: Home ( ) ~ ~% .? ~~ v ~ Work ( ) -~ ~ ~ -? ?~~~-Cell ( ) , > .~ ~` ~~~' _~' OWNER MAILING ADDRESS:~~ f. ;~ L ~ ~ ~"~ITY:~~~ -~u.~--~STATE: ~~~ZIP: ~'.} ~(~~ ..~ EMAIL -b~'~~s ~:.c~,.~ .--~ ;~~>_~~~'FAX ~ ~ ~ i . ~-. ?.-~ APPLICANT: (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner mast accompany this application.) APPLICANT INFORMATION: ADDRESS STATE; ZIP CITY: FAX PHONE #:-Home ( ) Work ( ) Cell ( ) CONTRACTOR: MAILING ADDRESS: PHONE: Home# EMAIL CITY EMAIL Work# FAX 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?~' N9.1, YES (Please bring copy of new legal description of property) tom. ; PROPOSED USE: ~ ~~~ ~ ~, ~~~_ ~~'~-~ (i.e., Single Family Residence, Multi amity, Apartments, Re odel, 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 agee to comply with all City regulations and State Taws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned property for inspeMions purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2000 lntemational Code in cases of any false statement or misrepresentation off Gt.iaihe~pplication oC„on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops forms. ~, ~. Signature:~f O~iei•~Applicant D ~ (~ ~ U D~ Do you p`ref'er to be contacted by fax, email or phone? Circle One WARNING -BUILDING PERMIT MUST BE POSTE NSTRUCTION SITE! Plan fees are non-refundable and are paid in full at the time of li on b~ipnigg it 1 City of Reaburg's Acceptance of the plan review fee does not c plat{ r a . STATE ZIP Cell# C{TY OF REXBURG ~ 2 • Please complete the entire Application! If the question does not apply fill in NA for non applicable NAME PROPERTY ADDRESS SUBDIVISION Permit# Required!!! MECHANICAL Mechanical Contractor's Name: ~N~+~2F~-e~ ~ch~1s~=-~ Business Name: ~c~i~~~ l~e~-~-j~~ ~L~ Address loY(o ~ i l/o~: r~r~> ~:- c ~ ec/e City ~e ~- b.: ~ ~ State ~ ~ ~ Zip C3 ~ ~ ~ Contact Phone: (Z~) s~I~ - ~~s"~'S Business Phone: ( ) Email ~SUI, ns~ ~ l~+e~,,-r`-~ ~ ~ s ~.; . ~~ ~~•. - -, ~ ~ . ~ Fax 2ti~~3 ~5~ ~ ens z5 Mechanical Estimate $ (Commercial/Multi Family Only) 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 j Decorative gas-fired appliance Incinerator System Boiler Pool Heater ~ Dryer Vents Range Hood Vents Cook Stove Vents 5 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 Hydronic Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. Signature of L' ensed Contractor License number Z`I -ola Date ~~~4:"ci~~a~ ~`i)ttt~)~E;{4' ~~t4' t'~~~~' 3=~1,~;~~'s~il;i~,~{.D.tt~ l~•t~~ ~~,~,.,;ri~,i~ tl~iscit .i~~~74~ #~i~ ~€a ~'V ~, #a~~'rtac NAME ~= tr ~ ,..., j....~ , _c.-,.:. PROPERTY ADDRESS `° wp~ ' O ~ Permit# SUBDIVISION `' `' ) .`~~~~ tcr~~c~ r MECHANICAL Mechanical Contractor's Name: f~ Na-f Y ~-~~>•-~ Business Name: ~ ~ns~-~ N~~~~~ LLC; r ~ Address (rayG~ r..~ , (o~ ~ ~~~ ~- ~' i'dzc ~ e- City (~ ~.~-~ '"~~ State ~~ Zip ~~ `~~Ca Contact Phone: (Z~~,) ~ `I ~ '~ c'5~2~ Business Phone: (Z~-~) ~ 57.E ` e ~ ~ 2 ~ Email .-~'~~~~I~Fc,~'1ti=~ ~. ~ 4°~ Fax Mechanical Estimate S (CommerciaUMulti Family Only) FIXTURES 8c APPLIANCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts ~_ Furnace/Air Conditioner Combo ( Dryer Vents Heat Pump ~_ Air Conditioner Evaporative Cooler ~_ Unit Heater 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 ~ it Coal Fireplace Electric other similar vents & ducts: Mechanical Sizing Calculations must be submitted with Plans & Application ~~ Point of Delivery must be shown on plans. 3~.€~+~ it=.ti i~~7 ~1-~l -~~ Lic=~nsc; nuau~er Date Range Hood Vents Cook Stove Vents S Bath Fan Vents The City of Rexburg's permit fee schedule is the same as required by the ,State of Idaho Building Safety Department City of Rexburg 19 E Main janellh@rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 04 ~,~.xet,,gc ,~ r~ r ~ 7y o ~~;, CITY O F REXBURG ~.,~, America's Famrty C;omrnunrty NAME PROPERTY ADDRESS SUBDIVISION Permit# Required!!! MECHANICAL Mechanical Contractor's Name: ~ r~~ J d ~ ~Sv ~ Business Name: ~©~ ~'So~1 ~'4' ~~"` `` LL [- Address ~p L/(c ~,,~ ~ [, [~w ~ro~ (L G i ~-c l ~ City ~P~-b.~ .r C-I State ~U Zip ~ ~ 1/~a Cell Phone: (2~~ 3° ~ ~ ®~ 2 ~ Business Phone: ( ) Fax: (2~g) ~ Flo " b S-Z ~ Email ~ 0~ X50 ~ ~~-n~, ~ ~ ~5 ~ . ~~~ Mechanical Estimate $ (Commercial/Multi Family Only) FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) Furnace ~ Exhaust or Vent Ducts ~- Furnace/Air Conditioner Combo ~ Dryer Vents Heat Pump Air Conditioner Evaporative Cooler ~ Unit Heater - C~ f+rA ~,e, Space Heater Decorative gas-fired appliance Incinerator System Boiler Pool Heater Range Hood Vents Cook Stove Vents (~ Bath Fan Vents other similar vents & ducts: _~_ Fuel Gas Pipe Outlets including stubbed in or future outlets Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic J~,n~4 i ~ cu~i7 CITYQF R~~CBl1RC Mechanical Sizing Calculations must be submitted with Plans & A Point of Delivery must be shown on plans. Signature of~icensed Contractor The City of Rexburg's /~z~ License number schedule is the same as the State of Idaho lication ~' O ~~P- Da e