HomeMy WebLinkAboutAPPLICATIONS, BP, MULT DOCUMENTS - 07-00256 - Mom's Kandy Kitchen - Exterior RemodelCITY OF
REX
CW
Americas Family Community
B uilding
Z
Per- m-- it
•
O ISSUED TO:
PERMIT #: v7 00
NAME: Ambercor Llc
FOR THE CONSTRUCTION OF: Mom's Kandy Kitchen - Exterio JOB ADDRESS:
GENERAL CONTRACTOR: Classic Foam Design
This permit is issued subject to the regulations contained in Building Code and Zoning Regulations of the
City of Rexbug. It is specifically understood that this Permit does not allow any Variance to the regulations
of the City of Rexburg or Zoning Codes unless specifically approved by the City Council and explained on
• the Building Permit Application as approved by the Building Inspector.
Date Approved
06/29/2007
Issued
Building Inspector
THIS PERMIT MUST BE PROMINANTLY DISPLAYED AT THE BUILDING SITE
THE BUILDING MAY NOT BE OCCUPIED OR USED WITHOUT FIRST OBTAINING ACERTIFICATE OF OCCUPANCY
1) A complete set of approved drawings along with the permit must be kept
No work shall be done on any part of
on the premises during construction.
2) The permit will become null and void in the event of any deviation from the
NOTICE!
the building beyond the point indicated
in each successive inspection without
1. Framing
accepted drawings.
approval. No structural framework of
3) No foundation, structural, electrical, nor plumbing work shall be concealed
any underground work shall be covered
without approval.
Date Approved
INSPECTION CARD
BUILDING
Date Approved
1. Framing
2. Final
ELECTRICAL
Date Approved
1. Rough -In
2. Final
24 Hour Notice
and Permit Number required
to make inspection appointments
For Inspections Call 359 -3020 option 2
ACERTIFICATE OF OCCUPANCY CAN NOT
BE ISSUED PRIOR TO FINAL ELECTRICAL
A PI IIMRIWf: IIJCDC(`TInW
CITY OF REXB URG # 0 PERMIT #
BUILDING PERMIT APPLICATION Pleas 07 00256
19 E MAIN, REXBURG, ID. 83440
208 - 359 -3020 X326 Moms Kandy Kitchen
PARCEL NUMBER: �� %X ; L%� L� Exterior Remodel
SUBDIVISION: UINIl+r LL%--I
Is based on the information - must be
OWNER NAME. f M &r co r JAI& C., CONTACT PHONE #
PROPERTY ADDRESS: zps
PHONE #: Home ( ) Work ( ) ,3�, - -?60 , Cell( )
OWNER MAILING ADDRESS: - 1 e CITY: STATE: ZIP:
EMAIL FAX 36 30�t�
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
PHONE #: Home ( )
EMAIL FAX
Work (
Cell (
CONTRACTOR C i 1
MAILING ADDRESS: 72 LL, /Y Imo' 4r -i-teq CITY STATE rD ZIP 99 �
PHONE: Cell# 1- / Work# S I�y Fax# S 3 � 7 7 `I
EMAIL IDAHO REGISTRATION # & EXP. DATE tl�C�', "iVI G' C 'PI A I Cg
Hnw mnnv hnilrlinac nrP lnra nn thic nrnnnrty�
Did you recently purchase this property? Uo Yes (If yes give owner's name)
Is this a lot split. YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt of perjury, I hereb 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 pernut on approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact
in the cation or Qn -tkie on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
• : \..,_
5 /7 /
tgnature of caner /Applicant DATE
Do you prefer to be contacted by fax, email o hone Circle One
WARNING — BUILDING PE UST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid in full at the time of application beginning TarnyAW 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 **
2
Please complete the eltre Application!
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Dwelling Units: Parcel Acres:
State Zip.
SETBACKS
FRONT SIDE SIDE BACK
Remodeling Your Building /Home (need Estimate) $ ' 4 ' " &X -
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area Unfinished Basement area
Second floor /loft area Finished basement area
Third floor /loft area Garage area
Shed or Barn Carport /Deck (30" above grade)Area
Water Meter Quantity:
" 4 4 , ` . ,` Water Meter Size:
Requiredffl
PLUMBING
Plumbing Contractor's Name:
Contact Phone: (
Business Name:
I City
Business Phone: (
F
FIXTURE COUNT (mcluding toughed fixtures
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub /Spa
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $.
