HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 06-00497 - 1117 Coyote Willow Way - New SFRZ
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CITY OF
REXBURti
— - 04% -- -
America's Family Community
Certificate of (ccupancy
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Building Permit No: 0600497
Applicable Edition of Code: International Residential Code 2003
Site Address: 1117 Coyote Willow Way
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: Fleming Nathan
Po Box 748
Rexburg, ID 83440
Contractor: Owner
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
vies inspected on the date listed vies found to be in compliance t4ith the requirements of the code
for the group and division of occupancy and the use for 14hich the proposed occupancy sties
classified.
Date C.O. Issued: September 1 07 (01:4 M)
r
C.O Issued by:
Building Official
There shall be no further change in the e)asting 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.
Inspector: ► ",Q
Plumbing specto Fire Inspector: I�
Electrical Inspector: P &Z Administrator: r ` 10,
- � s
CITY OF AEXB UKG p F.R MTT' H
BUILDING PERMIT APPLICATION Please c4
19 E MAIN, REXBURG, ID. 83440 If the questii 0600497
208 - 359 3020 X326 1117 Coyote Willow Way - Fleming
PARCEL NUMBER: (We
SUBDIVISION: w j 1 10 W F3 rOo F54r-4t UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER NAME: CONTACT PHONE #
PROPERTY ADDRESS: I 1 -N
PHONE #: Home (�D?) �' S�S73 9 Work
` (�cg) ,`,. '- Cell (,
/
OWNER MAILING ADDRESS: Pa &X 7 � CITY: '� ��✓ . STATE: ZIP: a 4 0
EMAIL nG&e — 6� 1C { �t� � 7 ► , � or✓1 FAX o _ q� _ 6 I
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner r a m n
APPLICANT INFORMATION: ADDRESS 11y:
STATE; ZIP EMAIL FAX ��J
PHONE #: Home ( ) Work ( ) O
CONTRACTOR
MAILING ADDRESS:
PHONE #: Home (
Work ( ) Cell (
EMAIL FAX IDAHO REGISTRATION # & EXP. DA
How manv buildings are located on this property?
Did you recently purchase this property? No Ye (If yes give owner's name) FU- � yj k
Is this a lot splito YES (Please bring copy of new legal description of property)
PROPOSED USE:
(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 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. �qm4 vJid if nqt pfrted within 180 days. Permit void if work stops for 180 days.
CITY STATE ZIP
l0 Oaf / 0
Slgr9ture of Owner / Applican 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** 2
Please complete the Elptire A p p lication!
•
np rr�� p pP
NAME
PROPERTY ADDRESS K .J Permit#
SUBDIVISION s,.i "t Cy;i e � "
Dwelling Units: ' Parcel Acres:
t /9--
SETBA /
'Q G i SIDE �. SIDE Sa BACK `
Remodeling Your Building /Home (need Estimate) $
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area 15 I S Unfinished Basement area
Second floor /loft area Finished basement area
Third floor /loft area Garage area ___ 3
Shed or Barn Carport /Deck (30" above grade)Area
Water Meter Quantity: I * * * * * * * * * * * ** *Water Meter Size:
Requiredffl 1 In OJ
PLUMBING
Plumbing Contractors Name: `� cc �►�w = A. Business Name:
City State Zip
Contact Phone: ( ) Business Phone: ( )
Email Fax
FIXTURE COUNT (includingroughed fix' tures�
Clothes Washing Machine Sprinklers
r ' Tub /Showers
Toilet /Urinal
Water Heater
(' ( Water Softener
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub /Spa
Sinks (Lavatories, kitchens, bar, mop)
Plumbing Estimate $.
(COMMERCIAL /MULTI - FAMILY ONLY)
Signature of Licensed Contractor
The
License Number& Expiration Date
Date
schedule is the same as required by the State of Idaho
4
Please complete the entire A p p lication!
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required Y MECHANIgAL
Mechanical Contractor's Name ��` "`` " usiness Name
City State Zip
Cell Phone ( ) Business Phone (
Fax (
Mechanical Estimate $ (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace 3i5l, I Exhaust or Vent Ducts 5
Furnace /Air Conditioner Combo � ^^ Dryer Vents S
Heat Pump V Range Hood Vents
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
4;io)v
Decorative gas -fired appliance 15'
Incinerator System
Boiler
C J Pool Heater
J Fuel Gas Pipe Outlets including stubbed in or future outlets I5'
Inlet Pressure (Meter Supply) PSI w
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivejy must be shown on plans.
