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HomeMy WebLinkAboutAPPLICATIONS, BP & CO - 10-00095 - Merrell Dental Office • • , C, Ifr ci 1 r,. Or Certificate of ccupancy REXBURG City of Rexburg 1 aIeriui f=amil Cornnnmity Department of Community Development 35 N. 1st E. /Rexburg, ID. 83440 Phone (208) 359-3020/ Fax (208) 359-3022 Building Permit No: 10 00095 Applicable Edition of Code: International Building Code 2006 Site Address: 1183 Summers Dr Use and Occupancy: Merrell Dental Office Type of Construction: Type V, non-rated Design Occupant Load: 20 Sprinkler System Required: No Name and Address of Owner: Merrell Mike 3756 Orrin Ln Rexburg, ID 83440 Contractor: Owner/Lessee Special Conditions: Occupancy: Business - office, professional or service transactions This Certificate, issued pursuant to the requirements of Section 109 of the International Building Code, certifies that, at the 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: - 2� C.O Issued by: . .----,7■11 ...._401111111ft,...._ cp 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 Inspe tor: eII! L4 , 09. LI. '-.f ,� Fire Inspector: I v Electrical Inspector !, P&Z Administrator exIL,?6:„..6„, � , 1 « F Certificate of Occupancy I � REXBURG !i� \ City of Rexburg '�_° r«i,-=l=t} =====T7=.==jY Department of Community Development 19 E. Main St./ Rexburg, ID. 83440 Phone 208 359-3020/Fax 208 359-3024 Building Permit No: 10 00095 Applicable Edition of Code: International Building Code 2006 Site Address: 1183 Summers Dr Use and Occupancy: Merrell Dental Office Type of Construction: Type V, non-rated Design Occupant Load: 20 Sprinkler System Required: No TEMPORARY Name and Address of Owner: Merrell Mike 3756 Orrin Ln Rexburg, ID 83440 Contractor: Owner/Lessee Special Conditions: Temporary Certificate of Occupancy until striping is completed in the parking lot. Expires June 30, 2011. Occupancy: Business - office professional or service transactions 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: March 15, 2011 (02:47PM) C.O Issued by: 4/4/0" / 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:? L . j,, Fire Inspector•/ _� /• 06 jo Electrical Inspector: _�rAgia� V or 0 ���� P&Z Administrator A nallialreak low - - Z li 0 m z • C7 -4. 0 --1 m O '— ��rj. 4110 qe. Mimi = OD rt. ):(1), al: ° ni -I M C a' F.,ig z - C -,::V Lt ' o iLk] f ii! 0 c -v '" = y O Z . c $.Z s -t o D Z. .a a m to n 0 _ �-. O N OD CD O .•°.° o nan 3 . y O 0-y. z a v o _ m m 0 -0 12, � . • O 6.c C„ 0.cs g 0 -a � -. --1 _UT 4.D y O c _ X m n xi mil. a g . to Z. a CD y a o c a) @ Qom v` D 0 S y SU = r' Way 90 o f 0 o (:::) c O -o m FL 11) ID CO * g a) •-• fit Ca a” cg 'a, ;.....:9 5- ,-..c%) (1:1)Z/ toulltalillitil:i 0: = N � .O C m ni c W to �� 0 < N Q L 0 rt k '� 5 00. 0 O 0 \ 1■11) 0 Z m o0. ..� 07 v a ,� z C7 to. R - 0 D 1111144 ■ m 0 -4 omm 73 (:::) /1110\11004 n < N Cvun "1 _ n- aa,, NNyax -I c n � � C 7 y C o 7 F.. -y { a Tt v Qptc 1%115 5 a C .6 O tD 0 Se C (jC:) o £ g<pao 0 to - C1 ' Z K tD m icy y sm C 0 _, c, ( jnz �p O N tD N . p W N. 0.N D •2 —3030 Z 0 G O • p�8 ° '�co m 0 O ? (:Jr1 -03 n n --------- 0,> — Z T t P w N oo :*-4 5") n w v M 73M _Ps CO o - v m �! T! CD p. 71 n n r_ 3 S o c 4 w o C m .CN N v ° C m vvN Q- . CD n N co = o `C 0 m o ;1. to v _ m t c 7)-1 o -, 0 cp ,.th, ft o O o j = Z. Z � Z m � . In O n��O ? C '�n 03 -5 _ 0 0 > m z o w 3 >�ZC � a z00 0 y -AO% a a m • INSPECTION TICKET • ❑ Bldg. ❑ Plumb. 