HomeMy WebLinkAboutAPPLICATION - 17-00181 - 826 S 2275 W - SFRCITY OF
REXBURG
Amencai rwmily Community
Affidavit of Legal Interest
State of Idaho
County of Madison
Name
City
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
Address
State
Building Safety Department
City of Rexburg
35 North 15C East
Rexburg, Idaho 83440
A. That 1 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 I V& day of 20—Ko_
:: -a-4�
Signature
Subscribed and sworn to before me the day and year first above written.
KARIN V. ANGELL
Notary Public
State of Idaho
Residing at:
My commission expires:
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10, 2016
C I TY OF
REXBURG
CW
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 submit your building permit application.
*Reasonable accommodations will be made upon request.
Submit the Following Documents:
❑ 2 sets of site plans (see Site Plan Checklist)
❑ 2 sets of building plans drawn to scale (see box to right)
❑ 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.
Note: All Plans and Construction must conform to 1RC2012 standards.
❑ Structural Calculations (see box to right) - stamped by a licensed Engineer Seismic Design Category- D
[IEnergy Compliance Report: As per the 2012 IECC, a RESCheck is required Ground Snow - SO lbs. per sq. R
Roof Snow Load - 35 lbs. per sq. ft.
(available online at www.energycodes.eov) Wind Load - 90 MPH
❑ Digital Plans (PDF Format - can be submitted by USB, CD, or Dropbox) Frost Depth - 36"
❑ **Copies of any Contractors' State License if not on file already.
Complete the Following Forms:
❑ Site Plan Checklist completed.
❑ Permit Policies Acknowledgment signed.
❑ Property Line form signed by builder.
❑ Building Permit Application signed by a registered General Contractor.
❑ Mechanical Permit Application signed by a registered Mechanical Contractor.
❑ Electrical Permit Application signed by a registered Electrical Contractor.
❑ Plumbing Permit Application signed by a registered Plumbing Contractor.
❑ Subcontractor list completed.
❑ Homeowner's Exemption signed, if Homeowner is doing work on their own home.
❑ Affidavit of Legal Interest signed by owner, if applicant is not working directly with owner.
❑ Notifications Distribution List.
Note: Please check the Rexburg Development Code for any requirements such as property setbacks,
design board approval, etc.
This information is available at http://rexbttrg.org/pages/development-code.
Inspection Hotline -(208)372.2344 ..rexburg.org Permit Technician -(208)372.2341 Revised 2/2017
o�p£XBURC
r
CITY OF
REXBURG
tit
Amerfc4 ramify Community
PERMIT POLICIES ACKNOWLEDGMENT
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
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 an
a roved ermit.
o Building without the pink building permit signed by the Building Inspector will result in double fees to be assessed and
the project to be red tagged. If your project is red tagged, halting all construction, only a City Official may remove the red
Initi tag. If the red tag is removed by anyone but a City Official, citations may be issued.
No buildin may be occupied without receiving a signed Certificate of Occupancy.
o If a building is occupied without receiving a signed Certificate of Occupancy, citations may be issued and the occupants
may be evicted.
Initials
A Certificate of Occupancy will not be issued without digital copies of the As -Built Plans.
It is the Applicant's responsibility to turn in digital copies of the As -Built Plans when the project is completed. No
Certificate of Occupancy will be issued without these plans.
Initials
Scheduling 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
dav.
o Required inspections can he found on the inspection sequence page in this packet 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 put up, the inspector may require the sheetrock to
InlHali be removed in order to perform the electrical rough in inspection.)
Construction on any project can begirt ONLY when you have received a Pink Building Permit from the Building
Department. Occupancy of any structure can begin ONLY when you have received an official Certificate of Occupancy
from the Building Department.
o A verbal approval does not constitute approval of these documents. Ultimately if you do not have a Building Permit or
Certificate of Occupancy, the above policies will be enforced. These documents must be signed by the appropriate
Ini la authorities from the City of Rexburg. Any approvals can be verified by calling (208) 372-2341.
It is your responsibility to inform anyone on your project of the above policies. All sub -contractors will be held to this
standard with no exceptions.
7_7 o The above policies will be enforced to all, regardless if this information is passed on to them or not.
Applicant's Name (print): 1 Q�G1 "�D � Signature: Date: �I 6/I
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 for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 2/2017
CITY OF
REXBURG
cy
Amerim} hmily Community
PROPERTY LINES
Building Safety Department
City of Rexburg
35 North 1%t 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. This information is available at madison.rexburg.org. If you want to request a copy of
your lot information, contact the Community Development Department.
