HomeMy WebLinkAboutAPPLICATION - 16-00552 - 1071 Washington Blvd - New SFRCITY OF
REXBURG
1>v
America} Fandfy Com,nunity
Building Safety Department
City of Rexburg
35 North 1st East
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:
2 sets of site plans (see Site Plan Checklist on page 2)
2 sets of buildingplans drawn to scale (see box below) - stamped by alicensed 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.)
Structural Calculations (see box below) stamped by a licensed Engineer
Energy Compliance Report: As per the 2012 IECC, a RESCheck is required (available online
at www.energycodes,ew)
Homeowner's Exemption signed, if Homeowner is doing work on their own home. (see page 4)
Building Permit Application signed by a registered General Contractor. (see page 3)
Mechanical Permit Application signed by a registered Mechanical Contractor. (see page 5)
Electrical Permit Application signed by a registered Electrical Contractor. (see page 6)
Plumbing Permit Application signed by a registered Plumbing Contractor. (see page 7)
Property Line form signed by builder. (see page 8)
Affidavit of Legal Interest signed by owner. (see page 9)
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 h_ ;J/rexburgorgJpagesfdevelonment-code.
Seismic Design Category - D
Ground Snow- 50 lbs. per sq. it.
Roof Snow Load- 35 lbs. per: sq. ft
Wind Load -90 MPH
Frost Depth - 36
Inspection Hotline -(208)372.2344 %w .rexlmrg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF g `7 Building SafeDepartment
° . Safety
Jam, �s
REXBURG City of Rexburg
°
n„ 35 North 1st East
A1tle"m`Family cam,°nmy Rexburg, Idaho 83440
Permit Policies Acknowledgement
The City of 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 you are 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
approved permit.
-o Building without the pink building permit signed by the Building Inspector will result in double fees to be
X09 assessed and the project to be red tagged. If your project is red tagged, halting all construction, only a City
inieals 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,
S 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
initials put op, the inspector may require the sheetrock be removed in order to perform the electrical rough in
inspection.)
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 if you hear from an Inspector that'yoti re good to go', ultimately if you 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 held 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 C�+
Applicanfs Name (print)• _ J
Signature: 7110SM 'r�L Date _
Inspections must be called in beforea AM on the day the inspection is requested. Inspection requests called in after AM will be scheduled for the next business day..
Inspection Hotline—:(208)372.2344 w,wv.rm1urg.org Permit Technician—(208)372.2341 Revised March, 2016
CITY OF
REXBURG
w
Amervrgk Fnmlly Cgnnnmiie
SITE PLAN CHECKLIST
Building Safety Department
City of Rexburg
35 North 15t 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.
5. 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 (111/2 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 vnvw.rexburgxrg Permit Technician -(208)372.2341 Revised March, 2016
x
°°a%11e"P CITY OF Building Safety Department
a
REXBURG City of Rexburg
cl 35 North 1st East
AmMdt3 Fhihirp Commdulq• Rexburg, Idaho 83440
BUILDING APPLICATION
Single Family Residence
For Office Useoo Digital Plans Included: ❑ CD ❑ USB ❑ Dropbox ❑ Not Included
Permit Number:. .-.(&- ❑New❑Remodel ❑Addition []Basement Finish
Deposit Amount: o $500 New Const. ❑ $100 Other than New Const. Deposit Included with Application: ❑ Yes ❑ No
1. Properly
-0wner _
Name:yar't2�Y a -y ;yeroo--G
Address: ht#V C" - 2_01 City: rO-XbN C State: Zip Code:4539Y 0
Phone&Type: 'S-261-z�1t'_(`il-Office0 Mobile Email:
Under Idaho Building Code, a homeowneris allowed to do work on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #4 and complete the Homeowner's Exemption) D No, l am a contractor working for the homeowner
NOTE: Any contractors/sub-contractors involved will need to submit thetrown signed applications...
