HomeMy WebLinkAboutAPPLICATIONS - 17-00203 - 1081 Washington Blvd - SFR;o pEXeVq�,a CITY OF
REXIiURG
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Amerimi 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, --T�1Y61 S� �Sq S `� cu,slaro Zoe
Name Address
k�Azj�(
City
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
W
State
A. That I 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. 1 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 203-7--_
Signat
Subscribed and sworn to before me the day and year first above written.
-------------
JANAE BINGHAM
NOTARY PUBLIC
STATE OF IDAHO
Inspection Hotline -(208)372.2344 w .rexlmrg.org Permit Technician -(208)372.2341 Revised 10, 2016
CITY OF
REXBURG
t�
Americo 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 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 permit.
o Building without the pink building permit signed by the Building Inspector will result in double fees to be assessed and
yJ the project to be red tagged. If your project is red tagged, halting all construction, only a City Official may remove the red
Initiali 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
day.
o Required inspections can be/bund 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
Init 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.
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
Inttial 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.
The above policies will be enforced to all, regardless if this information is passed on to them or not.
Applicant' sName (print)_��Signature: �y Date:
Inspections must be called in before 0 AM 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.rexburg.org Permit Tech nician-(208)372.2341 Revised 2/2017
CITY OF
REXBURG
cy,
America's Family Community
PROPERTY LINES
Building Safety Department
City of Rexburg
35 North 15C 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.
I have read and understand the above requirements.
Signature Date
dna311a-
Printed Name
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016
CITY OF
REXBURG
(�y
America's Family Community
BUILDING PERMIT FORM100
updated ro/2ots
BUILDING PERMIT APPLICATION
New Single Family Residence
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Zoning: Application Fee Paid: O $500
1. Propert}' Owner
Name: jigr-'7�C� AU AvY)ARa
Address: &II S �Je.Qifx..xshk 2b1 City:e— u State: �0 Zip Code:
Phone: Sdq-21%v U Emal�yeX y}SOP."
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #4 and complete the Homeowner's Exemption)
o, I am working with the homeowner
2. Applicant
Name: �a Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name:
3. General Contra or
Name: A ((�P US Akg"c Registration #: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
General Contractor Authorized Signature: Date:
A copy of your state registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
4. Project Description
Address: OR- Lot #: J, Block #: Subdivision: fa gd(:6 Sgt
Project Description:
• Square Feet: Building Total: sq. ft. • # of Water Meters: Water Meter Size:
o Main Floor: sq. ft. • Fireplace(s) Being Installed? Ekl)Yes ❑ No
o Additional Floors: E sq. ft. • Hydronic Heating Being Installed? O Yes[ ' No
o Basement:
Finished sq. ft. Building Permitfeesfor newhomes are charged hared on square
Unfiniss�hIe-�dpp,!tnG3 sq. ft. footageandthe City's estimated valuation. Fordetailsonhowfees
o Garage "S v sq. ft. are calculated, contact the Building Department. There will also be
• Estimated Total Cost:$ a('0 cl,00p aplan reviewfee totaling 10% ofthe building permitfee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and stale 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 truthrul 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 permiton approval issued under the provisions ofthe 2012 International Code In cases of any false sistementor misrepresentation affect in the application mon the plans on
which the permit or approval was based. Permit void if not started within 180 days. Permit void ifwork stops for 180 days.
Applicant's Name (print): �'lt(� S Signature: Ta,-
Date:
Inspections cost be called in before 8 AM on the day the inspection is requested. Inspection requests called in after
8 AM will he scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org
Permit Technician - (208) 372.2341
{ CITY OF
1 REXBURG
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BUILDING PERMIT FORM 1 Z O
uedmasepars
BUILDING APPLICATION
New SFR Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For 6ff3cli Use
Permit Number: p Electrical Fee Pald
1. Property, 0
Name:\�lf�G�1(1P�11"
Address: City: State: Zip Code:
Phone: zt f 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?
❑ Yes (Skip to H3 and complete the Homeowner's Exemption)
❑ No, l am working with the homeowner
2. Electrical Contractor t
Business: GState License N: PIMP Exp.:
Address: X( 1/6'.—City: 12 f 1' r State: . �M_ ZipCode:
Phone: — Z9A — Email: a d�-9'-- i �e f;;�L go&&?,60ha
Contact/Rep. Name: Phone: Email:
Electrical ContrSctorAuthorized Signatures Date:
A copy afyourstate rGgish•atlon/license is require 6e mr/Ile. f its Is Nrefrst thueyou have done wa•R Or the City ofRe+burg, please provide
a photo copy ofyon• license. Ifyou are unsure l our license is onflle, please check with the Permit Tecludclan by calflrlg(200)372-2341.
