HomeMy WebLinkAbout12 00531i : I ) il i:
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Certificate of Occupancy
D e pa rt m e "r |lT ;ll"#ilno"o", o p m e nt
35 N. 1st E. / Rexburg, lD. 83440
Phone (208) 359-3020 I Fax
Building Permit No:
Applicable Edition of Gode:
Site Address:
Use and Occupancy:
Type of Gonstruction:
Design Occupant Load:
Sprinkler System Required:
Name and Address of Owner:
12 00531
lnternational Building Code 2009
111 East Main, Rigby ldaho 8344.2
Royal Journey's, LLC
Type V, non-rated
195
No
Contractor:
Special Conditions:Based on existing building inspection for life safety issues only.
Occupancy:Residential - 2 units or less, permanent in nature
This Certificafe, issued pursuant to the requirements of Secfion 109 of the lnternational 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. lssued:
C.O lssued by:i.----
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 untilthe Building Official has reviewed and
approved said future changes.
Plumbing Inspector:Fire Inspect "r. flil- ln;Pu*cd ryn
Electricar tntor.tor= N'&t' incPectzC NIA P&Z Administrator
Building Official
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Rexburg Building Department-
Royal Journeys is a Developmental Disabilities Agency providing
developmental therapy. We are not educational and our cf ients are not
in our custodial care as an l-4 building classification, but should r.ather
be categorized similar to an occupational Therapy or Speech Therapy
agency. Our buildings are used exclusively to provide these Medicaid
reimbursed medical therapies.
At no time will non-ambulatory personaf exceed the number of fire
safety trained staff, therefore we believe we qualify as R-3.
Feel free to call me anytirne regarding the nature and scope of our
servlces.
Program Manager
749-Afi7
Thanks,
y Cros"sman
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A*rsnru} lhxi! {"}rrnranity
RESIDENTIAL BUILDING
35 N 1" E, REXBURG, ID 83440
208-372-2326
PARCEL NUMBER:
SUBDIVISION;
(Addressing is based on the infotmauon - must be accurate)
Dwelling Units:Parcel Acres:
Please Comple Dntire ;\pplication!
If the <lucstion clocs not apply fill in NA fcrr: non applicable:
PERMIT APPLICATION
(We will provide this for you)
UNIT# BLOCK# LOT#
RNXSIJR
CITY OS IG
CONTACT PHONE # 7oq- 0537
PROPERTY ADDRE,SS:
PHONE #: Home ( )
"L{5-:l.93't
Work (
OWI{ER MAILING ADDRESS' *TA E
Cell( ) 7o1-ot37
CITY:-STATE:-ZIP;
APPLICANT (If other than
(Applicant if other than owner, a statement authorizing apphcatt to act as agent forbwner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
STATE;-ZTP- EMAIL F.AX
PHONE #: Home ( )
CONTRACTOR
MAILING ADDRESS:STATE, ZIP
PHONE #: Home (Work (Cell (
EMAIL-FAX- IDAHO REGISTRATION # & EXP. DATE,
I{ow many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes, hst previous owner's name)
Is this a lot split? NO YES (?lease bring copy of new legal description of property)
PROPOSED USE:
(i.e., Single F-amily 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 Zontng 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 subiect 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
cascs ofany false 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 1 void ifwork stops for 180 days
il/ iqlfa
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 beginnin g laauaryJ,zQ/{Ciry of Rexburg's Acceptance of the plan review fee does not constitute plan approvalx*Building Permit Fees are due at time of application't'{' **Building Permits are void if your check does not clear**