HomeMy WebLinkAboutAPPLICATION - 17-00193 - 1140 Monroe Dr - SFRCITY OF
REXBURG BUILDING PERMIT FORM100
CIA,bpdaw 1012016
America's Family Community
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: ❑ $500
1. Property Owner
Gtfkovw ^(
Name: p
Address: r G ]A`
City: W -0— C1. State: Zip Code: "40
Phone: %Q-al�
Email: -aC4_4&? nee -190 MaC.Cittiq�
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
Sa'mR-
Name: �S �
Role: (Owner, Tenant, Contractor, etc.)
Address:
City: State: Zip Code:
Phone:
Email:
Contact/Rep. Name:
3. General Contrac or
Name: �A`W 2S 0b*lt
Registration #: Exp.:
Address:
City: State: Zip Code:
Phone:
Email:
Contact/Rep. Name:
Phone: Email:
General Contractor Authorized Signature:
Date:
A copy ofyourstate 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-
,r, a. A I
Lot#:,ti Block#:_1lubdivision:_"ea SgIaK—
Project Description:
• Square Feet: Building Total: _ %3t tU sq. ft.
• # of Water Meters: Water Meter Size:
o Main Floor: to1.-l. _ sq. ft.
• Fireplace(s) Being Installed?* Yes
o Additional Floorsy tji)' j_sq. ft.
• Hydronic Heating Being Installed? ❑ Yes` No
o Basement:
Finished sq. ft.
Unfinished sq. ft.
Building Permitfeesfornew homes are chargedbased on square
.10-1—
footage and the City's estimated valuation. For details on how fees
o Garage 1641 _ sq. ``ftpp
are calculated, contact the Building Department There will also be
• Estimated Total Cost: $_ e -It i
•S
a plan review fee totaling 10% of the building permittee.
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of penury,[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 City of Rexburg shall be truthful and correct I agree tocomply 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
building official may revoke a permit on approval Issued under the provisions of the 2012 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. Pamutvoid [foot started
within 180 days.Permltvoid lfwork stops for 3/80 �days,
Applicant's Name (print): a C J Signature: Date:
Inspections .at 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
C I TY OF
REXBURG
America's Family Community
PERMIT POLICIES ACKNOWLEDGMENT
Building Safety Department
City of Rexburg
35 North 15T 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 requites 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
the project to be red tagged. If your project is red tagged, halting all construction, only a City Official may remove the red
inn;ais 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.
Init Is
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.
i
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 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
inII is 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 ON 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
Initial 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.
o The above policies will be enforced to all, regardless if this information is passed on to them or not
Initizfs CC { �
Applicants Name (print):ar� J� Signature: Date: 3N
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 nextbr iness day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 2/2017
CITY OF
REXBURG
America's Family Camrnanity
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. 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
Tata -
Printed Name
3/51/17
Date
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016
p4pexuugc,
�d CITY OF
° REXBURG
n,v
A,nerfedsFemily Cornnunity
Excavation & Earthwork: �Y
SUBCONTRACTOR LIST
Concrete: N�\1Gk\rinci Ct)0CAr V k4/
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
�V)
Drywall:
Painting:��y�
Floor Coverings: CG ' &�� 1 y'red—
Plumbing: `\V` t `c � � 9
Beating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:'PViC V e+c�t Cat
Floor/Ceiling Joists: '(apo \Neje-' cOcyz)
Siding/Exterior Trim:
Other:
Inspection Hotline -(208)372.2344 %mvv.rexburgorg permit Technician -(208)372.2341 Revised 10/2016
Z�`:��i�[3�i�►"a�I�T.aifS►ri�L�+srZ►I[�7►'►
—
i
Roofing:
�4
Drywall:
Painting:��y�
Floor Coverings: CG ' &�� 1 y'red—
Plumbing: `\V` t `c � � 9
Beating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:'PViC V e+c�t Cat
Floor/Ceiling Joists: '(apo \Neje-' cOcyz)
Siding/Exterior Trim:
Other:
Inspection Hotline -(208)372.2344 %mvv.rexburgorg permit Technician -(208)372.2341 Revised 10/2016
CITY OF
7�����
a z 1�XBURG
o °
llv
'�aq,w a •.J Nnerfrn'rFmuOy Canonunfly
BUILDING PERMIT FORM ZZ�
uremelopacs
BUILDING APPLICATION
New SFR Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
rer omen: Use
Permit Number. d.- .0 rlcctrlcal Fee lIaid
1. propyy O�wner
Name: OA&bAyr S
Address 1554 S - 4A00611r.. (two SWI Clty:fTState: 1 Zip Code: S3�`iU
Phone: SCNR- 2111`0 Email: aVtY�4 M.: Q• eev>
Under ldnho Building Code, a homeowner Is allowed to do work on their own hofne.