3. Project Description r
Address: OR- Lot B:_I Block#: G Subdivision: [ OJ(�r.("-44v-tr'P
Description of work: Ne.1 h
0.l-�-YQ
❑ Now SFR Construction: •�2 sq. ft.
a Feesfornew constructtan are charged by sgomefootage: Up to 1,500 sg.ft.=$130+$65for each additional 1,000 sq.ft. or
portion thereof.
o Up to 1,500 sg.ft. as$130. Up to 2,500 sg.f.=$195. Up to 3,500 sg.ft.=$260. Up to 4, 500 sq.. ft. =$325, etc. ft e.a
hoale with 3,675 sg, ft. will be charged $325)
❑ Spas/Pools/Generators ❑ Yes Kr No
a Note thotspos/pools/generators are not Included hl sguarefootage costs mut willbe chaged$65per Inspection.
APPI.ICAN'1'SSIaNATURI{ CHII'I'IFICA'I'[ON AND AUTHORIZATION: Under penaltyof perjury, I heretycerllry that I have read this appl[callo l and state tile[ the hdormar[oa hereln
Is correct and 1 swear that any information which may hereafter be glvon by ma hr hearings before the Planning and 2011ingCo nlolsslon or the City Council for the City of Rexburg
shell be truthfni and correct. i agree to comply will. all City regulations and S1nteMws totaling to thesubject m;dter of this application end hereby authorized representatives of the
Elly to anter upon the above-mmdloued property for Inspections purposes. NOTE:: The hulldingaffklai may revoke a permit u)) opprov d issued ander the Inovhslons of lhm 7012
humudlmud Code Incases ofmay false statement or ndsrrill rsentAlon of fact In the application or on rho plans on which the lmnn[t or approval was based. PennlivotdIOmt
starred within 100 days. Permit Vold If wosksuops for 100 days.
Applicant'sName(print): - Ce4o' Signature: Date:�`�I
Inspectluns must be called it, before DAM on the day the ]aspect[.)) Is requested, inspection requests called In ager 0 AM will bescheduled lot the next business day.
luspeclimn Ilmline - (20H) 372.2344 www.rexhurgurg PernitTechnlclan-(206) 372.2341
I
OQaaxabRQ
CITY OF
1\L'.
Rr,XBURG BUILDING PERMIT FORM 110
R upe.ueroizors
MIMm3i0rnlyGormnunity
BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North 151 East
Rexburg, Idaho 83440
For Office Use
Permit Number: 0 Mechanical Fee Paid
1. Property Owl
Name:.
Name: �(ily�7�hY14
Address: City: State: Zip Code:
Phone: _ Emall:
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 03 and complete the Homeowner's Exemption)
❑ No, l am working with the homeowner
2. Mechanical Contractor
Business: nowli 1'�t+t+ � b State License ll: O� Z SS' � Exp.: S j/
Address:S119 t 1" ' City: 4,Stat :iy! Zi Code: � 14VI/Z-
Phone: 46 - L Em il: D cur" °a� i 4"
Contact/Rep. Name: I Phone: - Email:
Mechanical Contractor Authorized Signature: r� '� I Date: -/
A copy ofyour state registration/license is required to be onfle. Ifthls is t /Irst lhneyou have done work In the City of Rexburg, please provide
a photo copy ofyour license. If you are unsure Ifyour Ifce Ise Is on file, please check with the Permit Technician by calling (200) 372.2341.
3. Project Description
Address: OR- Lout 2Block tl: Subdivision: �a� G(eri uC rf
Description of work: T GVH( �±2 x �g
❑ SFR Construction: sq. ft.
• Feesfornew construction are charged bysquarefootage: Up to 1,500 sq.ft. = $130 + $65for each additional 1,000sq.fl. or
portion thereof.
o Up to 1,500 sq./L=$130. Up to 2500 sq.ft.=$195. Up to 3,500sq. ft. =$260. Up to 4,500 sq.R.=$325, etc. (i..e.a
horse with 3,675 sq. ft. will be charged $325)
,riNtunber of Fireplaces:
• Note that fireplaces are not Included In square footage costs and will be charged $65 per Inspection.
❑ 1lydrotic Heating: _`( < 01
• Note that hydronlc heating Is not Included In square footage costs and will be charged and additional $65 + ($10 x N of
manifolds/zones)
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and slate that the Information
herehs Is correct and I swear that any Information wblch may hereafter be given by me In hearings before the Planning and 7oningCommMion 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 rafter oflbfs"applluNon 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
Ixovisiom of the 20121ulernattoml 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. Permit void if not started within 160 days. Permit void If work stops for 180 days.
Applicant's Name (print): ��� Signature: _I o Date: L (30
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 die next business day.
