HomeMy WebLinkAboutAPPLICATIONS - 16-00551 - 1070 Washington Blvd - New SFRRio eexu°"0., CITY o P Building Safety Department
r
REXBURG City of Rexburg
ru, 35 North 1st East
Amedml Family community Rexburg, Idaho 83440
SINGLE FAMILY RESIDENTIAL APPLICATION CHECKLIST
The following items should be completed before you submityour building permit application.
*Reasonable accommodations will be made upon request,
Complete the Following:
W 2 sets of site plans (see Site Plan Checklist on page 2)
9( 2 sets of building plans drawn to scale (see box below) - stamped by a licensed professional
❑ Foundation Plan, Floor joist Layout, Floor Plan, Roof Layout, Truss Details, Sectional Views, Front,
Back, and Side Elevations, Mechanical Layout, Stair Details, and any details required to illustrate
/ special construction.)
H' Structural Calculations (see box below) - stamped by a licensed Engineer
tq/ Energy Compliance Report: As per the 2012 IECC, a RESCheck is required (available online
at www.energycodes.goy)
19/ Homeowner's Exemption signed, if Homeowner is doing work on their own home. (see page 4)
fJr Building Permit Application signed by a registered General Contractor. (see page 3)
Mechanical Permit Application signed by a registered Mechanical Contractor. (see page 5)
M/ Electrical Permit Application signed by a registered Electrical Contractor. (see page 6)
I/ Plumbing Permit Application signed by a registered Plumbing Contractor. (see page 7)
2/ Property Line form signed by builder. (see page 8)
m/ Affidavit of Legal Interest signed by owner. (see page 9)
IQ/ Subcontractor list filled out. (see page 10)
Subdivisions: 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 at littp://rexburg.ore/pages/development-code.
Seismic Design Category - D
Ground Snow- 50 lbs. per sq. ft. .
Roof Snow Load - 35 lbs. per sq. ft.
Wind Load -90 MPH
Frost Depth - 36"
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
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M1,voe CSL CITY OF
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REXBURG
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America's Family Community
Permit Policies Acknowledgement
Building Safety Department
City of Rexburg
35 North let East
Rexburg, Idaho 83440
The City Rexburg Building Safety Department is determined to provide excellent customer service. in an effort to help you
understand the City of Rexburg Permit Policies, listed below are several policies which youare required to know prior to
proceeding with your project.
Any construction within the City of Rexburg which requires a permit shall not begin until an approved permit is
obtained. If you do not have a pink building permit signed by the Building Inspector, then you do not have an
approved permit.
o Building without the pink building permit signed by the Building Inspector will result in double fees to be
COs assessed and the project to be red tagged. If your project is red tagged, halting all construction, only a City
"mal: Official may remove the red tag. If the red tag is removed by anyone but a City Official, citations will be issued.
No building may be occupied without receiving a signed Certificate of Occupancy.
o If a building is occupied without receiving a signed Certificate of Occupancy, citations will be issued and the
occupants will be evicted.
Initials
Calling in inspections is the responsibility of the applicant and their contractor. Inspections need to be called
into the hotline and not to the inspector. Inspections called in later than 8 AM will be scheduled for the following
business day.
4 o If an inspection is not done, the inspector may require any measures to be taken to allow him to correctly
perform the Inspection. (Example: If the electrical rough in inspection Is not done and the sheetrock has been
In;nai: put up, the inspector may require the sheetrock be removed in order to perform the electrical rough in
i77spect1onJ
Any approval for Certificate of Occupancies and Building Permits is only verified through the Permit Technician.
If an inspector says something like "You're good to go", understand that you still need to receive all relevant
documentation from the Permit Technician before you are truly good to go.
�g o Even ifyou hear from an inspector that'yoti re good to go', ultimately ifyou do not have a Building Permit or
Certificate of Occupancy, the above policies will be enforced.
Initials
It is your responsibility to relay this information on to anyone who this would be applicable to for your project.
All sub -contractors will be to this standard with no exceptions.
�g. o The above policies will be enforced to all, regardless if you pass this Information onto them or not.
