HomeMy WebLinkAboutAPPLICATIONS - 16-00658 - 864 S 2275 W - SFRO�weuq��d CITY OF Building Safety Department
REiBURG City of Rexburg
`u 35 North 1st East
Amerinaln°yo'"t'"n"Ity 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 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:)
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.energycodeseoy)
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 PermitApplicationsigned by aregistered 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 httn• / /rexburg ora/pages/development-code,
Seismic Design Category- D
Ground Snow - 50 His. per sq. it
Roof Snow Load - 35 lbs. per sq. fL'
Wind Load 90 MPH
Frost Depth 36"
Inspection Hotline (208)372.2344 rvww.rexlurg.org Permit Technician (208)372.2341 Revlsed March, 2016
M10 °� atr"st, CITY OF Building Safety Department
RMURaoCity of Rexburg
a
G 35 North 1st East
A nadcalFondly Community
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 an
approved permit,
o Building without the pink building permit signed by the Building Inspector will result in double fees to be
'CpS assessed and the project to be red tagged. If your project is red tagged, halting all construction, only a City
Indials 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 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 notdone, 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 sheetrockhas been
Imnals put up,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'you're good to go', ultimately if you do not have a Building Permit or
Certificate of Occupancy, the: above policies will be enforced.
Indials
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
Applicanes Name (print) • Signature: kQ1 016. S-rrLkl 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 for the next business day.
Inspection Hotline (208)372.2344 w .rexburg.org Parrott Technician—(208)372.2341 Revised March, 2016
OQ aPXBUgC
q CITY OF
REXBURG
to
AmeH dFamlly Cononunily
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 graphic scale (11 lh 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 mm.rexburg.org Permit Technician -(208)372.2341 Revised Mamh,2010
{or Fpfcppgob G I TY 0 F Building Safety Department
Cit of Rexburg
REXBURG y g
--- � 35 North 1st East
Anurka!; Fondly Community
Rexburg, Idaho 83440
BUILDING APPLICATION
Single Family Residence
For Office Use Digital Plans Included: ❑ CD ❑ USB ❑ Dropbox ❑ Not Included
Permit Number: Permit Type: ❑New ❑Remodel'=❑Addition ❑ Basement Finish
DepositAmount: ❑ $500 New Const, 0 $100 Other than New Const. Deposit Included with Application: ❑ Yes ❑ No
1. Property Owner
Name: Ka Y; e) Yt t Y- k a rKe s
Address: vS . S c j- ` e 6w � State: _L Zip Code: '& 3 j`( U
Phone & Type: Slo ^ 7-01-7- AA,2-- Office. ❑ Mobile Email:.. a li'RQ far-{-t�ty r (�LOYn2S • G>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?
❑ Yes (Skip to #4 and complete the Homeowner's Exemption) O No, I am a contractor working For the homeowner
NOTE: Any contracters/sub.contracturs involved will need to submit their own signed applications:.
2. Applicant
Name:: -ZE rl(W CIS U D0\-? Role: (Owner, Tenant, Contractor, etc;)
Address: City: _ Staten - Zip Code:
Phone &Type: ❑ Office 0 Mobile Email:
Contact/Rep. Name: Phone: Email:
3. General Contractor _
Name; -6 911u Registration#: I�}6� Exp.: l2 31 Ito
Address: -4.A VK2_ A-( P fM2 City: _ Staten 'Zip Code; .
Phone&Type: ❑ Office .0Mobile Email;
Contact/Rep. Name: _ P et Email:.
General ContractorAuthorized Signature: Date:
4. Project Description
Address: OR, Lot #:A1 Block #:? Subdivision:SWtrJTMt—f7-e-ld
Type of work:
Check one: KNew Construction ❑ Remodel* 'O Addition* ❑. Basement Finish*
*Check all that apply: PFraming JZ Mechanical Plumbing 013lectrical
NOTE: Any subaontroctms involved will need to aflonit llair own srped applications.
*Description of work: -Sh Q lQ - M f lam_
*Total cost of project.- materials and labor: $-2072 29jused to calculate permit fees)
126
BuildingTotal: sq. ft.6(
Main: I NN.b sq. ft. Basement: ❑ Finished ,Unfinished --19`6 sq. ft.
