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HomeMy WebLinkAboutAPPLICATIONS - 10-00199 - BYUI Physical Plant - Electrical Upgrade Y CITY OF_ EXB URG • 4, PERMIT # BUILDING PERMIT APPLICATION Please complete the entire Application! 19 E MAIN, REXBURG, ID. 83440 208-359-3020 X326 PARCEL NUMBER: (We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information-must be accurate) OWNER NAME: I3 VU ^/k• HO CONTACT PHONE # 2-08' Yf 4 •Z Y Y J PROPERTY ADDRESS: fell- 4/�TT Q,iooj/s , ve- PHONE #: Home ( ) Work (2C j 4196.2 yyy Cell (7-.98 '?U#• &YY7 OWNER MAILING ADDRESS: M.T OPfl'F 1213 CITY: Pi90 r STATE: 40 ZIP: & /(O EMAIL C'4t, Z 3Yt//.EAU FAX 2-0e 'Y9b• ( 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 EMAIL FAX PHONE #: Home ( ) Work ( ) Cell ( ) CONTRACTOR: O 0,L t e_ r CO3-y s 7 ' tic. MAILING ADDRESS: 1°0 Q /© CITY "e:r T STATE- PHONE: Cell#d2 Dg- Work# ,�vd'S`3 S s-// Fax# 8 EMAIL IDAHO REGISTRATION# & EXP. DATE / o o / - A 4 4 _ /j How many buildings are located on this property? Did you recently purchase this property. sl Yes (If yes give owner's name) Is this a lot split?. YES (Please bring copy of new legal description of property) PROPOSED USE: (A t o m n/cte. , q*p k,I/ /c y R u J e A t t 1 k (JZMt UGrq (i.e.,Single Family Residence,Multi 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 void if work stops for 180 days. add Q as-/ /7- / LC/0 Si re 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 January 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 Buil n Safety De artment� �F4ti�R�R� 9 Y p ,, cirY of City of Rexburg ` '- V REXBURG 19 E.Main janellh @rexburg.org Phone:208.359.3020 ext 326 America's Family Community Rexburg, ID 83440 www.rexburg.org Fax:208.359.3024 Affidavit of Legal Interest State of Idaho County of Madison 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 Please complete the Pure Application! If the question does not apply fill in NA for non applicable NAME /3Y0-/o+gHc PROPERTY ADDRESS fl°t 7 e 416St C.fs~ SUBDIVISION Permit# Dwelling Units: Parcel Acres: SETBACKS BACKS 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: Water Meter Size: Required!!! NA` PLUMBING Plumbing Contractor's Name: Business Name: • Address City State Zip Contact Phone: ( ) Business Phone: ( ) Email Fax 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 Only) 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 ene Application! If the question doeot apply fill in NA for non applicable NAME BYU-454/f0 PROPERTY ADDRESS Petri'' GA ST" Cf,,K/t/s yam- Permit# SUBDIVISION Required!! MECHANICAL N/4- 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 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's permit fee schedule is the same as required by the State of Idaho 5 Buil ng Safety Department JFXtixBuR,. —rte CITY OF City of Rexburg ` '' RE XBURG_ 19 E Main janellh@rexburg.org Phone:208.359.3020 x326 \ �' Rexburg, ID 83440 www.rexburg.org s E Americas Family Community 9• 9 Fax:208.359.3024 OWNER'S NAME iYU- /MHO PROPERTY ADDRESS frGT 1 Ge/tU- Corns ,4 4✓6- Permit# SUBDIVISION PHASE LOT BLOCK Required!!! ELECTRICAL Electrical Contractor's Name /3912NE// F )4/EE/",S Business Name 04,e i l/Lz)€.e/Ps t/ec v.c I�et Address 8'7 54 7O City lee 644 State JJ Zip )",3c d Cell Phone ( o ) 390 -- G iS Business Phone (&g) 3 CS y Fax (2o51) 3S6- 41'7 Email fwd' /9 ) iii ') , Co st Electrical Estimate (cost of wiring&labor) $ !S 250 (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: $ /5r ZSO Pumps (Domestic Water, Irrigation,Sewage) Requested Inspections (of existing wiring) Temporary Amusement/Industry *Indu.es a maximum of 3 ins.ections. Additional inspections charged at requested inspection rate of$40 per hour. /q W? /)74// /7 20/0 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 6 .c Builck Safety Department �oxBURC CITY or City of Rexburg : 3r�° Li,/ REXBURG 19 E.Main s^ %j \ n janellhQrexburg.org Phone:208.359.3020 y !!JJ Rexburg,ID 83440 www.rexburg.org Fax:208.359.3024 America's Fa,n[ly Co,ru,runuy APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO APPROVED BY: -APPLICANT INFORMATION: Business Name: Office Address: City State Zip Office Phone Number: ( ) Contractor Performing the Work: Contact Person: Cell Phone # ( ) -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 ❑ INDUSTRIAL OVENS ❑ LP-GAS ❑ PRIVATE FIRE HYDRANTS ❑ SPRAYING OR DIPPING ❑ STANDPIPE SYSTEMS ❑ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES Applicant's Signature Date 7 • • SUBCONTRACTOR LIST Excavation&Earthwork: Ar fritre 0 Concrete: ,51`1"4 rcc Masonry: Roofing: Insulation: Drywall: Painting: Floor Coverings: Plumbing: Heating: Electrical: ,1)4tRw U "37445. Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists: Siding/Exterior Trim: Other: 8