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Home My WebLink AboutALL DOCS & CO - 08-00092 - 1158 Horizon Dr - New SFRo f 1t8lCB URC, � f 0 U p m� '1 A �p " �"HED `s CITY O F REX Americo Family Community Building Permit INSPECTION CARD BUILDING Date Annroved 1. Mechanical Rough In No work shall be done on any part of on the premises during construction. 2. Mechanical Pressure NOTICE! 3. Mechanical Final Ins 2) The permit will become null and void in the event of any deviation from the in each successive inspection without 4. Layout 5. Footing approval. No structural framework of 3) No foundation, structural, electrical, nor plumbing work shall be concealed 6. Foundation without aooroval. 7. Framing 8. Insulation 9. Drywall 10. Sidewalk 11. Final ELECTRICAL 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 Issued By i 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. the building beyond the point indicated. NOTICE! 2) The permit will become null and void in the event of any deviation from the in each successive inspection without 4. Ground Rough -In 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 aooroval. Date Approved 1. Rough -In 2. Final PLUMBING Date Anoroved 1. Sewer Service Conn 2. Water Service Conn( 3. Rough -In 4. Ground Rough -In 24.Hour Notice and Permit Number required to make inspection appointments For Inspections Call 359 -3020 option 2 A CERTIFICATE OF OCCUPANCY CAN NOT BE ISSUED PRIOR TO FINAL ELECTRICAL & PLUMBING INSPECTION {r} Certificate of Occupanc City of Rexburg Department of Community Development 19 E. Main St. / Rexburg, ID. 83440 Phone (208) 359 -3020 / Fax (208) 359 -3024 Building Permit No: 0800092 Applicable Edition of Code: International Building Code 2006 Site Address: I is - 4oiZf4M br 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: Stevens Kyle 490 Pioneer Rd Apt 8106 Rexburg, ID 83440 Contractor: Stevens Construction Special Conditions: Occupancy: Residential - 2 units or less, 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 was inspected on the date listed was found to be in compliance with the requirements of the code for the group and division of occupancy and the use for which the proposed occupancy was classified. Date C.O. Issued: October 23, 2009 (12:52PM) C.O Issued by: � < Building Official There shall be no further change in the existing 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 Inspector: Fire Inspector: Electrical Inspector P&Z Administrator 11 o�QexeuR�, CITY OF Certificate of &cupancy REX Cit of Rexbur "°'— America's Family Community Department of Community Development +' •ee.o sa 19 E. Main St. / Rexburg, ID. 83440 Phone 208 359 -3020 / Fax 208 359 Building Permit No: 0800092 Applicable Edition of Code: International Building Code 2006 Site Address:S 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: Stevens Kyle 490 Pioneer Rd Apt 8106 Rexburg, ID 83440 Contractor: Stevens Construction 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 Intemational Building Code, certifies that, at the time time of issuance, this building or that portion of the building that "as inspected on the date listed vies found to be in compliance vuth the requirements of the code for the group and division of occupancy and the use for vihich the proposed occupancy vies classified. Date C.O. Issued: F b C.O Issued by: Vj! Building �Cfficial There shall be no further change in the eiasting 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. n Plumbing Inspec I Electrical Inspector: Fire Inspector: P&Z Administrator: 0 0 Please complete the entire App lication! If the question does not apply fill in NA for nor applicable NAME PROPERTY ADDRESS • C4--j ,p,, Permit# l SUBDIVISION (,(� .Required!!! MECHANICAL Mechanical Contractor's Name: '!