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HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 07-00224 - 530 Terra Vista Dr - AdditionZ -n O rn m o =_ lad eo m_ D) m pF1 r v n c V r o C o m CA O Exr m aic ■� i Wiz: Z-n0 ' a m r� o -1 C o Z§ 0 3 Cf ���-cD O Ch on �v A 0 � m m w m ZOO - Z <� 0 00 1 f 0 m O_ C N 00 C 0) C N O N T `° v O (D c y a nC� y a= v D � y Z o m m -1 3 v 0 < C o co o X N W y d C 3 - 0 r- < o y W a o � Z v v 3 m 0 a CD CD v -i v m 1 = o0 Z C) C 0 m uca ZOC 1:01 ; m CL 0 O m 6 C 0 'n r _. 7 N N `fD Q N < CL 2 _C Si Ol x N N N CD C Y/ j 01 O' m 3 .`G z n 0 0 �.gy m O S 0 � - 5i. CL mn m -n rn m o N lad eo m_ D) v Q pF1 r v n n CD r o C 3 � 0 CA O Exr nn m" G) ; 10 S Wiz: Z-n0 ' a m r� 3 " C) Nw �O N O C A 0 _ ZOO - Z ' _ O (DD @ a n 1 f 0 y PD' O N -v 0 9 Q N N C CL W S °, _ W cD °� cOO�_ - - h u, x = c 11 CL .a CO N H O CD C a �a I O - CD o = m O p 7 CD C C CL CC] O = .� C CD 3 .�+ CL 0 O CL rr y S 3 S 'O .+ O O n S = ME W W CL d m C so :► 3 CL W - a 0 COD =. CD < N Q, o CL 0 (a ,<d0 O am 0d a Og c �. to CD X CL O ml� CD 02 M X 0 .�+ � � O N CD C CD M °, 3_C CA m z m r n z O 0 (D X 2 m 0 z CO) -i X C 0 z O CA CA) 0 CD N N N n S CA' 3 Cv D C- 0 W v v X m y N w C) -A CD v z m CA 7 N v m . m x X r - I kid CA C v 0 p y53 Cip m K o � a m A r.i o "***4 C:) C:) v C ID m r m 0 -i X r D W c v z G) L D D 7 3 L Z CO) m n q Z D v D) p pF1 TI g CL TI g 3 c r o C i 1 f W c v z G) L D D 7 3 L Z CO) m n q Z D v CITY OF KEXBUKG * 0,00224 BUILDING PERMIT APPLICATION Please 19 E MAIN, REXBURG, ID. 83440 If the quf 530 Terra Vista - Christman 208- 359 -3020 X326 PARCEL NUMBER: �����[, �f�(;�% (We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information - must be accurate) OWNER NAME Va,- J- 06 C Ch CONTACT PHONE # 3 St 7 3 V , PROPERTY ADDRESS: .530 PHONE #: Home (2tS) 35� 7-1? Work ('ru'9') #91 Cell (? 313 -- 17 - OWNER MAILING ADDRESS: -5-36 VJ'Je, CITY: P- - Q STATE: b ZIP: 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 MAILING ADDRESS: CITY PHONE #: Home ( Work ( ATE ZIP. Cell ( ) EMAIL FAX IDAHO REGISTRATION # & EXP. DATE How many buildings are located on this property? Did you recently purchase this property? No Yes If yes give owner's name) Is this a lot split. NO YES (Please bring copy of new legal description of PROPOSED USE: S i nA i e e� �•.', I y F,-Q-s + ke".e_L (i.e., Single Family Residence, Alti Family, Apartments, Remodel, Garage, Commercial, C) io rU ) MAY 15 2007 APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATIO U er penalt of perjur I hereb y er that I have read this application and state that the information herein is correct and I swear that any in for a y me i hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall b to #u a d o )Ft en wit all City regulations and State laws relating to the subject matter of this application and hereby authorized repres ab e- mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions o t e 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. 7Permitvoid if not started within 180 days. Permit void if work stops for 180 days. Signature of Owner /Applicant DATE Do you prefer to be contacted by fax e? ircle One WARNING — BUILDING PE ST BE POSTED ON CONSTRUCTION SITE! Plan fees are non - refundable and are paid in full at the time of application beginning J anyga 1. 