HomeMy WebLinkAboutAPPLICATION - 17-00086 - 300 Baldwin Dr - SFRCITY OF
REXBURG BUILDING PERMIT FORM 100
rWupd2ud 10/2016
Ameriai 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 % pC 0g�
Permit Number: j Zoning:
LOR'1 Application Fee Paid: J2I $S00
1. Propertycaner
Name: tC�AAJ_lr %b`("QI
Address: llJ Q,n.*Jyy e �w� 1 bl
11
City: �kh1 f ( State: 110 Zip Code: 9351L[a
Phone: (0
Email: ro-1 L< -,n k. hJJ.W
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #4 and complete the Homeowner's
Exemption)
t) No, I am working with the homeowner
2. Applicant 1`-
Name: KG\ (�G11Y�L( YPYYWI
Role: (Owner, Tenant, Contractor, etc.) bb
Address: S IC y a%aVt
City: State: Zip Code:
Phone:
Email:
Contact/Rep. Name: !�fiC1irk .
3. General Contractor
!`f
1 �sq
Name:0. rk %eYy\onn!�
Registration #: Exp.:
Address: S. ea, tynsie.a K),0ZVt_
City: State: Zip Code:
Phone:
Email:
r^
Contact/Rep. Name: Q�
_
Lyrer
Phone:��q-Lt/t. Email: -T(\�}c�+v�c�Ywvyl �o
General Contractor Authorized Signature:
��� / Date: 8
A copy of your state registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please provide
a photocopy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
4. Project Description
Address: 13A1 (.., n d,(. OR-
Lot #: (0 Block #: Subdivision: fcw`nars Sy' V c w
Project Description:
• Square Feet: Building Total: r gal sq. ft.
• # of Water Meters: ^y �,'_J
\ Water Meter Size: l
o Main Floor: W1 sq. ft.
• Fireplace(s) Being Installed? ❑ Yes Y No
o Additional Floors: 101V sq. ft.
0 Hydronic Heating Being Installed? ❑ Yes EA No
o Basement:
Finished _� _sq. ft.
Unfinished_ l S'%— sq. ft.
Building Permitfeesfor new homes are charged based on square
o Garage WAV sq• ft•
footage and the City's estimated valuation. For details on howfees
are calculated, contact the Building Department There will also be
• Estimated Total Cost:$ a,3i14'a"I
aplan reviewfee totaling 10% of the building permitfee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpenury, l hereby minty that I have read this application and state that the Information herein Ismrrectaad 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. [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 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 lfwork stops for 180 days. n, ��77
Applicant's Name (print): T� ` a Signature: T� r Date: oC ZSI
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
(n,
Americas 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
approved 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
Initial 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.
Inftials
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.
InRials
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
da .
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
Initials 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
Inftials authorities from the City of Rexburg. Any approvals can be verified by calling (206) 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.
Applicant's Name (print): _'Si7
s Signature: w /U Date: a/01
Inspections must be called in before 8 AM on the daythe 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 Revised 2/2017
R;oQpeXep"° o n, TY OF Building Safety Department
1tC.T� T,XBURG City of Rexburg
.,
e,, 35 North 1st East
America's Family community Rexburg, Idaho 83440
PROPERTY LINES
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
771�lm S,
Printe— d'Name
2g 7
Date
Inspection Hotline -(208)372.2344 www.rexlmrg.org Permit Technician -(208)372.2341 Revised 10/2016
CITY OF
REXBURG
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, TG{.YGI*V*- llmnslrvr 'on SS9 S. yc�owS�of e � S}� 7 0�
Name Address
V_(N6 c
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:
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 Z K -f day of m'" 20�"�
x'44. -At Zfi
Signature
Subscribed and sworn to before me the day and year first above written.
E
RCEY E. VALERIO
NOTARY PUBLIC
STATE OF IDAHO
Inspection Hotline- (200) 372.2344
Notary
Residing at:
Vldl ep(o
�UP6
My commission expires: f ( G I q
www.rexhurg.org Permit Technician -(208)372.2341
Revised 10, 2016
CITY OF
REXBURG
AmericA 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 ofyour State
registration number or your exemption from the State registration. A homeowner may do work on the owner's
own home. If this applies to you, please sign this form declaring your exemption from registration and return 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.
Sign ture
Print Name
a-/ ZS / ►-7
Date
Permit Technician -(208)372.2341 w w.rexburg.org Revised 2/2017
CITY OF
REXBURG
ry,
Americas Fam[ y Cam munity
BUILDING PERMIT FORM 1ZO
BUILDING APPLICATION
New SFR Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Electrical Fee Paid
1. Property Owner
Name: KOIA-6nr edy6mef
Address: 8$4 e,. 16uIW fAr WVPA SIV M City: P-N4woIrm, State: 10 Zip Code: ; 0
Phone: 57&A—2-Itto Email: kGLtrRQ r inner iflpv�n��.