31 Elect. ❑ Mech. ❑ Fire Inspection Request: Rec'd By A mat-74k Date Op/ Req. By !i .Al'xrenif Phone No. Project 4'r dl , h�0.X Pennit No. /0 DLdq:C Address ug 3 Su. n rviecs Qn' Inspection Type A& [At fdeSe011ticcr—leel/tSpec-/ Day/Time Req. 3/' !! 4 n y 41 PM Inspector's Report ❑ Res. T'' Comm. keRN0qa-93.r eAr&kils-e--.0. NSPECTED ITEMS CONFORM TO A'PROVED DWGS ❑Y ❑N 7 N/A INSPE OR'S ACTION APPROVED ❑DISAPPROVED O FINAL 1O.(FINAL) ❑NOT APPLICABLE ❑DID NOT INSPECT ACTION REQUIRED:k0,, Signed P, Inspector Rec't Acknowledged mot-(Ace Copy Yellow-Job Copy Pink-Mnspodor's Copy F-FIR.0003 • INSPECTION TICKET ❑ Bldg. Plumb. ❑ Elect. ❑ Mech. ❑ Fire Inspection Request: Rec'd By j '11dg,___Date aighl Req. By J tk.,e__14tra Phone No. 313 -((7?--. Projectiierre tI eeeW Permit No. I(' 040 q5 Address /I$'S 3u err,erS Q r. Inspection Type FINAL Day/Time Req. c2/4/11 10:06 .ty/ . Inspector's Report ❑ Res. tit Comm. f ZA-1r-scr fr- ( e, (c --_ aN V'�cc INSPECTED ITEMS CONFORM TO APPROVED DWGS ❑Y ❑N ❑N/A INSPECTOR'S ACTION ❑APPROVED O DISAPPROVED D FINAL ❑C.O.(FINAL) ❑NOT APPLICABLE ❑DID NOT INSPECT ACTION REQUIRED: Signed Inspector Rec't Acknowledged While-OMice Copy -Job Copy Pink-Inspector's Cop F-FIR-0003 INSPECTION TICKET. ❑ Bldg. ❑ Plumb. Elect. ❑ Mech. ❑ Fire Inspection Request: Rec'd By AmaAck, Date 3 g/// Req. By ji/t(4e 1( Phone No. -350-W - Project'fLit r.t(l nJ( / (ePertnit No. /0 600 ?S- Address //g3 Jk4t*y?€(.S ehee . Inspection Type F/h/ c pe r t Day/time Req. /4/ '.!/0 41-'41 Inspector's Report ❑ Res. Comm. CPA/S `cc21L.s is I.S _vatt. INSPECTED ITEMS CONFORM TO APPROVED DWGS ❑Y ❑N biNIA INSPECTOR'S ACTION APPROVED MI DISAPPROVED O FINAL ❑C.O.(FINAL) NOT APPLICABLE ❑DID NOT INSPECT ACTION REQUIRED: e Signed ,_4' 4 Inspector Rec't Acknowledged While-Office Copy Yellow-Job Copy Pink-Inapectoes Copy F-FIR-0003 fb INSPECTION TICKET• Bldg. ❑ Plumb. ❑ Elect. ❑ Mech. ❑ Fire Inspection Request: Rec'd By 0 Date 3/S/l Req. By ,4/0C-€.. ✓fie fret! Phone No. 3.94 - 9691- Project../file- 104 t« Permit No. lb (10(696-- Address j103 re.r5 tOriy.c.., Inspection Type P/NA-L,, } cc_ " Day/Time Req. 3//4( g;u U a .n Inspector's Report ❑ Res. od Comm. o•��"�► _, Vii► 1�- LOP INSPECTED ITEMS CONFORM TO APPROVED DWGS ❑Y ❑N []N/A INSPECTOR'S ACTION APPROVED ❑DISAPPROVED ❑ANAL ❑ .(FINAL) ❑NOT APPLICABLE ❑DID NOT INSPECT ACTION REQUIRED: Signe. Inspector Rec't Ac it edged Whose-• opy Pink-Ing*dors Copp F-FIR.0003 • INSPECTION TICKET 0 Bldg. 0 Plumb. 0 Elect. 15,4 Mech. 0 Fire Inspection Request: Rec'd By Date OA/ Req. By -i/1,1 6e.Aertz t(1 Phone No. 35(D �-' 64 fl— Project,A.P.rett E A Permit No. /6 UQO?S Address //g3 tann er.S iii✓1.— Inspection Type FA AI Re-at Fe U Day/Time Req. S///tr 92i6 4 •/h • Inspector's Report 0 Res. fili Comm. // 2 h !O ri Ar INSPECTED ITEMS CONFORM TO APPROVED DWGS ❑Y ❑N ❑N/A INSP CTOR'S ACTION APPROVED ❑DISAPPROVED ❑FINAL ❑ .0.