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CITY of Certificate of Occupancy
REXBURG
— CW —
Americas Family Community
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Phone (2081359 -3020 / Fax (2081359 -3024
Building Permit No:
Applicable Edition of Code:
Site Address:
Use and Occupancy:
Type of Construction:
Design Occupant Load:
Sprinkler System Required:
0700098
International Residential Code 2003
651 Wheatland Cir
Single Family Residence
Type V, non -rated
Residential
IL70
Name and Address of Owner: Perkes Jacob R Etux
18371 Harney St
Elkhorn, NE 68022
Contractor: Kay, Jared
Special Conditions: �xcf -Rj - DIC[cc , ` 1 �- i S Y1fS :
, &d ��F n �s Vie -.
Occupancy: Residential - less than 2 units, permanent in nature
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 vtith 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: March 25 08 (09:23AM)
C.O Issued by:
00�00
1 _ - ro -0
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 Inspec Fire Inspector: in 10,
Electrical Inspector P &Z Administrator
CITY OF REXB UKG 0 P 9
BUILDING PERMIT APPLICATION Please co: 07 0009 8
19 E MAIN, REXBURG, ID. 83440 If the questioi
208 - 359 -3020 X326 651 Wheatland Circle -Kay
PARCEL NUMBER: K( (We will provide this for you)
SUBDIVISION: AAM5T 11L Jll 9T.5 UNIT# BLOCK# � LOT#
(Addressing is based on the information - must be accurate)
CONTACT PHONE #
PROPERTY
PHONE #: Home (
Work (
Cell ( ) 440 8U 8 1
OWNER MAILING ADDRESS: 10,25' WAST0000 lz�k STATE: 1D ZIP:
EMAIL .34KE Pf F Kf.S Q- 440'f k4AIL, . GOw% FAX 35 - 9 9SS
APPLICANT (If other than owner) :'A? -F D B . )ft
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS 9607 616'x4 4Uf- CITY: QfXB y?J
STATE; ZIP 83 EMAIL .14ZE01GFy6asmoze- N AAX 3ry-• l ,Ss y4
PHONE #: Home ( ) '' / f /o2 Work( ) 71(t - a3 7 4 Cell( ) 71(e
CONTRACTOR JAMr .4 S A30y
MAILING ADDRESS: CITY
STATE ZIP,
PHONE #: Home ( ) Work ( ) Cell ( )
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE A61 &80
How many buildings are located on this property? C>
Did you recently purchase this property? No 0 (If yes give owner's name)
Is this a lot split ?�rP YES (Please bring copy of new legal description of
PROPOSED USE: Or rUh q R- 8 2007
(i.e. tngle Family Resi Multi Family, Apartments, Remodel, Garage, Commercial, Additi
.a3.o7
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATIO nt ref
that I have read this application and state that the information herein is correct and I swear that any inforrr h A +Pgven gy t
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 w ithin 180 days. Permit void if work stops for 180 days.
Sign e of Owner / Applican 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 l anyArX l. 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
g Safety Department
City of Rexburg
19 E. Main
Rexburg, ID 83440
janellh@rexburg.org Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3024
Of pEXB URC
1 '.s
v a
CITY OF
RE)MURG
Americas Family Community
Affidavit of Legal Interest
State of Idaho
County of Madison
Name Address
C ity
Being first duly sworn upon oath, depose and say:
ID
V
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 of the application.
Dated this �• �'a 0 7 day of , 20
Subscribed and sworn to before me the day and year first above written.
�; tip�NERStp
°.•'
0 1 ARy''•
NotaK Public of Idaho
d �
. �V
Residing at:
PUg
\o0 My commission expires: I - ,f ` 7-013
STATE pF •.
Please complete the Stire Ap
P pP
NAME JAKE PMOS
PROPERTY ADDRESS Permit#
SUBDIVISION MANS6T 90605
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 Cq 9 3 Unfinished Basement area a 1 3
Second floor /loft area )/34 Finished basement area
Third floor /loft area Garage area I R 3
Shed or Barn Carport /Deck (30" above grade)Area
11
Water Meter Quantity: * * * * * * * * * * * ** *Water Meter Size:
Required!!)
