HomeMy WebLinkAboutAPPLICATION - 16-00688 - 895 S 2380 W - SFR* °UR CITY O ASafety BuildingSafetDep artment
:
RMURG City of Rexburg
C„ 35 North 151 East
,y > Amenml Family Cammmrity 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 ul2on 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.energycodes.gov)
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 Permit Application signed by a registered 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 httniNrexburg.org/oa/oagesldevelopment-code.
Seismic Design Category -D
Ground Snow- 50 His, per sq. ft
Roof Snow Load- 3S lbs. per sq. ft'
Wind Load - 90 MPH'..
Frost Depth - 36"
Inspection Hotline—(209)372.2344 w .rexlmrg.org Permit Tedmitimn (200)3722341 Revised March, 2016
CITY OF
REXBURG
A merird family Cou ..aridly
Permit Policies Acknowledgement
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
permit shall not begin until an approved permit is
the Building Inspector, then you do not have an
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
Initials Official may remove the red tag. If the red tag is removed by anyone but a City Official, citations will be issued...
No building maybe occupied without receiving a signed Certificate of Occupancy.
o If abuilding is occupied without receiving a signed Certificate of Occupancy, citations will be issued and the
occupants will be evicted..
Inrtlafs
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 AM will be scheduled for the following,
business day..
S o 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
initials put up, the inspector may require the sheetrock be removed in order to perform the electrical rough in
]nspection.)
through the Permit Technician.
need to receive all relevant
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.
Initials
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
Applicant's Name (print)• Signature: -f"M 5-r"04-1- Date
1y the Inspedion is requested. Inspection requests called in after SAM Wit be scheduled for the next business day:
www.rexburg.org PermitTechniciart (208)372.2341 Revised March, 2016
CITY OF
REXBURG
nv
Amedw's Fnmfly Conununity
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.
B. 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
ll. 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 a graphic scale (11 yz 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 Hallne-(208)372.2344 mw ,,rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
y
CITY OF Building Safety Department
° 0 REXB RG City of Rexburg..
i
— N 35 North 1st East
Amcrim3 Family Cmaraueiry
Rexburg, Idaho 83440
BUILDING APPLICATION
Single Family Residence
For Office Use Digital Plans Included: ❑ CD 0 USB 0 Dropbox 0 Not Included
Permit Number: Permit Type: ❑New, ORemodel ❑Addition .❑BasementFirtish
Deposit Amount: 0 $500 New Const. 0 $100 Other than New Const. Deposit Included with Application: 0 Yes ONO
1. Property Owner f
Name: karhGkOO-r FLwver / g3�F�kU
Address: U59 i-I70((UWS WV s ?nl City: r�Xbvl%e, ...State:,.) d Zip Lode:
Phone&Type•. x'.57-�9'ZI (7 kOffice13Mobile /l�'%-�f�a p-tehnor4OJ -C-C�m
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your awn 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-contracton involved will need to submit theirown. signed applications:
2. Applicant
Name: �5 A /YL t- GC al"Pe-- Role: (Owner, Tenant; Contractor, etc.)
Address:. City: State: - Zip Code:
Phone &Type:. 0 Office 0 Mobile Email:
Contact/Rep. Name: Phone: Email:
3. General Contractpt• - /
Name: T%di I/l� ('if"Clr.f Registration #:. � � Exp.: 2-'A � `�
Address: &aijo2 . oc.0 OG10CVe-- _City: State: Zip Code:_:
Phone & Type: 0 Office 11 Mobile Email:.
Contact/Rep. Name;. _ P e; Email:.
General Contractor,AuthorizedSignature: pate:
4. Project Description
Address:04 S• 2_a5c w • -OR- Lot #: Block #:-. Subdivision;
f rn i«f'J
Type of work:
Check one: Rl New Construction 0 Remodel* 0 Addition* 0 Basement Finish*
*Check all that apply: P Framing Z Mechanical prPlumbiilg 0 Electrical
NOTE: Any sub -contractors Involved will need to submit thei own signed appkation.