Initials
Applicant's Name (print)•_ _ Signature:lorVTS. �TL Date
Inspections must be called in before ll AM on the day the impection is requested. Inspection requests called in after SAM will be scheduled for the next business day,
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician—(208)372.2341 Revised March, 2016
CITY OF
REXBURG
Americg4 Family Community
SITE PLAN CHECKLIST
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
1 Site plan must be drawn to scale, be legible and also be submitted electronically if possible.
2. Adjoining streets labeled.
3. Right-of-way location and width, curb to curb widths and sidewalk location.
4. Building location, sq footage and dimensions, with distance to property lines and distances
between buildings.
S. Show existing and proposed easements,
6. Existing utilities (waterlines, sanitary sewer lines, manholes, storm drains).
7. Proposed utilities including tie in location to existing services and new easements.
8. Proposed storm drain and sanitary sewer elevations (for pipe inverts at manholes and catch basins).
9. Storm drainage plan for parking lot and roof areas, with calculations.
10. Fire hydrants and fire suppression lines (including tie to City lines).
❑ Sprinkled ❑ Not Sprinkled
11, Indicate Fire apparatus access.
12. Parking (including parking lot, drainage arrows, dimension of lot, distance between rows, and total
numbers).
13. Landscaping (type and total area, including dimensions).
14. Trash facilities.
15, North Arrow
16. Drawing to Scale, including a graphic scale (11 % x 17" paper if possible).
17. Proposed street improvements (curb, gutter, sidewalk, pavement, etc.)
18. Legal description of proposed building site included.
19. Percent of lot covered by building or paving calculated.
20. Show 10% snow storage area.
21. Distance of entrances from street corner indicated.
22. Current Vicinity Map. (81/2 x 11") at 1" = 300' scale, showing location of the property.
23. Lighting Plan
SITE PLANS MUST BE COMPLETE AND SUBMITTED FOR REVIEW BEFORE THE PROJECT WILL BE PLACED ON
THE PLANNING & ZONING AGENDA,
Inspection Hotline -(208)372.2344 v.rexharg.org Permit Technician -(208)372.2341 Revised March, 2016
y
CITY OF
REXBURG
Americas Pdiully Community
BUILDING APPLICATION
Single Family Residence
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use Digital Plans Included: 0 CD 0 USB 0 Dropbox 0 Not Included
Permit Number: Permit Type: O New O Remodel ClAddition 0 Basement Finish
DepositAmount: 0 $500 New Const: 0 $100 Other than New Const. Deposit Included with Application: ❑ Yes 0 No
1. Property Owne
Name: kari �hCr v
Address:.611 9. lQv�4Q-LV C�: lqldr State: I Zip Code: i _' IL4 y 0 .
Phone &Type: 0 -5 — 211 10 18 Office 0 Mobile Emai : Ott ° Ka Y 1 GisY1Pn hoYY QF . Gt/Y n
Under Idaho Building Code, a homeowneris allowed to do work on their own home.
Are you a homeowner doing work on your own home?
0 Yes (Skip to 94 and complete the Homeowner's Exemption) O No, I am a contractor working for the homeowner
NOTE: Any contractors/sub-mntractore involved will need to submit their own signed applications.
2. Applicant
Name: Role: (Owner, Tenant, Contractor, etc.) _
Address: City: State: Zip Code:
Phone &Type: 0 Office O Mobile Email-
Contact/Rep. Name: Phone: Email:
3. General Contractor
Name: jcarithrler +iwrtu:s Registration#: ,Ll Exp.:
Address: A"a4�ltrt S Ov_ City., State: - Zip Code:.
Phone & Type: 0 Office O Mobile Email: —
Contact/Rep. Name: P e: Email:
Ge ne;aLcontractor Authorized Signature Date:
4. Project Description
Address: -OR- Lot#:Z Block#: L Subdivision: �UUwC{2VIA(ti/�
Type of work:
Check one: lNew Construction 0 Remodel* ❑ Addition* 0 Basement Finish*
*Check all that apply: J017raming )Zmechanical /16 Plumbing 0 Electrical
NOTE: Any sub -contractors involved will geed to submit tbeirown signed applications.
*Description of work: le 7FCcmi1y
*Total cost of project - materials and labor: $48011 CO (used to calculate permit fees)
Building Total: 1171[06 sq. ft. Main: 005 sq. ft. Basement: ❑ Finished 61Unfinished l r s sq. ft.