(FINAL) ❑NOT APPLICABLE ❑DID NOT INSPECT ACTION REQUIRED: II Signed-.L `` Inspector Red Ac dged _ INN*•• ., PHI-Npgdor s Cary F-FIR•C003 • INSPECTION TICKET • ❑ Bldg. ❑ Plumb. ❑ Elect. Mech. Cl Fire Inspection Request: Rec'd By Date ` iff/lf Req. By 114 114 X(eiI Phone No. 313 —GoOR Project 114 e„ rr_l 1 e" Permit No. 1,0 O C' Address I!$3 c i.elrS t)r• Inspection Type _FJIJr4-t__- Day/Time Req. -2/l i/11 0:& ct.'YY) • Inspector's Report ❑ Res. Comm. Cre �'� ►' Al I 4 49 ��' % �. .:.� ♦sit. ��.� :drill� INSPECTED ITEMS CONFORM TO APPROVED DWGS 0 ❑N []N/A INSPECTOR'S ACTION ❑APPROVED (DISAPPROVED El FINAL ❑C.O.(FINAL) ❑NOT APPLICABLE ❑DID NOT INSPECT ACTION REQUIRED: Signed d ' . B e_ Non�� Inspector Rec't Acknow 41, While•011iee Copy Yellow•Job 11111 Pink.Msgedlots Copy r-FIR-0003 • INSPECTION TICKET S X Bldg. ❑ Plumb. ❑ Elect. ❑ Mech. tiik Fire Inspection Request: Rec'd By, e� Date &./AP/Req. By 1/i , 'Verret) Phone No. 313-4009 q Project v.{J/ and Permit No. ib 60196:- Address 11$3 ct4A,14,fy■vr.c 0-I-. Inspection Type F/t/ -L— Day/Time Req. zJ/t/l/ /6 :46 & '111 • Inspector's Report ❑ Res. g Comm. , . . . 4- _ - 24, —117 V -. NM W Ns — l 1 � 4 or • s0 A 1 I 1,r OW. -- - ' - Oa SRL • ".► may._. a) .P y INSPECTED ITEMS CONFORM TO APPROVED DWGS ❑Y ❑N ❑N/A INSPECTOR'S ACTION LI APPROVED ISAPPROVED) D FINAL 0 C.O.(FINAL) ❑NOT APPLICABLE 0 DID NOT INSPECT ACTION REQUIRED: Signed �►` � Inspector Rec'l Ackno Cr d whioi-Office C.. *Now- .. opy Pink-Inspocloes Copy F-FIR.0003 — • INSPECTION TICKET • ❑ Bldg. ❑ Plumb. J Elect. ❑ Mech. ❑ Fire Inspection Request: Rec'd By Date 6/9)/// Req. By 44114, Joffe Ai Phone No. 313-Le Oci Project ? / �.� Permit No. /O CkXJ q Address /) 's3 3LA Awl.r.e,.rs a9tr Inspection Type FIWJIrt, Day/Time Req. 0/4 / 16:Oil a m • Id • Inspector's Report ❑ Res. Comm. 1►►.• .w 1.►.�`:.'it.e.•. L— • r .... ��- �u�L: �'_ 1► L�ill. ►���: i • • .•.rte `• ' • �..[�.•. te■ •_t•_ . . .:� INSPECTED ITEMS CONFORM TO APPROVED DWGS ❑Y ❑N ►! N/A INSPECTOR'S ACTION EAPPROVED DISAPPROVED ❑FINAL ❑C.O.(FINAL) NOT APPLICABLE ❑DID NOT INSPECT ACTION REQUIREDSPC ��� '� Signed 45¼'J?,3 .S? lnspecior Rec't Acknowledged While•Office Copy McNow•Job Copy Pink-Inspectors Copy F-FIR•C003 licationl• e Entire App likable Complete the fill NA for non aPP .I I.w1.w/ �, please does • not app y o P If the question U1tV it*;" 1:$6 r � ._.-__._.____ I,r pfpLICAVON �' t;ommunrtY i % j� America's Family ILY BUILDING PERM II ,_, ULTI FAM COMMENT RG,ID 53440 you) LOT#� provide this for you 19 E MAIN (W e BLOCK# 208-359-3°2°X326 UNIT#� — �� , NUMBER' CONTACT PHONE## PARCEL r ,�ti, — jVISION: formation-rims accurate SUBDIVISION. the —i Addxessln:is based on i, ,, 3 '` —60 OVER NAME <F , 'c 0 _ Cell( ) g%/ 0 PROPERTY ADDRESS j >F Work ( .) TATE 1P: ,.1 i CITY. �' PHONE#'Home ( `1'"L 0 SS: o NER MAILING ADDRE c 'Ax MAILKY iE { i _ application.) (If other than owner) licant to act as agent for owner must accompany this app APPLICANT ( CITY: (Applicant if other than owner,a statement authoring app SS APPLICANT