HomeMy WebLinkAboutAPPLICATION, CO, BP - 07-00174 - 773 Griffin St - New SFRz
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Ak. �oQRExsuk�,' — CITY o F Certificate of Occupancy
G c
REX City of Rexburg
`
America's Family Communi 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:
Special Conditions:
Occupancy:
0700174
International Residential Code 2003
773 Griffin St
Single Family Residence
Type V -N, Unprotected
Residential
No
Sainsbury Construction
4697 N Haroldsen Dr
Idaho Falls, ID 83401
Muir Construction Co
tAYf h► s`htd' kast fi
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
Kos inspected on the date listed Kes 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 09, 200 3:14P
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 Inspecto • t Fire Inspector: �g
Electricallnspector: P &ZAdministrator:
.s
GlY OF KEXBUKG 0
BUILDING PERMIT APPLICATION Please
19 E MAIN, REXBURG, ID. 83440 If the qi
208 - 359 -3020 X326
0700174
773 Griffin -Muir
SUBDIVISION: bV;JQFA-5enl UNIT# BLOCK# LOT# $
(Addressing is based on the information - must be accurate)
PHONE # ZW S - 57
PROPERTY
2�
PHONE #: Home (" SZZ 1' - « Work (tog) 52_q- 4510
OWNER MAILING ADDRESS: 3 X47 � �"' CIT)
Cell (240 75`7 a0
1'r STATE: 1 ZIP: % 01
, AX 522 - 5 - 7'15
APPLICANT (If other than owner) MwA_ f�iu S'TR•v c�-1vJ C.v -- or.+Oc..t Mull,
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS 3
1 ZIP 5344 b EMAIL. &Aui�s"f cno.+ e- c FAX • $ - 354 - 9 9S2
STATE; I
PHONE #: Home (A) 35 - 3119 Work (Jvtp) 35f4^ rJ _70 Cell 220
CONTRACTOR-
MAILING ADDRESS: 9 &q 7 N - hk t -W CITY I F STATE 10 ZIP 53 A
PHONE #: Home " 5 -151 ° Work J?. ) Szq- 4 o Cell - 7s 7 - 0 7 0 -
EMAIL FAX 5S% -5 IDAHO REGISTRATION # & EXP. DATE
How many buildings are located on this property?
Did you recently purchase this property? No (1!jJ (If yes give own is name) rat-- So% ii s su 4 y
Is this a lot split? 40 YES (Please bring copy of new legal description of property)
PROPOSED USE: 51N 9; i -F ( f ' VV W NO
(Le., Single Family Residence, Multi Family, Apartments, Remodel, Garage,
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHI
that I have read this application and state that the information herein is correct and I swe
hearings before the Planning and Zoning Commission or the City Council for the City of
City regulations and State laws relating to the subject matter of this application and herel;
mentioned property for inspections purposes. NOTE: The building official may revoke
International Code in cas4 of any Wse statement or misrepresentation of fact in the app
based. Pelni v id if n(obtarted within 180 days. Permit void if work stops for 180 day
Signaturelf Owner /Applicant
Do you prefer to be contacted by fax, email or phone? Circle On
WARNING — BUILDING PERMIT MUST BE POST
Plan fees are non - refundable and are paid in full at the time
City of Rexburg's Acceptance of the plan review fee
**Building Permit Fees are due at time of application** **Buildin
nr, .trr 44 •
Addition, Etc.)
RIZATION: Under penalty of perjury, I hereby certify
that any information which may hereafter be given by me in
texburg shall be truthful and correct. I agree to comply with all
authorized representatives of the City to enter upon the above -
permit on approval issued under the provisions of the 2003
:ation or on the plans on which the permit or approval was
-/ // / 0
DATE
D ON CONSTRUCTION SITE!
application b e a m Wm=1. 2005.
es not constitute plan approval
'ermits are void if your check does not clear**
4
Builder Safety Depart ent
City of Pexburg
19 E. Main janellh@rexburg.org Phone:
Rexburg, ID 83440 www.rexburg.org Fax:
Affidavit of Legal
State of Idaho
County of Madison
I, 'fi" Sfi 0sS1Jiu4
Name Addt
City State
1(J
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 describe
permission to: G 2 n q a.1 1 4 y't-
Name
to submit the accompanying application pertaining to that p
B. I agree to indemnify, defend and hold Rexburg City
claim or liability resulting from any dispute as to the
ownership of the property which is the subject of th
on the attached, and I grant my
Address
id its employees harmless from any
tatements contained herein or as to the
application.
Dated this 1 1 4-) day of
Q
` gXa Ec;g
0 i C 17 X 0 F
REXBURG
4 �
:lnuricct� Fnrr�it }� £'� » :F� =e�rritt�
t
20
Subscribed and sworn to before me tie day
written.
Notary Public of Idaho
Residing at _
My commission expires:
3
Please complete the entire A p p lication!
1' p�
NAME '� &,a C R O M Cons t°. Cz� .