Are you a homeowner doing work on your own home?
0 Yes (Skip to N3 and complete the Homeowner's Exemption)
Cvmo, I am working with the homeowner
'l. Electrical Contractor
Business: Ge� Jf? r^e- State License S: �ig�'� Exp.:
Address: Y //CA City: fri r- State; TM Zip Code:
Phone: �•- Email: f�a��iu_•"COratar%• (u f✓f
Contact/Rep.Nante:-Phone-.• Email;
Blecti{c'al �oiitrae(o'r /lufliorized Signatdrei Date:
Acopy ofyoarstate rer3lstrntfon/licenseisrequfre be oil file. f uslsthe/irsttlmeyouhaveeloneworlchlfliaCityclRexbarg,pleaseprovide
a photo copyofyourlicense..ffyonoreunsfx•eI our• license IsonfIle, please check with tile Permit Technician bycallhng(200)372.2341.
3. Project Description - A
Address:OR- Lot#:�Block-J .Subdlvisiont V-4
Description ofwork: tsI
❑ Now SFR Construction: _ 1.11.0—sq. ft.
Peesfm•inew constriction are chnr0r`bysgnaie footage: Up to l,50osq. ft. =$130+$65 for each additfonall,000 sq. f .or
portion thereof
o Upto1,500sq,ft=$130. Up to2,500sq.f.-$195.Upto3,50osq.ft.=$260.Uptoh500sq.ft.4325,etc. (i.e.a
home tvfth 3,675 sq. ft. willbe charged $325)
❑Spas/Pools/Generators:❑ Yestf No
e Note Mntspns/pnois/penernfors are not Mduded In squarefootage costs and vvfll be Charged $65 per Inspection.
APPI.ICAN MIGNATURU, CFRI IFICRInON AND AUTHORIZATION: Underpenallyofperpuy, I herubycerillythat I have read tills application and state that the Information herefil
is correct and I swear that any Information which may hereafter be given by oa in hall before the Planning and Zoning Commission or the City Council for the C.Iryofilexburg
sbali be truthful aid correct, i agree to cooply will all City regulations and Statelaws relating to the subject malterof lids application and hereby autholaed representatives of the
citytoeolor upon the above anmitioucd propoly for inspalions paryoses. NOTE: Tile fnlldingomdai,lay Wake 0 pernnilol upprov:d issued tender the III vlslonsortile 2012
l[it eruallo al (:ado In cases Unity false slatenanl or adsrepresentatlon of fact In the appilcnllmn or on ties plans on which the pennitorapproval Ives based. Pendt vold Croat
started within 100 days. Permit void It work stops for 100 days.
Applicant's Name (print); I'laSitij- Signature:
Inspections must be called in before OA14 on the day the Inspection is requested. Inspection requests called In aner DAM will be scheduled for the next foulness day.
Inspection Bullion -(200)372.2344 www.rexfurgorg PernNtTechnlchn-(700)372.2341
CITY OF
REXBURG
c-
Arnedm3 A11,111p• CorrOnnnly
BUILDING PERMIT FORM 110
u,t.oa 101106
BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North Ist East
Rexburg, Idaho 83440
For Offlce Use
Permit Number: ❑ Mechanical Fee Paid
1. Property Owner
Name: VAAr' hY1Ytf VYI+b
Address: 1601 S- 'Yl --U1 City: Ae-`ebg',J�State: W,3,.,�,,Zip Code: 1-1W!
