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HomeMy WebLinkAboutALL DOCS - 11-00098 - 334 Harvard Ave- Remodel 0 I,' a: - c Zo is I it ±I , E Q -'Cry 4 s"a .�..n o s�. z Z = (7 d er•c o t.)-( w� 0 _ _ 0 4 � 8 ; m g 4 CO ak a 'Ai � a z C v u z .. Q- 0 O c •. m 6 co = y o a` ti� a a. .,o ti L. u. p ca o c o w fti co to S' ce c o c Uw am II I � oo2 j o u) LU ' O U 0 ›.- Q- 3 III +Fi "+r7 V ccun N 1'1 1 V 10,4 4 r 4 1 044 . �et. C Q r• f_y C j :. O U m° -c 0�-vo 0 0 a-;:. (pi mo)(Pi 4o) `'t It ' v c m U 3 2 2 'qt mm xr ti' C RS C � ; ♦ °' 1 C N >>,..r? `-)s. T iZ r% LU U o cu c WCe di 0 0 err/:) - No : N 1-.), -.,, (a() ,, E a)co 111111%0404 Q 12) — < � 1 _f, L `t 6 z .0 0 1 fl till) 4$ O Ti-)40 pliiii4 c)iiiii) - t1 `C 1.. _ t7 ..l o C:11 4 c m OS o. tj a ro ° ruilliiiiiiiiii _ N O � psi �i � o Cr I (6 H m >- o c E gioli):1414) v = 0 a I- �- _., tB a) i sa as ! I v) 3 t can) sa3E g v, °,= pO � Q 8 4) ? N .O. • w. Qc €f C') N : Y1') (a•C ° f. iz. w (a.. F1. 0 ?'1 �F, `ro i,�`` co c)• D N1)-.1 C N 9. c 4. © 4f ., . . .0 '. W e N f, O o �� `c1 , I ¢ z a .d,v-N U f,, °3 -n, a cv ci: o N K E 0 Iwo,.Q o l- '" m w z ua Z , .R Q 4 '\ Q,. U :-.1 li t� m L Di 12. 003 • INSPECTION TICKET 0 ❑ Bldg. ❑ Plumb. Elect. ❑ Mech. ❑ Fire Inspection Request: Rec'd By f e\\* Date 10 ri )I Req. By Phone No. Zo 1 L-02-04 Project y_ Permit No. 1`--(;\$ Address Inspection Type -\ .J _-.. , Day/Time Req. *flit... 0 i 1 1, , Inspector's Report et Res. ❑ Comm. II 0 % 1 siril al Le�1�.���T�1 w '-1 r ® a LA■�1& INSPECTED ITEMS CONFORM TO APPROVED DWGS DY 0 N N/A INSPE OR'S ACTION PROVED 0 DISAPPROVED 0 FINAL L101 C.O.(FINAL) 0 NOT APPLICABLE ❑DID NOT INSPECT ACTION REQUIRED: o . Signer �'�01 Inspector Rec't Acknowledged Whole-Oltice Copy Yellow•Job Copy Pink-Inspodors Copy F-FIR•C003 • INSPECTION TICKET • ❑ Bldg. ❑ Plumb. § Elect. ❑ Mech. ❑ Fire i •INSPECTION TICKET 0 . Bldg. ❑ Plumb. ❑ Elect. A Mech. ❑ Fire Inspection Request: Rec' By _ Cir6 Date /!/ Req. By c Phone No. Project /-6/2.4,1.1 .1= Permit No. / — 093 Address 33 CA- 16A'A inspection Type ,4),/, f--/A14-/ 4-/ n Day/Time Req. /(.319 2P/4 Inspector's Report A Res. Li Comm. ,iii. ♦ :_—,,.. INSPECTED ITEMS CONFORM TO APPROVED DWGS 0 IU N []N/A INSPECTOR'S ACTION ❑DISAPPROVED 0 FINAL ❑C.O. (FINAL) ❑NOT APPLICABLE ❑DID NOT INSPECT ACTION REQUIRED: Sig.ed , !I Inspector Rec't Ac wledged White•Ott opy Pink Insgdor's Copy F-FIR COO CONDITIONAL US MIT ` c KEKbtat. City of Rexburg Department of Community Development 35 N. 1st E./Rexburg,ID. 83440 Phone(208)359-3020/Fax(208)359-3022 Project Information Permit# 11 00314 Permit Type Conditional Use Permit Project Name Scott& Julie Ferguson - CUP for Site Address 334 HARVARD AVE Parcel # Duplex RPR000R01 62060 Project Description Names Associated with this Project Type Name Contact Phone# License# Exp Date Applicant Ferguson Scott&Julie Fee Information Project Valuation Conditional Use Permit 250.00 Public Hearing Notice Fee 200.00 Total Fees Paid $450.00 ***SEE ATTACHED CONDITIONS *** Print Name C ins Iu - 9 e� Date Issued: 10/26/2011 Signaturt Date /3 12-7 12-o i l Issued By: ELAINEM ft(k, CONDITIONAL USE PERMIT City of Rexburg "`°r°" Department of Community Development 35 N. 1st E./Rexburg,ID.83440 Phone(208)359-3020/Fax (208)359-3022 Project Information Permit# 11 00314 Permit Type Conditional Use Permit Project Name Scott&Julie Ferguson -CUP for Site Address 334 HARVARD AVE Parcel# Duplex RPR000ROI 62060 Project Description Conditions From Development Code Ordinance No. 1026 (6.12B.Standards Applicable to Conditional Use Permits. The approving body shall review the particular facts and circumstances of each proposed conditional use and shall find adequate evidence to show that the proposed use will: 1. Constitute a conditional use as established in Table 1, Zoning Districts, and Table 2, Land Use Schedule. 2. Be in accordance with a specific or general objective of the City's Comprehensive Plan and the regulations of this Ordinance. 3. Be designed and constructed in a manner to be harmonious with the existing character of the neighborhood and the zone in which the property is located. 