Garage E� sq. ft. Additional Floors: N% sq. ft
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenalty ofperjury, Ihereby cern fy that l have read this: application and state that the information herein
is carrectand I swear that any information which may hereafterbe given by in hearings before the Planning and zoom' commission or time 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 ofthe
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a pormiton approval issued under the provisions of the 2812
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. Permitvoid if not
started within 188 days. Permit voidOwork stops for 180 days.
Applicant's Name (print):
Date:
Inspections most be called in beforeAM on the day the inspection is requested, inspection requests called inafter 8 AM will be scheduled for the nest business day.
Inspection Hotline (208)372.2344 wNw.rezburg:org :Permit Technician—(2881372.2341 Revised March, 2016
CITY OF Building Safety Department
REXBURG City of Rexburg
CW35 North 1st East
Amerlw!, Family Geonn unity
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 at www.lbol.idabo.goy/cont.htm
Currently State licensed pursuant to Title 54 Idaho Code, Chapters:
a Architects,
10 Electrical Contractors/Journeyman;
12 Engineers/Surveyors,
12 Public Works Contractors (exempt from fee only registration required),
26 Plumbing/Plumbers,
45 Public Works Construction Management Licensing Act (exempt from fee only registration required), or
50 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
❑ 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�herebbyy certify that the above information is true and correct to the best of my knowledge.
Signature Date
Lta..a.ass c5-t�.t.r+�-.t
Print Name
Inspection Hotline ((208)372.2344 i rexburg.org Permit Technician, (208)372,2341 Revised March; 2016
SOF µExuugCJc CITY OF
^ REXBURG
r
rn�
Americas Famdly 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. Itis 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, see the front counter at the Community
Development Department.
I have read and understand the above requirements.
Signa ure
Printed Name
Date
Inspection Hotline -(208)372.2344 mmrexleurg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
�w
America's Family Community
Affidavit of Legal Interest
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
State of Idaho
County of Madison
I, fat-I-Oohe-r- N -S o� WkVn ,o. ��5 9-e,ws v,� ltwt� 5¢e. 20[
Name Address
R.ex bu r�
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:
CACI (e Asa s� nvwsren • k s-rn.7�i
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
2 ---
day of Se-Pt2 cy*>f r—,20 [ka
Signature
Subscribed and sworn to before me the day and year first above written.
�VIAepIo
Notary Publi daho
DARCEYE.VALERIO �/ �p //__
NOTARY PUBLIC Residingat: E/��1� 9 V
STATE OFIDAHO (� —
My commission expires:
Inspection Hotline -(208)372.2344 w .rexhurg.org Permit Technician -(208)372.2341 Revised March, 2016
CITYr OF Building Safety Department
�a 1EXBURG City of Rexburg
04 35 North 1st East
America's Family Cennlugfty Rexburg, Idaho, 83440
BUILDING APPLICATION
Mechanical
For Office Use
Permit Number: : Permit Type: 0 New 0 Remodel: 0 Addition 0 Basement Finish.
Fees Paid: 0 Yes ❑ No
1. Property Owner
Name: 0 M116f GIokykPL
Address;��,.. ¢IItihf f'Ul't2 "q.Siv-2UCity: RCXbU.Y-' State: l C1 Zip Code: 8a"4LIO
Phone &Type. 1b52`1-1i:Ib,.laOftice0Mobile Email: altaagkatrtt(nnerinrw,,oz.coy,
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 #3 and. complete the Homeowner's Exemption page).
0 No: I am a contractor working for the homeowner El No: This property is a Multi -family Residence or Commercial, Property.
NOTE: Any contractors/sub+mntraams involved will need to subnnt theirown signed aPplaations.
