HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 07-00223 - 1053 Widdison Ln - BarnZ
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Fio4 gEXBpAG ♦'
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SNE6
CITY 0 Certificate of Occupancy
REX
America's 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:
Name and Address of Owner:
Contractor:
Special Conditions:
Occupancy:
0700223
International Residential Code 2003
1053 Widdison Ln
Shed
Type V, non -rated
Residential
Z2
Thompson Douglas C Etux
1053 Widdison Ln
Rexburg, ID 83440
Owner /Lessee
General Utility
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 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: January 10, 2008 (02 :46P
C.O Issued by:
Building Official
There shall be no further change in the e)dsting 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 Inspect Fire Inspector: lam_ ICA
Electrical Inspector: c PBZAdministrator: )a IC�
CITY OF REXB UKG
i
BUILDING PERMIT APPLICATION Please 4 0700223
19 E MAIN, REXBURG, ID. 83440 If the ques
208- 359 -3020 X326 1053 Widdison- Thompson Barn
PARCEL NUMBER: P -NU� �Z2 I (w
SUBDIVISION: ttt dot t &(\ UNIT# BLOCK# LOT# 6
(Addressing is based on the information - must be accurate)
CONTACT PHONE #
PROPERTY ADDRESS: v J/213 �L)
PHONE #: Home ( ) (;, - (off `/ Q Work ( ) yq 1, - ,28/ 0 4v ' - Cell( - ,5
OWNER MAILING ADDRESS: S/-mr CITY: STATE: -£D ZIP: P3 ` gyp
EMAIL '� Q �Sor) 5/0 1 , ac a FAX
APPLICANT (If other than owner) et:
(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
PHONE #: Home (
EMAIL F
Work (
Cell ( )
CONTRACTOR
MAILING ADDRESS: CITY STATE ZIP
PHONE #: Home (
EMAIL F
Work ( ) Cell ( )
IDAHO REGISTRATION # & EXP. DA
How many buildings are located on this property?
Did you recently purchase this property ?DYes (If yes give owner's name).
Is this a lot spli NO YES (Please bring copy of new legal description of
PROPOSED USE: f Z)
(i.e., Single Family Residence, Multi Family,
Remodel, Garage, Commercial, Addition,
M AY 1 5 2007
III
R EXBURG
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: u J = ClY fO F R
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
base rmit void if not started within 180 days. Permit void if work stops for 180 days.
Signa e Owner /Ap 'cant 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 January 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**
Buil
19 E. Main
Rexburg, ID 83440
Safety Department
City of Rexburg
janellh@rexburg.org Phone: 208.359.3020
www.rexburg.org Fax: 208.359.3024
Of REXB URC
CITY OF
U � ° REXB
Americas Family Community
Eo
Affidavit of Legal Interest
State of Idaho
County of Madison
I,
Name
City
Address
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 day of 5 20
Signature
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing at:
My commission expires:
Please complete the entire Application!
p PP
NAME ULA.p
PROPERTY ADI?ESS JO
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT
0
Permit#
SIDE SIDE /U 1 BACK /D t
Remodeling Your Building /Home (need Estimate) $ S1 WO
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area Unfinished Basement are-,
Second floor /loft area Finished basement area
Third floor loft area Garage area
Shed o Carport /Deck (30" above
Water Meter Quantity: 1 - ) 4 * * * * * * * * * * * ** * Water Meter Size: 11 .1 11 '
Requiredffl
PLUMBING
Plumbing Contractor's Name: Business Name:
Address —City
Contact Phone: ( ) Business Phone:
Email Fax
FIXTURE COUNT (including roughed fixtures1
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub /Spa
Sinks (Lavatories, kitchens, bar, mop)
Plumbing Estimate $
State Zip
Sprinklers
Tub /Showers
Toilet /Urinal
Water Heater
Water Softener
(COMMERCIAL /MULTI - FAMILY ONLY)
Signature of Licensed Contractor
The
License Number& Expiration Date
Date
's permit fee schedule is the same as required by the State of Idaho
Please complete the entir A p p lication!
lication!
NAME
PROPERTY AIW)R SS r` I.e�►rk �.5 c � .. ; ,
SUBDIVISION 4-9
•
Permit#
RequiredN
MECHANICAL
Mechanical Contractor's Name 01 �� Business Name
Address City State zip
Cell Phone ( ) Business Phone ( )
Fax ( )
Email
Mechanical Estimate $ (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace
Furnace /Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Exhaust or Vent Ducts
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
other similar vents & ducts:
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.
Signature of Licensed Contractor License number
The City of Rexburg's permit fee schedule is the same as
the State of Idaho
Date
Building Safety Department
City of Rexburg
19 E Main lanellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
o f ptixa u
v o
CITY OF
REXBURG
America's Family Community
OWNER'S NAME bou — T kc w _k
PROPERTY ADD " I DS 3 44 Permit#
SUBDIVISION
PHASE LOT # BLOCK
HOME OWNER -S ELECTRICAL PERMIT
Home Owner's Name
A
�.1 c
Addres t'�5 3 �� Mo 1\1 City r State = D Zip f tY
Cell Phone ( ) 1 3 .. .S.3,y,7 ! Home Phone ( )
Fax (
Email jLng S zir4 6D b biz t i, c�
TYPES OF INSTALLATION
(New Residential includes everything contained within the residential structure and attached garage at the same time)
Number of meters being installed
X 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, Sw immin g 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.
Si ature of Home Owner Date
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
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
of Q' XB °Bc
.� 7
U �
CITY OF
REX
America's Family Community
OWNER'S NAME
PROPERTY ADDRESS
SUBDIVISION
PHASE LOT BLOCK
Permit#
Requiredffl ELECTRICAL
Electrical Contractor's Name Business Name
Address
City State Zip
Cell Phone ( ) Business Phone ( )
Fax ( )
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)
Number of meters being installed
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
License number
'.r permit fee schedule is the same as re,
Date
the State
•
............................................................ ...............................
SUBCONTRACTOR LIST
Excavation &
Masonry:
Floor
Plumbing:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor /Ceiling J
Siding /Exterior
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.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,
45 Public Works Construction Management Licensing Act (exempt from fee only registration required), or
50 Installation of heating, ventilation and ' 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
0 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.
,5 // - or
V I Date
Tk 10
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