Inspection Iiotline - (200) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341
pPp%oUq°
CITY or
° REXBURG
by
AmedeeS Family Cornmmarry
Iv `
BUILDING PERMIT FORM 10
opma 1¢/2816
BUILDING APPLICATION
New SFR Plumbing
Building Safety Department
City of Rexburg
35 North lit East
Rexburg, Idaho 83440
For Office Use
Pe)•najt Number: b Plumbing pee Pald
1. Property Owner
Name:
Address: City: State: Zip Code:
Phone: 611,Email:
Under Idaho Building Corte, a homeowner is allowed to tlo wo•!t on Uuell' own home.
Are you a homeowner doing work on your own hone?
O Yes (Skip to N3 and complete the Homeowner's Exemption)
$Alo, I am working with the homeowner
2,1"lunhinge Oro Lys tel ' . Le p�l� C-/15'%�
Business: v ties "" State License fl; xp•:
Address: L7 f3 ge'de t tGin. Lt �irw'n� �/ �s tel 1 Zip Code: Ci
Phone: Zafi 5-.35 / U Bmali: Ark-<&' ro 4ry •-Ir � yftioo,.
Contact/Rep.Name: Ald osr 0,de Phone: Smell:
Plumbing ContraeforAuthol`ized $ignatdre: Date: ,3
A copy ofyour state regtstratfon/license is required to c on /Ile, ifthis is first thneyou have done work IN the City ofnexburg, please provide
a photo copy ofyam• license, lfy0u are unsure tryout, license is on fila please check with the Penult Teclinklan by calling (200) 372.2341.
3. Project Description
Address: OR- Loth: _Block B: Subdivlslon:� fur= Ic �t
Descriptionofwork: Itih\r-.t B2,(�
❑ New SNR Construction: ��_ sq. R,
0 Vicesfor New construction are charlied hysiluarefootalle. UP to 1,500sil. ft, z $130 + $65for each additional 1,000sq.ft.arportlon
thereof.
o Up to 1,500sq,ff.-$130. Upt02,5008q.f.=$195. Up t03,500sq.ft,=$260. Upto4,500sq.f.=$325, etc, (i.e.it
ho)ine tvitb 3,675sq, R, tvlll be charged $325)
o Hydropic (in -Floor) Heating: ❑ Yes L9No
6 Note that hydronk heating lsnotincluded hisquarefoolage costsand will be Charged $65+($lex 0 ofmanlfolds/zones).
APPIdrANT'SSIGNATORR, CERTIFICATION AND AUTDORI7.ATION: Under peanllyofpmluty, I hereby certify lit -it i hove read this application and stale that Ilia Information heroin
Is correct And I swear nm1 Any Information which mnyhereaaor be given by ate In hearings before ilia Planning and xoningConnnisslan or ilia City rmmdi for ilia City of Ilaxtong
slnil be mnidnl old nvretl. 1 agree to comply with nil City regAlAllo11s and State Ines reloting to ilio subject urmlerof Ihls application And llerebynatlmrixad topreselltatives of the
city in enter 1111°11 the ollove-nlentinncd prope.rly for Inspections purposes. NOTS: Tile building official may revoke a porn It oil approval I%tivd under (lie provisions or the 2012
hado,bonal Code In eases orally fdse statement or misrepresentsllon of fact In the appllcntlon At. nth. plans on which Ilio permit or Approval was based. Permitvoldlrlmt
slnrled within Ilia days. PermltvotdlfwmkstopsfortnOdrys.
Applicant's None(print): TArA-J-JVff— _Signature: T Data:
Inspections most hncalled In before 0 AM on ilia day Ilio Inspediml Is regmesled. inspection rmpweta called 01 after U AM will be scheduled for the next buslin es day.
Inspedlon Ilolllno-(200)312.2344 www,roxialle rg Pandl Technician -(208)372.2341
o¢p¢X¢UgC
CITY OF
REXBURG
(ti
Anterlcak Family Connnuufly
Excavation & Earthwork:
SUBCONTRACTOR LIST
Concrete: IAV('Q0tnd Cot\CV&kb (1!
Masonry: �U�C wR�elft VVI / � t
Roofing: LnU ' 1� �S� COYQONrG�-sr-.
Insulation: \", _ e�� '0jVD\C "A�'J"-N
Drywall:
Painting:
Floor Coverings:
Plumbing:
Heating: _
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses: e.S'y C'at�JaCyloy�
Floor/Ceiling joists: � rriC Wept Co (" �Q oLaj�
Siding/Exterior Trim:
Other:
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
1V)
Inspection Hotline -(200)372.2344 wvn¢rexburg.org Permit Tedmlcian-(208)372.2341 Revised 10/2016