4. Not create a nuisance or safety hazard for neighboring properties in terms of excessive noise or vibration, improperly directed glare or heat,electrical interference,odors, dust or air pollutants, solid waste generation and storage,hazardous materials or waste, excessive traffic generation, or interference with pedestrian traffic. 5. Be adequately served by essential public facilities and services such as access streets,police and fire protection, drainage structures,refuse disposal,water and sewer service,and schools. If existing facilities are not adequate, the developer shall show that such facilities shall be upgraded sufficiently to serve the proposed use. 6. Not generate traffic in excess of the capacity of public streets or access points serving the proposed use and will assure adequate visibility at traffic access points. 7. Be effectively buffered to screen adjoining properties from adverse impacts of noise,building size and resulting shadow,traffic, and parking. 8. Be compatible with the slope of the site and the capacity of the soils and will not be in an area of natural hazards unless suitably designed to protect lives and property. 9.Not result in the destruction, loss or damage of a historic feature of significance to the community of Rexburg.) Print Name C,()J nS 4e v� .3, — Date Issued: 10/26/2011 Signature Date /0 3.-11 1 j Issued By: ELAINEM . .r _7 CITY 01 1^ Gr..:, ° REXBURG \+; E..' America's Family Camrn'endy October 26,2011 Scott and Julie Ferguson 576 Maple Drive Rexburg,ID 83440 Re: #11 00314 Conditional Use Permit—334 Harvard Avenue Dear Mr. and Mrs. Ferguson, Enclosed is the Conditional Use Permit document for 334 Harvard Avenue,to allow a Duplex in an existing home,per the Conditional Use Permit approval at the October 20,2011 Rexburg P&Z Commission meeting. Section 6.12 B-Standards Applicable to Conditional Use Permits, from Development Code Ordinance No. 1026,is stated. Please call if you have any questions or if we can assist you further. Thank you. Sincerely, . Elaine McFerrin Planning&Zoning Coordinator City of Rexburg Planning&Zoning City of Rexburg 35 North 151 East. Rexburg,ID 83440 Phone:208.359.3020 ext.334 Fax:208.359.3022 11 00098 334 Harvard Ave - Remodel Office Copy T:-- . — ,ee /4gA1 ar . BUIL61.N-'E, ; PECTOR - - .i; !:, • - t ..„ , .Acktil ,(60 e'lA,e Cloet .1,■---- ek,cr,..e", .15;U v\ 6.-+ ‘)- t.,>e-ii ,------- II ' t.-1..s'ieuej.... preer- 16.4, er,:,_ rs- i es. a 1 ----------- Cit - \ bpi:4-z t-tr 5- 2. AA-f-tv Y'Co vA .-.------------''''-''''-----------'' -----------------------, ,„ , C,c_r s v - 7 1 1--9 *el, t----(.\ 1 1 ,_,...f. Vx 77y1.px - .-- tAT41- --i i \ ex, r2 Buildeg Safety Department OF gEXB URC City of Rexburg �,3�� CITY 0 F ,700° IZEXBURG 35 N 1st Phone.208.372.2326 \ Rexburg,ID 83440 www.rexburg.org America's Family Community 208.359.3022 Office Hours: Monday-Friday 8:00am 4:00pm Sin• le Famil Residential Pre-Construction Checklist Seismic Design Category- D Ground Snow- 501bs. per sq. ft. Roof Snow Load - 35 lbs.per sq. ft. Frost Depth- 36" Wind Load- 90 MPH The following items should be completed oreyou submityour building permit application. Completion ofaBuildrzgPerinitApp&ation.• You may print this application from our website www.rexburrp org or pickup a copy at the City Hall Annex Building (address above). ForResidentialPemths.•(the following is required to be submitted before the Application can be approved ❑ 2 sets of site plans and 2 sets of building plans (must be drawn to scale) approved) -Plans must include foundation plan,floor joist layout,floor plan,roof layout,sectional views,front, back, and side elevations,mechanical layout,stair details and any details required to illustrate special construction. ❑ Energy Compliance Report:The State of Idaho has adopted the International Energy Conservation Code (IECC). A Compliance Review must be completed and submitted (the rescheck software is available online at www ere odes goy). ❑ Page 2 of the Application must include the Idaho Contractor's Re istration Number or the exem do must be completed and signed,see Page 10. p n form ❑ Page 5 of the Application must be completed and