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** BuilAg Safety DepartmentO I �xXB� City of Rexburg &� 9 a 19 E. Main ionellh @rexburg.org Phone: 208.359.3020 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 CITY OF REXBURG CW — ._._....._.._. _-. Americas Family Community 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 Clain 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 , 20 Signature Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: 3 Please complete the Mire Application! NAME Va-n C k r l 5' PROPERTY ADDRESS 530 SUBDIVISION Dwelling Units: Parcel Acres: 0 Permit# SETBACKS�� FRONT SIDE SIDE _Z� BACK ( � C •" 3 Remodeling Your Building /Home (need Estimate $ SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) t First Floor Area I y 5 Unfinished Basem Second floor /loft area Finished base nt area Third floor /loft area Garage area Z 2 V 4 �t Shed or Barn C .Z Carport /Deck 0" above rade)Area Water Meter Quantity: /y ►T * * * * * * * * * * * ** *W Meter Size: I jl Required.!! ^ � PLUMBING Plumbing Contractor's Name: Business Name: Address City State Zip Contact Phone: ( ) Business Phone: ( Email FIXTURE COUNT (lncludingroWhed fixtures C Clothes Washing Machine (_ Dishwasher D_ Floor Drain o Garbage Disposal © Hot Tub /Spa Q Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ The Date schedule is the same as required by the Sta of Idaho Signature of Licensed Contractor 0 Sprinklers © Tub /Showers 0 Toilet /Urinal _ 0 Water Heater O Water Softener (COMMERCIAL /MULTI - FAMILY ONLY) License Number& Expiration Date 0 Please complete the entire Ap NAME PROPERTY ADDRESS 2v 210 7�e_.rre SUBDIVISION Requiredffl N h MECHANICAL Mechanical Contractor's Name 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: E Permit# 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 lane. Signature of Licensed Contractor License number The City of Rexburg's permit fee schedule is the same as Date the State of Ida 5 Building Safety Department City of Rexburg 19 E Main jonellh @rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 of pBxs 's MFD C I T Y OF REXBURG Americas Family Community OWNER'S NAME V aA & r i s +r M PROPERTY ADDRESS 5 SO 'Try - P le i s- tom Permit# SUBDIVISION PHASE LOT BLOCK HOME OWNER'S ELECTRICAL PERMIT Home Owner's Name J a", (:hC i5 Tm11 � Address -5 30 ��_ rc V, City R Lx � L� State � Zip Ks Y Y U Cell Phone ( _31 / 7 35 Home Phone (NY) 35 " 7 � Fax ( TYPES OF INSTALLATION (New Residential includes everything contained within the residential structure and attached garage at the same time) 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) 9/ 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: $ SAWFOL 0 06 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 Home Owner Date The City of Rexburg's permit fee schedule is the same as required by the State of Idaho I SUBCONTRACTOR LIST Excavation & Earthwork: + S� 2 J Z ) r� t� n Sp , •L Concrete: �-0. ►� L"') Masonry: IV e 1/ r p / Roofin ,a: U Q " , O Insulation: V � Drywall: V a s -h -o-- Painting: Al 4 Floor / /� coverino,- /l d Plumbing: 10 Heating: "'VA Electrical: L �i h waft -v� Special Construction (Manufacturer or Supplier) Roof Trusses: 31\4C- Floor/Ceiling Joists: Siding /Exterior Tri 0 0 , . • . 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 h= ) ❑ 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 Date rij Print Name E Buildit 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 pexepge � 9 U O s, CITY O F M America's Family Community OWNER'S NAME Y e.v\ PROPERTYADDRESS 530 T:ej-ce, V ,5+ -� SUBDIVISION PHASE LOT BLOCK Permit #07 00224 530 Terra Vista Requiredffl ELECTRICAL Electrical Contractor's Name 9ROAl LF 151-k.n,41V Business Name �qz -S6, Address _ � T �- City � /�ei'�L112 r" State Zip yid Cell Phone (Zeyg) � 5Q5 Business Phone W09) Fax ( ) Email 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: $ - - :2C200, 0 ° 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 License number The schedule is the .came as Date the State of Idaho 7