(Commercial Only)
Required! Signature of Licensed Contractor
The City of&
Sprinklers
Tub /Showers
Toilet /Urinal
Water Heater
Water Softener
Permit#
License number Date
schedule is the same as required by the State of Idaho
4
Please complete the entir9pplication! If the question does 10apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Required f!l
MECHANICAL
Mechanical Contractor's Name: Business Name:
Address City State Zip,
Contact Phone: ( ) Business Phone: ( )
Mechanical Estimate $ (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
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
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 vl ane.
Required! Signature of Licensed Contractor License number
The City of Rexburg'permit fee schedule is the same as
Date
the State of Idaho
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
O4 4tiXBUR C
U � �
CITY OF
RE XBU R G
Ow _
America's Family Community
OWNER'S NAME L4M. 6 ^ (.A-�'
PROPERTY ADDRESS Z-S -so, C L. iti Permit#
SUBDIVISION
PHASE
LOT BLOCK
Required!fl ELECTRICAL
Electrical Contractor's Name A C, 4
Business Name
�' r
Address City t i State T Zip
Cell Phone ( ) U4 - (D q0 li Business Phone 009)
Fax ( ) 5qo Gl ��' 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*
Existing Residential (# of Branch Circuits)
Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year)
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: $ ,2nC) L c?
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.
Ljll J4� - 67
Siinature of Licensed Contractor License number Date
The City of Bexburg's permit fee schedule is the same as required by the State of Idaho
0
•
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete:
Masonry:
Painting:
Floor
Coverings:
Plumbing:
Heating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor /Ceiling Joists:
Siding /Exterior Trim:
Other:
EXEMPTIONS FROM STATE REGPTRATION
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 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
Print Name
Date
9
May 29 2007 11:39AM HP LASERJET FAX
0
WORKERS COMPENSATION
INFORMATION PAGE
•
p.3
FARMERS INSURANCE EXCRARGE
0 Ansipned Risk 17744 t� rnbr irrasrarese taxd+e�pe rnrelrs�r iarerilMr�ea RMerred Ts+ Its Llagne�
Members of the Farmers Insurance Group of Companies
Home Office: 4M Wilshire Bind., Los Angeles, Cal€famia 90010
.2007 A0609 -31 -70 00
Pe" Year Pantry Na of Co.
WESTERN -WCC
np cy
I. Named . CUSTOM FOAM DESIGN & SUPPLY, JJ43238
Insured - Z379 W. HEYREND issuing ice ekiweNumber
Mailing 75 -47 -330
Adder' IDAHO FALLS ID 83402 Ajinllc. IM denuricawn 1E.
rderAlfmatiat Na
Legal Entity. 0Ind€vidual L7 Partnersh €p O Corpmt€on ON FILg
M Other Federal Ward r Mim ft
aflarriployment 1=0 NIF
Federal lden0cation Ala
Other workplaces riot show n abovew ID E66 1" 10 83402
2. Policy Period: From 04/06/07 to 04/06/08 12:01 a.m. Staculard Time at the insured's malkrg address.
3. A. Workem Compensation Iromance: Part One of this policy applies to the Workers Compensation taw of the states listed here:
B. Employers Liability Insurance. Part Two of the pol applies to work in each state listed in item 3A. The limits of iiabiiit}r under Part
Two are: Bodily Injury by Accident $ 100, 000 each accident
Soft injury by {tease $ 100,000 each employee
Bodily Injury by Msease S 500,000 pdloy limit
Other States insurance. Pact Three of the policy applies to the states, If any, lishod here: 'All stator except No. Dakota, Ohio,
C. WasMngtan, West Virginla, Wyoming, states designated in hem 3A of the information Page and
4. The= premium lbr this policy will be determined by our Manuals of Rides. CiaasiBcations. Rates and Rating Plans. The information
required below is subject to verification and change by audit.
$
0.00
Total Deposit Premium
S
SEE INVOICE
Cash Reoeived
$ ...SEE
SEE INVOICE
O&w CndNw
$
INVOICE
BALANCE DUE
Thal Annual
Classification of Operations
Cork No.
Premium Basis
Rates
Estimated
Estimated
Per $1 t10
Annual
Thal Annual
of Remu-
Premium
Remuneration
neration
SEE CLASSIFICATION OF OPERATIONS SCHEDULE
THIS N NOT
INVOICE
Minimum
Premium $ 300.00
Total Estimated Annual Premium $ 3,063.00
Expense Constant $ 0.00
If indicated. interim adjustmlertts of premium shall be made: _ 13 NuidhlY
This policy incbades these endorsements and schedules:
VC000000A 56- 528SED3 VC000+419 WCOOOI13
E5O00 -ED2 E5022B
VC000414 NC000422 E5203 -ED3 WC000421A
4ft
CM 00 00 Ot a Eta. sas)
WSINE ft EbtMM 6-00 tnNWas mMw%l of NMkNW Cauocil an Conwnwdon lnwraneo. Copyright iSV, wod «d* eta p4ffto lam
Anent 131111A WIXON INS AA TWr_
2007 -05 -29 14,03
FARMERS
MIMI PAGE i OF 1
Page 3
Matj 29 2007 11:38AM HP LASERJET FAX
p.2
FRAM .GIw WIXOM INSLRANCE *FAX NO. :1-208-7135-2206
DA3 2OW 05-57PM P2
Commercial Certificate of Insurance
Al"cy Gins L. Wixom Insivance Agency, lvw.