2. Applicant
Name: Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone & Type: ❑ Office O Mobile Email:
Contact/Rep. Name: Phone: Email:
3. General Contractor
Name: Registration #: I`f69 Exp.: 12-/4 141 ("o
Address: City: State: Zip Code:
Phone & Type: ❑ Office ❑ Mobile Email: _
Contact/Rep. Name: P e: Email:
General Contractor Authorized. S gnaturq� Date:
4. Project Description
Address: OR- Lot #: 2 Block #: 3 Subdivision: Foltrxieij- xS s"
Type of work:
Check one:. JV1 New Construction ❑ Remodel* D Addition* ❑ Basement Finish*
*Check all that apply: I0Framing p Mechanical fp Plumbing 0 Electrical
NOTE: Any sub-rontractors involved wilt ne33d to submit theirown signed applications.
*Description of work: S(rl (P�
*Total cost of project - materials and labor: $ (use to calculate permit fees)
Building Total: 11 (O sq. ft. Main:5la 5W sq. ft. Basement: ❑ Finished I$ Unfinished l ir�'' O sq. ft.
Garage --LM�sq. ft. Additional Floors: sq. ft.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, l hereby certify that l 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 Cltyof Rexburg
shall be truthful and correct. 1 agree to mmplywith all Chyregulations and State laws relating to the subject matter of tbis application and herebyauthorized representatives oftha
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 2012
International Code In cases ofanyfalse statement or misrepresentation rffact in the application or on the plans on which the permit or approval was based. Permitvoidifnot
started within 180 days. Permit void ifworltstops for 180 days.
Applicant's Name (print):7T'CP04%, (S�1CiL Signature:7� Date:
Inspections must be called In before 8 A 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.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF Building Safety Department
a
t
REXBURG City of Rexburg
N. 35 North lxt East
Anerim} Fandy Connnunhy 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
seethe State's website atwww.ibol.idaho.gov/cont.htm)
17 Currently State licensed pursuant to Title 54 Idaho Code, Chapters:
$ Architects,
10 Electrical Contractors/Journeyman,
,Engineers/Surveyors,
12 Public Works Contractors (exempt from fee only registration required),
Plumbing/Plumbers,
}5 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 ,
13 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
1 hereby certify that the above information is true and correct to the best of my knowledge.
Signature Date
_"�Iva,a.�ss cStr..frrb
Print Name
Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician—(208)372.2341 Revised March,2016
CITY OF
REXBURG
Anterica1 Pnmlly Co,mnunfty
F5
Affidavit of Legal Interest
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
State of Idaho
County of Madison
I Kari CV) V)e_r I�vY� ps P>S9 S. t��Il�StyYti2. L'Uy .201
Name Address
Re-Algu Ly I tda
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 an 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 day of 20 �o
C7kzC�
Signature
Subscribed and sworn to before me the day and year first above written.
DARCEY E. VALERIO
NOTARY PUBLIC
STATE OF IDAHO
Inspection Hotline- (208) 372.2344
Notary
Residing at:
XDOG
My commission expires: I � 221 q
w .mxburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
nv
Amerim's Family Connnwiih,
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 wither 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.
Signa ure
7TP+-A,48
Printed Name
Date
Inspection Hotline -(200]322.2344 mw .rexlurg.org PermitTechnician-(206)3]2.2341 Revised March, 2016
d ptzuuq�
CITY OF
° REXBURG
t>y
Amctlm's Family Community
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: O New O Remodel ❑ Addition O Basement Finish
Fees Paid: O Yes ONO
1. Property Owner
Name: kartClnnP,Y h.omPS
Address: s 01161vstfPlz c(City: Re.xbftr_Q state: l CI Zip Code: 9RL4+10
Phone&Type 52h-'1-11! fdlOfficeDMobile Email: Qltzt(G�Kay-I-r,V�nGrfnow.�S.��rr.
