HomeMy WebLinkAboutAPPLICATION - 16-00656 - 460 Rolling Hills Dr - SFR AdditionCITY OF
REXBURG
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BUILDING APPLICATION
Single Family Residence
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use Digital Plans Included: ❑ CD 0 USB 0 Dropbox 0 Not Included.
Permit Number: JL_C_G _s__L_ Permit Type; 0 New 0 Remodel 0 Addition ❑ Basement Finish
Deposit Amount: O $500 New Const. o $100 Other than New Const. Deposit. Included with Application: ❑ Yes o No
1. Property Owner
Name: Kevin Anderson ____
Address: 460 Rollncn Hills or ___ _ _ City:Rexbur-q _—_— State: !D _ Zip Code: 63440
Phone & Type: 9492441063______ 0 Office 0 Mobile Email: Levin@silicatestudio.com
Under Idaho Building Code, a homeowner is allowed to do work m1 their own home.
Are you a homeowner doing work on your own home?
0 Yes (Skip to #4 and complete the Homeowner's Exemption) 0 No, I am a contractor working for the homeowner
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2.Applicant
Name: Role: (Owner, Tenant, Contractor, etc.)
Address: City: —__ _ State: Zip Code: __---_
Phone & Type:______ __ ® Office 0 Mobile Email: _ _ _
Contact/Rep. Name: —_ ___— Phone: _—_--_ Email
3. General Contractor
Name:Registration #: — _ Exp.:
Address: ___________ City: State: ____ Zip Code:
Phone & Type:------------ 0 Office 0 Mobile Email:-
Contact/Rep.
mail:_Contact/Rep. Naive: Phone: Email:
General Contractor Authorized Signature: Date:
4. Project Description
Address: 460 Rolling Hills dr -OR- Lot #: Block #: — Subdivision:
Type of work:
Check one: 0 New Construction 0 Remodel* 10 Addition* 0 Basement Finish*
*Check all that apply: 0 Framing p+ Mechanical El Plumbing 0+ Electrical
NOTE: Any sub -contractors involved will need to submit their own signed applications.
*Description of work: add 300 sgft to back of house + kitchen_____
*Total cost of project- materials and labor: $40K __ (used to calculate permit fees) '
Building Total: 340 __ sq. ft Main: 340___ sq. ft. Basement: 0 Finished 0 Unfinished —____ sq. ft
Garage ____ sq. ft. Additional Floors: —_—_sq. ft
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 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 relatingto the subject matter oftris application and hereby authorized representatives ofthe
City to enter upon the above-mentioned property for inspectors purposes. NOTE: The building official may revoke a penniton approval issued under the provisions ofthe 2012
International Code in rases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoidifnot
started citrin 180 days. Permitvaid ifwork stops for 180 days.
Applicant's Name (print): Kevin Anderson — Signature:
Signature:
Inspections must be called in before 8 AM on the day the inspection is requeswil.
Inspection Hotline -(208)372.2344 www.rexburgurg
Date: -_f/17
in after 8 AM will be scheduled for the next business day.
(208) 372.2341 Revised March, 2016