Garage_4_qtP sq. ft. Additional Floors:_ sq. ft,
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that I have read this application and state that the information herein
Is correctand I swear that any information which may hereafter be given by tie in hearings before the Planning and Zoning Commission or the City Council for the Cityof Rexburg
shall be truthful and correct. 1 agree to comply with all City regulations and State laws relating to the subject matter oRb@ application and herebyautborized representatives ofthe
City to enter upon the above-mentioned property for Inspections purposes. NOTE: The building official may revoke a permiton approval issued under the provisions of the 2012
International Code in cases ofany false statement or misrepresentation offact in the application or on the plans on which the permit or approval was based. Permit void Hour
staredwithin 180 days. Permit void ifworkstops for 180 days.
Applicant's Name (print)I'GPhli6 Signature: � v Date:
Inspections must be called in before B AM on the daythe inspection is requested. Inspection requests called inafter B AM will be scheduled for the nextbusiness day.
Inspection Hotline—(208)372.2344 www.rexburg.org Permit Technician—(208)372.2341 Revised March,2016
CITY OF Building Safety Department
r
REXBURG City of Rexburg
N 35 North 1st East
o AnrerloakAndly(A.ununtly Rexburg, Idaho 83440
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 atwww.ibolidaho.gov/cont.htm)
❑ Currently State licensed pursuant to Title 54 Idaho Code, Chapters:
d Architects,
10 Electrical Contractors/Journeyman,
42 Engineers/Surveyors,
19 Public Works Contractors (exempt from fee only registration required),
Plumbing/Plumbers,
45 Public Works Construction Management Licensing Act (exempt from fee only registration required), or
51 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
O 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.
Signature Date
Print Name
Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March,2016
CITY OF
REXBURG
America's Family Connnmdty
FS? -Bt
Affidavit of Legal Interest
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
State of Idaho
County of Madison
I I<C( r+ -c o n -r k a� osc) s yam( ( awst�
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 herein or as to the ownership of the property
which is the subject of the application.
Dated this
3
signature
Subscribed and sworn to before me the day and year first above written.
�rCe C�i1�21e io
Notary Pub Idaho
DA RCEY E. VALERIO Residingat: �e/x Q�`I V�"%,
_
NOTARY PUBLIC
STATE OF IDAHO My commission expires: G `'
Inspection Hotline -(208)372.2344 t mxoxburg.org Permit Technician -(208)372.2341 Revised March,2016
CITY OF
REXBURG
<e
An®ncaS Family Community
Property Lines
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
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, seethe front counter at the Community
Development Department.
I have read and understand the above requirements.
Signa ure
�PLPc14S
Printed Name
Date
Inspection Hotline -(208)372.2344 tvww.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
RMURG
cnr--
Atucim5 FamilyCouniaiifey
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: 0 New ❑ Remodel 0 Addition 0 Basement Finish
Fees Paid: 0 Yes 0 No
Y. Property Owner
Name: kat-lUnne+' homPS
Address: gc�cLS. ¢iloit tvY2'iW4Sh-)City. Re.xbur� State: tcl Zip Code: 533yN0
Phone &Type ,3 52-q-"106 [R Office 0 Mobile Email:_ Qlt"a(pKav�talnr7&rinorr�o:S.cm-..
Under Idaho Building Code, a homeowner is allowed to do wok on their own home.
Are you a homeowner doing work on your own home? 0 Yes (Ship to #3: and complete the Homeowner's Exemption page)
0 No: I am a contractor working for the homeowner 0 No: This property is a Multi -family Residence or Commercial Property.