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? D Yes (Slip to #3: and complete the Homeowner's Exemption page)
D No: I am a contractor working for the homeowner D No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub•mntractors invoivedwillneed m sutimit tlieirown signed applications:
2. Mechanical Con tactor
.. (raYG.y1
Name:l::a eSvr Registration #: 0I 5101 Exp.:
Address: 302-1 S•. P)UOE. City: _Pr¢.t-h}r, .Stater I Zip Code:'612Cv3
Phone &Type:(aoJ)?D(O-SC99 3_13 Office P Mobile EmaiL_lv)rcveli..c-,h2ig Cvrr,
Contact/Rep. Name; 5'a� GS abwE Phone: - Email:
Medhal ital ContractorAuthorised Signature,' S 8C2 CL{iZ G(1GG( -fU yn Date:
3. Project Description
Address: -OR- Lot#:_Block#:_Subdivision:
Check one: ❑ Single-family Residence D Multi -family Residence D Commercial
Check one: D New Construction* D Remodel D Addition D Basement: Finish
Description tion of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
D Up to $10,000 =. (total cost of system x.02) + $60 D $10,0014100,000 = ((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.
D Up to 1,500 Sq. Ft = $130 D 1,501-2,500 Sq. Ft. = $195 ❑ 2,501-3,500 Sq. Ft. = $260 ❑ 3,501.4,500 Sq. Ft. = $325
D Over 4,500 Sq. Ft.= $325+(65: x # of additional 1,000 Sq. Ft. (or portion thereof)) $
New Multi -Family Residential; El Duplex = $260 p Three or more units= $((130 x# of buildings)+(65 x # of units))$_
New work on any other residence and: Detached Shops:_ (65 + (10 x # of HVAC fixtures))
Miscellaneous: D Cas Pressure = $65 D Furnace or A/C = $65 ❑ Water Heater = $65 D Requested Inspectionz; $65
D Gas Line = $65 D Fireplace/Solid Fuel Burning Unit= $6S D Technical Service= $65/hour
❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION ANDAUTHORIZATION: Under penalty ofperjury, I hereby certify that] have read this application and state thatthe information herein
Is correctand I swearthatany Information which mayhereafter begiven byme in hearings before the Planning and Zoning Commission orthe CtyCouncil for the Cityof Rexburg
shall be truthful and correct. i agree to comply with all City regulations and State laws relating to the subject matter ofthis application and hereby authorized representatives ofthe
City to enterupon theabove•mentioned property forinspecdons purposes. NOTE: The building official may revoke a permitan approval Issued under the provisions ofthe 2012
International Code in cases ofanyfalse statement or misrepresentation affect in the application oron the plans on which the permitorappmval was based. Permitvoid if not
started within 180 days. Permitvoidifworksto rl ays. �C�
Applicant's Name (print): Signature:.'T'?Ayis .JcuW+a Date:
Inspections mustbe called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled forthe nembusiness day.
Inspection Hotline -(208)372.2344 www.reaburg.org PermitTechnician-(208)372.2341 Revised March, 2016
Building Safety Department
35 N. Pr E., Rexburg, Id 83440 City of Rexburg
OWNER'S NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
PHASE LOT BLOCK
Requiredlll
Mechanical
CITY OF
REXBURG
Nnedgri YnnJly Cmnnnmi�
Mechanical Contractor's Name Rrw[1CA/t Lat'y h Business Name M r- CM1 in.¢.c'tt"A CL4t-1
2'-1 S. 9 f.)0
CellPhone $01 bzt(l --12 (1? Business Phone — & L-
Fax Email /`1a'Cau`;4}r'Ei°.C�tl'I teh�ti=�t�i d'w+rw
(COMMERCIAL/INDUSTRIAL) Total cost of plumbing system (Contracted Amount) $
(blelader the cart ofmateiiafshistalled ugmd1w ofthe party voyj1 hig i1. The fees fisted aider this msfiwion ops sbalf npp/y is mgr nnAn11 sfedinnilnl
iu fallatians nal spetiftcn/wsantisued elsewhere aUhisfarn).
