HomeMy WebLinkAboutAPPLICATION, CO, BP - 07-00061 - 1076 Green Willow Dr - New SFRZ
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O� REXBURC �
5
CITY OF Certificate of Occupancy
REX
Americas Family Community
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
P
359 -3024
Building Permit No:
Applicable Edition of Code:
Site Address:
Use and Occupancy:
Type of Construction:
Design Occupant Load:
Sprinkler System Required:
0700061
International Residential Code 2003
1076 Green Willow Dr
Single Family Residence
Type V -N, Unprotected
Residential
No
Name and Address of Owner: Barton Tyler Joseph Etux
540 Commanche Dr
Rexburg, ID 83440
Contractor: Owner /Lessee
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 with the requirements of the code
for the group and division of occupancy and the use for Mich the proposed occupancy vies
classified.
Date C.O. Issued: November 14, 007 (03:39 M)
C.O Issued by:
G�
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: G I
Fire Inspector: n'GL
Electrical Inspector: P&ZAdministrator: LL
CITY OF REXB URG • PERMIT # , I Rn E LT � d ,#
BUILDING PERMIT APPLICATION Plea
I
19 E MAIN, REXBURG, ID. 83440 If the 1 070
208 - 359 -3020 X326
�� �� �� ���� 1076 Green Willow Dr- Barton
PARCEL NUMBER:
SUBDIVISION: i �aw b ooy. UNIT# BLOCK# LOT# (P
(Addressing is based on the information - must be accurate)
1 1 (o C-_7 r-P.e lrn U ) i I � n w r
ACT PHONE # 35Z,—g331 Lv 3 13
PROPERTY ADDRESS: 1 07 �p C-)rf,,�n Vy 111aAJ br,
PHONE #: Home ( ) �S?P 1Y33C1 Work ( ) _a 1 e 3Z25_ Cell( ) 3 i 3 — I B i'
OWNER MAILING ADDRESS: 5 C MG ur - CITY: TATE: U) ZIM §3
EMAIL ka ~rout @ J 37-1. LIZ , ,d .as as 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
MAILING ADDRESS: CITY
PHONE #: Home (
EMAIL F.
ATE ZIP
Cell ( )
IDAHO REGISTRATION # & EXP. DATE
How many buildings are located on this property ?.
Did you recently purchase this property? No es )If yes give owner's name) _1\1 I er 4 j ka ree. 1P`tL*1
Is this a lot split ?® YES (Please bring copy of new legal description of property)
PROPOSED USE: `S� rya1 -\ m
(i.e., Single Family Residence, Multi Family, Apartments,
Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt of perjur 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 Wsesof ' lse !state or misr presentation of fact in the application or on the plans on which the pernut or approval was
based. Permit voi hin da Pe void if wor ops for 180 days.
7
Signature of er/ licant DATE
Do you prefer to be contacted by fax, email phone. Circle One
WARNING — BUILDING PE ST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid in full at the time of application beginning januaix 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**
Work (
2
Bull
19 E. Main
Rexburg, ID 83440
g Safety Department
City of Rexburg
ionellh @rexburg.org Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3024
OF REXBUkC
CITY OF
REXI3
America's Family Community
Affidavit of Legal Interest
State of Idaho
County of Madison
13a�f�
Name
Cit
Being first duly sworn upon oath, depose and say:
I
FE`' 2 J e�J7 E l
CITY OFECu
�c�'p C � � c R G
Address
ldei- k
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 subject off� ^ the� application.
Dated this day of /— ice .20 07
Signature
Subscribed and sworn to before me the day and year first above written.
VAR / //y Notary Public of Id ho�
-it' 140TARY ss Residing at:
i My commission expires:
ROJO
4 � 1
y r
3
Please complete the f tire A lication!