NOTE: Anycontractors/subaontractorsinvolved will need to submit tlfeirown signed applications;
2. Mechanical Con�pt''a�ctopp
Name:. ErGtYtG-¢ 4:v,rSit-n Registration #: 01 G(01 )- Exp.:
Address:_ 302`-1 S. t300 & City: _practw State:. tD Zip Code: 13 3_2f-3
Phone & Type: (LduI)ti3w`ct6C110 00fficePMobile Email:Iv,rccvl�'�-ca`i�tiuCadInattrw;��1conn
Contact/Rep. Name:.5'n� cis ML Ww - Phone: - Email:
�v-emanicalConttactorApthorized5ighature _S'A.� CL`{{Li.G('l:t'(%( '(Wvn Date;
3. Project Description
Address: •OR- Lot #: — Block #: _ Subdivision:
Check one: 0 Single-family Residence 0 Multi -family Residence 0 Commercial
Check one: 0 New Construction* 0 Remodel 0 Addition 0 Basement:Finish
Description tion ofwork:
New Commercial Work: Contracted. amount: $ Calculated. Fee (See Below):
ElUp to $10,000 = (total cost of system x.02) + $60 0 $10,001-$100,000.= ((total cost of system -10,000).x.01)+ $260
0 Over $100,001= ((total costof system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. Ft.
0 Up to 1,500 Sq. Ft = $130 0 1,501-2,500 Sq. Ft. = $195 ❑ 2,501-3,500 Sq. Ft. = $260 0 3,501-4,500 Sq. Ft. = $325
0 Over 4,500 Sq. Ft.= $325+(65 x # of additional 1,000. Sq. Ft (or portion thereof)) $
New Multi -Family Residential:[] Duplex = $260 0 Three or more units= $((130 x# of buildings)+(65 x # of units))$_
New work on any other residence. and Detached Shops: =-T(65 + —(10x # of HVAC fixtures)) $
Miscellaneous:0 Gas Pressure =.$65 ❑ Furnace or A/C = $65 0 Water Heater =$65 0 Requested Inspection ,= $65
0 Gas Line= $65 0 Fireplace/Solid Fuel Burning Unit= $65 0 Technical Servicee: $65/hour
0 Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, i hereby certify. that i have read this application and state that he information herein
is correct and 1 swear that any Information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the qty Council for the City of Rexburg
shall be truthful and correct. I agree to comply with all City regulad am and State laws relating to the subject matter ofthis application and hereby authorized representatives of the
City to enter upon the above-mentioned. property forimpordom purposes. NOTE: The building official may revoke a permit on approval Issued under the provisions ofthe 2012
International Code in cases ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based, PermRvnid ifnot
starred within 180 days. Permit void if work sto rl Rya.
Applicants Name (print): Signature: :Tg� ZYTW�Cdd Date:
Inspections must be called In before 8 AM on the day the inspection is requested. inspection requests called in after 8 AM will be scheduled forthe next business day.
Inspection Hotline -(208)3722344 vww.rexburg.org Permit Technician—(208)3722341 Revised March, 2016
Building Safety Department
35 N. V, E., Rexburg, Id 83440
OWNER'S NAME
PROPERTY ADDRESS
SUBDIVISION
PHASE LOT BLOCK
Reguifedlll
City of Rexburg
Permit#
Mechanical
CITY OF
REXBURG
M,Meakh... yConnni iffy
Mechanical Contractor's Nahnc RY'Gj3d/t 1_CAL -5121n Business Name Mr• 0001 W-141 f ❑os C4 r-
Addtess 2h(j2°j S. or) F. City ypm,M ung State --V J'sZip,_ ln,�
CellPhone, 1,01 VZ r) r1� `1? Business Phone %2-
9
Fax Email VA ii,4, f' rv,
(COMMERCIAL/INDUSTRIAL) Total cost of plumbing system (Contracted Amount) $
(Iscbides the cost ofmalevialr installed regmdless oflbepe u y sipplying it The fees lined nude)- this inspection lope shd/l epp/y tomfr nud nllnreeLmeiea!
hatallatims 1101 spdgftall�, mentiosed elsemheur 0a lhis fan)-).
❑ Up to $10,000 (total cost of system x 0.02) + 60 = $
❑ Between $10,001- $100,000 ((Total cost of system -10.000) x 0.01) + $260 = $
❑ Over $100,001 ((total cost of system —100.000) s 0.005) + $1,160 = $
RESIDENTIAL
New.• Single PamilyDwelltng, including all butldings with wicing being constructed on each property. (*Based on Ilving space,
see definition below)
❑ Up to 1,500 sq ft- $130 ❑ 1,501 to 2,500 sq ft- $195
❑ 2,501 to 3,500 sq ft - $260 ❑ 3,501 to 4,500 sq ft- $325
❑ Over 4,500 sq ft $325 phis $65 for each additional 1,000 sq ft, or portion thereof
($325 + ($65 x # of additional 1,000 sa ft. or portion thereof)).