❑ Up to $10,000 (iotal 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) x 0.005) + $1,160 = $
RESIDENTIAL
Now Slagle PamilyDwellfag, laclud ng all buildings with widag being constmcted on each pmpettp. (*Based oa Rvs'ag space,
see dcBnidoa 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
❑ Ovu 4,500 sq ft $325 plus $65 for each additional 1,000 sq ft. or portion tbereof
($325 + ($65 x # of additional 1.000 sq. ft. or portion thereof]).
Nom Mvlti PamilyDwelGag (Contractors Only)
❑ Duplex Apartment $260
❑ Tltr'ee of more nnilti-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 maximum of the corresponding sq. ft. of the budding
($65 + ($10 x # of fixtuteQ
MISCELLANEOUS
❑ Plan Check: $65 per hour
❑ Technical Service: $65 pet hour
❑ Gas Lute: $65
❑ Water Heater Replacement: $65
❑ Requested Inspection: $65
❑ Fireplace/Solid Fuel BnrningAppliance: $65 per inspection
*Living Space — space cvidiln 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.
**Examples of HVAC Equipment -furnace replacement, solar, water heater, etc.
Signature of Licensed Contractor License number & Exp. date Date
ov ppznuq� CITY OF Building Safety Department
i
Bio REXBURG City of Rexburg
ro+
t 35 North 1st East
mm�rm}Fpmitp comnn"'l`) Rexburg, Idaho 83440
BUILDING APPLICATION
Electrical
For Office Use
PermitNumber: Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish
Fees Paid: ❑ Yes ❑ No.
1, Propel'ty Owner
Name: i<GT rt-(.lh n er 1,crvn2S
Address: G 5' GI cwsty S City, Rexbu State: 1 cl Zip Code: g3`f4y
Phone &Type:2oA-527 2 klb O ice❑Mobile Email: aPYur karfciin¢,rhorn�s cin
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? ❑ 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+mntractors involved will need: to submit their awn signed applications.
2. Electrical Contractor
Name: Gallup Registration#: ol£sioi4'io Exp.:
Address; Pa i,ox z5'2 City: R1!3bi.4 State: l0 Zip Code: P,3t-Np
Phone& Type: b0'6)c-9Citi-gSS3 '0 Office M Mobile Email: h Gu'ituP„Se,{nc,edwi
Contact/Rep. Name: Sa.0n.2 an utgove Phone: -Email:
Blectricaldo-urractorAuthorized;Signature: Sam of+taCVX,,a( �rrrn Date: -
ate:3,ProjectDescription
3, Project Description
Address: -OR- Lot #: _ Block #: —Subdivision;
Check one: ❑ Single-family Residence ❑ Multifamily Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition O Basement Finish
Description of work:
New Commercial World Contracted amount: $ Calculated Fee (See Below): $
13 Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,000 = ((total cost of system -10,000) x.01) + $260
❑ Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. 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 units= $((130 z # of buildings)+(65 x #of units))$
New work on any
other residence and Detached Shops: = $(65 + (10 z # of branch circuits))
Miscellaneous: ❑ Small Works (work costing less than $200 with no change in service connections)=$10(needs no inspection.
13 Central Heating/Cooling Systems= $6S ❑ Spas, Hot Tubs, and Swimming Pools= $65 ❑ Requested Inspection= $65
❑ Pumps • Water, Irrigation, Sewage (per motor) = O $65 up to 25HP ❑ $95 26- 200HP ❑ $130 over 200HP
❑ 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
❑ Temporary Construction Services ONLY =$65 (200 amp or less. One location for less than i ear;
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, (hereby certify that I have read this application and state that the information herein
Is correct and I sweartbat any information which may hereafter be given bymein 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 mfthe
City to enter upon the above-mentioned property for Inspections purposes. NOTE: The building official may revoke a pernrlton approval issued under the provisions ofthe 2012
International Code in cases ofany fake statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvaidifnot
started within 180 days. Permit void ilworhsJpitfol-f9Q.?lays.