Under Idaho Building Code, a homeowner is allowed to do work off their own home. Gory1
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #3 and complete the Homeowner's Exemption)
"a, I am working with the homeowner
2. Electrical Contractor
Business: Gil4z, r^c- State License #: Exp.:
Address: r 66 Y //G City: fri C State:T-�_ZipCode: S3�i/f�3
Phone: G20fk - - Email: ✓fid ��� i Y (� O.rt�,%. G� r7
Contact/Rep. Name: Phone: Email:
Electrlcal`Contractortlutllorized Sigaat irei Date:
A copy ofyour state registration/license is require beon/lle. f is is Urefirst timeyou have done work In the City of Rexburg, please provide
o photocopy ofyour license. Ifyou are unsure l our license is on file, please check with the Permit Technician by calling(208)372-2341.
3. Project Description
Address: 119 IS%Ldt4etn IU✓• -OR- Lot#:Block#: $ Subdivision: F44r(Wts S='~r
Description of work: NtW 4ye%& r-jcpan
New SFR Construction: Z" 1 sq. ft.
• Peesfornew construction are charged bysquarefootager Up to 1,500sq.f.=$130+$65for each additional),000 sq.ft or
portion thereof.
o Up to 1,500sq.ft. = $130. Up to 2,500sq.ft. = $195. Up to 3,500sq.ft. = $260. Up to 4,500sq.ft.=$325,etc .(i.e.a
home with .?,675 sq. JL will be charged $325)
❑ Spas/Pools/Generators: O Yes W No
• Note thatspos/pools/generators are not Included in square footage costs and will be charged $65 per Inspection.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state thatthe Information herein
Is correct and I swear that any Information which may hereafter be given by me In hearings before the Plamdng 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 penniton approval issued under the prov4sions of the 2012
International Code ht cases of any false statement or misrepresentation of fact In the application or an the plans on which the permit or approval was based. Permlt void if not
started within 100 days. Permit void If wet kstops for 100 days.
Applicant's Name (print): "%1 rot. S-I�Ft- Signature: ��'L Date:
Inspections must be called In before 8 A on the day the Inspect lon Is requested. inspection requests called In after 0 AM will be scheduled for the next business day.
Inspection Hotline- (200) 3722344 www.rexburg.org Permit Technician - (200) 372,2341
CITY OF
REXBURG
c1Y
Aeneriea3 Family Community
BUILDING PERMIT FORM 110
W.W 1012016
BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 63440
For Office Use
Permit Number: O Mechanical Fee Paid
1. Property Owner ' L
Name:.. AYA-eJA>N4 IiDKY>�G �'� �����"�
Address: BgQ j_tt Atdaje uu }Wye_ City: State: ZIp Code: 83H►i0
Phone: Sd�l- 211 V Email: ec1i� GYec(� �Cnri't Mile han,e., , in
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)
o, I am working with the homeowner
2. Mechanical Contractor t
Business: r ta�T (+ b State License 4: 91 Z 5 2— Exp.:
Address: C ' City: Stat : 'Lip Code:
Phone: `b Em 11: d u M ee/
Contact/Rep. Name: I Phone: - 1101W Hmaii: v"44-
MechanicalContractor Authorized Signature: r"u�i Date: 4
Acopy ofyourstate registrationfifcenseIsrequired tobeonfile.Ifthis Ist))rsttfineyouhavedoneworkIntheCityofilexburg,pleaseprovide
a photocopy ofyour license. Ifyou are unsure ffyour license Is on file, please check with the Penni[ Technician by calling (200) 372.2341.
3. Project Description 1
Address: :5\0 Md(W%,f\ ��r -OR. Lot #: ft Block #:3 Subdivision: fOr (Wed SaiU4 L
Description of work: W t t (ofyz+"A'4ri
• SPRConsunction: (,t 2.1 sq. ft.
• Feesfor new construction are charged by squarefootage: Up to 1,500 sq.f.-$130+$65for each additional 1,000 sq.ft. or
portion thereof.
0 Up to 1,500 sq. ft -$130. Up to 2,500 sq. A-$195. Up 10 3,500 sq.ft.=$260. Up to 4,500 sq.ft.=$325, etc. (i.e.a
Koine with 3,675 sq. ft will be charged $325)
❑ Number of Fireplaces:
• Note thatflreplaces arenot included fit squarefootage costs and will be charged $65 per Inspection.
❑ Ilydronic Heating:
• Note that hydronk heating Is not Included in square footage costs and will be charged and additional $65 + ($10 x N of
nlanlfolds/zones)
APPLICANTS SIGNA3'URE,CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and state that the Information
herehe Is carrect and I sweat that any Information which may hereafter be given by me In hearings before the Planning and Zoning Com alsslon or the City Council for the City of
Rexburg their be truthful and correct. 1 agree to comply whh all City regulatiom and Stole laws relating to Hit subject merle, orthis application and hereby authorlaed
representatives ofthe City to enter upon the above-mentioned property for luspections purposes. NOTE: The building official may revoke a permit on approval Issued under the
provisions of the 2012 International Code In cases ornery false statement or misrepresentation of fact In the application or on the plans on which the permit or approval was
based. Permit void (foot started within 180 days. Permit void Ifworkstops for 180 days.