Now,, Multi PamilyDwa Mug (Contractors Only)
❑ Duplex Apartment $260
❑ Three or more mutt -family Units: $130 per building plus $65 per unit: ($130 x # of buildings + ($65 x # of units)
❑ Existing Residence, Modular, Manufactured or Mobile Homes and Detached Shop: $65 fee plus $10 per
**HVAC equipment being installed up to the maxuuum of the corresponding sq. ft. of the budding
($65 + ($10 x # of fixtures))
MISCELLANEOUS
❑ Plan Check: $65 per hour
❑ Technical Service: $65 per hour
❑ Gas Line: $65
❑ Water Heater Replacement: $65
❑ Requested Inspection: $65
❑ Fiteplace/Solid Fuel Burning Appliance: $65 per inspection
*Living Space — space within a dwelling unit intended for human habitation which may reasonably be utilized for sleeping, eating, cooking,
bathing, washing, recreation, and sanitation purposes. An unfinished basement is considered put of the living space,
ke'Examples of H17AC Equipment -furnace replacement, solar, water heater, etc.
01,5(011 llate
Signature of Licensed Contractor License number & Exp. date
°"`zit°as CITY OF Building Safety Department
° REXBURG City of Rexburg
n 35 North 1st East
Nuer(rn3 Pnm(ly Cmnnumiry
Rexburg, Idaho 83440
BUILDING APPLICATION
Electrical
For Office Use
Permit Number: Permit Type: ❑New []Remodel ❑Addition ❑Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Owner
Name:. a_r--Fc:l� n er- 41 rrvn-teS
Address: S„ 1^,I City:Rexburg. State: \ c Zip Code: 5:?g40
Phone & Type: 206 -5201 - 2 it b LrS.O ice O Mobile Email: ct fi-ztF? ka r-f-chn-¢-r hr�t-.-res u�r�.
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you homeowner doing work on your own home? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page)
❑ No: I am a contractor working for the homeowner O No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub W houctars involved will need to submit their own signed applications:
2. Electrical Contractor
Name: _Na -N rnn GOltup Registration#: o19990 Exp.:
Address: Po P,oX 2 5'3 City: K I !3b l State: 1 D Zip Code: V :3L4H'po
Phone & Type: (2 0)_3ciu-95S73 ❑ Office MMobile Email: in, uAItuP,Sf-inC-2$m—i1C-Ohi
Contact/Rep. Name: .Cmrnz &.t CAUL Je Phone: Email:
1Ieetrica[ContractarAlYthor[zedSlgnature S° -P-- cl.}lzii.(n.ec4ri�.m Date:
3.'Proj ectDescription
Address: -OR- Lot #: _ Block #: _ Subdivision:
Check one: ❑ Single-family Residence O Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below):
❑ Up to $10,000= (total cost of system x.02) + $60 ❑ $10,001-$100,000:= ((total cost of system -10,000) x.01) + $260
❑ Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Faintly Residential World iSq. Ft.
❑ Up to 1,500 Sq. Ft. = $130 ❑ 1,501-2,500 Sq. Ft. =$195 ❑ 2,501-3,500 Sq. Ft. = $260 ❑ 3,501.4,500 Sq. Ft= $325
Over 4,500 Sq. Ft.= $325+(65 x # of additional 1,000 Sq, Ft. (or portion thereof)) $
New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more unitss: $((130 x# of buildings)+(65 x # of units))$
New work on any other residence and Detached Shops:= $(65 + (10 x # of branch circuits)) $'..
Miscellaneous: ❑ Small Works (work costing less than $200 with no change in service connections)=$10(needs no inspection.
