HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 07-00121 - 1105 Coyote Willow Way - New SFRW
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�XBUJ?, — CITY OF Certificate of Occupancy
° G City of Rexburg
Department of Community Development
Americas Family Community
19 E. Main St. / Rexburg, ID. 83440
Phone (208) 359 -3020 / Fax (208) 359 -3024
Building Permit No: 0700121
Applicable Edition of Code: International Residential Code 2003
Site Address: 1105 Coyote Willow Way
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: White Sands Construction Llc
P O Box 863
Rexburg, ID 83440
Contractor: White Sands Construction
Special Conditions: Unfinished basement, I NO SQ ff-
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 v►es found to be in compliance Wth 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: August 16, 2007
C.O Issued by:
�j
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: Fire Inspector: ! n
Electrical Inspector: P &Z Administrator: h A
CITY OF REXB UG
BUILDING PERMIT APPLICATION Plea
19 E MAIN, REXBURG, ID. 83440 If the q
208 - 359 -3020 X326
PARCEL NUMBER :�)L)Ej U(,- �,
0
PERMIT #
1!
0700121 le
1105 Covote Willow -White Sands
SUBDIVISION: e_S k e S UNIT# BLOCK# LOT# .3
(Addressing is based on the information - must be accurate)
Ct C 9 4F 70 1CONTACT PHONE # / - 0 `$ 3,? 9- S5l/ 9
PROPERTY ADD
PHONE #: Home (2jg) 3 59 - 8/ I I Work (Z8) 317 — G (o O S Cell ( K) 33 1 - Sys 9
OWNER MAILING ADDRESS: _?o ?_S0X 15 Co3 CITY: .Q STATE: 7.3> ZIP: VW0
EMAIL M 0 .Tn es{-�r a nn 4 , I. c avv%— FAX 9 co 7
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
STATE; ZIP
CITY:
EMAIL F
PHONE #: Home ( ) Work ( ) Cell (
CONTRACTOR
MAILING ADDRESS: _PO &X CITY ead STATE - rQ ZIP &. g`/a
PHONE #: Home ( ) ? 9 - 8115 Work ( ) 317-U(00 Cell ( ) .3.�Z 9 - 5_y1 2
EMAIL FAX J!5� -1 g(o ?' IDAHO REGISTRATION # & EXP. DATE ; 11 C U F
How many buildings are located on this property? 1
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split ?(0 YES (Please bring copy of new legal description of property)
PROPOSED USE: r I - , - l., c� s;
(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 r ' i of thr.. 9001 —
International Code in cases of any false statement or misrepresentation of fact in the application or on the pla wli tpeit aovgwa
based. Permit void if not started within 180 days. Permit void if work stops for 180 days
inii III
Signature o Owner /Applicant D11; 2 0 2
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING – BUILDING PERMIT MUST BE POSTED ON CONSTR CTI SIT D
Plan fees are non - refundable and are paid in full at the time of application begin i EXE U R G
City of Rexburg's Acceptance of the plan review fee does not constitute at o al
**Building Permit Fees are due at time of application** **Building Permits are void if your c ec does not clear** 2
Buildit Safety Department w o�QEXBUA�, CITY O F
City of Rexburg o n r V nT m G
REXB lJ 1\
C ,,
19 E. Main janellh@rexburg.org Phone: 208.359.3020 E a Americas Family Community
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
Affidavit of Legal Interest
State of Idaho
County of Madison \
I, ,
Name
R5
City
Being first duly sworn upon oath, depose and say:
Di O. bat< 7 9
Address
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
day of /f��. /�il� , 20 0 7
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
Signature
Subscribed and sworn to before me the day and
KEN N
C
� pf IDAHO
Address
written.
Residing at: VY
My commission expires:
K3
Please complete the Are Ap 0
p PP
NAME W L �J?rc�S C'�n1b
PROPERTY ADDRESS t& *QX 3 ( 0 4 - 3 Permit#
SUBDIVISION I,S.hew '&R.a4C- ebmk.e—S
Dwelling Units: ( Parcel Acres: o 1571f
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 0 Zd Unfinished Basement area 1 2 t
Second floor /loft area pt I Ar Finished basement area N JA
Third floor /loft area pi IA Garage area �Q
Shed or Barn N I h Camort /Deck (30" above grade)Area ►.}/Ar
Water Meter Quantity:
* * * * * * * * * * * ** *Water Meter Size:
Requiredffl
PLUMBING
Plumbing Contractor's Name: O; LA Z2.1 �, Business Name: �rce- F'WO&
Address Lc) City Stat Zip
Contact Phone: VOW) 7 ! Co -- 2 O 8'Z Business Phone: (20 $) 7 / (e 7.o9 Z
Email Fax
FIXTURE C UNT (in cludingroughed frxtures,�
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub /Spa
Sinks (Lavatories, kitchens, bar, mop)
I Sprinklers
�C 2- Tub /Showers
Z- Toilet /Urinal
I Water Heater
Water Softener
Plumbing Estimate $ h (COMMERCIAL /MULTI - FAMILY ONLY)
iv, LU�z� 3tZ (4) --�T)J-54-er7
Signature of Licensed - contractor License Number& Expiration Date Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
4
Please complete the enti•
p PP
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!! MECHANICAL
Mechanical Contractor's Name 1 l a � <r. j C, O v.,. � ' usiness Name
Address I c J City l o,.i State s D Zip A3 cl t ?
Cell Phone (Zut) qO3 _ S S2 U Business Phone
Fax ( )
Mechanical Estimate $ (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
1 Furnace /Air Conditioner Combo 1 Dryer Vents
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
1 Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Range Hood Vents
Cook Stove Vents
.3 * '% Bath Fan Vents
2 - other similar vents & ducts:
Z 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
Po o De must be h1` 1 •
Signature of Licensed Contractor License number
The City of Bexburg's permit fee schedule is the same as
0
the State of Idaho
Date
5
µ_ 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 �EXBUg
9
0
C I T Y O F
REXB
1-1---- Ow _.
America's Family Community
OWNER'S NAME 5M95, CgAZ: --
PROPERTY ADDRESS
SUBDIVISION
PHASE LOT 3 BLOC
Permit #07 00121
1105 Coyote Willow Way
Required!!!
ELECTRICAL
Electrical Contractor's Name K�J t Gt C2��tkSvt� Business Name 7 nr N,%%-,A, t 1eC -4& C
Address City State Zip
Cell Phone ( ) Business Phone ( )
Fax ( )
Electrical Estimate (cost of wiring & labor) $ (COMMERCIAL /MULTI - FAMILY ONLY)
TYPES OFINSTALLATION(RESIDENTIAL)
(New Resid7 includes everything contained within the residential structure and attached garage at the same time)
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
*Inclu s a maximum of • spections. Additional inspections charged at requested inspection rate of $40 per hour.
v
Signature of Lice ed Contractor License numb Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
7
.............................. 0 ...........................
SUBCONTRACTOR LIST
Excavation & Earthwork: C q-j,Ad ?ot ^V_
Concrete: Scc
Masonry: I t7 cw— C
Roofing: � 6n,
Insulation: ?mob 5 rn %,1
Drywall: C cv., C
Painting: S.—f t s,-,e
Floor
Coverings: cie- ; I^ c-e.wVta
. -w./
Special Construction
(Manufacturer or Supplier)
Roof Trusses: . J J= C- r—
Floor /Ceiling Joists: -'
Siding /Exterior Trim: 'r;t, (ass
Other:
EXEMPTIC*S 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.
(Phis 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.iboLidaho.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