signed by your p_ber ❑ Page 6 of the Application must be completed and signed by your Mechanical Contractor. ❑ Page 8 of the Application must be completed and signed bvvour Electrician. ❑ Home owners: please complete page 6 of the application if you will be doing your own electrical work ❑ Truss details including engineered floor joists are required. ❑ Property Line form needs to be signed by the builder or owner,see Page 4. Subd visions:If you plan to build in a subdivision please check the Rexburg Development Code for any requirements such as,property setbacks,architecture board approval,etc. This information is available from the Planning&Zoning Department at the Annex Building located at 19 East Main. New Resadentra.Homes:If your building permit is for a new home,you will need the parcel number number is the county s property identification which recognizes a plot of land) and a new physical address will be issued.If cyou do not know the parcel number and cannot find a record of it,please bring the name of the subdivision,phase, and the lot and block numbers. The correct location is vital to assure correct addressin•. Remodels:If you are considering a remodel,a my of the bid or estimate for the remodel must be submitted Permit Application. nutted with •2 sets of Plans are required (may need IECC Review). •Additions are the same requirements as new construction. 1 • of Xs j G CITY O F • �. o Please Complete the Entire Application! REXBURG If the question does not apply fill in NA for non applicable ' O b'°' America's Family Community CE RESIDENTIAL BUILDING PERMIT APPLICATION 35 N 1'E,REXBURG,ID 83440 208-372-2326 PARCEL NUMBER: (We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information- must be accurate) Dwelling Units: Parcel Acres: OWNERNAilfE: f �rrA c - CONTACT PHONE # ?Tte_ 1'2-9 o PROPERTY ADDRESS: 3 2 c f H,E vv ;-d Ae PHONE #:Home (2 ' 7, —;j�g0 Work (9 )J 35Co -P29,„ Cell( ) ( — &2 7 s OWNER MAILING ADDRESS: J CITY: STATE: ZIP: EMAIL 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 CITY: STATE; ZIP EMAIL FAX PHONE #:Home ( ) Work ( ) Cell( ) CONTRACTOR: MAILING ADDRESS: CITY STATE ZIP PHONE #:Home ( ) Work ( ) Cell( ) EMAIL FAX IDAHO REGISTRATION# &EXP.DATE How many buildings are located on this property? Did you recentlypurchase this property? No Yes(If yes,list previous owner's name) Is this a lot split? NO YES (Please bring copy of new legal description of property) PROPOSED USE: (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. Signature of Owner/Applicant DATE 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./<tauary 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 Build/gig Safety Department ,4EXBUR City of Rexburg c T Y OF REXBURG 35 N 15}E Phone:208.372 2326 fJ� t Rexburg, ID 83440 www.rexburg,org Fax:208.359.3022 K r o 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,depos, and say: (If Applicant is also Owner of '∎-cord, skip to B) A. That I am the record owner of the E+roperty described on the attached,and I grant my permission to: Name Address to submit the accompanying application pe .k' ' g to that property. B. I agree to indemnify,defend and hold -xburg City and its employees harmless from any claim or liability resulting from anydisp to as to the statements contained herein or as to the ownership of the propertywhich,.s the 'ubject of the application. Dated this da of ,20 Signature Subscribed and sworn to bef ire me the day and ye.r first above written. Notary Public of Idaho Residing at: My commission expires: 3 Buiin Safety Department• °44tiXB°R� gy p ent _���7 CITY OF City of Rexburg ">>";_� REXBURG 35 N 1s+E Phone:208.3722326 �fJ A Rexburg,ID 83440 www.rexburg,org Fax:208.359.3022 _ F o • America's Family Community 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 bes way to identify prope• line location is with a land survey. The City of Rexburg has aerial photos and a parcel line layer that can be c ecked,but they are only a tool and are not guaranteed for accuracy. If you want to req est a copy of .ur lot, see the front counter at the Community Development Department. I have read and understand the above requiem: Signature Date ❑ Owner or ❑ Builder Printed Name 4 • • Building Safety Department REX _ 04 CITY OF City of Rexburg � r�►��o n EXB mG 1�1V.