-"-s ae--i Business Name: efZrZ Address _If 2F e ; 4,k /{mil City-- ��f State_ - Zip ��YU Contact Phone: (?ok) Business Phone: Email Mechanical Estimate S (Commerciallblulti Family Only) FD ZTJP - & APPLIAA'CES COUNT (Single Family D*v&hvg Only) Furnace E or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater G Decorative Qas -fired appliance Incinerator System Boiler Pool Heater Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: Similar fixtures or Appliances Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure (Meter Supply) PSI Heat (Circle all that apply) Gas Oil Coal ireplace Electric AUG - 8 2008 CITY OF RIXBURG Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. /y�y �Un Cvea�Fd✓ Z 2�� d 8 c Si of Li ensed Coil ractor License number Date Required! The City ofRerhurg s perrnir fee schedule is the same as required by the Stale of Idaho J T 'd SGT T- 629 -802 ja2eaj0 uojRW e9E =0T 80 so 2nd Building Safety Department pFREXBVRC City of Rexburg 19 E Main janellh @rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 c[ T Y OF REXBURG America's Family Community OWNER'S NAME PROPERTYADD Permit #08 00092 SUBDIVISION `t, �d �` e � ' � c �.�> PHASE OT BLOCK HoriZOrl Dr l'u - 0 Required!!! ELECTRICAL Electrical Contractor's Name Business Name Address `r� `~ � �,� / r City ee '. I, t� va. State ] O Zip v qo Cell Phone (9^ ,) 39a - 3S Business Phone ( ) :359 7 I Fax (& 35 1 — D Co 7 2- Email Electrical Estimate (cost of wiring & labor) $ (COMMERCIAL /MULTI - FAMILY ONLY) TYPES OFINSTALLATION (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. ignature of Licensed Contractor License number Date The schedule is the same as required by the State of Idaho 4 µEXB URC t .o r CITY O F REXIiURG ' E America's Family Community RESIDENTIAL BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID 83440 208 - 359 -3020 X326 PARCEL NUMBER: - y V i1 (Q 9 CJC9 Q (We will provide this for you) �m SUBDIVISION:- 1(c 'c UNIT# BLOCK# T TT LOT# 7 (Addressing is based on t1d information - must be accurate) 11516 bp- 14 PROPERTY ADDRESS: U° U , � , e r : x PHONE #: Home ( ) Work ( ) CONTACT PHONE Cell (aee) 7,017 . 7 37e/ OWNER MAILING ADDRESS. I 1 i tl�mo °r � f� c��' { �!n CITY: 2r,4 u r STATE : LN- ZIP: ",iY4, EMAIL 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 txjr4 � 4- c vcrl MAILING ADDRESS: � lt _?ere C CITY STATE Std ZIP 53 PHONE #: Home ( 356 - 73/4 Work ( ) Cell (,2os) - 7 0 9 . 73 JZ EMAIL ZVR-S4ejrn�6 , AX 3510 - 31;2 7 IDAHO REGISTRATION # & EXP. DATE V4'r- y How many buildings are located on this property? Did you recently purchase this property? No .Yes)(If yes, list previous owner's Is this a lot split? NO YES (Please bring copy of new legal description of p. PROPOSED USE: n- �V+_ , \`'d"�� (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Additi / 2/oZ11VO APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: ' ' ° U(�U AI 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. -2-1 / Signatur f O er /Applicant DATE Do you prefer to be contacted by fast, 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 fanuarX 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** Alk Please CompleteThe Entire Application! If the question does not apply fill in NA for non applicable FEB 2 6 2008 , Bull 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 µtiXe URC 's v C CITY OF REXBURG Americas Family Community Affidavit of Legal Interest State of Idaho County of Madison j 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 rC day of d -20 6 Signature Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: A Please complete the Aire A lication! p pp NAME PROPERT�' ADDRESS \J�, , h ' c� Pnc Permit# SUBDIVISION Dwelling Units: Parcel Acres: SETBACKS , FRONT 3 5 SIDE SIDE BACK 3a / Remodeling Your Building /Home (need Estimate) $ SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) First Floor Area I � 11 Unfinished Basement area Second floor /loft area Finished basement area 7 71 Third floor /loft area Garage area Shed or Barn Carport /Deck (30" above grade)Area Water Meter Quantity: 1 * * * * * * * * * * * ** *Water Meter Size: Required!!! PLUMBING Plumbing Contractor's Name: T),-+ 04-A Business Name: - fcx5vr -, ^�' ^ c° '° "1 Address - )GG, ti City State J:_C Zip S34/06 Contact Phone: ( ) Business Phone: Email Fax FIXTURE COUNT Cmcludingroughed fixtures Clothes Washing Machine I Dishwasher Floor Drain Garbage Disposal Hot Tub /Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ Sprinklers Z Tub /Showers Toilet /Urinal Water Heater Water Softener (COMMERCIAL /MULTI - FAMILY ONLY) C 14'� °- 95 2 ignature of Licensed Contractor License Number& Expiration Date kate The 00 of Rexburg's permit fee schedule is the same as required by the State of Idaho Please complete the entire Ap P PP NAM PROPERTY ADDRESS ✓s'' N,? c �' 4 � SUBDIVISION 0 Permit# Required!!! MECHANICAL Mechanical Contractor's Name Business Name leM�� Address 7�L'o Aj 'c' ?