PLUMBING 0 Plumbing Contractors Name: 4 Y U v !1 , Busui Name:
Address �. �eX ��� City Ae r//� State .rJ - Zip,
Contact Phone: ( ) -7 57 97) d Business Phone: ( ) /
Email Fax -T�7 ? 7 b
FIXTURE COUNT (includOgroughed fixtures
Clothes Washing Machine Sprinklers
Dishwasher Tub /Showers
Floor Drain 3 Toilet /Urinal
Garbage Disposal Water Heater
I — Water Softener
Plumbing Estimate $,
(COMMERCIAL /MULTI - FAMILY ONLY)
C ( O 09 s
Signature of Licensed Contractor License Number& Expiration Date
Z�Z 2 —0 7
Date
The City of Aexburg's permit fee schedule is the same as required by the State of Idaho
4
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
OWNER'S NAME -.SAKE P EUSC5
PROPERTY ADDRESS
SUBDIVISION 94?- VEST - t1E1ryHr -S
PHASE oA LOT 1 A BLOC
-;OF pEXB Ulp
U �
C IT Y OF
REXBURG
1-11 Americas Family Community
Permit 907 00098
651 Wheatland Circle
Required!!!
ELECTRICAL
Electrical Contractor's Name EyAN 4"N" Business Name L�4Gy FiLfZTP-tC
L
Address 65 - :�U b ST Ci P161 State T.D • Zip e3W0
Cell Phone ( ) -31 - 330 Le Business Phone (&M) 35 7 0(aZ L
Fax (Zp*) 359 - 2�t� Email
0(0? -?
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
The City
35219
License number
schedule is the same as
Date
the State of Idaho
7
Please complete the entire A p p lication!
NAME J 4-KE PEeKES
PROPERTY ADDRESS
SUBDIVISION 444ZUf.SY APO'rS
Permit#
Required!!! MECHANICAL
Mechanical Contractor's Name U vrci Lim 7 r4 �tA Business Name
Address P 0 . 9-c 7_� City 144d<
Cell Phone ( ) Business Phone ( )
Fax ( ) 2 ' 57 7 C Email
Mechanical Estimate $ (Commercial /Multi Family Only)
Late
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
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.
Signa o censed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idabo
0
5
Building Safety Department L�exeuA�
� � CITY OF
City of Rexburg � y n �. V 7?T m G
l�.GLV� V 1\
19 E Main ionellh@rexburg.org Phone: 208.359.3020 x326 Americas Family Community
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 °
OWNER'S NAME J AA< Fi Pfi f,5
PROPERTY ADDRESS Permit#
SUBDIVISION IiA f U£57' "616rWIS
PHASE a? .4 LOT / B BLOCK o2
HOME OWNER'S ELECTRICAL PERMIT
Home Owner's Name
Cell Phone (
City
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
The
fee schedule is the same as
Date
the State of Idaho
0
SUBCONTRACTOR LIST
Excavation & Earthwork: M0ir ?.
rV U tMY90
Masonry: L'EWLS z 4EN F,
Roofing: wFQep mF►xrz
Insulation: DVA6940 hq SV b4
Drywall: k 40AD CS 0 9twA ,
Painting: 6 aAA"S
Floor
Coverings: j 'Ag E'r GDwapr5
Plumbing: pLV P*I*
L f l-SAG y f grre 1 G
Special Construction
(Manufacturer or Supplier)
Roof Trusses: ST06k 0e1nA4AVT.S
Floor /Ceiling Joists:
Siding /Exterior Trim:
Other:
EXEMPTTCOS 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.gQy /cont.htm
2
0
M imi
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.
&I - Ya,*4 )ZGT &840 a ?.c0.07
Signature V `-- Date
JW57 (3. KAY
Print Name