Nam to Box 1009
1k Blackfoot, 10 $3221
Address
SL 75 _ T)( 47 Agent 330
Inwfed
0910712007
" Classic Fum & Dmip
Nma
- 2379 HeyreM Way
&
- Idaho Fans, ID 9342
AArlms
I
4ftFARM Eits
lvw, Date MWDDrM =12/13/ftO6
Dam nwallute k twahl as a mover of kX*nu#Wn only and awfi" no rlshtt
apace the ca0we kokler, TW c*Ttft*e dm r* wwwW. oteved ur alter the
cmffW affat*4 by the poke* shuwn blow.
Compainks NeviWal Cav&W.
cwnrowA Tnwckhut*awv6%c1h*aV
L xpny 8 Fw"wft Inmronto Exchow
Fompww C mw-ceattry tnuiranee Company
D
This 6 to vw* tW &e pokin a( #wwmce HdeO b*w have hem Wm-A to Or Imund oaw&A M)ove k the pobq pwkA k4=wk Nutwuluwwift
any re "t. wM of ft"tima of any Aftwam us uthm dmuffwg with fwvwt to wMa Ah cartmicaut =q be wAwd ff may pertain, f1w fret nom.
aftcdedby the palkIn6wilhed bewin h w*d to 30 the Mmes, mvivakma and rAptlit6ant of twh prilWz. Limits shown t►ity have kwi (Ww-ed by
paki claim&
044")/M
C4 7 Type of Imwance
Ltr.
R 9 GiNwal 11"Ity
commenjil cat ill
LUNIfty
- OLuffence Ventan
rxM"KtPI - TACWMtAl
Only
owners & OxwKton PfDL
Amwbk liability
Alt 0wjwdCmwnrxr.Ix1
Auto$
ScW Avics
Hked Afitnt
Non-Owned Atom
GuW tiatility
Polky Nuthber
035118971
Umbrella Usibifity -1
08/07/206
erld
Iff4kyn Lwany
of OpemtWS/Vehicies/Rfiit.tirOom/SpeciaI fleyns;
Rcy roomion
ate NWOWV)
0910712007
rAw",[
2,0KOW
Pm&;ctx-CampK)NS
Ar"te
S
pe"CM11 &
AdvwU*% ItOwy
I
tfuh(kauumt
$ 1,000,000
I've Dm age
(Any ow. fire)
S
medw
(Any one =
t
Cwd*wd Single
Limit
NMNW)
Propeny T*"w
I
Gonp Ao!tpk
Limit
I
Each Acd&m
Disease • NO rMolow
I
Dimm • Poky Limit
I
Wcate HOW CamMistion
ADD11:10NAL INS1.71RED: Swmd any of the twm &Miw po**% he cAnmarA b&rr. t1w 04kattan date
Nam" ookknLook ArrEN:Jiiu Mcw&nPC.M thered. On Witing enmpm will tndrAvur W NW 30 1140 W"ttfft 40 "m In the
3401 Hot= Anderson Rd. ratift9te hader "Noid to tlw kft, but faime to me such to Awl Imew no
Add"" fAdess. TX. 76040 a
obt4jr of er)Ubtky %#V kind Vm the amrilwy. Its 890MO of 'rM-v
a . f -
2007-05-29 14:03
Page 2
Oct 09 2007 11:28PM
C1 *ic Foam Design & Sup 208 - 523 -3779 p.1
•
0700256
Mom's Kandy Kitchen -
Exterior Remodel
rAX MEMO
Classic Foam Design & 5u LLC
2379 W. He e-nd Way, Waho Falls, ID 83402
Fax # 208. -523 -5779
rkone: 2-0-6-52-5-5352-
TO: V w4 - a t TTGN StN
FROM: jmkVF
DATE: 101410-(
RE:
FA4T e,111 j A)e- -SYs -rnp -pjFCj r-d,_
OCT 102007 10
01
CITY OF REXBURG
P- 2
0
0
0700256
Morn's Kandy Kitchen
Exterior Remodel
T Cobblestone around
M Window
10 15 2025 30 35 40 =5 50 55 60 65 7075 80 85 9095