2. Mech, ;_i r_t,nd nr
Name:_M06{Gr>1 fF Q'f-1 K9 Z Vip?c.e Registration #:_Q 12 5 5
Address 0K G D Exp.:_
po e �- � city: � f2t'g � state: t Zip Code; 8a�tz
Phone & Type _ LAS_ _ 0 Office WMobile Email:- _ VIN CL m °��.P H� . C om
13-31 _
Contact/Rep. Name; .S r~ 645 G1bov � Phone:. ...Email:
Mechanical Contractor Authorized Signature: (2 a4j 6 6) m .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* O.Remodel '0 Addition 0 Basement: Finish
Description of work:
New Commercial: Work: Contracted amount: $ Calculated Fee (See Below): $
0 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 0 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':.0 Duplexe: $260 13Three or more units = $((130 x# of buildings)+(65 x # of units))$_
New woilc on any other residence and Detached Shops: (65 + (10 x # of HVAC fixtures)) $
Miscellaneous: 0 Gas Pressure := $65 0 Furnace or A/C = $65 0 Water Heater $65 ❑ Requested Inspection= $65
0 Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit =.$65 0 Technical Service= $65/hour
0 Plan Check =.10% of Contracted Amount
APPLICANT'S SIGNATURE; CERTIFICATION ANDAUTHORIZATION: Underpenalty
is correct and 1 swearthatany information which mayhmeafter be given by mein
shall be truthful and correct. 1 agree to comply with all City regulations and State h
City to enterupon the above-mentioned property for inspections purposes. NOTE:
international Code In cases ofmry false stutementor misrepresentation of (actin th
startedwithin 180 days. PermRvmdifworkstop %r Days.
Applicant's Name (print):
Inspections mustbe called in before 8AM
Inspection Hotline—(208) 372.2344
have read this application and state that the information herein
rovlsions fthe 2012
Permitvoidifnot
Signature: 7T?A" urX.a Date;:
day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the nextbusiness day.
www.rexbmg.org Permit Technician—(208)372.2341 Revised March, 2016
ctrl of
Building Safety Department REXBU G
35 N. I- F., Rexburg, id 83410 City of
Phone - (2081359 30 0 / H di c _ l�nuiii2-2344 /Pax-- (208)359-3022 .n rc r ty
OWNER'S NAME
PROPERTY ADDRESS Permit#
OWNER'S CONTACT PHONE
OWNER'S EMAIL ADDRESS
Requ redlll mechai2ical p7
Mechanics! gnmactor's Name ( c-C.%s- Business Name d4z
Address O %.xm-Y 16i - ('''v L
y-� City-'-.�%�-c'%g//`s'si'state -ter'%' Zip s L{s
Cell Phonc 71 �a " 31 €i ; Business Phoneme - 7 -0Z -
Fax 7"15 --
(COMMERCIAL/INDUSTRIAL) Total cost of mechanical system (Contracted amount) $.
(ladi,des the cut of materwlr rnslalled regaaff,, 4f the party rupp!ying if. The fees Apled muter dw in.rperkan t#pe.rball apply to my and all rnerbamad
rnrtalla6nps eat spg7cali# ruralised e/seuhar on Alis feat).
❑ 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 Usmm-100 OOO) x 0.005) + $1,160 = $
RESIDENTIAL
Nem: Slagle F=LIYDwelling, including all buildings with wiring being constructed on eachpmpettF. (*Based an living space,
see dekaidan below)
❑ Up nr 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
D Over 4,500 sq ft $325 plus $65 for each additional 1,000 sq ft. or portion thereof
($325 + ($65 x # of additional 'I 000 suer newton the et4)•
New.•Mutd-FamilFDwrlliag (Coatmctars OalF)
❑ Duplex Apartment$260
❑ Three or more muld-family units: $130 per building plus $65 per uric 4$130 x # of buildi g) ±(GS x ii of nits)
❑ Existing Residence, Modular, Manufactured or Mobile Homes and Detached Shop: $65 fee plus $10 per
**HVAC equipment being insealiccl up to the maximum of the corresponding sq. It of the building
(S(5+(SIO x##of fimw ti
MISCELLANEOUS
❑ Plan Check: $65 per hour
❑ Technical Service: $65 per hour .
❑ Gas Line: $65
❑ Nater Heater Replacement $65
❑ Requested Inspection: $65
❑ Fireplace/Solid Fuel Burning Appliance: S65 per inspection
xl-iving Spacc - space within a dwelling unit intended for human habitation which may reasonably be utilized for sleeping, eating, cooking,
bathing, shiny, recreation, and mu nation purposes. An unfinished basement is considered part of the living space.