*Description of work:
*Total cost of project- materials and labor: $A010-N6TUsed to calculate permit fees)
Building Total: 2,3bU sq. ft. Main:) )!47 sq. ft. Basement: El Finished 0 Unfinished i`t{i sq. ft.
Garage 1100 sq, ft. Additional Floors: 11313 sq. It.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenalty
is currectand I swearthatany inforination which may hemafterbe given by mein'.
shall be truthful and coma. .I agree to complywith all City regulations and State Ir
City to enter upon the above-mentioned. property. for inspections purposes. NOTE:
International Code in cases onny fake statement or misrepresentation offset in III
started within 180 days. Perri Rvoid ifwork stops for 180 days.
Applicant's: Name
plication and hereby authorized representatives ofthe
no approval issuedunder the provisions ufthe 2012
permit or approval was based. Permitvoidifnot
Date:
In;pections must be called in before 8 AM on the day the. inspection is requested. Inspection requests called inafter8 AM will be scheduled for the next business day.
Inspection Hotline (208)372.2344 www.rexburg.org Permit Teclenkirm—(288)372.2341 Revised March, 2016
CITY OF Building Safety Department
xexau
REXBURG City of Rexburg
ey 35 North 1st East
Amerim's Faddl Community 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 atwww.ibol.idaho.gov/cont1tm)
Cp Currently State licensed pursuant to Title 54 Idaho Code, Chapters:
3 Architects,
10 Electrical Contractors/journeyman,
12 Engineers/Surveyors,
39 Public Works Contractors (exempt from fee only registration. required),
2-6 Plumbing/Plumbers,
¢a Public Works Construction Management Licensing Act (exempt from fee only registration required), or
LO Installation of heating, ventilation and air conditioning systems
Employeeor 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 wonting 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 hereby certify that the above information is true and correct to the best of my knowledge.
Si nature Date
Iy1.�a:5st c�Z..�Z.
Print Name
Inspecdon Hotline—(208)372.2344 w .rezburg.org Permit Technirlan-(208)372,2341 Revised March, 2016
CITY OF
REXBURG
y
Amedto i Fnmfly Conmmrrity
Affidavit of Legal Interest
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
State of Idaho
County of Madison
I, Alfa clot vy, gG 0, dwsinz- 2a! _
Name Address
t2¢.xb(A V5 ,
City
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
lotatko
State
A. That I am the record owner of the property described on the attached, and I grant my permission to:
Kcwtc 4( ner ¢tots e Sz► S. �W lcw ,rYe &I. . z"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 to day of U (rf U h le- C , 20—.o—
�P ��
Signature
Subscribed and sworn to before me the day and year first above written.
DREWTHURMAN
NOTARY PUBLIC
STATE OF IDAHO
InspecHon Hotline - (208) 372.2344
Public of Idaho
Residing at: /Bladt/ , _
My commission expires: MYCOMMISSION EXPIRES:
v vwxexburg.org Permit Technician -(208)372.2341 Revised Mamh, 2016
CITY OF
REXBURG
<a
Amencak rwmily Conununhy
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
utilitylines. 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. .
Sigma ure
Printed Name
Date
Inspection Hotline -(208)372.2344 w rexhurg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
cn,
Aitinfo'a Family Community
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho $3440
For Office Use
Permit Number. Permit Type: D New D Remodel D Addition 0 Basement Finish'
Fees Paid: D Yes ❑ No
1, Property Owner
Name: kaL:-tkl)ef V,OrvtPC
Address: O5 S. ¢jioW 1 Nie S •2�GCty. Re2tbul ,� State:. I c1 Zip Code: 233 (ytJ
Phone &Type 06'.51c-11:1(, IXOffice DMobile Email: 0.1'toCz7tKatr-t-chnCrinarr�¢.S.evr>,
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)
D No:.I am a contractor working for the homeowner O No: This propertyis a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-contraceors Involvedwill need to submit theirown signed applications.
