HomeMy WebLinkAboutAPPLICATIONS, BP, CO - 06-00564 - 810 Griffin St - New SFR MechanicalZ
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CITY OF
1 E XBV1\V
Americas Family Community
Certificate of (5ccupancy
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Ph
Fax
Building Permit No: 0600564
Applicable Edition of Code: International Residential Code 2003
Site Address: 796 Griffin St
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: Housley Lary
Contractor: Olympus Building Group
Special Conditions: 1 500 sf of basement finished
Occupancy: Residential, single family dwellings, lodging houses
This Certificate, issued pursuant to the requirements of Section 109 of the lntemational 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 "ith the requirements of the code
for the group and division of occupancy and the use for VIhich the proposed occupancy vies
classified.
Date C.O. Issued: August
C.O Issued by:
W —
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.
Plumbing Inspector: Fire Inspector: - �G
Electrical Inspector: PlZAdministrator: n1A
•
CITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 - 359 - 3020 X326
•
Pleas 0600564
If the q'
810 Griffin -Woma k
e
PARCEL NUMBER: � ""1�,��� `y l� c � !' � ,,V,,
SUBDIVISION: UNIT# 3 BLOCK # # - 10
(Addressing is based on the information - must be accurate)
v WIV R IvAM.E: CONTACT PHONE #
PROPERTY ADDRESS: ,
PHONE #: Home ( ) _ =r, 7� '-;t 5' Work ( ) —Cell( )
OWNER MAILING ADDRESS: CITY: STATE: ZIP:
EMAIL FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing pplicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS CITY:
STATE; ZIP `y - Iq Lf S EMAIL FAX
PHONE #: Home (a.,, c y - it— s Work- (/ _-) ,CSC; . ( :, "n-) 1 . -.. -C-en )
CONTRACTOR i _ 1
�� t .
MAILING ADDRESS: �% s' x } 7 CITY Z�l I X > STATE Z - .d ZIP 3
PHONE #: Home ( ) Work - ` 2 - I L'L Cell (
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE ` `Ili
H ow many buildings are located on this property? < ") Y1 c
Did you recently purchase this property? No(!E&(If yes give owner's name) 144 F. , t F S,j,
Is this a lot split? 1NU YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartment Remodel, Garage, Commercial, Addi n n E
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATI er pen ty o perjury, I here e
that I have read this application and state that the information herein is correct and I swear that any info which may here fter be ven n
hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall j
a rect. agco 1 all
City regulations and State laws relating to the subject matter of this application and hereby authorized re e ve, o the City to enter upon t e ab ve-
mentioned property for inspections purposes. NOTE: The building official may revoke a permit on apr roval i, ued under the provisions oft e 200
International Code in cases of any false statement or misrepresentation of fact in the application or on th plans pprpy as
based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
CITY 0 v K
' ` )
Signature of Owrper' /Applicant 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 fanuary 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
Buil
19 E. Main
Rexburg, ID 83440
g Safety Department
City of Rexburg
jonellh@rexburg.org Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3024
of Qexaugc
1 ,7
U G
_CI TY OF
REX BURG
Americas Family Community
Affidavit of Legal Interest
City
State of Idaho
County of Madison
I,
Name
Address
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 r't day of r �r F u, y , 20 & L-
Subscribed and sworn to before me the day
ANDY
Notary
first above written.
of Idaho 1
Kesiding at: r }a I / L� . 4
My commission expires:
Please complete the entire A p p lication!
P PP
NAME v t., „► . rti.G�
PROPERTY ADDRESS t14 I I Permit#
SUBDIVISION �Le"v•�vr,
Dwelling Units: Parcel
SETBACKS
FRONT SIDE SIDE BACK
Remodeling Your Building /Home (need Estimate) $,
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area Unfinished Basement area
Second floor /loft area Finished basement are 5'0Zb 54 FT
Third floor /loft area Garage area 4 / 7 f. Cr
Shed or Barn Carport /Deck (30” abov grade)Area
Water Meter Quantity: i * * * * * * * * * * * ** *Water Meter Size:
RequiredLY
PLUMBING
� l n
Plumbing Contractor's Name: j , , t d 7/ : yi Business Name: tlL X6_111
Address City State Zip ,
Contact Phone: ( ) Business Phone: ( )
Email Fax
FIXTURE COUNT (includingrougbed fixtures
Clothes Washing Machine Sprinklers
Dishwasher i t Tub /Showers
Floor Drain S Toilet /Urinal
Garbage Disposal i Water Heater
Hot Tub /Spa _� Water Softener
' Sinks (Lavatories, kitchens, bar, mop)
Plumbing Estimate $ (COMMERCIAL /MULTI - FAMILY ONLY)
_ C /00 - g 10
Signature of Licensed Contractor License Number& Expiration Date Date
The City of Rexburg's permit fee schedule is the same as requ by the State of Idabo
Ell
Please complete the entire . P A p p lication!