"EXxa(m-I-t-s�of�HVAC®�-B-q'ufia mens -furnace replacement, solar, wafter heater,
etc. /j fj)
Y rlJ ,„rte 5! 7=' / f t �✓�
number &E* date r --- Dam
CITY o F Building Safety Department
REXBURG City of Rexburg
nv 35 North 1xt East
Amerirnk Itmti7yconmRnity Rexburg, Idaho 83440
BUILDING APPLICATION
Electrical
For Office Use
Permit Number: :,:PermitType: ❑New.❑Remodel ❑Addition 13 Basement Finish
'
Fees Paid: 0 Yes ❑ No
1. Property Owner
Name: 1<6 rt(,V-) n er> 1n uyyta r,
Address: 556S'•. P.! mn+5ty S City: Pe-Kburc State: 'lCA Zip Code: 87?14lq-0
Phone .&Type: 10A1 W!31 1'6k ice0Mobile Email: cil— 1u r-i-chv�e�ri.wnes.cnrn
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you homeowner doing work on your own home? 0 Yes (Skip 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. Any contractors/sub-comnectom Involved will need to: submit their own signed applications.,
2. Electrical Contractor
Name: NOL+V) n GG1W12 Registration#: 019°100 Exp.:
Address: Po qox Z 6a City: K l Dabt4 State: 10 Zip Code: 02t-11-4 p
Phone &Type;(20'0)9'io--cl593 00fffceMMobile Email: h All up vPi-ti.
Contact/Rep. Name: SoLrf\.P, CLi cAbcr e .Phone:. Email:
Electrical Contractor Authorized Signature; Sae C,4NC[n.ece Fpm' Date:
3. Project Description
Address: -OR- Lot #:_ Block #:_ Subdivision:
.
Check one: 0 Single-family Residence Cl Multi -family Residence 0 Commercial
Check one: 0 New Construction* EI Remodel ❑ Addition 13 Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
0 Up to $10,000 = (total cost of system x.02) + $60 0 $10,0014100,000 = ((total cast 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 Upto 1,500 Sq. Ft = $130 0 1,501-2,500 Sq. Ft. = $195 0 2;501-3,500 Sq. Ft. = $260 0 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: El Duplex= $260 0 Three or more units = $((130 x# of buildings)+(65 x # of units))$....
New work on any other residence and Detached Shops:,= $(65 + (10 x # of branch circuits)).$.
Miscellaneous: 0 Small Works (work costing less than $200 with no change in service connections)=$10(needs no inspection.
0 Central Heating/Cooling Systems= $65 El Spas, Hot Tubs, and Swimming Pools= $65 0 Requested Inspection= $65
0 Pumps -Water, Irrigation, Sewage (per motor) = ❑ $65 up to 25HP 0 $95 26- 200HP 0 $130 over 200HP
0 Irrigation Machine= $65 for center pivot+ $10 per tower of drive motor$ 0 Technical Service= $65/bout'
0 Temporary Amusement = $65 + $10 per tide, concession, or, generator $ 0 Plan Check =10% of Contracted Amount
0Temporary Construction Services ONLY= $65 (200 amp or less. One location, ..for less than l ear.:
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify than have read this application and sate that the information herein
1s correct and I ..or that any mfimmad.n which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City ofRezburg
shall be truthful and correct. iagree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives afthe
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke permit on approval issued under the provisions of the 2012
International Code in cases ofanyfalse statement or misrepresentation offactin the application or on the plans on which the permit or approval was based. Permit void mint
started within 180 days. Permit void ifworkS>12fo(Rmus.
Applicant's Name (print): U x. c Signature: a,/s,.rsc ZrM0A,1- Date
Inspections trust be called in before 8 AM on the day the inspection is requested. Inspection i equests called in after BAM will be scheduled forthe next business day.
Inspection lholue-(208)372,2344 xavwraxbur&org Permit Technician -{208)372.2341 Revised March, 2016
35 N. P':E., Rexburg, Id 83440 City of Rexburg
Phone - (408)359.3020 / Nadine — (208)372-2344 / Net - (208)359-3022
OWNER'S NAME
PROPERTY ADDRESS Permit#
SUBDIV[SION
PHASE LOT BLOCK
Electrical
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pnnimeliitrwlofumnrsnutnnnnmttgAra¢n sJlaepagy rnppryngrt. lac/rztmlrAmrarr/buvrrprrlron7pr r4allnDPJ10 unynnArr//rlrrnfm/lurPo6
Ila/ rpttlfrmlljmativewddit Aor sar11DfomiJ,
13 'Up to $10,000.. (10101 cost of aNstem x 0.02) + 60 =:5.