2. Mechanical rnnh,n,tnr
Name:— V I I I LQ pRegistr tion #: Exp.: _
Address: city:_ %%y gy State: ib ZipCode.>?J?j1f�f2.
Phone&Type:: C,J- .- 2i TMOffice,pl.Mobile Email;.
Contact/Rep. Name: S(Arh4- aS mt w& e Phone: .Email:. /
Mechanical Contractor Authorized Signature; SUS a4iU(,W JPv1 .Date:
3. Project Description
Address: -OR-. Lot#::_Block#:_Subdivision:
Check one: 0 Single-family Residence 0 Multi -family Residence D Commercial
Check one: 0. New Construction* 0 Remodel 0. Addition D 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 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 0 1,501-2,500 Sq. Ft = $19S 0 2,501-3,50O Sq. Ft. = $260 0 3;501-4,500 Sq. Ft: = $32S
0 Over 4,500 Sq. Ft: = $325+(65.x It of additional 1,000 Sq. Ft. (or portion thereof)) $
New Multi -Family Residential: 0 Duplex= $260 0 Three or more units= $((130 x# of buildings)+(65 x # of units))$_
New work on any other residence and Detached Shops: =: (65+ (10 x # of HVAC fixtures)):
Miscellaneous: 0 Gras Pressure= $6S D Furnace or A/C = $65 ❑ Water Heater = $65 D Requested Inspection= $65
0 Gas Line =$65 0 Fireplace/Solid Fuel Burning Unit= $65 D Technical Service= $65/hour
0 Plan Check a.10% of Contracted Amount
APPLICANT'SSIGNATURE,CERTIPICATIONANDAUTHORIZATiON: Underpenalty ofperjury, I hereby artifythatI Have read this application and state that the information herein
Is correct and I stveatthat any information which mayhereafte be given by me in hearings before the Planning and Zoning Commission or the GYtyCounnl forthe Cityofgexburg
shall behuthful and correct. I agree to comply with all City regulations and State laws relatingto the subject matter ofthlsapplcation 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 ofthe 2012
International Code in cases starry false statement or misrepresentation offset in the application or on the plans on which the permit or approval was based. Perm tvoldifnot
started within 180 days. Permit void if mrkstopvN, Sys.
Applicant's Name (print): % 4r�' v' � :Signature:..` 1?vOMLs .DFTW_" Date
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called In after AM will be scheduled for the next business day.
Inspection Hotline -(208)3722344 wwwrexbmg.mg Permit Technician -(208)372.2341 Revised March,2016
p561Y tAC
Building Safety Department fi ' -
° REXBuRG
35 N V, E., Rexburg, Id 83440 City of Rexburg na, ......
Phone (2081359-3020 I Hotline — (208)372-23441 Fax -. (208)359-3022 A ttnnV unit e+A.. ,q
i
OWNEWS NAME
PROPERTY ADDRESS Permit#
OWNER'S CONTACT PHONE
OWNER'S EMAIL ADDRESS
-Requrredll! mechanical 1
4 1j Mechanical ontractor's Name ---Business Name PE�
Address
t
City. �i�'�•3 State W/' Zip
N'
CCU Phone --,i 1 161'I S Business Phone 7 IS- CJ.L.-/
Pa,. �ES— 73 7 7—Email Ls—tF't+ OC!'Gdl2 e- &';V '.
t
(COMMERCIAL/INDUSTRIAL) Total cost of mechanical system (Contracted Amount) $
(brdiidrr the cost of malenals installed mmdlerr oft/beperrh npp#iig i(. The jeer listed igidertbis h4wtiaa type shall appy, to my and alLmrhmiral
muinQalism utas �0sg6enliy eientioaed e/nwbere on 1hisfonv)
❑ Up to: $10,000 (ental cost of system x 0.02) + 60 -$
❑ Between $10,001- $100,000 ( (total cost of sysrem —1 0 0, 00) x0.01) + $260
! ❑ Over $100,001 ( (total cost of syrstcm —100 000) x 0.005) + $1,160_
3 RESIDENTIAL I
Nets. SinglePaoillyDweBwg, including all buildings with miring being constructed on eacipropexty (Based on l ving apace,
i see deiWoon,below)
❑ Up to 1;500 sq ft -:$130 ❑ 1,501 to 2,500 sq ft.- $195'
❑ 2,501 m 5,500 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 additiomtl 1.000 sq ft or Portion thereof)).
