HomeMy WebLinkAboutAPPLICATIONS, CO, MULT DOCS - 07-00393 -329 S 4th E - Remodelr�rM
CI "I'Y OF
REXBURG
- -._ --
Ow- - - --
ArneTktls Fnnaily COMMUn t)=
Certificate of ('ccupancy
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Building Permit No: 0700393
Applicable Edition of Code: International Residential Code 2006
Site Address: 329 S 4th E
Use and Occupancy: Single Family Residential
Type of Construction: Type V, non -rated
Design Occupant Load: Residential
Sprinkler System Required: No
Name and Address of Owner: Clark Michael Etux
329 S 4th E
Rexburg, ID 83440
Contractor: Owner /Lessee
Special Conditions: Basement and Upstairs remodel
Occupancy: Residential - less than 2 units, 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
vies inspected on the date listed vtes 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: January 12,,2M9 (04:29PM)
C.O Issued by:
Building Official
There shall be no further change in the e)asting 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 Inspe
Electrical Inspector.
Fire Inspector:
P &ZAdministrator: #1 / eL
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CITY OF REXBURG � i
BLrILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208 - 359 - 3020 X326
PERMIT #
Pleas - -_ A--I __Li_�,�
If the q •
PARCEL NUMBER: QY N UL VDtH 329 S 4th E -C lark Remodel
SUBDIVISION: Hilk L iVlly't
(Addressing is based on the information - must be accurate)
0WWER NAME CONTACT PHONE # 5 (� - O 3 3
PROPERTY ADDRESS: 3 5 . V' E
PHONE #: Home (zoy) G54, Work ( ) R - 1 3 1 0 Cell( 5 (- - 7 S 7 J
OWNER MAILING ADDRESS: 32 9 : 5 • K E , CITY: &xborq STATE:To ZIP: $3y�
EMAIL M U m t - ats n . C d Yn C �rV FAX
vl. j
APPLICANT (If other than owner)
(Applicant if other than owner, a statement auiliorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell (
CONTRACTOR
MAILING ADDRESS: CITY
PHONE #: Home (
Work (
EMAIL FAX IDAHO REGISTRATION #
How many buildings are located on this property ?,
Did you recently purchase this property? No Yes (If yes give owner's name) h
Is this a lot split? & YES (Please bring copy of new legal description of property)
PROPOSED USE: 6 t m le �-ay
(i.e., Single Family Residence, Multi Family, Apartments,
AM 11
REXBURG
nCe
0700393
Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION:, Under penalty of perjur I hereby certify
that 1 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 start�i wit�in: 80 days.) Permit void if work stops for 180 days.
Signature of Owner /Applicant — `DATE
Do you prefer to be contacted by fax, aemail or ph one? Circle One *' , 200 WARNING – BUI ERMIT MUST BE POSTED ON CO
Plan fees are non - refundable and are paid in full at the time of applicatio be ng j�uat�1, 2005
City of Rexburg's Acceptance of the plan review fee does not con ' to
**Building Permit Fees are due at time of application** **Building Permits are oV V cue
f
Build% Safety Department sfxsu" c
City of Rexburg 4* o CITY O F
REXBURG
19 E. Main ionellh@rexburg.org Phone: 208.359.3020 OW
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 Americas Family Community
State of Idaho
County of Madison
I,
Name
Affidavit of Legal Interest
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 etire Application!
NAME
PROPERTY ADDRESS
SUBDIVISION
Dwelling Units: Parcel Acres:
* * * * * * * * * * * ** *Water Meter Size:
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 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:
Required.!!f
PLUMBING
Plumbing Contractor's Name: CV.► Business Name:
Address
City State Zip
Contact Phone: ( ) Business Phone: ( )
Email Fax
FIXTURE COUNT (including roughed fixW es1
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
The City
License Number& Expiration Date
Permit##
Date
fee schedule is the same as required 4 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 Fax: 208.359.3024
aF p 8xe URC
�i r0
CITY OF
REXBLRG
_____ _ 0 ._____
Americas Family Community
OWNER'S NAME
PROPERTY ADDRESS
SUBDIVISION
PHASE
LOT BLOCK
Permit#
HOME O W INER'S ELECTRICAL PERMIT
Home Owner's Name
Address 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
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)
' -t. 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
The
schedule is the same as
"qlnh - / -
Date
the State of Idaho
0
•
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 certi that the ab e information true and correct to the best of my knowledge.
J� �L
�
- �?
Signature ) Date
Print Name
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
.��f RtiXB URC ♦7
U G
C I T Y OF
MXBURG
Americas Family Community
OWNER S NAME
PROPERTY ADDRESS '? - 2 i S
SUBDIVISION
PHASE
LOT BLOCK
Required!!!
ELECTRICAL
Electrical Contractor's Name � A C�Q� ����� �k Business Name
Address - ) - 12::,! w city - - 1&g "�'l State \Q Zip U
Cell Phone (Zb�) Business Phone (R)') LV S u -C ( ZZZ,
Fax U VI A Email \.1�L�,- �1
, tl�
Electrical Estimate ( cost of wiring & labor $ 'LUDD' (COMMERCIAL /MULTI - FAMILY ONLY)
TYPES OF INSTALLATION
(New Residential includes everything contained within the residential structure and
Number of meters being installed M
Up to 200 amp Service*
201 to 400 amp Service*
Over 400 amp Service*
Temporary Construction Service, 200 amp or less, one
Existing Residential (# of Branch Circuits)
Spa, Hot Tub, Swimming Pool
Permit#
)Lq W��
? 7
C� OF RE )(BURG
on or a period not to exceed 1 year)
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-ainaximurn oVins ctio Additional inspections charged at requested inspection rate of $40 per hour.
v
Signature of Licensed Con ractor License number Date
The
schedule is the same as required by the State of Idaho
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INSPECTION TICKET
❑ Bldg. ❑ Plumb. ❑ Elect. ❑ Mech. ❑ Fire
Inspection Request Rec'd By _T Date
Req. By �y Phone No.
Project T ( � � Permit No �X
Address
Inspection Type
Day/Time Req.
Inspector's Report Res. ❑ Comm.
INSPECTED ITEMS CONFORM TO APPROVED DWGS ❑ Y ❑ N ❑ N/A
INSPECTOR'S ACTION
APPROVED ❑ DISAPPROVED ❑ FINAL
❑ C.O. (FINAL) ❑ NOT APPLICABLE ❑ DID NOT INSPECT
ACTION REQUIRED:
White - Office Copy Yellow - lob Copy Pink - Inspector's Copy