HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 07-00011 - 1120 Green Willow Dr - New SFRZs
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CITY O F
REX
Americo Family Community
Certificate of Occupancy
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
020 / Fax
Building Permit No: 0700011
Applicable Edition of Code: International Residential Code 2003
Site Address: 1120 Green 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: Alan Fransen
707 S 5th W Suite 1001
Rexburg, ID 83440
Contractor: Clark Brothers Builders
Special Conditions: Unfinished basement
• ja.s wA-ter heAJw iii bat�me
fa be - inspcefe..V ;�c
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 Kes found to be in compliance vWth the requirements of the code
for the group and division of occupancy and the use for vihich the proposed occupancy v►es
classified.
Date C.O. Issued: September 14, 2007 (10:57AM)
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.
Plumbing Inspector:
Electrical Inspector:
Fire Inspector: 0
P &Z Administrator: V 10—
Bull
ng Safety Department
City of Rexburg
19 E Main
Rexburg, ID 83440
janellh@rexburg.org Phone: 208.359.3020 x326
www.rexburg.org Fax: 208.359.3024
aF R�xaoR�
9
U �
C I T Y O F
REXBURG
Americas Family Community
OWNER'S NAME
PROPERTY ADDRESS n2.1
SUBDIVISION � f \\ jam!
PHASE r LOT BLOC
Permit #07 00011.
1120 Green Willow Dr
Required!!!
ELECTRICAL
Electrical Contractor's Name S 4 y%o Z 6;�O Business Name
I L.
Address 13 AA S G D City State Zip 8 3RD
Cell Phone (zaj) 3 Business Phone (U V) 6,5 Z S7- - S
Fax ( ) 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 time)
I� 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 0 f fie V n#1 c istEc
and no additional wiring)
Modular, Manufactured or Mobile Home pp�
Other Installations: Wiring not specifically covered by an f e al�bb'� � 2 2007
Cost of Wiring & Labor: $
Pumps (Domestic Water, Irrigation, Sewage C �Ty 0 F R EXB U R G
Requested Inspections (of existing wiring)
Temporary Amusement /Industry
*Includ a aximum of 3 inspecti ns. Additional inspections charged at requested inspection rate of $40 per hour.
Signature of Licensed Contra x License number
The
schedule is the same as
Y- 13 -0
Date
the State of Idabo
h
A
Building Safety Department a FA�Xg�R�,
City of Rexburg �� y
s'. o
19 E Main jonellh@rexburg.org Phone: 208.359.3020 x326 4
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
C I T Y O F
REXBURG
Americo Family Community
OWNER'S NAME &!G-
PROPERTY ADDRESS
SUBDIVISION _4zz(d4
PHASE ,T LOT — V BLOCK_
Permit #07 00011
1120 Green Willow Dr- Fransen
Requiredffl
ELECTRICAL
Electrical Contractor's Name ���Z11fle t -� �� +-�. e l ./ Business Name
Address X / ;Z City Lf / State Zip
Cell Phone 2e, 5 W 7150 Business Phone 7 2--.
Fax (Z �•� Ema>l
Electrical Estimate ( cost of wiring & labor $ (0590 Irk (COMMERCIAL /MULTI - FAMILY ONLY)
TYPES OFINSTALLATION(RESIDENTIAL)
(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*
L -..
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 Lice ise num er Date
The City of Rexburg s permit fee schedule is the same as required by the State of Idabo
VA
CITY OF REXB URG PR R N4 T'T tk
BUILDING PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If the ques 0700011
208 - 359 - 3020 X326 1 1120 Green Willow Dr- Fransen
PARCEL NUMBER �1��( c ,.� X,
SUBDIVISION: I� 16V/ kbD L ES '-)'I S UNIT# Y) BLOCK# _LOT#
(Addressing is based on the information - must be accurate) ¢ ! n _ n r _ r it
PROPERTY ADD
-�. (o N
CONTACT PHONE #
PHONE #: Home (pv,) 5 ,L 1 . ;2,::z , . Work () -� q Z Cell
OWNER MAILING ADDRESS: 161 S&a & 6 -ICJ. 1JA1061 CITY: 2 b t_ g STATE:E9ZIP: 8344
,a
EMAIL .,t�20 I - 1 (d7 gcnr, r{cs1 FAX
APPLICANT (If other than o wner) N I a
(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: 33�5 E_ • 1 i3QC N . CITY �)�V1 STATE i b ZIP _b34�
PHONE #: Home ( ) U - Work ( ) S?IM e Cell ( ) I - 5 5 - 7 3
EMAIL FAX I � J IDAHO REGISTRATION # & EXP. DA
now many buildings are located on this property?
Did you recently purchase this property? No 'e (If yes give owner's name) A<�Y- A
Is this a lot split? NO YES (Please bring copy of new legal description of pro ,J
PROPOSED USE: I W 1c Fc' m 1 S� 66 n E C E 0 V E
(i.e., Single Family Residence, Mxlti Family, ApartnwAts, Remodel, Garage, Commercial, Addition
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: dl� enal4 perLbe'gWiven �Ay ce
that I have read this application and state that the information herein is correct and I swear that any informati n whi h may hereaft by e in
hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall bet hful a th all
City regulations and State laws relating to the subject matter of this application and hereby authorized represe to e o t 5ve-
mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approv s j}�jii
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. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of Owner /Applicant I ��—
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 TanuarX1, 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
BuilAg Safety Department 4 V EXB�R� a CITY a F
City of Rexburg '� .� �-.�T mG
OW
' o i� lJ 1�
19 E. Main janellh @rexburg.org Phone: 208.359.3020
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 Arnerica'sFamilyCommuniry � ' "`°
State of Idaho
County of Madison
I,
Name
Affidavit of Legal Interest
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 sub)ect 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:
Address
3
"Building Permit Fees are due at time of application" "Building Permits are vo' if you check does not clear"
Please complete the eAre Application!