'o laween $10,001—SI00,600 (Omdl cULQUpmm — 70800) x 0.01) +$260 =S
O Over $100,001 ((nral coat orsystem_100.000)x0.005)+$1,160=S
Small Works (Contractors ONLY): SIO fee for Work not exceeding $200 in cost and not involving a change in
service connections. Does NOT require inspection. (
RESIDENTIAL
:S(oglaPcmllyDwe!/ing,lecludlugallbutldfggswlth ttddagbciag aoattmctedoa caa6property. (+Based opUtlogapace,
(adufdonlralow)
o Upto1,500sgft-$130 0 1,501to2,500sgfc-5195
0 2,501 to 3,500 sq fr-$260 n 3,501to4,5d0sgft-$325
o Over 4,500 sq k $325 plus 565 for each additional 1,000 sq ft. or portion thereof ($325 + ($65 x # of additional
ct Three or more muld-familyunits::$130pe
o Existing Residence, Modular, Manufm
branch chcok, up to the maximum of the
o Central Beating/Cooling Systems: $65
$65 fee for each trip to inspect
P x$130 over 200 HP
MISCELLANEOUS
n Temporary Construction Services ONLY: 200amp or less, one location (for n period not to exceed I pear) -$65
o: Temporary Amusement: V65 fee plus $10 per ride, concession or generator
p Irrigation Machine: $65 for center pivorplus$10 per tolvecofdrive motor
o Technical Service: $65 per hour
ct Plan Cloche $65 per hour
D Reguestod Inspection: $65
+living Space—space within a d%v leng unit intended for human habitation which may seasonably be, u62ed for sleeping, cadng, cooking,
bathing, waslJM1g, rrYMa[IUn, and altndon purposes. An unfinished basement is considered pgntertheliving space.
Siiimru&oTTTcemcd Contractor License number & exp. d. to llate
h�qa p4.%IIpRee. CITY OF
` RMURtG
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Anmrim's Fnntily Community
BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: : Permit Type: ONew❑Remodel ❑Addition OBasementFinish
Fees Paid: 0 Yes' -❑ No
1. Property Owner
Name: kG rf_ rim Humps ��''��
Address:fS5y5- 01iaw5i-dy'±p tbvw S7ffi 2oi City: Qe,\b"oq State: yt_ZipCode:: e3yW0
Phone &Type:20¢e'iS2q -z ll ko CROffice O Mobile Email:. 0.1'tzt�? ka r:�l clnri?.f"( - , „.e . to"
Under Idaho Building Code, ahomeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home? 0 Yes (Skip to #3 and complete the Homeowne?s Exemption page)
0 No: Iam a contractor 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 theirownsignedapplications.
2. Plumbing Contractor
Name: 12i9d Registration #:. LB -(J'_ sla Exp.:
Address: p3 k,2 , C.seco5ic(.0 ri) City: .A,mrnor-t State: t ° Zip Code: 102,' 6
Phone&Type:_13 Office MMobile Email' `IoleShc�i-hluf'nbinq.0 ia,,,.hoo tla;
Contact/Rep. Name: SAI1a2 .Gig auov - Phone: Email:
Plumbing Contractor Authorized Signature; so-- Date:
3. Project Description Water Meter Quantity: Water Meter Size:
Address: -OR- Lot#: Block#: Subdivision:
Check one: 0 Single-family Residence ':❑ Multi -family Residence 0 Commercial
Check one: ❑ New Construction* ❑ Remodel 0 Addition 0 Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
0 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
❑ Over $100,001=i((totalcost of 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 0 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; (0 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 S stem = $65 or $4 per sprinkler head (whichever is greater)
New work on any other residence and Detached Shops: $65 for sewer and water stub connections
Miscellaneous:. 0 Sewer Line = $65 0 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
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjmy, I hereby coal y,that I have read this application and state that Hie information herein
is correct and I swear that any information which may hereafterbe 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 with all City regulations and State laws relatingto the subject matter ofthis application and herebyanthoiized 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 oftlie 2012
International Code Incases ofany falsestatementor misrepresentation affect in the application or on the plans on which the permitorappmval was based. Permitvoidifnot
started within 180 days. Permit voldif Ck!tops Y8 .
Applicant's Name (print): C__ Signature: 0-vv.e-rla 5-tt.._4z. Date:
Inspections mustbe calledin before 8 AM on the daythe inspection is requested. Inspection requests m
called after SAM will be scheduled forth, neztbasmess day.