INFORMATION: ADDRE FAX ZIPS EVIL STATE; Work ( ) Cell( ) PHONE#:Home ( ) - — A cITY srATE�ap .5 CONTACTOR r' MAILING ADDRE�S�S: Work# 1 �� J 0�� Fax# PHONE:Cell# � A EMAIL 1'� , Ci� ifr}iO REGISTRATION#&EXP.DATE 44" How many buildings are located on this property? Did you recently purchase this property? No Yes If yes,list previous owner's name) SI Swl���, : ? NO YES (Please b 'ng copy of new legal ascription of property) STt��, Is this a lot split? PROPOSED USE: �40 l � k(‘J �� (i.e.,Single Family Residence,Multi Family,Apartments,Remodel,Garage, '°maxim �pn�Etc.))_CIRCLE ONE APPLICANT'S SIGNATURE,CERTIFICATION AND AUTHORI��jL��I xj have read this application and shoe that the information herein is correct and 1 swear that any iofonttion • 0"• Under penalty Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful sod trect.which gig L.__ ft be given •wry'I hereby certify t}I agree to the subject matter of this application and hereby authorized representatives of the City to enter up the abo Ply with all •C• r�to hears s before the The building official may revoke a permR on approval issued under the provisions of the 2003 Intelon Ye` Property City .,_ and State laws in the application or on the plans on which the permit or a t . ' based. Permit void if not st,w Code of any fpert 1thon if wok Signature of ner/App/li an, ,f Do you prefer to be contacted b fax, email o•,� j \/ 1IARNING–BUILVIN • hone. Circle One Plan fees are non-refundable and 1 ' ST B n�r paid.*Build.ngpe�n;tPee aedueat • ptan eofthe4fitllal etimeofDONcy l/ 1� \l ar6meofaPPPcanont4►nrevrewfeed 8lonbe RU�f 'tauildmg pe Nsaiii°vi� �'Sfith Fo�dt fA�cdp'44, 1 6Pe4.oes On. Building Safety Department Qoxet,,pC City of Rexburg ��,�� C I T Y O F REXBURG 19 E.Main janellh @rexburg.org Phone:208.359.3020 ext 326 e.__s Family ._mm-_`_ Rexburg,ID 83440 www.rexburg.org Fax:208.359.3024 America's Family Community 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 herin 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: 3 L' Building Safety Department RBxB�R City of Rexburg CITY O F `° REXBURG__ 19 E.Main janellh @rexburg.org Phone:208.359.3020 ext 326 Rexburg,ID 83440 www.rexburg.org America's Family Community g• g Fax:208.359.3024 Property Lines Each site plan that is submitted to the City of Rexburg for the Building 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. ./1.6/713 0 Signature Date M tkie Printed Name 4 v' . • I Building Safety Department p�RBX6(�RC City of Rexburg ,:t;1 �°, CITY o x ,,ao� ° REXBURG 19 E Main ";�� \ • cy, janellh©rexburg.org Phone:208.359.3020 x326 America's Family Community Rexburg,ID 83440 www.rexburg.org Fax:208.359.3024 Remodeling Your Building/Home (need Estimate) $ SURFACE SQUARE FOOTAGE: (Shall include the e er' wall measurements of the building) First Floor Area (`WOO ` 29i G finished Basement area Second floor/loft area t Finished basement area Third floor/loft area Garage area Shed or Barn Carport/Deck (30"above grade)Area Water Meter Quantity: , .r,,._, , , _ t Water Meter Size• � , v\Ft i( ) Required..! PLUMBING Plumbing Contractor's Name: 1611.6.