Applicant's Name (print): �� Signature: Date
Inspections most be called in before 8 AM 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 wevaerexburg.org Permit Technician -(208)372.2341 Revised March, 2016
Building Safety Department
35 N. P.E., Rexburg, id 83790 City of Rexburg
phone - (208)3593020 / flodine - (208)372-23-14 f Ynx'— (208)3593022
OWNER'S NAME
PROPERTY ADDRESS Permit#
SUDDMSION
PHASE LOT BLOCK
.Required/!! ELECTRICAL
cart o.
P.E�;]3URG
.a,uln fmnyr �+�n.,.nq
(COMMERCIAL/INDUSTRIAL) Total cost of electrical system (Contracted Amount) $
(farladaAtvilofmaodab rued/rifrtynil/rrrof/Grpuyynopptfit. TkifellIiurAaaderfUsi"*ff11oafjpr 44110P.P/yfo o,yondulfr/rndral4nMl/uriom
aolrpaifrralfyeiratlomdrlrat0dr sit l9frfvnu)
0 Up 10 $10,000 (total cost of sptens x 0.02) T 60 = $
0 8otween$10,001-$100,000 ((IQMUQsrofaystem-10.0001x0,01)+5260=5
o Over $100,001 (()oral cost of sostern-100.000)x0405)+$1,160=$
Small Works (Con❑actors ONLY: S70 fee for worst not exceeding $200 in cost and not Involving a change in
service connections. Does NOT require inspection. (
RESIDENTIAL
NarvrStaglepaailryDtvdliag, ladudlaga!!bu((dings with wMaghelog eoaawared as eacApmpe ry. (Vased on Avfagspaee,
soaeegaldimbelow)
o Up to 1,500sq ft -$130 0 U0Ito2,500sgft-$195
❑ 2,501 to 3,5Q0 sq fr- $260 0 3,501 to 9,540 sq ft =$325
❑ Over 9,500 sq A $325 plus S65 for each additional 1,000 sq ft. or portion thereof ($325 + (S65 x # of additional
0 Duplex Apartment
o 'three or more multi -family units: $130 per building plus S65 per unin
,�5 x #f %coss)
o Existing Residence,ModularManufacturedoflelobile Homesand DccohfdshA+5(irS6plus$10
per
branch circuit, up to the maximum of the corresponding sq, ft, of the building (US -tt(, In x # branch cffirc�.i.<u
D Central Prating/Cooling Systems: 565 Mean NOT part of new residential or HVAC permir%vtrh no additional
Wiring
o Spas, Hot Tubs, and Swimming Poois: $65 fee for each uip to inspect
romps -/fate, Tndgation, so"so (as Ch motor)
0 $65 up to251•IP ❑$95-26 to200MP o$130over 200HP.
MISCELLANEOUS
o Temporary Construction Services ONLPr 200 amp or less, one location (for a period not to exceed 1 year) • $65
❑ Temporary Amusement: $65 fee plus 510 pet ride, concession or generator
o litigation Machine; $65 for center pivot plus 310 per tower of drive motor
o Tccbnicnt$cwlcet S65perhour
o Platt Chuck: $65 per hour
❑ Requested Inspection: $65
"living Space—space within a dwelling unit Intended for human habitation which may reasonably be.6ited for sleeping, eating, cooking,
baddog.wasiting, recreation, and nitadonpurposes. An unfinished bacmcnr is eonsideted patgofthe living space.
