HomeMy WebLinkAboutAPPLICATIONS, CO, MULT DOCS - 07-00028 - 265 Polo Dr - New SFRZ
00
V
�
O
7
�
v
C
z
fR
m
_=
'
CD
� K y
W n��
0
�.
m m
N
nrt(
�
v
;u
`C x
o
O
o
�
m
co
(D
2
(
�
rn
2
(D
M
A
N
cr
F Z 'O 0. D
oo0CD -0
3
C
D
� N
'a o
y
��
m
v m a 3 3
.
z
O
0
C
= A
3
tv
O
_
v � F
m
al rt
H
co m
F �, a
O
n
_
0 .
A/ O <D
m
C
T
N
Q
N
o<0
CD m a
0
�
c� - a i 0 5'�
N 3 E .O+
25' a� f
0 0 0 B
O
;a
Z
Q ' O Q ' O
rr N S N
7 �- ? N
C
�'► e�.F
O
3Mm w C
_ CD f0
C
�'
M
Qo y; N m
Q
"�
ca��
S
-I
v
Z
Q. <D
o
W
N
CL
c
V1
_c
N
7
co -0 a C CL
= 3
.
Q
�D
W
n
CD
?
W
-1
o
m
. f Q. O 3
oa��
o �
W
°
cc
2L CD
Z
D"
0 C.
fD fD
a m
O
n 3
Z
G)
--I
O
7
`< a
mQf
m
rrl
�`
0��
:3 << 3 E. o
m °—' w °
X
�_
7 3 3
Cl Cl lC
CE Z0'co S
O O 0 c-
: l
C>
C
.�-'/�
O O
R N N O N
.Di
Q. e.►
S
O
0
Z
m o
' CD O
m m o.
O
oc�
1 M 0
Qr � 0 3c r'F
7
o
-- 3 v
0
N
cD
CL
0 °= 0
M
7 3
T. O C7 0
SL
m
N
w lD
C _» a
n
Q
�
M 0 Z 's �y0
M X
M -i m CO) m x
fl1 c �C
m
0 n n � 0 -
O O
Z Z
4 n A"
O
O ?.
Z
o . m o o
iU � ►� 1
0 al ►�1 f
O .'
0
o O
C:)
N
0
O
0
x
0 �� •
C:) *om it
g
X
m
CA
0) •
cn C:)
0 •
0 r\) "! or
00
a
o
00
V
�
7
�
o
C:
O
�
p
O
z
fR
m
A
v
'
0
7
T
0
�.
�
v
;u
m S
T m
O
o
�
m
(D
�
M
A
N
V
C
CD
_
0 .
_�
c� - a i 0 5'�
�1
�
CD
�p
O
3Mm w C
M
Z
v =
CD
c
W
n
Zoo ° z
?
cc
c
T ty
v
CO) C (00
z
Z
D
n Z O O
N C� O
o�,
oc�
1 M 0
Qr � 0 3c r'F
N
N
z00 ° = a
� v,
N
Q
a
00
V
�
7
�
o
C:
O
�
p
O
m
A
v
'
0
7
T
0
�.
�
v
;u
00
V
�
7
�
o
C:
O
�
p
O
m
O
o
v
A
v
n
v
�
v
;u
(D
�
^ 04 gEXBURCl9
�e<
CITY OF
REX
Americas Family Community
Certificate ofeccupancy
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
/ Fax
Building Permit No: 0700028
Applicable Edition of Code: International Residential Code 2003
Site Address: 265 Polo 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: Haycock Mason
168 Harvard
Rexburg, ID 83440
Contractor: Nomarco Inc
Special Conditions:
Occupancy: Residential, single family dwellings, lodging houses
This Certificate, issued pursuant to the requirements of Section 109 of the Intemational 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 vtith 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: August
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 Inspe ire Inspector:
Electrical Inspector: P&ZAdministrator: '
23� (12:23PM)
Building Safety Department o4 atiXBV R � ,
City of Rexburg �; y
^ Q o
79 E Main janellh@rexburg.org Phone: 208.359.3020 x326 ,r•
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
CITY OF
MXB
Americas Family Community
OWNER'SNAME NA1S n t Permit #07 00028
PROPERTY ADDRESS 6 1010
SUBDIVISION 265 Polo Dr
I���e���a�
PHASE LOT BLOCK I
HOME OWNER -S ELECTRICAL PERMIT"
Home Owner's Name M lk'&Q tJ 4 A v WCA -
Address
Cell Phone (
Fax (
City State Zip
Home Phone (
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 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: $ :Z Q00
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.
-': Z_
ature of Home Owner
The
schedule is the same as
Date
the State of Idaho
31
0
0
CITY OFxEXBURG 0700028
BUILDING PERMIT APPLICATION Please c
19 E MAIN, REXBURG, ID. 83440 If the questi 265 Polo Dr- Haycock
208- 359 -3020 X326
PARCEL NUMBER - ff) (We will provide this for you)
SUBDIVISION: REOzu'sot l UNIT# BLOCK # LOT# 13
(Addressing is based on the information - must be accurate)
OWNER NAME kAI,Si)hl CONTACT PHONE #
PROPERTY ADDRESS: (.-y`r - PC) I 0 D �
PHONE #: Home ( ) Work (S51) 30--:5 Cell ( )
OWNER MAILING ADDRESS: I U! JJ11g_VA,1Zj:� AJ -. CITY: PCARuP6, STATE: -1 h ZIP: V `f `
EMAIL jN�:S:��1 _y C CY' �: EJ ca�1 t Z' , G�` ►yt FAX
APPLICANT (If other than owner)
(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 Ok 1-,� 0 pJAK C O L
MAILING ADDRESS: 176 E M, CITY iZexocoz_6 STATE 11 ZIP g ii /iic
PHONE #: Hotn L� 5�� , Work (2cy) 'W - 301, Cell ( )
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE
How many buildings are located on this property?