[]Central Heating/Cooling Systems= $65 ❑ Spas, Hot Tubs, and Swimming Pools= $65 ❑ Requested Inspection= $65
❑ Pumps -Water, Irrigation, Sewage (per motor) = ❑ $65 up to 2SHP ❑ $95 26- 200HP ❑ $130 over 2o0HP
❑ Irrigation Machine = $65 for center pivot+ $10 per tower of drive motor $ ❑ Technical Service = $65/hour
❑ Temporary Amusement= $65 + $10 per ride, concession, or generator $ ❑ Plan Check =10% of Contracted Amount
O Tem orar V Construction Services ONLY = $65 f 200 amp or less. One location for less than 1 ear.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION; Under penalty of perjury, I hereby certify that I have, ead this application and state that the information herein
is mrrectand I swearthatany Information which mayhereaRer be given by mein hearings beforethe Planningand Zoning Commission orthe City Count!] for the City of Rexburg
shall be truthful and correct. 1 agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives ofthe
City to eller upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions ofthe 2012
International Code incases ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void Hoot
started within 180 days. Permit void ifworksjpafurTMays.
Applicant's Name (print): � Signature: zs� Date:
Inspections must be called in before SAM on the day the inspection is requested. Inspection requests called In after 8 AM will be scheduled for the next business day.
Inspection Hotline—(208)372.2344 www,mxburg.org Permit Technician—(208)372.2341 Revised March; 2016
®uuuuly Julely LicliuunlCnl
CRy of Rexburg �r 1����>y-,
35 N. V E, RearbuA
rg, Id 83990 E .C1LLl URG
Phone - (208)359.3020 / Not0ne - (208)372.2399 / Pax ^(206)359.3022
O%WNRI SNAME
PROPERTY ADDRESS Permit#
SUBDIVISION
PHASE LOT BLOCK
Requiredffl ELECTRICAL p
Electrical Comractocs N \IMIA0 1 _ Business Name .Zt,;�
_Smic 1'1J 2io��r `KI�2
(COMMERCIAL/INDUSTRIAL) Total cost of electrical system (ConaactcdAmounr) 5
guninarrliretorrofnmhdrr/r darnllafawmIlettof11, par(IvrrftigiR TGefreslured xodrrl8iriurprrAertbrpejhallappp tome and nil drrMmfintrtl/orimu
aslrpedfiorllynanRmmlrlrendnroil rLbfone).
13 Up to $10,000 (total cost ofgstem x 0.02)+ 60=$
o Between $10,001 - $100,000 ((rntal cost ofaystem-10.009)x0.01)+$260=$.
O Over $100,001 ((roml costof system; 1 •00.0001 x 0.005) + $1,160= $
Small Works (Contractors ONLY): SIO fee for worlt not exceeding $200 in cost sad not involving a change in
service connections. Does NOT require inspection. {
RESIDENTIAL
Now Singh pamtiplhvefling, larludlagetl6uLdingo rvlrh tvfdngbelag coasauaredon earLproperry, (•9aredonl/vfagspser,
serdegaldoabelom)
o Up. to 1,500.59 ft -$130 o f,501m2,500s9f1r-5795
0 2,501 to 3,500 sq fr- $260 0 3,501 m 4,5d0 sq ft $325
o Over 4,500 sq ft $325 plus $65 for each additional 1,000 sq ft. or portion thereof ($325 + (S65 x # of additional
I
)per building plus $65 per train ( 13hit of hai_ I �rrlinasl+(865x#ofunlrsl
ufactured of Mobile Homes, and Detached Shope $65 fee plus $10 per
the corresponding sq. ft. of the building 4$65 +S( 10 x ft branch circuito
565 %ften NOT part of new residential orHVAC permit with no additional
Wiling
o Spas, Hot Tubs, and Swimming Pools: $65 fee for each trip to inspect
pumps-WAfor, fnigedon, so mg# (do CAmotoo
o $65upto 251 -IP 0$95-26 to 200HP 0130 over 200 HP
MISCELLANEOUS
o Temporary Construction Services ONLY: 200 amp or less, one location (for a period not to exceed l year)
a Temporary Amusement: S65fee plus $10 per ride, concession or generator
o Irrigation Machine; $65.for center pivot plus 310 per tower of drive motor
C1 Technical Service: S65perhour
0 flan Chuclu S( IS per hour
$65
n d=ffing unit Intended for human habitation which may reasonably be u{Wiaed for sleeping, eating, cooking,
and nlmtion purposes. An unfinished lamemem is considered pautorthcliving space.