��x,:�.ac �l'n',�da .� City <x�vra.. State 3t�'4 Cell Phone ( ) Business Phone (; v S ) 356 - g77 a Fax ( Mechanical Estimate $ (Commercial /Multi Family Only) FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) I Furnace Furnace /Air Conditioner Combo Heat Pump I 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 other similar vents & ducts: Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic • 1 nt I De must be 1 on p lans, Signatur censed Contractor License number Date Exhaust or Vent Ducts � f Dryer Vents I Range Hood Vents Cook Stove Vents '2- Bath Fan Vents The City of Rexburg's permit fee schedule is the same as required by the State of Idaho SUBCONTRACTOR LIST Excavation & Earthwork: awl Concrete: F—OWMtief Masonry: CAX r� C Roofing: 4 Drywall: Floor Coverings: Mow) 1 ,600 j1:1 Plumbing: -A Heating: Electrical: lea a C Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling joists: 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.ibo1.idaho4ov /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 Cl Operation of a farm or ranch or construction of agriculture buildings exempt from Idaho Building Code Cl 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 Build Safety Department City of Rexburg 19 E. Main Rexburg, ID 83440 ionellh@rexburg.org Phone: 208.359.3020 www.rexburg.org Fax: 208.359.3024 OF R£XBURC o co CITY OF REXBU Americas Family Community Office Hours: Monday - Friday 8:00am- 4:00pm Single Family Residential Pre - Construction Checklist Seismic Design Category — D Ground Snow — 50 lbs. per sq. ft. Frost Depth — 36" Roof Snow Load — 35 lbs. per sq. ft. Wind Load — 90 MPH The following items should be completed be oreyou submityour building permit application. Completion of Building Permit Application: You may print this application from our website www.rexbuig.org or pick up a copy at the City Hall Annex Building (address above). For Residential Permits: (the following is required to be submitted before the Application can be approved) ❑ 2 sets of site plans and 2 sets of building plans (must be drawn to scale) -Plans must include foundation plan, floor joist layout, floor plan, roof layout, sectional views, front, back, and side elevations, mechanical layout, stair details and any details required to illustrate special construction. ❑ Energy Compliance Report: The State of Idaho has adopted the International Energy Conservation Code (IECC). A Compliance Review must be completed and submitted (the rescheck software is available online at www.energycodes.gov • Page 2 of the Application must include the Idaho Contractor's Registration Number or the exemption form must be completed and si ed, see Page 9. • Page 4 of the Application must be completed and signed by your Plumber ❑ Page 5 of the Application must be completed and signed by your Mechanical Contractor ❑ Mechanical system sizing and design is required including gas line distribution system. ❑ Page 7 of the Application must be completed and signed by your Electrician ❑ Home owners please complete page 6 of the application if you will be doing your own electrical work. ❑ Truss details including engineered floor joists are required. Subdivisions: If you plan to build in a subdivision please check the Rexburg Development Code for any requirements such as, property setbacks, architecture board approval, etc. This information is available from the Planning & Zoning Department at the Annex Building located at 19 East Main. New Residential Homes: If your building permit is for a new home, you will need the parcel number (a parcel number is the county's property identification which recognizes a plot of lana) and a new physical address will be issued. If you do not know the parcel number and cannot find a record of it, please bring the name of the subdivision, phase, and the lot and block numbers. The correct location is vital to assure correct addressing Remodels: If you are considering a remodel, a gDpy of the bid or estimate for the remodel must be submitted with the Permit Application. • 2 sets of Plans are required (may need IECC Review). • Additions are the same requirements as new construction. 