HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 07-00012 - 1094 Green Willow Dr - New SFRZ .� G)
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CITY OF
REX
America's Family Community
Certificate of ftcupancy
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Phone (2081359 -302(l / Fax ( '2nR1 35Q - Rn1
Building Permit No:
Applicable Edition of Code:
Site Address:
Use and Occupancy:
Type of Construction:
Design Occupant Load:
Sprinkler System Required:
Name and Address of Owner:
Contractor:
Special Conditions:
Occupancy:
0700012
International Residential Code 2003
1094 Green Willow Dr
Single Family Residence —
Type V -N, Unprotected
Residential
No
Taylor Justin
12939 N 65th E
Idaho Falls, ID 83401
Owner
1287 sq ft unfinished basement
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 Aith the requirements of the code
for the group and division of occupancy and the use for Mich the proposed occupancy Kes
classified.
Date C.O. Issued: Septem 1, 200 1 5AM)
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.
Ins pector: Plumbinq nr: " Aw". L
Electrical
Fire Inspector: n' a-
P&Z Administrator: `n to
T
^ 04 pEXB URCl7
U�
'•f f �MfD
CITY OF
REXBURG
America's Family Com,nunh
Certificate of Occupancy
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Building Permit No:
Applicable Edition of Code:
Site Address:
Use and Occupancy:
Type of Construction:
Design Occupant Load:
Sprinkler System Required:
Name and Address of Owner:
Contractor:
0700012
International Residential Code 2003
1094 Green Willow Dr
Single Family Residence
Type V -N, Unprotected
Residential
No
Taylor Justin
12939 N 65th E
Idaho Falls, ID 83401
Owner
Special Conditions: 1287 sq ft unfinished basement
P rcd (�r ire S b be, i nS lle '
Witl��n �;o daq. '
Occupancy: Residential, single family dwellings, lodging houses
This Certificate, issued pursuant to the requirements of Section 909 of the Intemational Building
Code, certifies that, at the time time of issuance, this building or that portion of the building that
was inspected on the date listed vies found to be in compliance with the requirements of the code
for the group and division of occupancy and the use for which the proposed occupancy vies
classified.
Date C.O. Issued: Septem 1, 200 1 5AM)
C.O Issued by:
WIN
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.
Electrical Inspector. .t�tA
Fire Inspector:
P &Z Administrator: n l L
•
"CITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X326
•
Please 0700012
If the ques 1094 Green Willow Dr- Taylor
PARCEL NUMBER• (We will provide this for you)
SUBDIVISION: \�\\OW `P�r Q�� �✓ UNIT# BLOCK# 4 LOT #
(Addressing is based on the information - must be accurate)
OWNER NAME QC CONTACT PHONE # U413 - C,ogc,
PROPERTY ADDRESS: MA Q" Vv \,��YV �(oV p '��lr�� 253�4D
PHONE #: Home (to{,) (;AA-(J2_0) Work (10$) 3r2(Q' ?�CD Cell (t,) 'log - 5O9G,
OWNER MAILING ADDRESS: N3 Gl'�^ ! . CITY: l STATE: k�) ZIP: :�3401
EMAIL ' iA ( FAX &(i) n Zb (029!,
APPLICANT (If other than owner) \1C Vy T t 1pf
(Applicant if other than owner, a statement authorizing applica t to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS \ 26A ?4 N. epCAV, F . CITY:
STATE; ZIP EMAIL C�a►w �A c j2 - Co 6 GQ�
PHONE #: Home (��) G�2Qj 29 Work ('�*) -3Gj(Q_ 3DA 1 Cell (I,%) look - C101{G
CONTRACTOR
MAILING ADDRESS:
CITY STATE ZIP
PHONE #: Home ( ) Work ( ) Cell ( )_
EMAIL FAX IDAHO REGISTRATION # & EXP. DA'
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's nam
Is this a lot split? G) YES (Please bring copy of new legal description p erty��
PROPOSED USE: '5�dv\,A o, �iwvvl� \ wn t?vc l �� 0 inr o
(i.e., Single Family Residence, Multi Family, Ap4r1 Remodel, Garage, Commercial, A V
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt of pe 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. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of Owner /Applicant DATE
Do you prefer to be contacted by fax, email or one Circle One
WARNING — BUILDING PE UST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid in full at the time of application beginning J anmgov 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
Bull
g Safety Department
City of Rexburg
19 E. Main
Rexburg, ID 83440
ioneiih@rexburg.org Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3024
O F *VXaI) *
�4 �O
�o
CITY OF
REXBURG
Americas Family Community
Affidavit of Legal Interest
State of Idaho
County of Madison
-"aw► �or
Name Address
\— A)1)
City
Being first duly sworn upon oath, depose and say:
� MI o
State
(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.
u ♦l�
Dated this 1 day of 3 a'-j wa.- , 20 01
Signature
Subscribed and sworn to before me the day and year first above written.