p pp
NAME f V 1 ff 4, - S ha re - e— ba r fm
PROPERTY AD RESS jo X 7(0 6reeri w, l loul bl''- Permit#
SUBDIVISION JA, i I )ou]
Dwelling Units: Parcel Acres: + /Z—
SETBACKS 1
FRONT 2-5 SIDE SIDE 0 I BACK . `15
Remodeling Your Building/Home Estimate) $
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area I & /15� Unfinished Basement area
Second floor /loft area Finished basement area I & / O 5
Third floor /loft area Garage area q j (7
Shed or Barn Carport /Deck (30" above grade)Area
Water Meter Quantity:
* * * * * * * * * * * ** *Water Meter Size: .li
Requiredffl
PLUMBING
Plumbing Contractor's Name: L) o it Business Name:
Address City State Zip
Contact Phone: ( ) Business Phone: ( )
Email Fax
FIXTURE COUNT (including toughed fixtures
Clothes Washing Machine 56l e tprinklers
Dishwasher 2— Tub /Showers
I
Floor Drain
Garbage Disposal
Hot Tub /Spa
` Sinks (Lavatories, kitchens, bar, mop)
Plumbing Estimate $
Toilet /Urinal
Water Heater
Water Softener
(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
El
Please complete the entire Application!
NAME S Y`tw
PROPERTY A DRESS 1 'QW bf
SUBDIVISION W'► IOW RjV
other similar vents & ducts:
Requiredffl
MECHANICAL
Mechanical Contractor's Name V wU1e,4 Business Name
Address City State Zip
Cell Phone ( ) Business Phone ( )
Fax ( )
Mechanical Estimate $ (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
_ Boiler 3 19'
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) < as Oil Coal Fireplace Electric
Mechanical Sizing Calculations must be submitted with Plans & A lication
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The City of
Exhaust or Vent Ducts
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
License number
schedule is the same as
Permit#
Date
the State of Idaho
Building Safety Department a FAiXB �
� � CITY O F
City of Rexburg n TVnT mG
1\.G1�1� V 1\
Ow ---- _-----
T__
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 Ty kx- 4 f`�hc r'�ee r tv)
PROPERTY ADDRESS I D tp 63 rIn[� OW 6 f Permit#
SUBDIVISION p
PHASE LOT BLOCK
RequiredN
ELECTRICAL
Electrical Contractor's Name C 1 QYTV OLLJ &9r 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 attachedgarage 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'r permit fee schedule is the same as
Date
the State of Idaho
7
■ ■R ■. ■r ■. ■.: ■ ■ ■ ■.... ■ ■ ■ ■ ■ ■. ..■■■■■.■...■■■■..■■■...■■■■ ■. *............................
Excavation &
SUBCONTRACTOR LIST
Concrete: R--7 C h 51Ytticfi ✓► - 5 - e:i- 8e,linn n ZZ 1 - o 3Z
Masonry:
Roofing: 0 yj V) e,-Ar
Insulation: I U V C
Drywall: e /—
Painting: O W n ems —
Floor
Coverings:
Plumbing: n w ne r-
Heating:
Electrical: eyr
Special Construction
(Manufacturer or Supplier)
Roof Trusses: ` u VY m It - Er'wsS &Zq -0j
Floor /Ceiling joists: Z-t CPA)hC C
Siding /Exterior Trim: ' 7 - et ��
EXEMPTI(*S FROM STATE REC*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
V,✓ 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)�eyffify tl#t the above information is true and correct to the best of my knowledge.
6Z
Date
T �4 Sharec H
Print ame
0
Building Safety Department opgxspR CITY o F
City of Rexburg � rXBV1� ll rvnT mG
19 E Main janellh@rexburg.org Phone: 208.359.3020 x326 America's Family Community Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
OWNER'S NAME TWer 0 6haree 6arh✓1 Permit # 07 00061
PROPERTY ADDRESS' 10 Greel1 UJ lla,)
I� Pr-
SUBDIVISION Wil low &D09- 1076 Green Willow Dr
PHASE LOT BLOCK
HOME OWNER'S ELECTRICAL PERMIT
Home Owner's Name T 8a t - t 3Y1
Address 5L10 coo aV1CldP.i - City State zip '93 I Nh
Cell Phone (2J) e- l r 3 — 3 2.2, Home Phone � °J
) 3 `J� —� 33
Fax Og) 35 —a �,2 ] Email Y� a r t c 3Z,1. ICI Z. - id - uS
TYPES OF INSTALLATION
(New Residential includes everything contained within the residential structure and attachedgarage 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, Sw immin g 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.
U Signature of Home Owner
The
schedule is the same as
DZ -/6 -a7
Date
the State
n