Nem.•Muld PamilpDwelling Xwomcton Odw
❑ Duplex Apartment $260
it Three or more multi -fancily units: $130 per building plus $65 per unit: (57 30 x:# of buildings) + 465 x # of u` iu)
0 Existing Residence, Modular, Manufactured or Mobile Hames and Detached Shop: $65 fee plus $10. per
*"HVAC equipment being installed up to the maximum of the corresponding sq. ft; of the building
(.565 + ($10 x # of fixmresj)
MISCELLANEOUS
t ❑ Plan Check: $65 per hour
t ❑ Technical Service: $65 per hour
r. ❑ Gas Line: $65
€ ❑ Water Heater Replacement $65
❑ Requested Inspection: $65
❑ Fireplace/Solid Fuel. Burning Appliance: $65 per inspection
E *Living Space space within a dwelling unit intended for human habitation which may reasonably be utili2ed for sleeping; eating, cooling,
7 -q'7
, nshiug, recce t .0 and sanitation purposes. An unfinished basement is considered part of the living space,
i
"Exam les of HVAC L:quipmens-fumace replacement, solar, water heater, etc.
J �
Signatur f Licensed Contractor License number dace Date
�;o gFXnUgoro C I TY OF Building Safety Department
Da REXBURG City of Rexburg
f 35 North 1st East
Atnrrlm4fiunhyCeummniry Rexburg, Idaho 83440
BUILDINGAPPLICATION
Electrical
For Office Use
Permit Number: a. Permit Type: ❑New ❑Remodel DAddition❑Basement Finish'
Fees Paid: ❑ Yes ❑ No
1. Property Owner
Name; I n ri c i n er- b rm-L¢ S
Address: $ S �I �✓S-t7. S City: R e-:bu rr, State: 1. CA Zip Code: E) - 4qO
D
Phone &Type; 2043.62q - 2 II b L5�0� Ice O Mobile Email; ct..f1'u�? ka.r-i-chi�.e.tr hw+2�s . ung
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 (Ship to #3 and complete the Homeowner's Exemption. page)
❑ No: I am a contractor working for the homeowner ❑:No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2. Electrical Contractor
Name: N A.:t-itJCA I G et l l u. n Registration #: 019-1" . Exp.:
Address: 2Q RoX 2- 52 City: K I cbcj State: 11) Zip Code: i32,L4 4 p
Phone& Type: (20'0 S 9 3 ❑Office El Mobile Email: n tiiluP>Sf.InG�C�tmrtiil �e�tn
Contact/Rep. Name: C'tn.rn. as a f0'we Phone:. Email;
Electrical Contractor Authorized Signature: : SR -e- a+tAC,Vtzxc2 -E< " Date:
3. Project Description
Address: -OR- Lot#:_Block#':_Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition D Basement Finish
Description of work:.
New Commercial: Work: Contracted amount: $ Calculated Fee (See Below): $
❑ Up to $10,000 (total costof system x.02) + $60 ❑ $10,0014100,000 = ((total cost of system -10;000) x.01) + $260
❑ Over $100,001 ((total cost of system -100,000) x,005) + $1,160
New Single -Family Residential Work;;. Sq. Ft.
❑ Up: to 1,500 Sq.Ft:= $130 ❑ 1,501-2,500 Sq. Ft. = $195 ❑ 2;501-3,500Sq. Ft. = $260 ❑ 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: ❑ Duplex= $260 El 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: O Small Works (work costing less than $200 with no change in service connections)=$10(needs no inspection.
