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Home My WebLink AboutAPPLICATION - 07-00584 - 740 Lupine St - Mobile Home HookupsCM 0 AEXB URG • BUILDING PERMIT APPLICATION Please c 07 00584 19 E MAIN, REXBURG, ID. 83440 If the quest 740 Lupine Cir- Mobile Home hook -up 208 - 359 -3020 X326 PARCEL NUMBER: �� a� L � (We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information - must be accurate) OWNER NAME P (h e,,W i 3 f r , S CONTACT PHONE # PROPERTY ADDRE A ^ - �Z L � � 1 C PHONE #: Home (2p8) 3� 6 1 6 _ Work QoQ) r -,!3 — P1 Cell (� I ocl 2_664 OWNER MAILING ADDRESS: S Z 2 C�, 9 o o o w CITY: 1 w 6' STATE: t! 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 ( CONTRACTOR MAILING ADDRESS: CITY PHONE #: Home ( EMAIL F Work ( Cell ( Cell ( TE ZIP IDAHO REGISTRATION # & EXP. DATE now many aunaings 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 property) PROPOSED USE: _ (i.e., Single Family Residence, N Apartments, Remodel, Garage, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt of perjur I hereb 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. Permit void 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, 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 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** BuildIg Safety Department oF R�XBUA� a � CITY OF City of Rexburg 1 72 n rVnr mG � 0 1\.C.1\t) V It 19 E. Main janellh@rexburg.org Phone: 208 Americas Family Community Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 " ° Affidavit of Legal Interest State of Idaho County of Madison I, 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 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 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 A p p lication! p PP NAM E,, l�r +ttS PROPERTY ADDRESS SUBDIVISION Dwelling U Parcel Acres: Permit# SETBACKS FRONT SIDE SIDE BACK Remodeling Your Building /Home (need Estimate) $ 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 or Barn Carport /Deck (30" above Water Meter Quantity: * * * * * * * * * * * ** *Water Meter Size: Required f PLUMBING 1 L Plumbing Contractor's Name: 1�Y a� �C�a g l� Business Name: Address 1"j S� } We S I City �� State ]cal Zip '�?0 4 Contact Phone: ( ) 4L�W Business Phone: ( ) _9b `- tL (,,O Email Fax FIXTURE COUNT tmcluding rou -hed fixtures Clothes Washing Machine Sprinklers Dishwasher Tub /Showers -�— Floor Drain Toilet /Urinal -�— Garbage Disposal Water Heater Hot Tub /Spa rt Water Softener `2. Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ q 0 U y � (COMMERCIAL /MULTI - FAMILY ONLY) Signature of Licensed Contractor License Number& Expiration Date Date The City of Kexburg's permit fee schedule is the same as required by the State of Idaho Please complete the entire Application! NAME )a I &,-J =0 r r e PROPERTY ADDRESS SUBDIVISION Permit# Requiredffl MECHANICAL Mechanical Contractor's Name Business Name Address City State Zip Cell Phone ( ) Business Phone ( ) Fax ( ) 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 r. -Wemm 1 Con 437.t i • . _!. 1 X17 . ,_ Signature of Licensed Contractor The License number schedule is the same as • Date the State of Idabo Building Safety Department �YO atiXB�R�fo C IT OF City of Rexburg � m � C.1 V� V It 1t rVT�T mG � 0 19 E Main janellh @rexburg.org Phone: 208.359.3020 x326 << America's Family Community Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 OWNER'S NAME -f, to �10 r V -c S PROPERTY ADDRESS Permit# SUBDIVISION PHASE LOT BLOCK HOME OWNER'S ELECTRICAL PERMIT Home Owner's Name Address City State Zip Cell Phone ( ) Home Phone ( ) Fax( ) Email TYPES OF INSTALLATION (New Residential includes everything contained within the residential structure and attached garage at the same time) For power supplier requirements visit www.rockymtnpower.net 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 Home Owner Date The City of Bexburg's permit fee scbeduk 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 Fox: 208.359.3024 4 ' f� cITr i OF REXBURG r1' =rcric;�:� �:zr ;;• OWNER'S NAME ►T �`�2��R '� (` a S PROPERTY ADDRESS u�l iV \ IN ( SUBDIVISION PHASE LOT BLOCK Permit #07 00584 740 Lupine St Mobile Home Hookup Requ*edN ELECTRICAL Electrical Contractor's Name Bron Leishman Business Name Leishman Electric Address 442 South 4th East Cit Rexburg State ID Zip 83440 Cell Phone (2 0 8) 390-143 Business Phone (2 0 �- 3 5 6 - 3 7 7 0 Fax(208) 359 -0918 Email bcleishman @msn.com Electrical Estimate (cost of wiring & labor) $ (COMMERCIAL /MULTI- FAMILY ONLY) TYPES OFINSTALLATIONI (New Residential includes everything contained widVa the residential structure and attachedgarage 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) 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 License number Date The schedule is the same as required by the State of Idaho 7 Requiredffl ELECTRICAL Electrical Contractor's Name -TOdd `I V- ten.,,,- Business Name L -t Stn im k, , G l-f CAY'v C Address q 2 u A (�eS f" City 01- State ��d = Zip Cell Phone ( ) °� 0 - S'6 Gl Business Phone ( ) Fax ( ) a Electrical Estimate ( cost of wiring & labor $ , 3 � ca (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) 43 " 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 Z5 - Other Installations: Wiring not specifically covered by any of the above Cost of Wiring & Labor: $ Pumps (Domestic Water, Irrigation, Sewage) 26 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 Date The schedule is the same as required by the State of Idaho Building Safety Department City of Rexburg . ct •rY of c � n TV�T mG � o ltl✓1V71.11\ 19 E Main janellh @rexburg.org Rexburg, ID 83440 www.rexburg.org Phone: 208.359.3020 x326 Fax: 208.359.3024 __._..._...__..___ Ow Americds Family Community OWNER'S NAME PROPERTY °�` '` s 0700584 ADDRESS SUBDIVISION 740 Lupine Cir- Mobile Home hook -up PHASE LOT BLOCK Requiredffl ELECTRICAL Electrical Contractor's Name -TOdd `I V- ten.,,,- Business Name L -t Stn im k, , G l-f CAY'v C Address q 2 u A (�eS f" City 01- State ��d = Zip Cell Phone ( ) °� 0 - S'6 Gl Business Phone ( ) Fax ( ) a Electrical Estimate ( cost of wiring & labor $ , 3 � ca (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) 43 " 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 Z5 - Other Installations: Wiring not specifically covered by any of the above Cost of Wiring & Labor: $ Pumps (Domestic Water, Irrigation, Sewage) 26 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 Date The schedule is the same as required by the State of Idaho • SUBCONTRACTOR LIST Excavation & Masonry: Roofing: Floor Roof Trus Floor /Ceiling Joi Special Construction (Manufacturer or Supplier) 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 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 Print Name