Phone: `5&q -21111 Email: �lR �i.C7 (tui 1YL!�l ,�(p�"p—dank
Under Idaho Building Code, a homeowner is allowed to do work on their own !tome.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #3 and complete the Homeowner's Exemption)
ra, I am working with the homeowner
2. Mechanical Contractor y LZ(✓
Business: olnv ' (+ b State License #I 0l Z ✓r-� Z Exp.:
Address; t - City: 4 - Stat g: �_ Zip Code:
Phone- 2b Z Email: O ce: f//f9"e�L7'/cAe-fC !-
Contact/Rep.Name: I Phone: 7 Email:�_��Mechanical Contractor
Acopy ofyourstateregfstratIan/license Is required to beonnle.Ifthis Ist firstUmeyouhavedoneworkintheCityofRexburgpleaseprovide
a photocopy ofyour license. Ifymf are unsure if your license is on file, please check with the Permit Technklan by calling (100) 372.2341.
3. Project Description
Address:OR- Lot4 Block#I_'ISubdivision:. t15-clt/Wf
Description of work: Ie i -
❑ SPR Construction:_ X-bLip_sq.ft.
• Feesfor new construction are charged bysquarefootage: Up to7,500sq.ft.=$1304$65foreachaddltlona11,000sq.ft. or
portion thereof.
o Up to 1,500 sq. ft. = $130. Up to 2,500 sq. f t = $195. Up to 3,00sq. ft. = $260. Up to 4,500 sq. ft. = $325, etc. (i.e. a
home
"�with 3,675 sq. ft. will be charged $325)
❑ Number of Fireplaces: 1
• Note thatprepplacees are not [Included in squarefootage costs and will be charged $65 per Inspection.
11flydronic Heating: Nies
• Note that hydronk: heating Is not Included In squorefinotoge costs and willbe chargedand additional$65 # ($10 x # of
manifolds/zones)
APPLICANT'S SIGNATUJIM, CEWI-II'ICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that I have read this application and state that the Inrminatian
herein I, 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 regulatimn and Suite laws Ielal Ing to the subject matter of thbi applucation and hereby authorized
representatives niche City to enter upon the above-meinloned property for inspections purposes. NOTE: The building official Any revoke a permit on approval Issued under the
provisions of lite 2012 International Code In cases orally false statement or misrepresentation of tact In the appllcatlon or on the plans on which the permit or approval was
based. Permit void If not started withln 180 days. Permit void If work stops for 180 days.
Applicant's Name (print): �a fef J t" r 2 Signature: �u—� Date:
Inspections must be called In before 8 AM all the day the Inspection Is requested. Inspection requests called In after 8 AM will be scheduled for me next business day.
Inspection hotline- (2 08) 372.2341 ww•sv.rexburg.org Permit TeclmWin - (200) 372.2341
GQRR%cUgO
CITY OP
a a tlTtrbllr)!3 BUILDING PERMIT FORM 1�0
1t.C21�c- V l�V' Updaxd 10/core
nv
•'q'rx ,p• Nndrfm}Fnmily Cornnnndy
BUILDING APPLICATION
New SFR Plumbing
Building Safety Department
City of Rexbttrg
35 North 11t }fast
Rexbtug, Idaho 8344.0
For Of ce Use.'
Pei niit,Number: b Plumbing pee.Paid
1. Property Owner
Name:\fib(*vhHys-f
Address: 861 S. sfeablCtty:— re State:--ZtpCode:
Phone: 'yag-2 14 y4nqr3Q trtiyfehne� %1�no Prodi-�
Under Idalto Building Corte, a homeowner is allowed to do wo?* on thell• own /tome.
Aro you a homeowner doing work on your own home?