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Dwelling Units:
Parcel Acres:
SETBACKS
FRONT SIDE SIDE
Remodeling Your Building/Home (need Estimate) $
Permit#
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area
Second floor /loft area
Third floor /loft area_
Shed or Barn
Unfinished Basement area
Finished basement area_
Garage area
0" above
Water Meter Count:
ANN
Water Meter Size:
Required!!!
PLUMBING
Plumbing Contractor's Name: z,r yt.vt . Business Name:
Address 76`7 .T Z ;a ..i City e State .� o Zip .
Contact Phone: ) '�" -- 9,`3 y 2 Business Phone: ( )
Email
FIXTURE COUNT (including roughed flxtures)
2 Clothes Washing Machine
i Dishwasher
_ 2 Floor Drain
T Garbage Disposal
Q Hot Tub /Spa
5 Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $
(Commercial Only)
Sprinklers
_ Tub /Showers
Toilet/Urinal
Water
Water
E C A
Required! Sig na ure of Licensed Contractor License number Date
The City of Rexburg permit fee schedule is the same as required by the State of Idaho
Fax
0
Please comp lete the Atire A lication!
p pp
NAME rLiiGS�� -
PROPERTY ADDRESS if z 4 4!),�ehe a Mint) a/,
SUBDIVISION f�r"&7 ;3r:ra i �S�S
Dwelling Units:
Parcel
0
Permit##
SETBACKS J7 / tf
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 1 0 Unfinished Basement area
Second floor /loft area Finished basement are
Third floor /loft area Garage area C 15
Shed or Barn Carport /Deck (30" above grade)Area
Water Meter Quantity:
1211 I 1
* * * * * * * * * * * ** *Water Meter Size: .
Required!Y
PLUMBING
Plumbing Contractor's Name: Business Name:!
Address '726k / L29 f �1 2 City tc at State Zip
Contact Phone: t5 ? 76? Business Phone: ( ) It
Email Fax SZ`Q - 7T(
FIXTURE COUNT /inclu&n_a rou_hed fixtures
_: klothes Washing Machine Sprinklers
Dishwasher Tub /Showers
d oor Drain Toilet /Urinal
Garbage Disposal Water Heater
Hot Tub /Spa Water Softener
Sinks (Lavatories, kitchens, bar, mop)
Plumbing Estimate $ (COMMERCIAL /MULTI - FAMILY ONLY)
=kc
Signature of Licensed Contractor License Number& Expiration Date D to
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
4
Please complete the entire A p p lication!
NAME 41A�Lk
PROPERTY ADDRESS Q �-
SUBDIVISION 4)41 .J 3hzli . sg GS
0
Permit#
RequiredN
MECHANICAL
Mechanical Contractor's Name Xbixa1 � u l�blho► q usiness Name Vr //�
Address City State ` Zip L ?`71
Cell Phone c^1 Business Phone ( ) ' K7 76
Fax b7,(r� Email
Mechanical Estimate $ 2,0._ (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace
Furnace /Air Conditioner Combo J,<`
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Exhaust or Vent Ducts 6
/ Dryer Vents
Range Hood Vents 6
Cook Stove Vents
3 Bath Fan Vents ( ,S
other similar vents & ducts:
14
? Fuel Gas Pipe Outlets including stubbed in or future outlets Z,5
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.
' L& ZZ "Ar--_ .- C'- /K i 2 - w-
Signature of c sed Contractor License number Date
The City of Rexburg s permit fee schedule is the same as required by the State of Idabo
5
Building Safety Department �a REXBUpq C IT Y OF
City of Rexburg 'y --
° REXBURG
Ow I-,,--,-- _ --
19 E Main janellh@rexburg.org Phone: 208.359.3020 x326 Americas Family Community
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
OWNER'S NAME I-Ce,r -,-
PROPERTY ADDRESS itj o reJeg t rte, Dc.. Permit#
SUBDIVISION 6y4" $rer, L zah- cS
PHASE _� LOT BLOCK
HOME OWNER'S ELECTRICAL PERMIT
Home Owner's Name
Address City State Zip
Cell Phone ( ) Home Phone ( )
Fax ( ) Email
TYPES OFINSTALLATION(RESIDENTIAL)
(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 Rexburg's permit fee schedule is the same as required by the State of Idaho
G
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete: LAnb VVCVb
Roofing V `► '
Insulation:
Drywall:
Painting:
\Nall
Floor
Coverings:
Special Construction
(Manufacturer or Supplier)
Roof Trusses: YV*I- �-
Floor /Ceiling Joists- O "tv w-;y.
Siding /Exterior Trim: ZZVV` (
Other:
EXEMPTI(WS 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
E