PROPERTY ADDRESS 8Lo c y- S, l.o r I Permit#
SUBDIVISION 41Er 05LS4vJ
Dwelling Units: I. Parcel Acres: d v �3
SETBACKS f
FRONT S SIDE SIDE BACK - 3 0
Remodeling Your Building /Home (need Estimate) $
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall
First Floor Area 1 7 D 7 Unfinished
Second floor /loft area Finished b:
Third floor /loft area —' Garage are:
Shed or Barn Carport/D(
Water Meter Quantity:
Reguired,X
PLUMBING
Plumbing Contractor's Name: J°+y
Address City
Contact Phone: ( ) 50 ._ ? o¢ g Business P:
of the building)
area
above
Meter Size 314 "
less Name: St,` If fue
F State Q Zip
( ) 5 y= in s
FIXTURE COUNT onciudw grbed fixtures
+ Clothes Washing Machine
Sprinklers
j Dishwasher
Tub /Showers
Floor Drain 3
Toilet /Urinal
Garbage Disposal
Water Heater
Hot Tub /Spa
Water Softener
Sinks (Lavatories, kitchens, bar, mop)
rEsLfimate $ (COMMERCIAL /MULT - FAMILY ONLY)
_
Signature of Licensed Contractor License Number& Exp T.7wred tion Date Date
The City of Rexburg's p"mit fee schedule is the same as by the State ofldaho
4
Please complete the entire Application! If the qu vstion does not apply fill in NA for non
Applicable
NAME_ S 4g 9 a. ° ,
PROPERTY ADDRESS 9 Lo CYG `b 1 -°T � Permit#
SUBDIVISION_ 4�oar� -mot
RequiredW MECII"
Mechanical Contractor's Name: Sr c bae.v— Business Name:
Address O K Z
b �? City 1 State Zip �3
Contact Phone: qp r 10 q – i00 Business Phone: ( )
Mechanical Estimate $ (Commercial /Multi
FIXTURES & APPLIANCES COUNT (Single Family
Furnace
Furnace /Air Conditioner Combo �S
Heat Pump
Air Conditioner
Q Evaporative Cooler
Unit Heater - -
Space Heater
_ Decorative gas -bred appliance !
Incinerator System
Boiler
Pool Heater
lts I tip
Fuel Gas Pipe Outlets mcludtng stubbed in or suture
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) (9� Oil Coal Fireplace Electric
Contractor V Ikense number
The City of Bexbw's permit fee schedule is the same as
Only)
' Only)
Exhaust or Vent Ducts
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
w g 2001
3-G-0 q
Date
the State ofldaho
5
BullcMg Safety Depart enter 4 � . �
a ,
City o Rexburg
19 E Main janellh@rexburg.org Phone: 208.3.5P.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax 2 8.359.3024
c, i`rY o r
E BURG
:lmerrraa Erin ri; t_�,n;rnrrnit
OWNER'S NAME 57"0004 CoNS7V--j C-T1&1J C.o-
PROPERTY ADDRESS L OT' ':v e,
SUBDIVISION H4-y0M6uJ
PHASE LOT - S BLOCK I_
Permit #07 00 174
773 Griffin -Muir
Required l jj
EI.ECTRI
Electrical Contractor's Name I.IE9 -Sar4
Address P • 0 . So X K 2- City
Cell Phone (74ta) 'O - 31 14 Business
Fax ( )
Electrical Estimate (cost of wiring & labor) $,
TYPES OFINSTALLATION
(New Residential includes everything contained within the residential
Number of meters being installed
I Up to 200 amp Service*
201 to 400 amp Service*
Name tJ O"41 , J FLE&M C-
f3-1
( ) 22t - 31 Z4
TI- FAMILY ONLY)
and attached garage at the same time)
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)
1 SP Hot Tub, Swimming Pool
Electric Central Systems Heating and /or Cooling en 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)
3 Requested Inspections (of existing wiring)
Temporary Amusement /Industry
*Includes a maximum of 3 inspections. Additional inspcctions charged at requesid inspection rate of $40 per hour.
c 3 575 1 6
Signature of Licensed Contractor License number Date
The
schedule is the .came as required by the State
SUBCONTRACTOR LIST
Excavation & Earthwork: SL*r h
c Ca p i r p-v o, e a
Masonry: ►J M �+ ANN
Roofing:
Insulation: Pr0 ✓ rAj j 4AV
Drywall: h AFB
Painting. ► NJ
Floor
Coverings: MTN /LI tJ F7L
Plumbing: Bj4?j yi N WM 4�aG,
Heating. R( 4 h 1°l t j $
Electrical: WAAW �-
Special Construction
(Manufacturer or Supplier)
Roof Trusses: 5k-X'-4 M t f
Floor /Ceiling Joists: 1"f
Siding /Exterior Trim: K0A sAN D Eat P;F4 � 99 tIO ,S
• •
EXEMP'T'IONS FROM STATE REGISTRATION
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 xvivRF.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,
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
propert
❑ 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 hFrepy e that the above information is true and correct to the best of my knowledge.
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