1 have read and understand the above requirements.
Signature
61 (4 S+in-
Printed Name
�
-7
Date
Inspection Hotline—(208)372.2344 w .rexburg.org Permit Technician—(208)372.2341 Revised 10/2016
0 t7e }bXl4gC
oh a, ', 4 CITY OF
I ;XBLaG` BUILDING PERMIT FORM 100
cY+ updaae m/2016
America's Family Community
BUILDING PERMIT APPLICATION
New Single Family Residence
Building Safety Department
City of Rexburg
35 North igt East
Rexburg, Idaho 83440
For Office Use
Permit Number: Zoning:
Application Fee Paid: ❑ $500
1. Property Owne}}
Name: ``o,�&\)yw �DMPS
Address: M S. ly"OR siaxe ww S+[, 20A
City: 1Q txA a fF State:Zip Code: tb_ i Li -1Z,
Phone:
Email: V :t' )fGcq `{rAT,�)Y16f
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 #4 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
2. Applicant
Name: �Cw-i\e
Role: (Owner, Tenant, Contractor, etc.) C.a.
Address:
City: State: Zip Code:
Phone:
Email:
Contact/Rep. Name:
3. General Contractor C
Name: SA' VV_
q
Registration #: I � S I Exp.: 11/10 7
Address:
City: State: Zip Code:
Phone:
Email:
Contact/Rep. Name:
Phone: Email:
General Contractor Authorized Signature:
'-
Date:31W:1
A copy ofyour state registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide
a photocopy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
4. Project Description
Address: -OR-
�
Lot#: a% Block#: $ Subdivision: SVMMC,(- G 1
Project Description:
• Square Feet: Building Total: -�, 05"1' sq. ft.
• # of Water Meters: Water Meter Size:
o Main Floor: -13\ sq. ft.
• Fireplace(s) Being Installed? O Yes I$ No
o Additional Floors: gsg sq. ft.
• Hydronic Heating Being Installed? O Yes'p No
o Basement:
Finished sq. ft.
Unfinished sq. ft.
Building Permitfeesfor new homes are charged based on square
o Garage "A41 sq. ft.
footage and the City's estimated valuation. For details on howfees
are calculated, contact the Building Department There will also be
• Estimated Total Cost:$
aplan reviewfee totaling 10% of the building permitfee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperlury, I hereby certify that l have read this application and state that the Information herein is correct and l 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 Clry of Rexburg shall be truthful and correct I agree m mmplywith all City
regulations and State laws relating to the subject matter of this application and hereby authorbmd 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 nfthe 2012 International Code in cases ofany false statement or misrepresentation of fact in the application oron the plans on
which the permit or approval was bared. Permit void if not started within 180 days. Permit void Ifwork stops for 160 days.
Applicant's Name (print): :::t�VG S Jft Signature: I �-(. S- /</7 &C"( Date: "J/O//_7
%
Inspections must be called in before ;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 www.rexburg.org Permit Technician - (208) 372.2341
If
Q}}xa4Rq CITY OF Building Safety Department
J EMLTRG BUILDING PERMIT FORM110 City of Rexburg
0
�, °^°""'°°:°" 35 North 1St East
Arneraa7 family Community Rexburg, Idaho 83440
BUILDING APPLICATION
New SFR Mechanical
For Office Use
Permit Number: ❑ Mechanical Fee Paid
1. Property 0wne
Name: of If Gh'(\2X V)0TN a A
Address: �ivl w v s lam+ a 1tU k Sired City: � State: Zip Code: %2V 1 io
Phone: tia°I-7-111. Email: 4 -ttyr7`<ay-+y,ln4,r �/1D✓heq,.ort
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)
t f No, I am working with the homeowner
2. Mechanical Contractor r W,
Business: yrtR irwtzrPAX State License #: 0/7-5-5-Z- Exp.: S 5t -s
Address: 2-901V ' City: Stat : Yr7 Zip Code: VX6rte7-
Phone: % -- Em 11: O N.r e M •s-- r
Cvyl—
Contact/llep. Name: 4KI! Phone: - Email: o str �l%n
Mechanical Contractor Authorized Signature: r`~^'1 Date: - a
A copy ofyour state registrationflicense is required to be onfile. if this Is t first timeyou have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure Ifyour license Is on fie, please check with the Permit Technician by calling (200) 372-2341.
3. Project Desert tion
Address: �eW LanS� CU Iol�� •OR- Lot #: _D� Block #:`a Subdivision: S u rn m.eA 5=4
Description of work:
❑ SPR Construction: I S ca y sq. ft.