❑ Central Heating/Cooling Systems= $65 ❑ Spas, Hot Tubs, and Swimming Pools= $65 ❑ Requested Inspection= $65
❑ Pumps -Water, Irrigation, Sewage (per motor) = ❑ $65 up to 25HP ❑ $95 26- 200HP ❑ $130 over 2OOHP
❑ Irrigation Machine= $65 for center pivot+ $10 per tower of drive motor $ ❑ Technical Service= $65/hour
El Temporary Amusement= $65 + $10 per ride, concession, or. generator $ ❑ Plan Check =10% of Contracted Amount
❑ Temporary Construction Services ONLY= $65 200 amp or less. One location for less than 1 ear.
APPLICANT'S SIGNATURE,CERTIFICATION AND AUTHORIZATION: Under penalty ofperjary, I hereby certify that I have read this application and state that the Information herein
is correct and I swear that any Information which may bereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall betrunful and correct: lagree to comply with all City regulations and State laws relating to the subjectmatterof 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 permiton approval issued under the provisions ofthe 2012
International Code in cases of.Uy false statement or misrepresentation of (actin the application or onthe plans on which the permit or approval was based. Permitvoidifnot
startedwithm190days. Permit void ifworit SkV%IlMays.
Applicants Name (print): 7'— u Signature: �ircA..a7( �' -3- Date
Inspections mustbe called in before AM on the day the inspection is requested. Inspection i equests called in after 8 AM wdl be scheduled for the next business day.
Inspection Hotline—(208)372.2344 wwwrexburg.org Permit Technician—(208)372.2341 Revised March,2016
L)UIIUIIIU QU11=1y wMIJG11111CI11 ° •"•'t, stir u
City of Rexburg e!
33 N. 1�� 11., Rexburg, Id 83440 , REXBURG
Phone -• (208)359-3020 / Hotline - (208)372-2399 / FAX - (208)359-302 to,ala, 6.0'r-1 ,,.,,q.
OWNER'S NAME....
PROPERTY ADDRESS Permit#
SUBDIVISION
PHASE - LOT - BLOCK
—
I Electrical
( Coll
Fnx
Total
ark' an&r11 rha dial kitalludonr
�❑ Up to $10,000 - (10101 cost ofystem x 0.02)+60=S
❑ Eetsveen$10,001-$100,000 ((total cost ofeysrem10,000)0.000)x0.01)+$260=5
❑ 0170r$100,001 ((total COSI ofsretens-7OOA00)x 0.005)+51,160=$
Small Worics (Contractors ONLY):: $10 fee for tvorlt not exceeding $200 in cost and not involving a change in
service connections. Does NOT require inspection.
RESIDENTIAL
vSinglepsarllyDwelllog,IarJudlogatlbvUdings ivlt6 svldagbelag coostmesadoe eacbpmperty.. (Maaed cn/lplagspsae,
fegaldoa below)
❑ Up to1,500sgft-5130 t31,501 to 2,500 sq ft -$195
❑ 2,501 to 3,500 sq ft -.$260 ❑ 3,501 to 4,50 sq ft - $325
o Over 4,500 sq ft $325 plus $65 for each additional 1,000 sq ft. or pordon thereof ($325 +-(S65 x # of nelditional
1000 sq, ft.. car portion therenfl),
: Aru1dFsaa4rDwelftag (Coaaaerars 0d1)
a Duplex Apartment $260
❑ Three or more mulu-fanuly units: $130 per building plus $65.per unha 130x•1 of badding4+(965 x At nfun,1
o Existing Residence, Modulur,ManuiactumdofMobile Homes, send Deached Shop: $65 fee plus $10 per.
branch circuit, up to the ma%imum of the corresponding sq. ft. of the building (565 •t (St0 ie # branch ai u
o Ccnnad Heating/Cooling Systemst 565 When NOT part of new residential or HVAEgermit with noaddidonsd .
