HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 07-00213 - 1128 Green Willow Dr - New SFRZ
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CITY O F Certificate of Occupancy
`+ REX City of Rexburg
Department artment of Communi Development
Americas Family Community p
19 E. Main St. / Rexburg, ID. 83440
Phone (208) 359 -3020 / Fax (2081359 -3024
Building Permit No: 0700213
Applicable Edition of Code: International Residential Code 2003
Site Address: 1128 Green Willow Dr
Use and Occupancy: Single Family Residence
Type of Construction: Type V, non -rated
Design Occupant Load: Residential
Sprinkler System Required: No
Name and Address of Owner: Angell Sam
125 Centennial St
Blackfoot, ID 83221
Contractor: Owner /Lessee
Special Conditions: Unfinished Basement
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
Kes inspected on the date listed wes found to be in compliance Mh the requirements of the code
for the group and division of occupancy and the use for Mich the proposed occupancy ties
classified.
Date C.O. Issued: April 24, 20Q8- (@8:31AM)
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 Fire Inspector: V1 !
Electrical Inspector: P &Z Administrator: g lQ-
tt_ -
CI jT Y OF REXB UKG • PERMIT # •
BUILDING PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
208 - 359 -3020 X326
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: W l'llwo Bro E51*c 5 UNIT# BLOCK# ! LOT# 3
(Addressing is based on the information - must be accurate)
OWNER NAME: .Sq n CONTACT PHONE # ?bg 6'6
PROPERTY ADDRESS: 112-T rilYe*l 0i'll ot.,1
PHONE #: Home ( ) Work ( ) Cell ( )
OWNER MAILING ADDRESS: 125 C&T*Mni'ak S f- CITY: &,ek &f STATE:Z_ZIP: T3 221
EMAIL $ L fMl (�c[l @ . NET 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:
PHONE #: Home (
CITY
Work (
TE ZIP
Cell ( )
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE
How many buildings are located on this property? /
Did you recently purchase this property? No &If yes give owner's name) S4-" Ve4r,q
J
Is this a lot split? & YES (Please bring copy of new legal description of property)
PROPOSED USE: J
(i.e., Single Family Residence, Multi
'1N Q+esi Alt
, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt of perjur I hereby 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 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 ��arted within 180 days. Permit void if work stops for 180 days. I r-1 !a � ra n n n .�
Signature Owner /Applicant
Do you prefer to be con ta ed by fax, email o hone Circle One
WARNING — BUILDING PE MUST BE POSTED ON CONSTRI
Plan fees are non - refundable and are paid in full at the time of application begil
City of Rexburg's Acceptance of the plan review fee does not constitute
**Building Permit Fees are due at time of application** **Building Permits are void i1
U � uv
DATE
MAY 1 1 2007
SITE!
Wing ua 12005.
y� c ° �FREWURG
2
Build
Safety Department 0
City of Rexburg
19 E. Main
Rexburg, 1D 83440
jonellh @rexburg.org Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3024
REXBU,p
's
U �
�Eo
CITY O F
REXBURG
America's Family Community
Affidavit of Legal Interest
State of Idaho
County o f Madison
Name J Address
R IAl Tl�
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 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 y day of l' t , 20 D 7
Subscribed and sworn to before me the day and year first above written.
yN Z HIA H ,
f N O TA's:
N S ota P I& of Idaho
A
N ' %Lip
% :A % Residing at:
ID A NO #
My commission expires: U de/a
3
Please complete the A Ap
NAME 4d
PROPERTY ADDRESS ll? -!g W ts-t Eire I j1C116r•J Permit#
SUBDIVISION Wlita.7 1&yeL 6=s &
Dwelling Units: I Parcel Acres: - S
SETBACKS
FRONT a S SIDE G SIDE i� BACK 010
Remodeling Your Building /Home (need Estimate
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
1430 q.3
First Floor Area OV4 X Unfinished Basement area Sq- l
Second floor /loft area Finished basement area
Third floor /loft area — Garage area 1 140T 2 ' t +
Shed or Barn Carport /Deck (30" above grade)Area --
Water Meter Quantity:
* * * * * * * * * * * ** *Water Meter Size:
�,/+ it
Requiredffl
PLUMBING
Plumbing Contractor's Name: �� � Pf pt , Ar g Business Name:
`T
Address '1 dUov -jj ���gue Gast City 91. & ��f State Z Zip
Contact Phone: Business Phone: ( )
Email Fax ?4'S'- YRo S
FIXTURE COUNT (inc ludintr rou --hed fixtures
1 Clothes Washing Machine I Sprinklers
Dishwasher _ 3 Tub /Showers
Floor Drain Z Toilet /Urinal
Garbage Disposal Z Water Heater
Hot Tub /Spa D Water Softener
S Sinks (Lavatories, kitchens, bar, mop)
Plumbing Estimate $ /,,V TZE. " (COMMERCIAL /MULTI - FAMILY ONLY)
Signature of Licensed Contractor
The
License Number& Expiration Date
schedule is the same as required by the State
Date
4
FROM FAX NO, :2087854905 May. 10 2007 02:26PM P1
MAY, 7. 2H7 9:23AM ATDtR$vN NELSON HALL SMITH NO. 405 P. 2
Please complete the entire Applications
NAME
PROPERTY ADDRESS i f&% Waf &M w r`!(er�tJ Peanit#t
SUBDIVISION Wlitt2 Arnk &S
Dwe+lhng Uma• i P4teel Antic:
SETBACKS
FROM 3 9 SIDE 1� S ID$ RA r
RemoddlhW YourBuMbg /Home ( need Estitnate)
SURFACE SQUARE FOOTAGE: (Shall inch 9 the exte6ot wall Measurements o f t the buildkW
q3v
F ,r�ras
ist P1oot � s unfizisbed Sases�oeat ar.� sw jalp-
Second Boor /loft a* Finished bascm=t asea�;
Third floor /loft use — C--- /^� •—�..