- TA)i LLL �' 'Di � . l �� Business Name: � /<, Address 51 r C tY �' � State J Zi � �� p Contact Phone: ( ) 3 i - 3 -----� Business Phone: ( ) _StD.41;.-?` Email Fax FIXTURE COUNT(thcluding roughed fixtures) Clothes Washing Machine Sprinklers Dishwasher —Tub/Showers / Floor Drain -7 N Toilet/Urinal Garbage Disposal Water Heater Hot Tub/Spa Water Softener 41 Sinks (Lavatories,kitchens,bar,mop) Plumbing Estimate$ ki9)-� o.. (Commercial Only) �� , . ?L3-C- 11622 /.�/o equired! Signature of Licensed Contractor License number 3/i /es — I 5 • Building Safety Department aEXa� Cf CITY OF City of Rexburg ' �"�/'° 1�1�vRG 410,r % \' /anellh @rexburg.org u" � www.rexburg.org Phone:208.359.3020 x326 America's Family Community Rexburg,19 I D E 83440 Main Fax:208.359.3024 OWNER'S NAME PROPERTY ADDRESS Perrnit# SUBDIVISION PHASE LOT BLOCK Required! MECHANICAL Mechanical Contractor's Name: K>`°;, W1 Id/A 4.4 �-� D A'f4 b . Business Name: 1 Address 5 1 4 66C0 A I , f City State ��-rP Zip_ , ;�'�` Contact Phone: ( ) 51 cY Business Phone: ( ) 3 -33 g Email Fax ei Mechanical Estimate 1�j � ' ' $ (Commercial/Multi Family Only) FIXTURES&APPLIANCES COUNT (Single Family Dwelling Only) /Furnace . I Exhaust or Vent Ducts V Furnace/Air Conditioner Combo Dryer Vents Heat Pump Range Hood Vents Air Conditioner Cook Stove Vents Evaporative Cooler Z 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 4 VC-0--1357 3 AO o R quired! Signature of Licensed Contractor License number Date 6 • Building Safety Department o49,:fX$�R� iG CITY OF City of Rexburg = — ,D 35 N 1 E <�%, . Phone:208.372.2326 Rexburg,ID 83440 www.rexburg.org America's Family Community 9 9• 9 Fax:208.359.3022 -_ OWNER'S NAME IA( ke n4 er( Permit No. 10 00095 PROPERTY ADDRESS 1183 a u M 5 `Dry Pern (e Merrell Dental Office SUBDIVISION 1183 Summers Drive PHASE LOT BLOCK Service Required!!! ELECTRICAL 2 Electrical Contractor's Name 3err , Irti C Business Name B ) ,.c� EieC+,r,c �.lG Address "� VV1 1 I ace_-- K—. City gee b Ltr State J 2 Zip R34-/Y© P Cell Phone (Z'8) U�( —5 68-1 Business Phone ( ) Fax ( ) Email Electrical Estimate (cost of wiring&labor) $ i6(5CO-de (COMMERCIAL ONLY) (Includes the cost of materials installed regardless of the party supplying it). TYPES OF INSTALLATION (New Residential includes everything contained within the residential structure and attached garage 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 ❑ Multi-Family Only: #of units per building-$120/bldg+ $60/unit ❑ Services: Alterations/Repairs that require utility disconnection. (Estimate applicable for commercial). ❑ 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$10 per circuit ❑ Other Installations: Wiring not specifically covered by any of the above: Cost of Wiring&Labor:$ (includes the cost of materials installed regardless of the party supplying it). ❑ Pumps (Domestic Water,Irrigation,Sewage): horse power ❑ Requested Inspections (of existing wiring) -$40/hr(1 hr minimum)plus $40/hr thereafter ❑ Temporary Amusement/Industry-$40 plus $10 per ride,concession or generator *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. — 1C1/r #2_3( S'r ature of Licensed Contractor License number Date 7 r c 1 • • Building Safety Department 04 v CITY OF City of Rexburg _1r ',/,010%' REXBURG 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 PROPERTY ADDRESS Permit# SUBDIVISION PHASE LOT BLOCK Required.!! ELECTRICAL Electrical Contractor's Name V $01?