Did you recently purchase this property? No ( (If yes give owner's name) MhS®1J k%{c,Qe.—,
Is this a lot split? YES (Please bring copy of new legal description of property)
PROPOSED USE: i t`1Cn Lr - j;ytA t L_1e �t5 i�c►J C
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt of perjur I hereb certif
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.
Vi / -:2 —/
Sigry6ideXf Owner /Applica e _ 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 Januaix 1. 2009.
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
Build
19 E. Main
Rexburg, ID 83440
Safety Department
City of Rexburg
janellh @rexburg.org Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3024
CITY OF
° REXBURG
F o Americas Family Community
Affidavit of Legal Interest
State of Idaho
County of Madison
I,
Name
Address
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 subject of the application.
Dated this
day of
Signature
Subscribed and sworn to before me the day and year first above written.
20
Notary Public of Idaho
Residing at:
My commission expires:
Please complete the Antire A lication!
P PP
NAME
PROPERTY ADDRESS
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT
9
Permit# 61 C () O`a g
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 7 0Q sg, �C+ Unfinished Basement area
Second floor /loft area Finished basement area 1700 sr. t' 4
Third floor /loft area Garage area
Shed or Barn Carport /Deck (30" above grade)Area
Water Meter Quantity:
* * * * * * * * * * * ** *Water Meter Size:
Requiredffl
PLUMBING
Plumbing Contractor's Name: M05 IV 0 A I CO( IS, Business Name:
Address City State.
Contact Phone: ( ) Business Phone: ( )
Email Fax
FIXTURE COUNT (mcludWgroughed fixtures,
r Clothes Washing Machine g f'
Dishwasher
Floor Drain'
Garbage Disposal
Hot Tub /Spa
LP Sinks (Lavatories, kitchens, bar, mop)
Sprinklers
6' Ll Tub /Showers -
Toilet /Urinal -
Water Heater -
Water Softener
Plumbing Estimate $ cM Ov (COMMERCIAL /MULTI - FAMILY ONLY)
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
Zip
Signature of Licensed Contractor License Number& Expiration Date Date
4
Please complete the entire A p p lication!
P PP
NAME
PROPERTY ADDRESS
SUBDIVISION
0
Permit#
Required!fl
MECHANICAL
Mechanical Contractor's Name M1aU)t,) i 4q(0(/k Business Name
Address
City.
to Zip
Cell Phone ( ) Business Phone ( )
Fax ( ) Email
Mechanical Estimate $ (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace
Furnace /Air Conditioner Combo 3 5-
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance IS
Incinerator System
Boiler
Pool Heater
n s
�� Fuel Gas Pipe Outlets including stubbed in or future outlets f k � C�,
Inlet Pressure (Meter Supply) PSI
ZuM.�
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-al-ans.
Signature of Licensed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
Exhaust or Vent Ducts 15-
Dryer Vents 5
Range Hood Vents ii,-
Cook Stove Vents
H — Bath Fan Vents zo
other similar vents & ducts:
5
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
o � R �xeU A �
`� 9
v o
CITY O F
MXBURG
America's Family Community
OWNER'S NAME
PROPERTY ADDRESS
SUBDIVISION
PHASE LOT
BLOCK
Permit#
Requlred!►l
ELECTRICAL
Electrical Contractor's Name Business Name
Address City State Zip
Cell Phone ( ) Business Phone ( )
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)
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
The City of Rexburg's pe rmit fee schedule is the same as
Date
the State of Idaho
7
■ ■ ■.'... ■ ■. ■. ■ ■. ■. ■ ■ ■ ■ ■ ■ ■ ■..■ ■■■...■■■■■.■■■■■■■■..■■■■■■. ..0. ...........................
SUBCONTRACTOR LIST
Excavation & Earthwork: I V f'>Z M ZG O f I\�C-
Concrete: 30ill F-ilhL VICIi2 Gc�NS iZUCTit? 1
Masonry: Oi: MAKC)MIJ - 1
Roofing: ig Nl L W
Insulation: a MC.. W &8' r Drywall:
Painting: 1J i, W ARC, o I Q L .
Floor
Coverings: KJC �- 11 Al? Cel I r,X,
Plumbing: Iyt IBS ci nl lA H Y c V c r
Heating: MA-SQ P; 4A1 (oc j
Electrical: IkA, �C yC. k
Special Construction
(Manufacturer or Supplier)
Roof Trusses: 9 C- W c ST
Floor /Ceiling Joists: j3 l-kc - WL
Siding /Exterior Trim: i3 is C - Wk 5 i
Other:
• EXEMI'TIC*S FROM STATE REC'OTRATION
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.
Date
' to WS Q f� 14A' Ce)c. K
Print Name
W