�l�1\ 35 N 1st E Phone:208.3722326 America's Family Community Rexburg,ID 83440 www.rexburg.org Fax:208.359.3022 NAME PROPERTY ADDRESS Permit# SUBDIVISION PHASE LOT BLOCK Remodeing YoarBuilding/Home(need Estimate) $ 6260 an 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: Regithede PLUMNING Plumbing Contractor's Name: (9 bc/j'-�.r Business Name: Address City State Zip Contact Phone: ( ) Business Phone: ( ) Email Fax FIXTURE COIl1VT/izcluding roughedfzxtures) Clothes Washing Machine Sprinklers Ye�G 9a vcx� Dishwasher X Tub/Showers / 70,1.- 1169a Floor Drain 74, Toilet/Urinal 11 Garbage Disposal • Water Heater Hot Tub/Spa Water Softener )( Sinks (Lavatories,kitchens,bar,mop) Plumbing Estimate $ (COMMERCIAL/MULTI-FAMILY ONLY) ;/ -; 1 11 Signature of Licensed Contractor License Number&Expiration Date Date 5 l • Builtng Safety Department 030308° CITY OF City of Rexburg • o RE)BT mG 35 N 1st E Phone:208.3722326 �/� Rexburg, ID 83440 www.rexbur or America's Family Community 9 9' 9 Fax:208.359.3022 NAME PROPERTY ADDRESS Permit# SUBDIVISION PHASE LOT BLOCK Reqith-ede MECHANICAL 6,4 '964 Mechanical Contractor's Name iii s' _ Business Name Address ��` `f ���'-r c� City (1/,--1,....„.v State � Zip 73 'Alta Cell Phone ( ) Business Phone ( ) 35Ka Fax ( ) Email Mechanical Estimate $ (Commercial/Multi Family Only) FIXTURES APPLIANCES COUNT /Single Familyl}zeeling On y0 Furnace Exhaust or Vent Ducts (water heater) 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 appl)) Gas Oil Coal Fireplace Electric Hydronic gc0t Signature of Licensed Contractor License number Date 6 l • • Building Safety Department 4EXBUR y° �% CITY OF City of Rexburg 4;�� „'x p, R_EX_ BURG 35 N 151 E Phone:208.3722326 -,,,'�/�,, America's Family Community Rexburg,ID 83440 www.rexburg.org Fax:208.359.3022 OWNER'S NAME PROPERTY ADDRESS Permit# SUBDIVISION PHASE LOT BLOCK HOME OTxWLRSELECTRICAL PEWIT 1 Home Owner's Name Address City State Zip Cell Phone ( ) Home Phone ( ) Fax ( ) Email TYPES OF INSTALLATION (NewResidentialinc/ndes ezerything containedwithin the reside/mid struetnre and attached garage at the same time/ O. For power supplier requirements visit www.rockymtnpower.net ❑ *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 ❑ 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 - lr , ❑ Modular,Manufactured or Mobile Home - $50 plus $10 per circuit h S' ❑ Other Installations: Wiring not specifically covered by any of the above: l q. fi fl As' ' Cost of Wiring&Labor:$ (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 hour minimum) plus $40/hr thereafter *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. if 3 1 // Sin e of Home / g Owner Date B 7 Builccg Safety Department. R�XBUA °� Cr CITY O F City of Rexburg �;� 'y _R_EXBURG_ 35 N l E Phone:208.372.2326 /f America's Family Community Rexburg, ID 83440 www.rexburg.org Fax:208.359.3022 "E° OWNER'S NAME PROPERTY ADDRESS Permit# SUBDIVISION PHASE LOT BLOCK Reylth-ede ELECTRICAL Electrical Contractor's Name Business Name Address City State Zip Cell Phone ( ) Business Phone ( ) Fax( ) Email Electrical Estimate (cost of wiring&labor) $ (COMMERCIAL/MULTI-FAMILY ONLY) (Includes the cost of materials installed regardless of the party supplying it). TYPES OF_INSTALLATION /NewResidentialincludes ezerything contained within the resident alstrncture andattachedgarage 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 ❑ 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 "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. Signature of Licensed Contractor License number Date 8 • SUBCONTRACTOR LIST Excavation&Earthwork Concrete: Masonry: Roofing: Insulation: Drywall: Painting: Floor Coverings: Plumbing: Heating: Electrical: Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists: Siding/Exterior Trim: Other: 9 EXEMPTIANS FROM STATE RE STRATTON 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 certify that the above information is true and correct to the best of my knowledge. R� 3(3l ( Signature Date Print Name " 10