Applicant's Name (print):_&6( S_Signature: !�� Uate: �j
Inspections nmsl be called In beforell AM on the day the hrspectlon Is requested. inspection requests called In after 8 AM will bescheduled for the next business day.
Inspection Hotline - (208) 372.2344 wsvw.rexburg org Permit Technidan - (208) 372.2341
CITY OF
REXBURG
cW
Ana@e} Fandfy Cmunwilfy
BUILDING PERMIT FORM 10
and. e,artare
BUILDING APPLICATION
New SFR Plumbing
Building Safety Department
City of Rexbtlrg
35 North 1e1, Bast
Rexburg, Idaho 83440
For Offlee Use
Permit Number: O Plumbing FeePald
1. Property Owner,1�
Nanta:
Address:frfj9S.ygDQ pl¢ City: _State: V Zlp�Code: 133t111(g
Phone: s$r'1q.21j�1, Email:
Under Idaho Building Code, a homeowner is allotved to do woi* on their own home,
Are you a homeowner doing work on your own home?
❑ Yes (Skip to 93 and complete the Homeowner's Exemption)
To, l am working with tho homeowner
2,PlunlbingC, itractor //��
Buslness:�?�.�y�1e5AWt /��N"6'"'� GL6- State License N:
Addr'essi z/vlfs Z_ a S'C 7' u_.' d e","e> ` State: a ZiIC de:' h
Phone: 'ZV& 5-33- 6 Entail:
Contact/Rep. Name: k6d er Ogle Phone: Bm il:
PlumtiingC6n66fdrAatiio'Iz6dtlinafare: Date: 3//
Acopy ofyourstate rcylstration/IlcenseIsrequired to beonple.Ifthlsls QrstNntayonhavedonetvorktittheMyofltexburg,pleaseprovide
aphoto copy ofyour license. ljyom are li .sunt Ifyourllcense is on file, please check with the Permit Tectinklan by calling (200) 372.2361.
3, Project Description
Address: �JIO (?ajp(win oft/• OR. Lot N: Block 4h A Subdivision: EcaJne&jm SF'v.nr
Description of work: biew corislNct1 an
13 New SPR Constnlctlom sq. ft.
I7ees%r new tonshvlctlmr Aro dmrgerl hysgume footage: Up to 1,SOOsq. ft. = $130+ $6.5/ur ertch nddlllonni I,000s1./t or portion
thereof.
o Upto1,500sg,ft.=$130. Upt02,500sgft,=$19.5,Upta3,500sg.ft.=$260, Upto6,500sg,ft:=$325,etc. (te.ft
home tvlth 3,675 sq.R, will he charged $325)
E3 Hydronic (In -floor) Heating: ❑ Yes Ey No
I Note thatltvdronlchearinglsnotIncludedINsguarefoolagecostsandWI1bcchinged$65+($lox#ofm ranifolds/zmfe.+),
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTIIOR17ATION: Under pvnnlly.rio riury, I berehyeorlify that l have read this appllcolon And state that lhalnformatlon hurain
Is correct and I &%Year that any Informnllan which mny hereafter begiven by Ina to hearings before Ilse Planning and%mengCommission or Ilia City Council for lhoCity of fiokhurg
shall he Inmbbd mud anrttl. 1 Agree to comply with nil ctlyrognlntlons And State laws reliable to Ihasublal matlerorlhis Application and herchyntabodecA representatives of the
City in enter upon the shove menllnnnd properly fol• Inspections p irpnse&. NOIR: The building official mny revoke pern It tan approval Issued under Ilia provlsloos of tine 201.1
international coda In cases ofanyraise statement or misrepresentation of (not In Ilia Application o•on the plans on which the permltorapproval suns hosed. Permit void Ifuot
smrtodwlliduil)(Idnys. Permll volt] lfwork stops for 100Anys.
Applicant's Nelle (print)I
._ _Signature:
Datta
Inspections must be called fn beforo 0 AM on the day the Inspection Is requested. inspecllon roquests called Ica after UAM will he scheduled for the next business day.
inspection IlAMRA- (200) 372.2344 www.roxhurg.org Parink Technician -(200) 3712341
C I TY OF
REXBURG
cn,
AmericA Family Community
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete: IJV 64CtVtd CofNcArtek . 101,
Masonry:
Roofing: z m (� %v f'5 V Coy QWA*f Cir" u
Insulation:
Drywall:
Painting: _j4e
L$1�\^
Floor Coverings:
Plumbing:
Heating: fyi
Electrical:
`a C,
Special Construction
(Manufacturer or Supplier)
Roof Trusses: CatoCo.k- o\Z ,
Floor/Ceiling Joists: (�riic WC'St �f tDad�
Siding/Exterior Trim:
Other:
Building Safety Department
City of Rexburg
�V)
35 North 1st East
Rexburg, Idaho 83440
Inspection Hotline -(208)372.2344 w .rexhurg.org Permit Technician -(208)372.2341 Revised 10/2016