Inspection Hotline -(208)3722344 www.rexburg.otg Permit Technician (208)372.2341 Revised March, 2016
Building Safety peparthnenf;.' REXBURG
'
35N hr H, Reshurg, Id 03440 City of Rexburg ,unMmttan�ilip('a,mm�ntry
OWNER'S NAME _
PROPERTYADDRESS
Petinit#
Water Meter Quantity: **************Water Meter Size:
Regtn't'edN
Pluxn,bing
Plumbing Contmctoc's Name ?WA Business Name \Ao�ESYhok Dlsmhohnrh
Address 3051n3 E S�nn�Asdr. (Load's) City f4mmon Smte tda�.n Zip4Z4ol..
CellPhone (2oS) X35 — 1'i tN Business Phone ( )
Pas( ) Email r,nle¢nn�lo_m�u44n:nttn. CArn
(COMMERCIAL/INDUSTRIAL) Total cost ofplumbing system (Contracted Amount) $
(lntlnrlrr /Ge tort rfronrednG inrin/Ird regm9/<n of /htpmlynrpplyiirg Ir. TLe fret /idednndn7LGln97ec/far Oft tiinl/appy to my mxI allphawhiig Inrtalladenr
norrprrymllyice a0oneddrayLen at d5frJazz).
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 ( (mtal cost of system —100.00) x 0.005) + $1,160 = $
RESIDENTIAL
NervrSingle FamiO�AmelGng, inehrdingallbufldinga ndtL ndr/ngbeing coastmcredon eachproper05 (*Based orsusing apace,
see defrnlrlan 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 plus $65 for each additional 1,000 sq ft. or portion thereof ($325 + ($65 x # of additional
1.000 aq. ft. orpordon thereof)),
Nett. Ibfultf-j7M4DmeLVag (Conuacrora On f)
❑ DupImApamnest$260
❑ Three or more multi -family units: $130 per building plus $65 per unit-, (8130 x # of buildings) + (865 x # of milts)
❑ Existing Residence, and Detached Shop: $65 fee plus $10 per fixture up to fire maximum of the corresponding
sq. & of the building IB65 + (810 x # of fixtures))
❑ Gtay Watct Systemst $130
❑ Lawn SpAnklets/Baek0ow Deviect 865
❑ Modular, Manufactured or Mobile Homes: $65 for sewer and water stub connections
❑ Multipurpose Fire Sprinkler and Domestic Water Supply System: $65 fee at $4 per sprinkler head, whichever
Is greater
Server & water
❑ $38 SetvetUne o$38 Water Line ❑$65 Sewer & Water- if inspected at the same time
❑ $65 Sewer turnaround under house (change from septic to city)
MISCELLANEOUS
❑ Plan Cheeki $65 per hour
❑ Technical Service: $65 per hour
❑ Gas Line: $65
❑ Water Heater Replacement: $65
❑ Requestedlnspectiont$65
❑ Hydeotde Heating: $65 + ($10 x#of manifolds/zones)
*Living Space —space within a dwelling unit intended fox human habitation which may reasonably he utilized for sleeping, eating, cooking,
bathingy, Mpg, recreation, and sanitation purposes. An unfinished basement is considered pact of the living space.
`�oQ aexao"o CITY Y. OF Building Safety Department
7n�
uo 1EXBURG City of Rexburg
nv 35 North 1st East
Amermak Family Community Rexburg, Idaho 83440
Subcontractor List
Excavation & Earthwork: Tr I efe- (� @ K C6(V eq;fl h Cq V)C.
Concrete: f; VC, tofnd C,VVAwe-iA? inC-
Masonry: j -LI --e-d 5 CrM"h'u C, -b' vi 1 iii C.
Roofing: RM C, LV C, s f- Gvr�061r-ct-t 0�1 _
Insulation: g n, C I v S u i(A fi' vla
Drywall: OV) 6 rt,(w a
Painting: De.V.ICdh deSt�r, (hG•.
Floor Coverings: -S F l Cr -V r coye- trt'vtc-i L -L -C .,
Plumbing: 001 e'5 % a F_ Y� � L-1 rn
Heating: 640Cwt� * - - �_p ¢ r _ M 1/ C cio
Electrical: cVtj h Pircjtl d C"f'111 C Inc.
Special Construction
(Manufacturer or Supplier)
Floor/Ceiling Joists:
Siding/Exterior Trim:
Other:
lupecHon Hu0ine (20R)322.2344 w .rezpurg,aig Permit Techniclan (208]392.2341 '.Revised Mardi,2016