GINGER BOTT Notary Public of Aaho
Notary Public
Staic of Idaho Residing at:
My commission expires: /0'
3
• •
Please complete the entire Application!
-�^ If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS NW W 4 NVe) Permit#
SUBDIVISION
Dwelling Units: , Parcel Acres:
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 �b * Unfinished Basement area 20
Second floor /loft area 0 Finished basement area _ n
Third floor /loft area 0 Garage area ( 649-2
Shed or Barn 0 Carport /Deck (30" above Prade)rlrea
Water Meter Quantity:
* ** * * * * * * * * ** *Water Meter Size:
Require&. f
PLUMBING / �[
Plumbing Contractor's Name: Business Name:
Address �� ���A Ci �yh �� State l Zip FSKO,
Contact Phone: Wz 317 1061 Business Phone: (24f) 5Z3 -gF7,F_!F
Email Fax D 2 - O 4 1 - v 6
FIXTURE COUNT (including toughed fixtures)
Clothes Washing Machine
Sprinklers
Dishwasher
Tub /Showers
� J
Floor Drain
Toilet /Urinal
/
Garbage Disposal
Water Heater
—'
Hot Tub /Spa
Water Softener
Sinks (Lavatories, kitchens, bar, mop
Plumbing Estimate $ (Commercial Only)
Signature of Licensed Contractor License Number& Expiration Date Date
The City of Re,'�•burg s permit fee schedu is the same as required by the State of Idaho
11
Please co lete the entire Ap
P Pp
4 m
NAME�STI
PROPERTY ADD S L_).
SUBDIVISION
0
Permit#
Requiredffl
MECHANICAL
Mechanica
�� f l Contractor's Name // 2/22 d��e� J�� ,6 4 usiness Name
Address ����t A City 6 4 4 State Zip 3 -Z
Cell Phone (oRM _ IS - ArD,V- / Business Phone ( ) 313
Fax ( 2 2 7 - Q/ Email
Mechanical Estimate $ l D� (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts /a
Furnace /Air Conditioner Combo Dryer Vents i S
Heat Pump Range Hood Vents
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fixed appliance
Incinerator System
Boiler
Pool Heater
Cook Stove Vents
_�— Bath Fan Vents zo
other similar vents & ducts:
Fuel Gas Pipe Outlets including stubbed in or future outlets 3�
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & At)ylication
Point of Delivery must be shown on la_ s
Signature of Licensed Contractor License number Date
The City of Bexburg's pemit fee schedule is the same as required by the State
5
SUBCONTRACTOR LIST
Excavation & Earthwork: 6_14 �_ L. f—
Masonry: &__,,j C_
Insulation: d
Drywall:
Palntina-
Floor
Coverings:
Plumbing:
Heating:
Electrical: \c - ,
Special Construction
(Manufacturer or Supplier)
Roof Trusses: - Tr�
Floor /Ceiling Joists: ".,�
Siding /Exterior Trim:
Other:
8
EXEMPTI WS FROM STATE RECWTRATION
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.h tm )
❑ 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.
` 1 /A /0
Signature U
lam,
Print Name
O
s
Building Safety Department
City of Rexburg
19 E Main jane11h @rexburg.org Phone. 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359 3024
A.
CITY OF
REXBURG
America's Fandly Connnanity
OWNER'S NAME J&� ry
O Z
Permit #07 00012
1094 Green Willow Dr- Taylor
Requiredffl
ELECTRICAL
Electrical Contractor's Name _5E-1— 61 e&; Business Name -54 45'
Address 1 )< 396 City A44' IQ �S State —1:71 Zip 9
Cell Phone (70s) 7 0 9 0 56 Business Phone ( ) 51 e-
Fax ( Zag) Email Lei e e-A rlc 0 V,2406. C'ot-I..
Electrical Estimate (cost of wiring & labor) $ (COMMERCIAL /MULTI- FAMILY ONLY)
TYPES OF INSTALLATION (RESIDENTIAL)
(New Residenaaf mcludes everything contained within the mssidendal structure and attachedgarage at the same tithe)
X Up to 200 amp Service*
201 to 400 amp Service*
Over 400 amp Service*
X Temporary Construction Service, 200 amp or less, one location (for a period not to exceed I 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 Inspecti�)ns (of existing wiring)
Temporary Amusement /Industry
*Includes a maximum pf 3 inspections. Additional inspections charged at requested inspection rate of $40 per hour.
.r-
Signature of Licensed C tractor License number ate
The City of Bexbmrg's permit fee schednk is the same as regra by the State
7