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required Y
MECHANICAL
Mechanical Contractor's Name Business Name '�C3 Vil V IJa4�j N r� �9.1
Address P . 6. t 7 $� City J, X ff Uo G— State Zip 034W
Cell Phone ( ) Business Phone ( ) 077
b
Fax ( ) 7 7 i5� Email
Mechanical Estimate $ (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
L Furnace � S
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance tS
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets 3,v
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Oil Coal Fireplace Electric Hydronic
- 7 D
Mechanical Sizing Calculations must be submitted with Plans & APPlication
Point of Delivery must be shown on Plans
/J�� e
, P 4 & - 4m
Signa of Licensed Contractor License number
The City of Rexburg's p ermit fee schedule is the same as
0
Date
the S tate
Exhaust or Vent Ducts i n
Dryer Vents 16
Range Hood Vents
Cook Stove Vents
Bath Fan Vents l S
other similar vents & ducts:
5
Building Safety Department
City of Rexburg
19 E Main jonellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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�<D
C I T Y OF
REXBURG
Americas Family Community
OWNER'S NAME
PROPERTY ADDRESS
SUBDIVISION
PHASE LOT BLOCK
Permit#
HOME O ti NER'S ELECTRICAL PERMIT
Home Owner's Name
Address City State Zip
Cell Phone ( ) Home Phone ( )
Fax ( ) Email
TYPES OF INSTALLATION
(New Residential includes everything contained within the residential structure and attached garage at the same 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 Home Owner Date
The City of Bexburg',r permit fee schedule is the same as required by the State of Idabo
0
Building Safety Department 4 V-,XBU R � f
City of Rexburg �
19 E Main jonellh @rexburg.org Phone: 208.359.3020 x326 *,
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
C I T Y OF
REXBURG
- .,.__ nv --- --------
America's Family Community
OWNER'S NAME V\�O �LQCX,Y—
PROPERTY ADDRESS Permit #06 00564
`1 q W Cn n� l 1
SUBDIVISION ttrLTn,'0Yl 796 Griffin St
PHASE ; > LOT } Q BLOC
RequlredMf ELECTRICAL
I
Electrical Contractor's Name ` r 1, Business Name
Address 1
Ls � �41 City i� State - 1� Zip
Cell Phone (a;O 7((--, (H Z c ) Business Phone Vt 9) 3 L -- C ,7 L
Fax (ae ` &�;q — Ci ,7 C.1( Email
Electrical Estimate (cost of wiring & labor) $ (COMMERCIAL /MULTI - FAMILY ONLY)
TYPES OF INSTALLATION
(New Residential includes everything contained within the residential structure and attached garage at the same tune)
A 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
*Inclu es a maximum of 3 ' spections. Additional inspections charged at requested inspection rate o f $40 per hour.
' c �2 i GEC-
Signature of Licensed Contractor License number Date
The
schedule is the same as required by the State of Idabo
7
momm ) ............. 0 ............................
SUBCONTRACTOR LIST
Excavation &Earthwork: kj; I ( j 5 c>r. � x• 4, �, .
Masonry: T i�j e l w , A
Roofing:
Insulation:
Drywall: e Z l �V
Painting 1 . �. �'� �� . , . 4
Floor
Heating: 6C r> r : 14)�
Roof T
Special Construction
(Manufacturer or Supplier)
Floor /Ceiling Joists: P i - T'1 (-_ t-t_:`v'o!!
Siding /Exterior Trim: � il 1, i _ (1 - -� 7
EXEMPTI*gS FROM STATE REASTRATION
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
Print Name
Date
1 G