eased ComractorLicense numbcrR•exp. Mae I)ac
;Ce pp.xnUgU6
CITY OF
9�
` REXBURG
r
04
Aucnwm Fondly Community
BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North lxt East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: 0 New ❑ Remodel 0 Addition ❑Basement Finish
Fees Paid:❑Yes ONO
1. Property Owuer
Name:_KGtr'ct'oe111e-r hfMnns
AddressYCfib?An,4 S-N.2df City: QexblA!Z State: Id Zip Code: G9HHO
Phone & Type:260' Ib> -q -)-Ilio ROffice O Mobile Email: al -t c16? Jra r d-cVuwrLei.,-, c c.�m
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home? 0 Yes (Skip to #3and complete the Homeowner's Exemption page)
0 No: I am a contactor working for the homeowner O No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2. Plumbing Contractor
Name: J?,2cl Registration #:Lf3-C-List -Exp,:
Address: 3gto!b C-Swnnt450,g f'd.`Ff City: 'prnMIn State: 1 61 Zip Code: 0,6
Phone &Type: 2095-S'3S- 13 ry ❑ Office m-MobileEmail: btoleskui-pl ti rnloi n, P, u,„ home' f
Contact/Rep, Name: _-0 int G S GtW "e- Phone: Email: v
)'lumbing Contractor Authorized Si nature: See a FI c W yc( Fv n Date:
3. Project Description Water Meter Quantity:. Water Meter Size:
Address: -OR- Lot #: Block #: Subdivision:
Check one: 0 Single-family Residence 0 Multi -family Residence p Commercial
Check one: 0 New Construction' ❑ Remodel 0 Addition 0 Basement Finish
Description of work:
New Commercial Work: Contacted amount: $ Calculated Fee (See Below): $
O Up to $10,000 = (total cost of system x.02) + $60 0 $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260
0 Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family. Residential Work: Sq. Ft.
0 Up to 1,500 Sq. Ft. = $130 01,501-2,500 Sq. Ft. = $195 02,501.3,500 Sq. Ft.= $260 0 3,501-4,500 Sq. Ft. = $325
0 Over 4,500 Sq. Ft.= $325+(65 x # of additional 1,000 Sq. Ft. (or portion thereof)) $.
New Multi -Family Residential; 13 Duplex= $260 0 Three or more units= $((130 x# of buildings)+(65 x # of units))$_
0 Gray Water Systems = $130 0 Lawn Sprinklers/Backflow device= $65 0 Multipurpose Fire Sprinkler & Domestic Water
Supply System= $65 or $4 per sprinkler head (whichever is. xeater)
New work of any other residence and Detached Shops: _ $65 for sewer and water stub connections
Miscellaneous: 0 Sewer Line = $65 ❑Water Line = $65 0 Sewer and Water Line =.$65 ❑Requested inspection= $65
0 Sewer Turnaround (septic to city) = $65 0 Hydronic Heating= $65 + ($10'x # of manifolds/zones)
0 Technical Service= $65/hour 0 Plan Check=10% of Contracted Amount
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperlury, I hereby certify that I have read this application and state that the information herein
fs correct and I swear that any Information which may hereafterbe given by me in hearings before the Planning and Zoning Commission or the City Council far the City of Rexburg
shallbe truthful and correct.tI agree to comply with all City regulations and State laws relating to the subject matter ofthis application and hembyauthodzedrepresentatives ofthe
City to enter upon the above-merumned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012
International Code incases ofanyfalse statement or misrepresentation of fact in the application or on the plans on which the Fermltor approval was based. Permit void Ifnot
started within 180 days. Permitvoid:if orkstos 18
Applicant's Name (print): r Signature: �b S'Cta...N2 Date:.
Inspections mustbe called mbefore 8 AM on the day the inspection is requested. Inspection requests oiled !nailer SAM will be scheduled for the nextbustness day.