04 gHXBUR U C a� aweo , • C I T Y OF REX IiURG Ame&4 Family Community • Please Complete the Entire Application! If the question does not apply fill in NA for non applicable RESIDENTIAL BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID 83440 208 - 359 -3020 X326 PARCEL NUMBER: (We will provide this for you) SUBDIVISION: 1 /14LLEI ()1 E,J UNIT# BLOCK# _ LOT# (Addressing is based on the information - must be accurate) 115a /I69 bit. Dwelling Units: Parcel Acres: CONTACT PHONE # PROPERTY ADDRESS: 1 1 54 cAzo I 11 PHONE #: Home ( ) �JS� 3 I a Work ( ) Cell ( ) - 7 05 .7 3 1 OWNER MAILING ADDRESS: CITY: STATE: 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 PHONE #: Home ( EMAIL F Work ( Cell ( CONTRACTOR MAILING ADDRESS: 0 1 ' e4 - 3 04 CITY Lisfidri STATE ZIP g ggio PHONE #: Home ( ) 35("131 J! Work ( ) Cell ( ) 7 05 - 1 3. 1 . EMAIL FAX 3j L - 31 � IDAHO REGISTRATION # & EXP. DATE RC - 4 2 How manv buildines are located on this property? Did you recently purchase this property ?(9 Yes (If yes, list previous owner's name)_ Is this a lot split? 6) YES (Please bring copy of new4egal description property) A/. kin Family Residence ? ulti Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby 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 old if work stops for 180 days. wn Signature of Oer /App 'cant DATE 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 anuarE1,. 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** 14 Building Safety Department City of Rexburg 19 E. Main ionellh @rexburg.org Phone: 208.359.3020 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 oQ aExBURC c CITY OF R C'W---- Family Community Affidavit of Legal Interest State of Idaho County of Madison Name On City Being first duly sworn upon oath, depose and say: A. 1 3) P1 e,,,A J'& J 04 Address State (If Applicant is also Owner of Record, skip to B) 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 o ( S} day of DL } " , 20 11 riNf't Signature Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: 3 Building Safety Department City of Rexburg 19 E. Main joneilh @rexburg.org Phone: 208.359.3020 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 p ��exBUR C, v o „ Neo C I T Y OF RE — 0% — Americ4 Family Community Property Lines Each site plan that is submitted to the City of Rexburg forte uilding Permit process requires that property lines are shown accurately. It is the Developer's responsibility to correctly identify on the site plan the location of these lines in reference to the public right -of -way, other adjoining property lines, the street, other structures and all utility lines. The Developer should find property pins that are still available at the lot in question. If these pins do not exist or have become unrecognizable then a new survey should be performed. Accurate property line information is a must for a timely review. In addition to finding existing property pins, legal descriptions should be checked. The best way to identify property line location is with a land survey. The City of Rexburg has aerial photos and a parcel line layer that can be checked, but they are only a tool and are not guaranteed for accuracy. If you want to request a copy of your lot, see the front counter at the Community Development Department. I have read and understand the above requirements. Signature Printed Name Date ❑ Owner or ❑ Builder 4 • • Building Safety Department XB 0 City of Rexburg cQ 19 E. Main ionellh @rexburg.org Phone: 208.359.3020 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 '• "`° CITY OF MX America's Family Community NAME c-,/ PROPERTY ADD SS 1 tI�^S ,t• SUBDIVISION - el V t e-4.J PHASE LOY BLOCK Remodeling Your Building /Home (need Estimate) $ Permit# 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 1_ Third floor /loft area Garage area Shed or Barn Carport /Deck (30" above grade)Area Water Meter Quantity: /y A * * * * * * * * * * * * * Water Meter Size: /�A Requiredffl PLUMBING n Plumbing Contractor's Name: NePk ( A U,*_ J Business Name: J � � It � �e -� � • City State Zip Contact Phone: ( ) d [ 0 Business Phone: FIXTURE COUNT (including roughed Fixtures) Clothes Washing Machine Sprinklers Dishwasher Tub /Showers Floor Drain Toilet /Urinal Garbage Disposal Water Heater Hot Tub /Spa Water Softener Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate (COMMERCIAL /MULTI - FAMILY ONLY) Signature of Licensed Contractor License Number& Expiration Date Date I 9 0 Building Safety Department C I T Y OF City