i
Signs tf u 4.tccnscd Contractor — Lkcnsc number&cxp..ddm Oam
C I TY OF Building Safety Department
REXBLTRG City of Rexburg
°
r 35 North lit East
Amerlm's Family Community Rexburg, Idaho 83440
BUILDING APPLICATION
Plumbing
For Office Use
Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement:Finish
Fees Paid: ❑ Yes ❑ No
1.Properry0wner
Name: f/r}f,V1he'r hoYr 's
Address:Vi395.!de1(ow91-vr'e b'I Ste: 2()l city:_(Zenb'A!2_. State: Zip Code: 0.3y�10
Phone&Type:ROff(ceDMobile Email: ctl'tzl�karlc6y�rG� .,c.cahn
Under Idaho Building Code, a homeowner is allowed to do work on their own home,
Are you a homeowner doing work on your own home? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page)
❑ No: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2. Plumbing Contractor
Name: a,-rcl Registration#:L�1FSfg_Exp.:
Address: 3,"101Q1 E-Su-ylnr,t�sjct8 rd. l City: :Ftiur'r„on State: i o ZipCode:10340l6
Phone &Type: ?_C�0-`�35 13 ro ❑ Office M -Mobile Email: �/ oleShu}hl to hi)ai n u hao cr, '
Contact/Rep. Name:-Othae uS 00"e- Phone: Email: y
phumbiniii Contractor Authorized Sl miture'. Date:__
3. Project Description Water Meter Quantity: Water Meter Size:
Address: -OR- Lot #:_ Block #:_Subdivision;
Check one; D Single-family Residence ❑ Multi -family Residence 11 Commercial
Check one; ❑ New Construction* ❑ Remodel O Addition ❑ Basement Finish
Description of work:.
New Commercial Work: Contracted amount:$ Calculated Fee (See Below): $
Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,000 = ((total cost of system -10,000) x:01) +$260
11 Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. Ft.
13Up 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
0 Over 4,500 Sq. Ft. = $325+(65 x # ofadditional 1,000 Sq. Ft. (or portion thereof)) $
New Multi -Family' Residential: D Duplex= $260 ❑ Three or more units= $((130 x# of buildings)+(65 x # of units))$_
O Gray Water Systems= $130 ❑ Lawn Sprinklers/Backflow device= $65 ❑ Multipurpose Fire Sprinkler & Domestic Water
Supply I System= $65 or $4 per sprinkler head whichever is greater)
New work on any other residence and Detached Shops: =$g
for sewer and water stub connections
Miscellaneous: ❑ Sewer Gine = $65 ❑ Water Line = $65 ❑ Sewer and Water Line = $65.❑Requestedinspecdon = $65
❑ Sewer Turnaround (septic to city) = $65 D Hydronic Heating= $65 +($10 x # of manifolds/zones)
❑ Technical Service= $65/hour ❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpelury, I hereby certify that 1 have read this application and state that the Information herein
Is correct and 1 swear that any information which may hereafterbe given bymein hearings before the Planning and Zoning Commission or the City Council for the Cityof Rexburg
shall be truthful and correct. I agree to comply with all City regulations and State laws relating to tiie subject matter ofthe, application and herebyauthodaed representatives ofthe
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 ofthe 2012
International Code in cases ofany false statement or misrepresentation of fact in the application or on the plans on which tile pm ndt or approval was based. Permit void ifnot
started within 180 days. Permit void If orkare s 18 elap.
Applicant's Name (print): -s- Signature:: _ra-A'J%21 5-ei..,-txz _ Date:..
Inspections must be called in before SAM on the day the Inspection is requested. Inspection requests called in after SAM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rel,burg.org Permit Technician (208)372,2341 Revised March,2018
Building Safety Department
35 N. I" R, Rexburg, Id 63440 City of Rexburg
OWNER'S NAME
PROPERTY ADDRESS Permit#
Water Meter Quantity:
.�equrredffl
Plumbing
Meter Site:
cera• o
REXBURG
CW
Amrtlm}tanalyruninamlry
Plumbing Contractor's Name Kms\ Business Name VkMeSY}o} Plomb}nt.