• Feesfornew construction are charged by squarefootage: Up to 1,500sgft=$130+$65foreach additional 1,000sq.f, or
portion thereof.
o Up to 1,500 sq. f =$130. Up to 2,500 sq. f: w$195. Up to 3,500 sq. f. = $260. Up to 4,500 sq. f. = $325, etc. (i.e. a
home with 3,675 sq. f: will be charged $325)
❑ Number of Fireplaces: 1D
• Note thatfreplaces are not included in squorefootage costs and will be charged $65 per Inspection.
❑ 1lydronic Heating: n101
• Note that hydronlc heating is not Included in squarefootage costs and will be charged and additional $654($IOx#of
manifolds/zones)
APPLICANTS SIGNATURE,CERTIPICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the Information
herein is correct and 1 swear that any information which may hereafter be given by me In bearings before the Planning and 7nn Ing Commission or the City Council for the City of
Rexburg shall he truthful and con act. I agree to comply with all City regulations and Slate laws relating tonne subject matter of this application and hereby embattled
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 20121nternational 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 it not started within 180 days. Permit void It work stops for 180 days.
Applicant's Name (print): :T-01tici S±di Signature: : , Date: 3 i3/1-7
Inspections mustbe 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 if.dine- (208) 372.2344 mm.mxburg.org Permit Technician - (208) 372.2341
CITY OF
REXBURG
cy
AnudmtfnmRy Commonly
BUILDING PERMIT FORM �ZQ
ura..es•fress
BUILDING APPLICATION
New SFR Electrical
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
Poi Ofnce Use _...,.
Permit Number: ` f3 Electrical Fee Paid
1. Property Owner
Name:, rlhoelc t^�S
Address: 0e9 s-iy ow3tW.t .hiam S)G2al City: J2 State: 10 ZipCodel 83440
Phone: Selq- 2.11y V Email: : �QYcc JR i<a izhnerhoms.c•h_
Under Idaho Building Code, a honeowner is allowed to do workol their own home,
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #3 and complete the Homeowner's Exemption)
,Jo, I amwo•kingwith the homeowner
2. Electrical Contractor
Business: vAeraV Ek�Nz rfc State License It: �i8`i'PA Exp.:
Address: , _ Y / ka City: f /-I' C State:Z_ Zip Code,f33�y3
Phone:— Email:d���SGf�Qp4fne%.(i]tt�/
Contact/Rep. Nance: Pltolle:Entail; —'
Electrical b on fractoi• Authorized Slgnatai ei Date:
A copyofyourstate regisuntfoollicense is requh•e be oil file. f is lsthe/frsl tfineyou have done fvorhfn the City olRexburg please provide
aphotocopy ofyoIIriicense.Ifyouareuusure{� amUconseIsoil flie, please check withthe PeranftTechnician bycallttlg(208)372.2341.
3. Project Description
Address: -011• Lot#:)--Dlock#:g Subdivision: SUMrn.e,r'6CR_c
Description of work: �fCtN G�fls1`nr
❑ New SFR Construction: Is -e51 sq. ft.
• Feesfornew constructlon are charged bysquarefootage: lip to 1,500sq.ft=$130+$65for each additional 1,000sq.ft. or
portion thereof.
o Up to 1,500sq.f.=$130. Up to2,500sq.f.-$195. Up to3,500sq.ft.=$260. Up to 4,500sq.ft.=$325, eta (i.e.a
home with $675 sq. ft. wlil be dtarged $325)
❑ Spas/Pools/Generators: O Yes V No
• Note thotspos/pnals/generators are not bldudedbl squarefootage costs and will be charged $65 per inspection.
APPI.ICAN'rSStGNATURU,CF.if1'IFICATIoNANDAUTIIORIZA710N: Underpenallyofpvgnry,Iherebycerlify, chat l have read this application and state that lite Information hareln
Is correct and I swear that any Infornialimn which aayhereafterbe given by am Inhearhigs before the Planniugaud ZoningCon udsslou or the City Council for the Ciryofftexburg
shill be truthful and convct. I agree to comply with all City regulations and State laws relating to the subject turner orthis application and hereby anlhori led representatives of the
City to enter "poll the properly for Inspraloes purposes. NOTE Tim building official may reecho a permit on approval Issued under the provisons of elm 2012
Internacional Code hi cities array false Satennent or misrepresentation of fact in the Application Gran the plans on which Ilia perni t or approval was based. Penult void lOwl
started within 100 days. Permit void gworkstops for 100 days.
