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HomeMy WebLinkAboutAPPLICATIONS - 08-00210 - Dr. Hopkins Medical OfficeCITY OF KEXB UAG 10 BUILDING PERMIT APPLICATION Ple; 19 E MAIN, REXBURG, ID. 83440 208 - 359 -3020 X326 0 0800210 Dr. Hopkins Medical Office PARCEL NUMBER: eMP) XP 1 0 W 15 (We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# )n! 1S based on the Information - must be OWNER NAME• D fZ T yTe „�, c CONTACT PHONE # PROPERTY ADDRESS: PHONE #: Home ( ) Work ( )_ — Cell( OWNER MAILING ADDRESS: ' fy)Odi 5cw ?4- i X S CITY: 4� STATE: 2 1 5 ' 34 _ 1 15 1 6 1 EMAIL zL Lo —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 /v� �o� Alm CITY: cc. STATE ZIP EMAIL cMRd e2i tb�P �+ AX ter• 35 5 — a?a 7/ PHONE #: Home ( ) Work ( ) 959 -40 Z Cell ( ) J90 CONTRACTOR `,CS / "eQP1��,•f `6c, ' I J ea 5 �/ C_ MAILING ADDRESS: ��So2 �d_ ,pz CITY e �_, STATE _;j2 ZIP PHONE: Cell# 3 3z�'3 Work# 3,�N © 6,2-0 Fax# - a)L- 7 EMAIL IDAHO REGISTRATION # & EXP. DATE How many buildings are located on this property? / ,�) 1 Did you recently purchase this property ? (lam - "/ Yes (If yes give owner's name) Is this a lot split? YES (Please bring copy of new legal description of prod PROPOSED US 1' [ M 1 0 I--P (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition APR 2 3 2008 APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: [JndL4JalT J4l u g QI L !P !� f have read this application and state that the information herein is correct and I swear that any information which may herea er e�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. Z 11 / 1 Signature o Owner /Applicant v ` , r DATE Do you prefer to be contacted by fax, email or on ?- 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 ranuary 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 Building Safety Department City of Rexburg 19 E. Main jonellh@rexburg.org Phone: 208.359.3020 ext 326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 04 gEXB uRG "0 0 C I T Y OF REXB Americas Family Community Affidavit of Legal Interest State of Idaho County of Madison I�..�`1 is 1, Q y Name Address d 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: 0 �,��1 ki cr. �, I Z• � !_ t �. L 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 ) r�e i L , 20 cf C Signature Subscribed and sworn to before me the day and year first above written. Notary blie of Idaho ...... = Residing at: l� � r '',('1 � `mil t ►) ' �, I I My commission expires: .� tw 1Q_.a Please complete the Aire Application! If the question does not apply fill in NA for non applicable NAME PROPERTY ADDRESS SUBDIVISION Dwelling Units: Parcel SETBACKS ' FRONT 5 Permit# o i i SIDE S SIDE BACK 1s Remodeling Your Building /Home (need Estimate) $ SURFACE SQUARE FOOTAGE. • (Shall include the exterior wall measurements of the building) First Floor Area _S C3h Unfinished Basement area 10,4 Second floor /loft area /l7C Finished basement area Third floor /loft area A114 Garage area /Jl Shed or Barn ti 14 Carport /Deck (30" above grade)Area ?� Water Meter Quantity: Water Meter Size: Required ff! PLUMBING Plumbing Contractor's Name: Business Name: Address City State Zip Contact Phone: ( ) Business Phone: ( ) Email Fax FIXTURE COUNT (mcluftetoy hed fixtures 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 Required! Signature of Licensed Contractor License number Date The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 4 Please complete the ent1l Application! If the question doeslfot apply fill in NA for non applicable NAME PROPERTY ADDRESS Permit# SUBDIVISION Requiredffl 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 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 r _ Decorative gas -fired appliance Incinerator System Boiler r Pool Heater Fuel Gas Pipe Outlets including stubbed in or future outlets 42 Inlet Pressure (Meter Supply) PSI 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 plans. Required! Signature of Licensed Contractor License number Date The City of Rexburg'rhermit fee schedule is the same as required by the State of Idaho 5 BuildliNg 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 4EXBUR C �Y f 0 ,� 7 o CITY OF R EX B URG America's Family Community OWNER'S NAME PROPERTY ADDRESS SUBDIVISION PHASE LOT BLOCK Permit# Required!!! ELECTRICAL Electrical Contractor's Name Business Name Address City-----------. Zip Cell Phone ( ) Business Phone ( ) Fax ( ) 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* 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. Signature of Licensed Contractor License number Date The City of Aexburg's permit fee schedule is the same as required by the State of Idabo n Build ng Safety Department o 4��XBVRG City of Rexburg >> o 19 E. Main janellh@rexburg.org Phone: 208.359.3020 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 C I T Y O F REX BURG 0& Americas Family Community APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES /NO APPROVED BY: - APPLICANT INFORMATION: - Business Name: _ r� f' ele- r :r� i % c _� < ` c . (�'Uc.C..X > 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 Applicant's Signature Date ............................................................ ............................... To City State Zip Cell Phone # ( ) 7 r • SUBCONTRACTOR LIST Excavation & Earthwork: Concrete: Masonry: Painting: Floor Coverings: Hea Special Construction (Manufacturer or Supplier) Roof Trusses: Floor /Ceiling Joi Siding /Exterior Trim: Other: 8 • JaNell Hansen From: Johnny Watson Owatson @JRWA.com] Sent: Friday, May 22, 2009 11:49 AM To: JaNell Hansen Subject: RE: Hopkin Medical Use them to start a campfire this weekend. Thanks, Johnny From: JaNell Hansen [mailto:janellh @rexburg.org] Sent: Friday, May 22, 2009 10:35 AM To: Johnny Watson Subject: Hopkin Medical Johnny, Dr. Hopkin's medical office permit has expired. Do you want the plans back or can I throw them away? JaNell Hansen Building Safety Coordinator Phone: 208.359.3020 ext 346 Fax: 208.359.3024 , rarefimis f4m iy Ctammtsniq • JaNell Hansen From: Johnny Watson Uwatson @JRWA.com] Sent: Tuesday, September 02, 2008 10:45 AM To: JaNell Hansen Subject: RE: Dr. Hopkin Medical Office It's on hold for right now. I'll let you know when he gets wants to start again. Thanks, Johnny From: JaNell Hansen [mailto:janellh @rexburg.org] Sent: Tuesday, September 02, 2008 10:20 AM To: Johnny Watson Subject: Dr. Hopkin Medical Office Johnny, What is the status with Dr. Hopkin's office? Has the project been cancelled? If not, when do they plan to start? JaNell Hansen Building Safety Coordinator Phone: 208.359.3020 ext 346 Fax: 208.359.3024 I > Y () t^ REXBURG Arnty cxa� Finnily Community 1