Address Sotto? ESopn�s,Ar. ¢oad'rl City_Ammori State lde, Zip &-16t
CCU Phone (zoJ) G-2.5 — ItL U Business Phone ( )
Fax ) Ftnail nleCnn'cpWrvb�@Hnu,ra}. Com
(COMMERCIAL/INDUSTRIAL) Total cost of plumbing system (Contracted Amount) $
(fntbidetrbe rot/ afraarrdn%i inrinllydregnrd/en af!!n tiny trrJrp/ybg IG The fru tided nndn7hlrinrprdion tha//spf1jloeery nod nl/flnmbirig Int/n//nrfanr
aal.rprr�m//ymntllaned elrnulirre are ddrfane).
❑ Up to $10,000 (total cost of system x 0.02) + 60 = $
(3 Betweea $10,001- $100,000 ( (total cost of system -10.000) x 0.01) + $260 = $
o Over $100,001 ( (total cost of system —100.000) x 0.005) + $1,160 = $
RESIDENTIAL
New Single inehrdingallbuildings nith yvAingbeing eonsimeted on each propeW, (•*Based on Gving epneq
see definition below)
❑ Up to 1,500sgft-$130 ❑ 1,501to2,500sgft-$195
❑ 2,501 to 3,500 sq 16-$260 ❑ 3,50lto4,500s4Ift-$325
❑ Over 4,500 sq it $325 plus $65 for each additional 1,000 sq ft. orpordon thereof ($325 + ($65 x # of additional
1.000 sq, ft, or portion therecto),
New, MWri-FamilyDmelling (Conuactaa Ong+)
❑ DuplexApartmeat$260
❑ Three or more multi -fatuity units: $130 per building plus $65 pec unit. (8130 x *of badings) + 065 x # of wilts)
❑ Existing Residence, and Detached Shop: $65 fee plus $10 per fixture up to die maximum of the corresponding
sq. ft of the budding (S65 + (910 x # of fixonow
❑ Gray Water Systems: $130
❑ Lawn Sprinklers/Backflow Dev&et$65
❑ Modular, Manufactured or Mobile Homes: $65 for sewer and water stub connections
❑ Multipurpose Fire Sprinfder and Domestic Water Supply System: $65 fee or 34 per sprinkler head, whichever
Is greater
Server& water
❑ $38Sewer Line ❑$38 Water Line 13$65 Sewer& Water. if inspected at the same time
❑ $65 Sewer turnaround under house (change from septic to city)
MISCELLANEOUS
❑ Plan Cheelt:$65 per hour
❑ Technical Service: $65 per hoax
❑ Gas Linel $65
❑ Water Heater Replacement: $65
❑ Requestedluspectiont$65
❑ Hydcoule Heating: $65+($10 x#of manifolds/zones)
*Living Space --space widdn a dvveR ng unit intended for human habitation which may reasonably be utilized for sleeping, eating, cooking,
bithing,wsMpg, recreation, and sanitation purposes. An unfinished basement is considered part of the living space.
CITY OF Building Safety Department
REXBURG City of Rexburg
rn• 35 North 1st East
America! FamRy Cannnunity Rexburg, Idaho 83440
Subcontractor List
Excavation & Earthwork: Tr ipf e Cy g X CU V 4;tl V) C
Concrete: 9 (A C K t CA v) C( C vyj r V -e il? i V) C
Masonry: SCAR I p 1L -ec( gfv-i R Cy -n-- -oL t [ ivi e) i In C.
Roofing: RM G Vv e- s i- GU 10cl,-ot j-;
Insulation: $ M r- I" S u 1 CA
Drywall:
0�
drdwmll
the
Painting:
D c -V
1 Q v-\
Ct<2,. tl 2h In(,
Floor Coverings: -S 'F I V r ca ve tr7 v(cj i,L-C .
Plumbing: t+01eSk& 0mbIny
Heating: M - • WD { 1>2A -i1 V1 cI es" F
Electrical: h r �2N p Z- G fi l' c Inc.
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists: _
Siding/Exterior Trim:
Other:
Inspection Hotline -(208)372.2344 w .rezburg.org Permit Technician -(208)372.2341 Revised March, 2016