of Rexburg �o nr.XB TT�/'� 19 E. Main j anellh@rexburg.o r g Phone: 208.359.3020 Ow 1 \t. 1 g g y e o America's Family Community Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 NAME PROPERTY ADDRESS SUBDIVISION PHASE LOT BLOCK Permit# Required.!! MECHANICAL Mechanical Contractor's Name A I Business Name Address Cell Phone ( ) i �j usiness 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 (water heater) 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 Signature of Licensed Contractor License number Date G Building Safety Department oQs BU City of Rexburg f o 19 E Main jonellh@rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 CITY O F REXBURG �v— cw _e_____ America's Family Community OWNER'S NAME PROPERTY ADDRESS SUBDIVISION PHASE LOT BLOCK Permit# HOME OWNER'S ELECTRICAL PERMIT Home Owner's Name City State Zip Cell Phone ( ) Fax ( ) Home Phone ( ) 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 ❑ *Up to 1,500 sq ft - $72 ❑ *1,501 to 2,500 sq ft - $120 ❑ *2,501 to 3,500 sq ft - $168 ❑ *3,501 to 4,500 sq ft - $216 ❑ * *Over 4,500 sq ft - $216 plus $.04 /sq ft: sq ft total ❑ Existing Residential (# of Branch Circuits) - $40 plus $10 per circuit: # of circuits ❑ Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year) - $40 ❑ Spa, Hot Tub, Swinuning Pool - $40 plus $40 grounding grid where applicable • Electric Central Systems Heating and /or Cooling (when notpart of a new residential construction permit and no additional wirin,g) - $40 • Modular, Manufactured or Mobile Home - $50 plus $10 per circuit • Other Installations: Wiring not specifically covered by any of the above: Cost of 1Viring Labor (Includes the cost of materials installed regardless of the part' .supplying it). • Pumps (Domestic Water, Irrigation, Sewage): horse power ❑ Requested Inspections (of existing wiring) - $40 /hr (1 hour minimum) plus $40 /hr thereafter *Includes a maximum of 3 inspections. Additional inspections charged at requested inspection rate of $40 per hour. ** Includes a maximum of 4 inspections. Additional inspections charged at requested inspection rate of $40 per hour. Signature of Home Owner Date 7 Building Safety Department o QaaUR� �4 f 0 City of Rexburg °y 19 E Main janellh @rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 CITY OF M XBURG r ,,, - Americas Family Community OWNER'S NAM PROPERTY ADDRESS ( 1 5 ('b t l Z,m..) 10 2. Permit# SUBDIVISION 0 l c 4 l e i PHASE LOT to BLOCK _ Requiredffl ELECTRICAL Electrical Contractor's Name L e5k-J Business Name Let aC-N Address City Cell Phone ( ) 310 3 3 O 6 Business Phone Fax ( ) Email to Zip Electrical Estimate (cost of wiring & labor $ (COMMERCIAL /MULTI - FAMILY ONLY) (Includes the cost of materials installed regardless of the party suppying it). TYPES OFINSTALLATION (NewResidendal includes everything contained within the residential structure and anacbedgarage at the same time) RESIDENTIAL ONLY ❑ *Up to 1,500 sq ft - $72 ❑ *1,501 to 2,500 sq ft - $120 ❑ *2,501 to 3,500 sq ft - $168 ❑ *3,501 to 4,500 sq ft - $216 ❑ * *Over 4,500 sq ft - $216 plus $.04 /sq ft: sq ft total ❑ Existing Residential (# of Branch Circuits) - $40 plus $10 per circuit: # of circuits ❑ Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year) - $40 ❑ Spa, Hot Tub, Swimming Pool - $40 plus $40 grounding grid where applicable ❑ Electric Central Systems Heating and /or Cooling (when not part of a new residential construction permit and no additional wiring) - $40 ❑ Modular, Manufactured or Mobile Home - $50 plus $10 per circuit ❑ Other Installations: Wiring not specifically covered by any of the above: Cost of lYliring Labor. (Includes the cost of materials installed regardless of the part' supplying it). ❑ Pumps (Domestic Water, Irrigation, Sewage): horse power ❑ Requested Inspections (of existing wiring) - $40 /hr (1 hr minimum) plus $40 /hr thereafter *Includes a maximum of 3 inspections. Additional inspections charged at requested inspection rate of $40 per hour. ** Includes a maximum of 4 inspections. Additional inspections charged at requested inspection rate of $40 per hour. Signature of Licensed Contractor License number Date 8 SUBCONTRACTOR LIST Excavation & Masonry: Floor Special Construction (Manufacturer or Supplier) Roof T Floor /Ceiling Joists: 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 Print Name Date 10