HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 07-00181 - 603 S 4th E - New SFRZ
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.o �gEXBUR C.G
CITY O F Certificate of Occupancy
—
° REX 13URG City of Rexburg
OW Department of Communi Development
America's Family Community p
19 E. Main St. / Rexburg, ID. 83440
Phone (208) 359-3020 / Fax (208) 359 -3024
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:
0700181
International Residential Code 2003
421 Eagle Ct
Residential
Type V, non -rated
Single Family Residential
No
High Mark Investments Llc
300 N 2nd E
Rexburg, ID 83440
Owner /Lessee
Unfinished Basement 1784 Sq Ft.
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 with the requirements of the code
for the group and division of occupancy and the use for which the proposed occupancy vies
classified.
Date C.O. Issued
C.O Issued by:
rsuuuing urnciai
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 Fire Inspector: �J I , T ! 1
Electrical lnspettor _ P &Z Administrator: I v-
CTl Y OF KERB uRG 0 0 * 0181
BUILDING PERMIT APPLICATION Pleas i!
19 E MAIN, REXBURG, ID. 83440 If the q 603 S 4th E -Lewis le
208 - 359 -3020 X326
PARCEL NUMBER �� � (1� O (We will provide this for you)
SUBDIVISION: fC �) L'V ocl UNIT# BLOCK# — 1 LOT #_�
(Addressing is based o the information - must be accurate)
S� 7c�c ✓t2 << C 1 C'✓I S CONTACT PHONE #
PROPERTY ADDRESS: LP 0 � S' (' L,(+l -1 4 4 f7(q S
PHONE #: Home (tt� ; j _ (P .� e' Work ( :3 5(4' 'Ll*' 5- C)o Cell ( ) 7
OWNER MAILING ADDRESS: /V 2-"L 50 CITY: Peke "!2 STATE - -Fd ZIP: , !R 3 ` , _jg 0
EMAIL 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
f
MAILING ADDRESS: CITY STATE ZIP
PHONE #: Home ( ) Work ( ) Cell ( )
EMAIL FAX IDAHO REGISTRATION # & EXP. DA
How many buildings are located on this property ?.
Did you recently purchase this property? 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:
(i.e., Single Family Residence, Multi Family,
Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, 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 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. Pr v id if not sta ed within 180 days. Permit void if work stops for 180 days. M�, _
Signature of Owner /Applicant
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTI
Plan fees are non - refundable and are paid in full at the time of application beginning
City of Rexburg's Acceptance of the plan review fee does not constitute plan;
**Building Permit Fees are due at time of application** **Building Permits are void if your
APR 19 2007
ED
Bull
Safety Department
City of Rexburg
19 E. Main
Rexburg, ID 83440
jonellh@rexburg.org Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3024
� r
otaiy Publi "" -of Idaho
Residing at: _
C I T Y O F
REXB
Americas Family Community
Affidavit of Legal Interest
State of Idaho
County of Nhdison
T
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 re5,Q�owner of the property described on the attached, and I grant my
permission to: L
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 thi day of 3 20 0 - 7
A
Subscribed and sworn to before me the day and year first above written.
LYNDA MERRILL
O F REXBV q
to
a
` i7
My commission expires:
Please complete the dire Application!
NAME
PROPERTY ADDRESS tlp
3 5L t Permit#
SUBDIVISION c;) e C oc'
Dwelling Units: Parcel Acres:
SETBACKS
FRONT SIDE
Remodeling Your Building /Home
SURFACE SQUARE FOOTAGE: (Shall ini
First Floor Area
Second floor /loft area
Third floor /loft area
She or Bar
Water Meter Quantity:
Iding)
RequiredLY
PLUMBING
Plumbing Contractor's Name: h Business Name:
Address ity tae Zip
Contact Phone: ( ) Business Phone: ( )
Email Fax
FIXTURE COUNT (mcluding roughed fixtures
Clothes Washing Machine '/ Sprinkle
f Dishwasher 3 Tub /Sh C 0
Floor Drain Toilet/
Garbage Disposal S Water eate MPR 2 3}f
Hot Tub /Spa 1 Water of O C R eV
Sinks (Lavatories, kitchens, bar, mop) t C/\BURG
Plumbing Estimate $ (COMMERCIAL /MULTI - FAMILY ONLY)
tur o tensed Contractor License Number& Expiration Date Date
The City of Kexburv's bermit fee schedule is the same as reauired by the State of Idaho
Please complete the entireyApphcation!
NAME iG�u�z J ' - 3 t oc, "1zc� �c ✓i S
PROPERTY ADDRESS (� �� r�� S Permit#
SUBDIVISION eery e , 4 I (' e-1/ox) 8
Required!!!
MECHANICAL
Mechanical Contractor's Name 1401>?-ek) - - - SbA 45€ J Business Name 3 iSo,�
Address (I/ / lam/ (,y� I br oo(c Ci ecle City 1� ,-G State Zip B!yam
Cell Phone (00� `�'�jc7 -0 5 - a5 - Business Phone ( )
Fax (2 � 3 <& ' 05 Email ids nj • �`
Mechanical Estimate $ (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo _� Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents &ducts:
Space Heater U JNT - er 4-eArcr U2j'
2 Decorative gas -fixed appliance t uc/17
E Incinerator System
E0,
Boiler PR Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets OF
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
1 A A Point of Delivery must be shown on plans.
15 — 07
Signature o Licensed Contractor License number Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
•
EXEMPTIONS 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 www.iboI.idaho.g9v/cont.h1m
❑ 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 $2000
❑ Operation of a farm or ranch or construction of agriculture buildings exempt from Idaho Building Code
❑ Any type of water district operations
❑ Work in rural districts for fire prevention purposes
Owner who performs work on own property or contracts with a registered contractor to do work as long as
/ \ the property is not for resale within 12 months
❑ Owner or lessee of commercial property performing maintenance, repair, alteration or construction on that
property
❑ Real estate licensee /property manager acting within Idaho Code
❑ Engaging in the logging industry
❑ Renter working on the property where they live with the property owners approval
❑ Construction of a building used for industrial chemical processing per Idaho Code
❑ Construction of a modular building (defined by Idaho Code) to be moved out of state
the, bove inforrnaion is true and correct to the best of my knowledge.
Sign �J
fc-
j t
Print Name
n)9lGL�UV [fir
� i APR 2 0 wog L
CITY OF REXBURG
Building Safety Department ��o4tiXeUR�.
City of Rexburg 's
0
19 E Main jonellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
CITY OF
RE XBU RG
Americas Family Community
OWNER'S NAME K- ` Cc I' tJ ''� S Permit #07 00181
PROPERTY ADDRESS
SUBDIVISION .` 603 S 4th E - Lewis
PHASE ( L T I BLOCK
HOME OWNER'S ELECTRICAL PERMIT
Home Owner's Name Q iri 1 ct 1'N
Address q40 E7 : 2'' :�' OLA`t, City k 1 1 - State a<C A0 Zip g� �40
Cell Phone (24) 35 ( Ii (C 7 D Home Phone (9O$) - 7 0
Fax ( ' - 5S OCO Email
TYPES OF INSTALLATION
(New Residential includes everything contained within the residential structure and attached garage at the same time)
Number of meters being installed
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
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
Signature of Home O
The
schedule is the same as
l a g 6E L V LS
E AP:R2 0 2007
CITY OFRFXEUR
rate of $40 per hour.
Date
the State of Idaho