❑ Yes (Skip to t!3 and complete the Homeowner's Exemption)
?No, l ant worldng with tiro homeowner
2,PluntbhtgCIometer
Business: Lt Gy5�y" l�Itir�� ^0 I�L� StaAteLicenseff:
Address; SiEfS C 5W -1E4 M4,1 •/ / Tr i•'�v 1 �S to:: Zip Code; y'Ci
Phone: 706 5-.35 /' 6 Email) Luo% 'r�r tirwd ,� E!:' aA,,', eco-•,
Contact/Rep. Name; 6d or 0-71e- Phone: _ EMAI l:
PldmbldgClintracto'rAtitloi'izei!$Igitafdre: dt c Date: .3 /
Acopy ofyourstate registmttoir/llcenselsrequired to eonjfle.lftldsls/IrsttfmeyouhavedoneworkfittheCityoftlexburg,pleoseprovide
rt photo copy ofyour license. lfyou are unsure Ifyour license is on filo, pleose check Ivlth Ure Pmmit TechiNclon by calling (200) 372.2341,
3. Project Description
Address: OR. Loth 4-131ock4: -j,Subdlvlsion:-4j �C 3 Sgv44Ct
Description ol4ork: tye.,i ffii;
❑ New SPR Construction:at 3LAO_sq,R,
• peasforflow construction arechepeelbysgunrefoetnge:Upto1,50osel.f.v$130+$65foreach oddfdonall,000xg.f.orpofxon
thereof.
o Upto 1,500sg,ft.-$130. Up to2,500sg,f-=$19,5. Up tn$500sq,ft.=$260. Up tu4,500sg,ft=$325, etc, (i.e.a
hence with 3,675sg. Jt. wfif bo charger/ $325)
❑ Hydropic (In -Rom.) Heating: 13 Yes 6ACI
• Note that lWdronfcheating Isflat included hisgfmr•efooingecosts and will bechmDed$65+($10x#ofmmnlfolds/zones),
APPLICANT'S SIGNATn6R,CORTIPICATION AND AUTHORIZATION: Under peuollyuf p.nury, I Ilerabyearllry alit I Imva read ads Application And slate trial theinformatlon heroln
Is correannd Isivrar that Any Infntmallon whlch nmy hereafter be given by Ire In Ilenrhlgsberar, Zile Nanning And 20111ng C01111n1551aA or II ICIlyConn41 for the City of HeXblog
shall be tnnhfnl and nrtrttt. I agree to cotaply with nil cilyregnlnilons and slalelaws relating to Iimsabled mAnerof Ihk Application And herobymrhothed representatives of the
city to Prier 111,01/ lheabove-mentioned property for Inspections purposes. NOTg: Tire building oficial may revoke per alt on approval Issued colder (lie provisions of the 2a 12
International Code It, ases orally this. slalement or misrepresentation Wact In the Application Arne thoplAns all which rho permitarnpproval was based. Permit void Illlot
statledwllhlnlll0dayl. Peroat vold lfwnrll slops for l Godoys.
ApplicanesName (print); TGfWqjyt:,H-_Signature: � �- Date:_ 4/11/1-7
IlnpeclIons Inrit Imealled fn heforo 0 AM oil IIP day Ibo Inspucllun Is requested. Iaspectlan laulquis called in after 0 A svlll be scheduled toy the next business day.
Irspeeilml ilotllno- (200) 372.2341 svww,roxbmg,org Parnll Toehnlclall- (200) 3722341
CITY OF
REXBURG
rn�
America! 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 lna
C -Dos -b -i I to l �� S. ✓ c� r tX iJs 1� c sic Zip
Name Address
�e
City
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
State I�
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. 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 LI i'_ day of n 20 1-7
Signature
Subscribed and sworn to before me the day and year first above written.
JANAE BINGHAM
NOTARY PUBLIC
STATE OF IDAHO
My commission expires: V 101 // 2V �%
Inspection limline- (208) 372.2344 w .rexhur&org Permit Technician -(208)372.2341 Revised 10, 2016