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Home My WebLink AboutALL DOCS - 08-00120 - Tabernacle - Remodelw o �ptXBFR C A . � CITY OF mew REXBURG Please Complete the Entire Applicationl ,.' America's Family Community 08001 S MFO COMMERCIAL & MULTI FAMILY BUILDING 19 E MAIN, REXBURG, ID 83440 Tabernacle Remodel 208 - 359 -3020 X326 PARCEL NUMBER: ►2`U4I3,o (We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressin-a is based on the information - must be accurate) CONTACT PHONE # 35q - 3ozo PROPERTY ADDRESS: 51 Q. Czvl}e_,r PHONE #: Home ( Work ( ) Cell ( ) - 1 1 6 - 134ci OWNER MAILING ADDRESS: P.O. 13ox Zl(�.O CITY: Isc STATE: =u ZIP: 834 EMAIL FAX rq - 30 ZZ APPLICANT (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must APPLICANT INFORMATION: ADDRESS STATE; ZIP EMAI] PHONE #: Home ( ) Work ( CONTRACTOR MAILING ADDRESS: CITY PHONE: Cell# Work# EMAIL IDAHO REGISTRATION # & EXP. How many buildings are located on this property? Cell ( Did you recently purchase this property? No Yes (If yes, list previous owner's Is this a lot split? (� YES (Please bring copy of new legal description of p. PROPOSED USE: S o (i.e., Single Family Residence, Multi this ap T tio { I A� , { ,e , Apartments, Remodel, Garage, Commercial, Addition, Etc.) — CIRCLE ONE APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt ofperjut 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 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 lamwa 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** 2 0 . Building Safety Department o FAEXB�R�, City of Rexburg 19 E. Main janellh @rexburg.org Phone: 208.359.3020 ext 326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 CITY O F REXBURG Americas Family Community Affidavit of Legal Interest City State of Idaho County of Madison I, Name 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 herin or as to the ownership of the property which is the subject of the application. Dated this day of . 3 2 0 Signature Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: 3 • 0 City of Rexburg NAME PROPERTY AD SS 5�1 SUBDIVISION Dwelling Units: Parcel Acres: SETBACKS FRONT I Please Complete the Entire Application! I If the question does not apply fill in NA for non applicable SIDE SIDE BACK Remodeling Your Building /Home (need Estimate $ �Q 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: .: " j Water Meter Size: Requiredffl PLUMBING Plumbing Contractor's Name: Business Name: Addres City State Zip Contact Phone: ( ) Business Phone: ( ) Email Fax FIXTURE COUNT (inclu fte roWhed ftxtures� Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal Hot Tub /Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ (Commercial Only) Sprinklers Tub /Showers Toilet /Urinal Water Heater Water Softener of Licensed Contractor License number Date 4 !� The City ojexburg'rhermit fee sebeduk it the came as required by th?Wato of Idaho NAME x PROPERTY A DRESS SUBDIVISION Required!!! Please Complete the Entire Application! If the question does not apply fill in NA for non applicable Permit# MECHANICAL Mechanical Contractor's Name: Business Name: Address City State Zip Contact Phone: ( ) Business Phone: ( ) Email Fax Mechanical Estimate $ (Commercial /Multi Family Only) FIXTURES &APPLIANCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace /Air Conditioner Combo Dryer Vents Heat Pump Range Hood Vents Air Conditioner Cook Stove Vents Evaporative Cooler Bath Fan Vents Unit Heater other similar vents & ducts: 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 Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic Point of Dehyesy must be shown on plans. Required! Signature of Licensed Contractor The License number 's permit fee schedule is the same as Date the State • Building Safety Department City of Rexburg 19 E Main ionellh@rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 of pExs °Rc �� td C I T Y OF R Americas Family Community OWNER'S NAME PROPERTY ADDRESS SUBDIVISION PHASE LOT BLOCK Permit# Requiredffl ELECTRICAL Electrical Contractor's Name Business Name Cell Phone ( ) Fax ( ) City Less Phone ( 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: $ 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. P Signature of Licensed Contractormw License number Date The City of Bexburg's permit fee schedule is the same as required by the State of Tdahm Building Safety Department City of Rexburg 19 E. Main janellh@rexburg.org Phone: 208.359.3020 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 cit CITY O F MXBURG Americas Family Community APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES /NO - APPLICANT INFORMATION: Business Name: Office Address: Office Phone Number: ( ) Contractor Performing the Work: Contact Person: - LOCATION OF WORK TO BE DONE: Street Address Where Work Will Be Done: Business Name Where Work Will Be Done: Dates For Work To Be Done: Contact Person: Phone Number: ( ) Cell # ( ) PLEASE CHECK THE TYPE OF PERMITS) YOU ARE APPLYING FOR: ❑ AUTOMATIC FIRE- EXTINGUISHING SYSTEMS ❑ COMPRESSED GASES ❑ FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT ❑ FIRE PUMPS AND RELATED EQUIPMENT ❑ FLAMMABLE AND COMMBUSTIBLE LIQUIDS ❑ HAZARDOUS MATERIALS ❑ INDUSTRIAL OVENS ❑ LP -GAS ❑ PRIVATE FIRE HYDRANTS ❑ SPRAYING OR DIPPING ❑ STANDPIPE SYSTEMS ❑ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES APPROVED BY: O� REXB URC �i r 0 v o State Zip Cell Phone # ( ) Applicant's Signature Date 7 • • SUBCONTRACTOR LIST Excavation & Earthwork: N a YX Q Concrete: Masonry: tA d+1_e_, Roofing: k coy- rL, Insulation: �I OY - Le, Drywall: "oY1.9- Painting: N OYI-e, Floor Coverings: NoYtp, Plumbing: N ooi, Heating: Electrical: Novae, Special Construction (Manufacturer or Supplier) Roof Trus Floor /Ceiling Joists: Siding /Exterior Trim: l�ovLe_ Other: �1110 v\-e EXEMPTIAS FROM STATE REAT TRATION 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 Cl 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 ceJifyd=Aw ve information is true and correct to the best of my knowledge. Signature " 1 Date -- �U,G -� - Ba Print Name E