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HomeMy WebLinkAboutAPPLICATION - 17-00107 - 523 Edith Cir - RemodelCITY OF REXBURG Ob Amerlms Family Community Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 SINGLE FAMILY RESIDENTIAL REMODEL APPLICATION CHECKLIST The following items should be completed before you submit your building permit application. *Reasonable accommodations will be made upon re uest. Submit the Following Documents: D( 2 sets of building plans drawn to scale ❑ Include the following as applicable: Floor Plan, Sectional Views, Mechanical Layout, Stair Details, and any details required to illustrate special construction. J- Digital Plans (PDF Format- can be submitted by USB, CD, or Dropbox) n' h 9 **Copies of any Contractors' State License if not on file already. Complete the Following Forms: A Permit Policies Acknowledgment signed. AIA, CK Building Permit Application signed by a registered General Contractor, AIA R, Mechanical Permit Application signed by a registered Mechanical Contractor. 5t,.ero:NQrn^r}. A/� ig Electrical Permit Application signed by a registered Electrical Contractor. n/A JR Plumbing Permit Application signed by a registered Plumbing Contractor. S t. K Subcontractor list completed. pbly- $1 Homeowner's Exemption signed, if Homeowner is doing work on their own home. nIh 2Q Affidavit of Legal Interest signed by owner, if applicant is not working directly with owner. n/h Notifications Distribution List. 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 http://rexburg.org/pages/development-code. Inspection Hotline -(208)372.2344 www.rexburg.arg Permit Technician -(208)372.2341 Revised 10/2016 C I TY OF REXBURG tw America's Family 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 excellelit customer service: In an,effort to help you; underseandthe City of RexburgPermit Policies hstedbelow areseveral polices which you are required to knSv prinrko > 1 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. Ao Building without the pink building permit signed by the Building Inspector will result in double fees to be I 1 assessed and the project to be red tagged. If your project is red tagged, halting all construction, only a City Initials Official may remove the red tag. If the red tag is removed by anyone but a City Official, citations may 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 may be issued and the occupants may be evicted. 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 6 AM will be scheduled for the following business day. 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 up, the inspector may require the sheetrock to be removed in order to perform the electrical rough in inspection.) Construction on any project can begin 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. These documents must be signed by the appropriate authorities from the City of Rexburg. Any approvals can be verified by calling (206) 372-2341. o Even if you hear roman inspector that 'you'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 inform anyone on your project of the above policies. All sub -contractors will be held to this standard with no exceptions. o The above policies will be enforced to all, regardless if this information is passed on to them or not. mitrals Applicant's Name (print): AAAI", 'F -V" T S Signature: � � Date: 3 J I 17 Inspections must be called in before SAM on the day the Inspection is requested. Inspection requests called to 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 10/2016 04 pvXnURa lt, is CITY OF `+ RMEXUB BUILDING PERMIT FORM 102 CW Updated 10/2016 Amerim's Pandly community BUILDING APPLICATION Single Family Residence Remodel Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use, Permit Number: = Zonin .GDI' g APplicatiCT Fee 140 1. Propert Owner Name:t�Ghn d �Vli� Fyar4C Address: 1. cI•' Gr/: City: Rex6vf� State: Zh Zip Code: �S"o Phone: 8 ' 7 i S- �" S Email: 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? )KYes (Skip to 44 and complete the Homeowner's Exemption) ❑ No, I am working with the homeowner 2. Applicant Name: Role: (Owner, Tenant, Contractor, etc.) Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: 3. General Contractor Name: Registration #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep, Name: Phone: Email: Ganeral,Contr-actor Authorized Signature: Date: 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 .i,l t /� Address: 3 ECA llC,Ir• c ,�(- Project Description: Re-rKodci ¢b, 41-c Up r, •r 1 Ae vIS`-Sc • Estimated Total Cost: $ 1!1,006 • Check All Included in Scope of Work: *Mechanical Work Cost: $ A Electrical Work Cost: $ 1, 00 ,� Plumbing Work Cost:. Note: Any contractors involved will need to fill out their respective application, trtt • Fireplace(s) Being Installed?)( Yes El =P° Nle PIoY..y'A5 d1114 6'9 �'C4t7_LJV r5 �el'M�}3 nfed by Building Permitfees for remodels are charged based on cost. The application fee applies toward the fee total. For details on howfees are calculated, contact the Building Department. There will also be a plan review fee totaling 10% of the building permitfee. 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 correct and 1 swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned property for Inspections purposes. NOTE: The building official may revoke a permit on approval Issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days, or Applicant's Name (print): f 7f ' yt'1 FUO�(_13 Signature: _L ' Date: 44 7 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 CITY OF REXBURG cw— America's Family Commumry BUILDING PERMIT FORM updaretl 10/2016 111 BUILDING APPLICATION Remodel SFR Mechanical Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number:❑ Mechanical Fee Paid-'. 1, Property Owner Name: hdaw. Address: 5A? EdeAn CiT� P' City: Rex "r5 State: � Zip Code: g3 `fy0 Phone: ,•% 1 S ' 951 Email: sut"'t "t+i '1'.�ot%1'r `�atY3 �f.ot,L.dgyf_c Under Idaho Building Code, a homeowner is allowed to do work on their own home. Y Are you a homeowner doing work on your own home? XYes (Skip to #3 and complete the Homeowner's Exemption) 'OCNo, I am working with the homeowner 2. Mechanical Contractor 'PPJ'Mj% "}6 % Fi (eA k?,/ Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Mechanical ContractorAuthorikd Signature: Date: - 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 photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. ProjectDescri tion Address: sort 4,::1 f ,k Cir, �,x i Description of work: ,kr. f;m tee /tel Inj (ar{' t-�a C!' V,%A Y' lvm-Ij "6h:t5 lig (Remodel Cost: $ fir 9JP MA tje<3f( \y1QtC • Feesfor remodels are charge by cost.- 0 ost:0 First$10,000 =2% + $60, From $10,000 to$100,000= 1% + $260. Above $100,000 =.5% +$1,160. i.e. Workcosting $15,000 will be charged $260 far the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 total fee APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall he truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work steps for 180 days. Applicant's Name (print): "� �u�f3 Signature:-- Date: IZ% / 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 oQ µY,XRaaC y ra CITY OF o REXBLaG BUILDING PERMIT FORM 121 Usd.udto/zue tU� Amerimi Family Community BUILDING APPLICATION Remodel SFR Electrical Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Ilse Permit Number: 0Tlectrical Fee Paid: 1. Proper�jj Owner Name: !'tGIA�'�-1 d- er�S 83�fC/d Address: G/`, City, State:/ 'J Z' Code: L Phone: Email: Svw w. �nl.1r vlOc>3 C• kaa,t� 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 43 and complete the Homeowner's Exemption) ❑ No, 1 am working with the homeowner 2. Electrical Contractor Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Electrical ContraCorAuthorized Signature:, Date: 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 photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Des5ipfn �F 1 L, Address: �� y't F� /Tt CI P • L' _ ^ l Description of work: t�a�1 G I. h t�rl WIC'/ R--yU ekcsi»`Cw( �6ijo�" y� 6 roo nn5� 1a'Remodel Cost: $ 1 Cyo Rn� ✓L°!Mo it� IL ll�zlnar� • Feesfor remodels are charge by cost' jt"ue- Ceir,,� ele6f„-(al p&} o First $10,000=2%+$60. From $10,000 to$100,000=1%+$260. Above $100,000=.5%+$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 total fee APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, 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 City of Rexburg shall be truthful and correct I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation offact in the application or on the plans on which the permit or approval was based. Permitvoidifnot started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): fl*FV`f,J' Signature: A Date: 3/_ /y// 7 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 CITY OF REXBURG Anwrirnk Family Community BUILDING PERMIT FORM 131 uva.m to/zms BUILDING APPLICATION Remodel SFR