Shed or Ban "' Csrpmt/Derk (30 abo idc)At=s
Water Meter Quaoeityo sa= Merec Site:
PLUMBAING
Plumbing C omtcactoes Nawe: " k-.. 6,'k a Business Name:
Address '4°1 #JgC# -U _ _ gdAe 6Re+ City -_ 9& State Zap S_ 5,2
Contact Phone: (W ) Ws-- Y9'05 Buainfts Phone: ( )
F ,.,4;1 F ax 4's- Hie e"
EWTURL COUNT CMch geughed �
Clothes Washing Machine
l Dishwasher
Floor Drain
l G-mbage Disposal
I_ Hot Tub /Spa
5' Sinks (L&vwmxies, kitchens, bat, mop)
� SpsiaJrlexs
Tub /Showers
2 - Toilet/Uanal
Z Water Hearer
Wster Softener
Flusnbing Es ' s °p (CO ER /MULTI -FAMMY ONLY) �� l/c
of Ceetzaetor License Nua%bm& F*Mtion gaffe gate
The City is tie raw# ac sga irod ij trib f� ej lLbe
.� ■u
Please com lete the entir•
P Pp
NAME S tm / and
PROPERTY ADDRESS 1125 +-aesf 0i..
SUBDIVISION wrl(oo &"Ic 6WaLk
1 0
Permit#
RequiredLY
MECHANICAL
r / mow'
Mechanical Contractor's Name &,r Wi ° ,S� / &O�p+✓ f ` Business Name tn-i fir`
Address S! 2 w .�k�C�`�l •..� City B(- ,(,1apf State Me( ip P
Cell Phone ( ) Ow - / Z TCt Business Phone ( ) 7� b� S — �? 7-t
Fax ( ) ITS -%- S'f Email
Mechanical Estimate $ (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace
I Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
I Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
other similar vents & ducts:
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & A 121ication
Point of Delivery must be shown on plans.
a 42�f --- d-uC Sow l`
Signature of Licensyd Contractor License number Date
6tl(- Z
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
Exhaust or Vent Ducts
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
5
MAY -08 -2007 11:17 AM
��A . l 2001 5!52PM DERSON NELSON HALL SMITH NO, 441 P. 2
Bui ing Safety Department CI C
CRY of Rexbu a -�
19 E Mov1
Ja sithOmbuip.oq Phony, 2M359.3020 x ,
RattbUrp, ID ii�tO �wwv.roxb 0
208.9S9.a0Z�1 • „ ,•• An�triabAorlrC�Ow
oanvEWs N.a,.Nne. �
PROPER #07 00213
TY ADDR I lrlr A. Permit
SU9DMSION Wad "a ArL.tii
PHASE _ : . J HzO 1128 Green Willow Dr -Angell
Regr�ired.!! ELECTRICAL
Bimtricai Ceattsacbut's Name Business N
AcWess C�
Cell. Phone ( �2 �,ZS , B usiness Phone (� �D�j
Electrical E's'"'M a (aost orvikigg "W $ (CONUSICUL/MULTI- FAMILY ONLY)
?"RS OPI VBYA A27ON
(Are- A voldmiAd Amak ke WydW&e setieedw* hCe t�ereaidl a#! al etruttatieand ,atidu,d�+enr�eatthei dme)
Number of meters being installed
Up to 200 amp Service*
201 to 400 amp Se Ace*
Over 400 amp Sa rise*
Tasnpe:a:p Canatruction Sexvice, 200 amp or kw, one locatiiom (lot a period not to exceed 1 yeas)
Fasting Resi=tisl (# of Branch Citaui )
Spa, Hot Tub, Swiauning Pool
Meade Central Systems Heating and /er roolieg (when not peat of a am naidennal oonsln ction petatit
and no additional vvid*
Modular, Manatactasted or Mobile Home
�. Otbrz Imt0ationor Wiring not spedfleally covered by any of the above
Cost of Wring tit Labor. S
Pnmps (poweslic Wahet Imgation, Sewav)
Requnwd Inspections (of existing wiring)
-------- TanPozW A=uaemeAt /Indwtry
wlselu Inian-imte of 3 inepecnow. A Ational i uP6ed0= chatpged It re"ted inspection rote of X40 per ho ur.
r leeneea Coatsacoac Fieanea numabez note
a re. &SA, Iry
■u�
0 A
SUBCONTRACTOR LIST
Excavation & Earthwork: (-Q R CiKSl�zco�t'
Masonry:
LtS
Roofing:
Gralb►
4.& Cry►
Insulation:
Im c
t
Drywall:
Gi vv c
Ci :!, h "a,(
Painting:
04
P^i'A f
Floor
Coverings: M/'ke /
Heating: h6?6i tl
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses: Q 94 C 4--
Floor /Ceiling Joists:
Siding /Exterior Trim: A.,,wCk St
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.iboIddaho.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
'f 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 tify that the above information is true and correct to the best of my knowledge.
y o
Signature Date
S ajj j �G(
Print Name
E