--- Business Name f3Z 1 &)K t ,4_,N o,t Address ` -�IX , 1€4,01... bd.!, City gt ga State F' Zip 5344f) Cell Phone ( ) /��� - � P / Business Phone ( ) r^ 63 Fax ( ) Email Electrical Estimate (cost of wiring&labor) $ f(pi �OtDs (COMMERCIAL ONLY) (Includes the cost of materials installed regardless of the party supplying it). TYPES OF INSTALLATION (New Residential includes everything contained within the residential structure and attached garage 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 ❑ Multi-Family Only: #of units per building- $120/bldg+ $60/unit ❑ Services: Alterations/Repairs that require utility disconnection. (Estimate applicable for commercial). ❑ 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 $10 per circuit ❑ Other Installations: Wiring not specifically covered by any of the above: Cost of Wiring&Labor:$ (Includes the cost of materials installed regardless of the party supplying it). ❑ Pumps (Domestic Water, Irrigation,Sewage): horse power ❑ Requested Inspections (of existing wiring) -$40/hr(1 hr minimum)plus$40/hr thereafter ❑ Temporary Amusement/Industry-$40 plus $10 per ride,concession or generator *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. jiltof License Contractor License number Date f)3!'A (AVYT4-) C,ciJT12-1A- litrt:AV kci\A - • • Building Safety Department OQ gEXBURC i C I T Y O F City of Rexburg u�i.� — _-... ° REXBURG 19 E.Main America's Family Community Rexburg,ID 83440 www.rexburg.org Fax:208.359.3024 APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/NO $50.00 FEE PAID: YES/NO APPROVED BY: -APPLICANT INFORMATION: Business Name: i E -R.: LL Office Address: G7 A P e ' 4; c.7.4 :,. .'.. - 4 City State Zip Office Phone Number: (_2L' _) 766, 9 ?7 Contractor Performing the Work: Contact Person: Cell Phone # (2-41 ) 31.3--&097 -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: To Contact Person: Phone Number: ( ) Cell # ( ) PLEASE CHECK THE TYPE OF PERMIT(S) 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 LI INDUSTRIAL OVENS ❑ LP-GAS ❑ PRIVATE FIRE HYDRANTS ❑ SPRAYING OR DIPPING LI STANDPIPE SYSTEMS ❑ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES .3/ ibt2--- Applicant's S ature Da 8 • SUBCONTRACTOR LIST Excavation&Earthwork: l/v TAN L L r Concrete: Vj'042, Masonry: LA'1j 1 K-S 0i1.1 I Roofing: M t nCS r'AJC Insulation: &if L Drywall: 6112-G-6, / l Painting: CAW(f)(,i P1 Ali' Floor Coverings: CI iii/FCtp A-e-D ; ,y12-0jJ 60) Plumbing: `f J4ikilb L "(gyp Heating: Electrical: Strg-ky 1;a4 u k: Special Construction (Manufacturer or Supplier) Roof Trusses: DOA Floor/Ceiling Joists: frilA Siding/Exterior Trim: D ELI. a I W-C 2 Other: 9 • S 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 Tide 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. P r Signature t+ Da A4 1 (.6-6-- Print Name 10