0
Signature of Licensed Contractor License number Date
The City of Rexburg's permit fee schedule is the came as required by the State o f Idaho
�% Cook Stove Vents
Bath Fan Vents Zb
other similar vents & ducts:
5
Bull
Safety Department
City of Rexburg
19 E. Main
Rexburg, ID 83440
jonellh @rexburg.org Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3024
V. tIR l7
U O
l �s�
Eo
C I T Y O F
REXBURG
Americas Family Community
Affidavit of Legal Interest
State of Idaho
County of Madison
I, Gl�
Name Address
City U 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 q N day of Oda �- .20
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing at:
My commission expires:
Building Safety Department
City of Rexburg
19 E Main ionellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
0 REXBURC
�4 f 0
U �
CITY O F
REXBURG
____ __.� Ow _._.______
America's Family Community
h
OWNER'S NAME ')1
PROPERTY ADDRESS l L
SUBDIVISION \W��\bZAXOO�_
PHASE LOT 4- BLOCK 3
Permit #06 00497
1117 Coyote Willow Way
HOME OWNER'S ELECTRICAL PERMIT
Home Owner's Name RK�'t —. 1 '.,F j1,,1 t
Address , i % City 2. $ State ( Zip Ci f
Cell Phone (aff) ? ` ' ° .a�� Home Phone ( )
Fax ( ) Email
TYPES OFINSTALLATION(RESIDENTIAL)
(New Residential includes everything contained within the residential structure and attached garage at the same time)
V Up to 200 amp Service*
201 to 400 amp Service*
Over 400 amp Service*
Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year)
Existing Residential (# of Branch Circuits)
Spa, Hot Tub, Swimming Pool
Electric Central Systems Heating and / or Cooling (when not part of a new residential construction permit
and no additional wiring)
Modular, Manufactured or Mobile Home
Other Installations: Wiring not specifically covered by any of the above
Cost of Wiring & Labor: $
Pumps (Domestic Water, Irrigation, Sewage)
Requested Inspections (of existing wiring)
Temporary Amusement /Industry
*Includes a maximum of 3 inspections. Additional inspections charged at requested inspection rate of $40 per hour.
6) i
Signature of Home Owner / Date
The
schedule is the same as required by the State of Idabo
G
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
OF R' XB URC
�a 'a
� 9�
U G
CITY O F
REXBURG
Americas Family Community
OWNER'S NAME
PROPERTY ADDRESS
SUBDIVISION
PHASE LOT BLOCK
Permit#
Required!!!
ELECTRICAL
Electrical Contractor's Name Business Name
Address City
Cell Phone ( ) Business Phone ( )
Fax ( )
Zip
Electrical Estimate ( cost of wiring & labor) $ (COMMERCIAL /MULTI - FAMILY ONLY)
TYPES OF INSTALLATION (RESIDENTIAL)
(New Residential includes everything contained within the residential structure and attached garage at the some time)
Up to 200 amp Service*
201 to 400 amp Service*
Over 400 amp Service*
Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year)
Existing Residential (# of Branch Circuits)
Spa, Hot Tub, Swimming Pool
Electric Central Systems Heating and / or Cooling (when not part of a new residential construction permit
and no additional wiring)
Modular, Manufactured or Mobile Home
Other Installations: Wiring not specifically covered by any of the above
Cost of Wiring & Labor: $
Pumps (Domestic Water, Irrigation, Sewage)
, Requested Inspections (of existing wiring)
Temporary Amusement /Industry
*Includes a maximum of 3 inspections. Additional inspections charged at requested inspection rate of $40 per hour.
Signature of Licensed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State
7
.......................... 0 .............................. 0 ............................
Excavation &
tf�t
Masonry:
SUBCONTRACTOR LIST
4
Insulation:
ru
Floor
Plumbing: - - - uk*,
Heating: ; � - VJ (D
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses: / WC , �/� Ll / � ,, w
Floor /Ceiling Joists: e / L61
c.
Siding /Exterior
• EXEMP'TI(WS FROM STATE REA�TRATION
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
Cl 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 herebw certify djatffie above information is true and correct to the best of my knowledge.
— V-0
Signature Date
J G..� - �
Print Name
z