Inspection Hotline -(208)372.2344 www.vexbmg.org Permit Technician—(200)372.2341 Revised March, 2016
Building Safety Department
35 N, IAA, Rexburg, Id 03440 City of Rexburg
OVINEWSNAME
PROPERTYADDRESS Permit#
Water Meter
Requiredffl
**************Wates Meter Size:
Plumbing
c: rx o r
RE.)(BURG
Ana40Malt,
(bnimunlry
Plumbing Contractors Name IQC —I\ Business Name 1A01eSsncrY P6mb21
Address SaIWO E Sona.Aptie Road"I City �Lmmon SL1te t0las�n Zip4Z�1o1„
Cell Phone (209) C,a5 - Xin Business Phone ( )
Fax( ) LmainleCnn4-Ql�mb.nnfei 4Nnnn.0 m
(COMMERCIAL/INDUSTRIAL) Total cost ofplumbfug system (Contracted Amount) $
(!nrindu Iberout ofnmhdnl+bu/n/Ird rCvmr7len'af diepmiy n�plyh+g h. rbr fru lured midn•rblrhrrpnlion pju rhnl/n.pp/y to nny and nllplrmibittg /nrealln/1011
vol.rprr�rn/lylntnllanrd'h"i"M an ILirfann).
O Up to $10,000 (total cost of system x 0.02) + 60 = $
❑ Between $10,001-$100,000 ((total cost of system, -10,000)x0,01)+$260=$
❑ Over $100,001 ( (total cost eE system —100.000) x 0.005) + $1,160 = $
RESIDENTIAL
Nem Slogh panil/•AtVellfng, including allbuildings with w1finabeing constructed on eachproperhi (•a$nsed on h'vingepnce,
see definition below)
❑ Up to 1,500 sq ft - $130 ❑ 1,501 to 2,500 sq ft - $195
❑ 2,501 to 3,500 sq ft - $260 ❑ 3,501 to 4,500 sq ft - $325
❑ Over 4,500 sq It $325 plus $65 for each additional 1,000 sq ft. or portion thereof ($325 + ($65 x #F of additional
1,000 sq. ft, or portion theceofl),
New, Mult!-I'amilyDsrelling (Contractors Ont)
❑ Duplex Apartment $260
❑ Three or more multi-farnity units: $130 put building plus $65 per unit: (M90 x # of building i + f865 x # of uallof milts)
❑ Existing Residence, and Detached Shop: $65 fee plus $10 per Emnare up to the maximum of the corresponding
sq. ft of the building (95 + all) x # of fixturoD
❑ Gray Water Systems! $130
❑ Lawn Sptinldexs/Banknow Device: $65
❑ Modular, Manufactured at Mobile Homes: $65 for sewer and water stub connections
❑ Multipurpose Fire Sprinkler and Domestic Water Supply System, $65 fee or $4 per sprinkler head, whichever
Is greater
Server & Water
❑ $385ewer Line 13$38 Water Line ❑$65 Sewer & Water- lFinspected at dee same thus
❑ $65 Sewer turnaround under house (change from septic to city)
MISCELLANEOUS
❑ Plan Check: $ 65 per hour
❑ Technical Service: $65 per hour
❑ Gas Linet$65
❑ Water Heater Replacement: $65
❑ Requested laspection:$65
❑ Hydrosde Heating: $65 + ($10 x# ofmantfolds/zones)
*Living Space —space wi bin a dweVing unit intended fox human babitation which may reasonably he utilized for slceping, eating, cooking,
bathing).vaVpg,recreation, and sanitation putposes. An unfinished basement is considered part of the living space.
Date
.�°�epexovgQb
CITY OF
REXBURG
A meriwk Fnml(y Connnuniry
Subcontractor List
Excavation & Earthwork: Tr- l e (e Cy g X CGf V a;f-? h.� I V -) C.
Concrete: R u c K I G til cl f vyi c.r e i" P Inc.
Masonry: S:C" I P f -Li rec( CII -n rtvC1 G'f `t ' [q,. , Cin C
Roofing: RM C, Vv e. s i- v.g
Insulation: $ M c I n& A CA 1"vv,
Drywall: 0 V1 G( r y w ox 1 1 _ i h (,
Painting: 0e_V1Qv-\ 1.nt,-
Floor Coverings: Rcl-MI 2S61-t'S -f I CV r COVe! l vice L.L,C .
Plumbing: tiO( e S k r+ r f v1 rn b/ h
Heating:/fit/ _I'_ CC'D I ft'2 n vtg G off
Electrical: 1-1;lJ h -�"rC) Lt .Pe> C -f ✓l L I h c .
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists: _
Siding/Exterior Trim:
Other:
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
Inspection Hotline -(208)372.2344 mm.re%hurg.org Pemit Technician -(208)372.2341 Revised March, 2016