Applicant's Name (print)::rOPt-SI w i I Signature: Date:
Iinfectious must betalled hl before 8 A nn Om day the Inspection Is requested. Imspecliun requests called In after 0 AM will be scheduled for the next harness day.
Inspection While- (208) 372.2:144 www.rexburgorg Permit Techoldan- (2110) 372.2341
CITY OF
REX BURG
w
Andral, FmnllyConnnunlry
UILDING PRRMITFORM
B 130
aos:eda72016
BUILDING APPLICATION
New SFR Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 8344.0
For OfflceUse
PernnftNumber, - - M Plumbing Fee Pald..:
1. Property Owner 1
Address: 4,sa S. yC9 IjR51yne Skul City: W—c>clojr� State: _I Y) ZlpCode: 3`I
Phone: 5aei- 2114 Enlal� ti 4 h a
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 (Sldp to 43 and complete the Homeowner's Exemption)
CYNo,1 am worldng with the homeowner
2,PhnnbingC(tractor ii
Business: U e5 a,�Gf^` .SGL StateLicenselt: Ptg-)�—AVAXp.: 4 D n-
Addl•ess; cE 'u+ C /fin. ; Aenv"Ta —state: :1 Zip Code: V/C)
Phone: 7116 5-35 / cl Email; Ae ,o 40/111" t'
Contact/Rep. Name: eel O, a Phone: Hirt
PlumbinicontractorAutho•IzedSid natul'e: Date: .� l
A copy ofyoa• state registration/license is required to a unflle.Ifthis is first tlnleyou have done work hl the City of Rexburg, please provide
a photo copy ofyour license. Ifyou ore ufbsure Ifyour llcease is or file• please elleci(tvitll the PerTnit TeciOnciau by calllrg (200) 372.2341.
3. Project Description
Address: OR- Lot A:LBlock Subdivision: sure y,,.. --t CU
Description of work: (gyp( CI)A S�•'t�/yrl'vr-
❑ New SFR Constnlctlon; sq, ft.
e peesfornewconstructform•echnrgedbysgrmrefootnge:Uptol,500sq.ft.=$130+$65for•eacliaddltionall,000sq.ft.orpor•tion
thereof.
o Up to 1,500sq.ft=$130. Upto2,500sg,ft.=$19.5. Up to 3,500sq.ft.=$260. Up 104,500sq.ft.=$325, etc. (I..e.(I
hone with 3,675 sq. f t, will be chargefl $325)
rl Hydronic (In -nom•) Heating: ❑ Yes WNO
I Note that Hydronic heating is not included in squarefootnga casts mel will be charged $65+($lox Nnfoanifalds/zones).
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under ponnityofpor(ury, i hereby coriify that I have read this application and state that the Information herein
Is correct and 1 swear flint ally Information which may horen8er be gives by me In hearings hereto the Planning and Znaingcommissioh or the CityConncll for the City of Itoxhnrg
shall be tmlhf ll mid mired. I agree to comply wait all City legalist tons and state laws relating to the subiecl uatlerorthis application Hall heroby authorized ropMentallves of the
City fnanterupon the nbovrmentlmad property fm' Insptttlans pnrposrx. NOTE: The building official may revowa pert ilt on approval issued under the provisions of ilia 201 Z
Dust national Cada lu cases orally false slalement or misrepresentation of fact In the nppllcatiotl or an the plans on which the permit or approval was based. Permit void l(iint
slatted wllhhi t H dnys. Permit void Ifworh stops for 180 days.
Applicant's Name (prhlt)I ��i 0. ,.1 / " t r __ _Signature: Tit-"! v Date; _ 313/1
Inspections mmst be called In before O AM on the day the Inspectlou Is mptested. Inspection requests called In after U AM %viii be scheduled far the next bushels; day.
Inspection Ilolllne- (200) 372.2344 swvwa'oxbarg,mg Porndl Technician- (209) 372,2341
CITY OF
REXBURG
cy
America's homily Cammnnily
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete: PSV ('QC VIA LOnc wkb 1101'
I
Roofing:w
V 1.
Drywall:
Painting: oes', 5Y-,
Floor Coverings: p1Ceok-
Plumbing:
Heating:
Electrical:
rl G .
Special Construction
(Manufacturer or Supplier)
Roof Trusses: ZffiL' \t4 g& 60le!'o-J1ay''
Floor/Ceiling Joists: 1S�iC WC'S� �C tDad ate.
Siding/Exterior Trim:
Other:
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
1V)
Inspection Hotline -(208)372.2344 w vxexhurg.org Permit Technician -(208)372.2341 Revised 10/2016