Plumbing Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office 1Jse Permit Number: ❑Plumbing Fee Pald ` 1. Propert�t(r,Owner Name: !to`�t^'t ti- Address: 5.Q3 F,�IiA Cir City: RtKt"'J State: �Zi Code: g%FVyIO Phone: bt08—)/5-- y Email: ! uV t 14.1'i-po..tr 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) ❑ No, I am working with the homeowner 2. Plumbing Contractor erA, a k tb b- Fil4 by casex� r Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Plumbing Cont;actor Authorized Signature: Date: A copy ofyour state registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please provide a photocopy ofyour license. Ifyou are unsure ifyour license is collie, please check with the Permit Technician by calling (208) 372-2341. 3. Project DesCCcription Address:_M OOi—Y'ail' d(' ii,, Description of work: fi _ C IhnI� -t+uo (.JS'[•+itll3' rv�cph /b�.M$�c, wt,l�SL'2f' r'. �qu t '�✓ti Remodel Cost: $ • Fees for remodels are charge by cost: 0 First$10,000 = 2% + $60. From $10,000 to$100,000=1%+$260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $60 for the first $10,000 and 1% of the remaining $5,000 = $60 + $50 = $110 total ree APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, 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 mein 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 withal] City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes, NOTE: The buil ding official may revoke a permit on approval issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoidifnot suited within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): FVtJ h Signature: /� 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 for the next business day. Inspection Hotline - (20 B) 372.2344 www.rexburg.org Permit Technician - (208) 3722341 arxno"� a C I TY OF Building Safety Department .;o4 o REXBURG City of Rexburg ro -- 35 North 18t East AnierWAamlly C.urnmanity Rexburg, Idaho 83440 SUBCONTRACTOR LIST Excavation & Earthwork: Concrete: Masonry: Roofing: Insulation: Drywall: Painting: Floor Coverings: Plumbing: Heating: FV5Uit©rl tjOWe_ SQsVI'CeS Electrical: Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists: _ Siding/Exterior Trim: Other: Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016 CITY OF REXBURG Amerlcas Family Community HOMEOWNER'S EXEMPTION Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 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 fill out this form showing your exemption and send it with your permit application. Idaho State Statute allows a homeowner to do work on their own residence: An owner performing construction on the owner's personal residential real property, whether or not occupied by the owner, provided however, this exemption shall not apply to an owner who is otherwise regulated by this chapter who constructs a building, residence or other improvement on the owner's property with the intention and for the purpose of promptly selling the improved property, unless the owner has continuously occupied the property as the owner's primary residence for not less than twelve (12) months prior to the sale of such property; Title 54, Chapter 52, Subsection (2) I hereby certify that the above information is true and correct to the best of my knowledge. Signature Print Name Date 3//417 Permit Technician - (208) 372.2341 wwv.rexburg.org Revised 10/2016 OQ0.nOA� � a CITY OF REXBURG OW Amerlcds Family Commanity Affidavit of Legal Interest State of Idaho County of Madison 1, 89a Eyo%r+-s 523 fit; Name Address city Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) State Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 A. That I am the record owner of the property described on the attached, and 1 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. Datedthis �ovr}ee. day of JMcN-6\ 2011 /XL-�� Signature Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: Inspection Hotline -(208)372.2344 www.rexhurg.org Permit Technician -(288)372.2341 Revised 10, 2016 OQ pFxa URC, CITY OF REXBURG CIW- Amerlcai Pamlly Community DISTRIBUTION LIST Building Safety Department City of Rexburg 35 North 15t East Rexburg, Idaho 83440 Please provide the names and emails of anyone who should begetting automated updates for this project: Review Notes Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Inspection Tickets Name: Email: Name: Email: Name: Email: Name: Email: Name: Email: Inspection Hotline -(208)372,2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016