Wiring
❑ Spas, Hot Tubs, and Swimming Pools: $65 fee for each trip to inspect
as-werar, Iclgadoa, so -go (CA Ch nearar)
o $65 up to 251 -IP oS95-26 to200HP o$130ovcr200HP
❑ Temporary Construction Services ONLY: 200 amp or less, one location (for n period not to exceed l year) -565
o Temporary Amusement; §65 fee plus $10per ride, concession or generator
❑ Irrigation Machine: $65 for center pivot plus 0 per tower of drive motor
a Toohnlcal Services $65 per hour
❑ Plan Checht $65 per hour
❑ Requested Inspection: $65
,IS Space -space within A dwelling unit intended for human habitation Which may reasonably ha .62cal for sleeping, "dog, cooling,
ng, wusiJng, nerend0n, and ganl/tntlo�n putpoacs. Anunftnishcdbisemcariseansideredpgtttofihe5vingspacc.
�,.y _ :'=-✓ of I�jO ;� L.
SignafWnf deensed Contractor License temberS expexp. tl. tete llarc
t 8
CITY x OF Building Safety Department
1 E
V XBURG City of Rexburg
t
ro 35 North 1st East
America's Family Community Rexburg, Idaho 83440
BUILDING APPLICATION
Plumbing
For Office Use
PermitNumber: Perm(tType: ❑New ❑Remodel.❑Addition ❑Basement Finish`
Fees Paid: O Yes '❑ No
1. Property per
Name:..kGtr76011&i hornvs
Address:5eg'lCity: PeAbi.tyn State: 1ZipCode: e3HHO
Phone&Type: 20Pi,IS19 -z 1110 lStOffice0Mobile Email: .lA('l'at4%?kar%c(nn21-%e:�-„� c utrn.
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you homeowner doing work on your own home? ❑Yes (Skip to #3 and complete the Homeowner's Exemption page)
13 No: Iam a contractor working for the homeowner O No; This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/subcontractors involved will need to submit their own signed applications.
2. Plumbing Contractor
Name: prod Registration#; 'LB-G-�I51 Exp.:
Address: 3gkoe, C.Swrtnt4'.516tz iGi,'`*( City: hmrn� Stat Zip Code; `a3ya6
Phone&Type:. 2: pJ-S35 13fTP ❑OffrceM-Mobile Email: {)Ole 4,oi-p1+�1'�'l�in t.r� hoo..,
Contact/Rep. Name;. 5(Awy- EIS (to"e- Phone; Email: v
Plumbing Contractor Authorized Signature: Se"e' 6At4+U.e1^.:,�,,1 leo Date:...
3. Project Description Water Meter Quantity: Water Meter Size:.
Address: -OR- Lot#: Block #:::_Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one; ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work: .
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,000 = ((total cost of system -10,000) x.01) + $260
❑ Over $100,001.=.((totalcost of system -100,000)x.005)+$1,160
New Single -Family Residential Work:. Sq. Ft.
❑ Up to 1,500 Sq.'Ft. = $130 ❑ 1,501-2;500 Sq.Ft. = $195 ❑ 2,501-3,500 Sq. Ft. = $260 ❑ 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: 0 Duplex= $260 ❑ Three or more 'units= $((130 x # of buildings)+(65 x # of units))$_
❑ Gray Water Systems= $130 ❑ Lawn :Sprinklers/Backflow.device= $65 ❑ Multipurpose Fire Sprinkler:& Domestic Water
Supply System= $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: ❑ Sewer Line = $65 ❑ Water Line =$65 ❑ Sewer and Water Line= $65 ORequested inspection =:$65
❑ Sewer Turnaround (septic to city) = $65 ❑ Hydronic Heating= $65 + ($10 x# of manifolds/zones)
❑ Technical Service= $65/hour❑ Plan Check =10% of Contracted Amount
citytn
NOTE:
have read this application and state that the information herein
Zoning Commission or the Oty Council for the Cityofaezburg
International Code in cases of any false statement or misrepresentation of fact in the application or the plans on which the permit or approval was based. Permit void hoot
started within 180 days. Permit vmdif Ick stops YBQ��.
Applicant's Name (print): ems' Signature: �O4A,s b ST-,& , .Date: -
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after AM will he scheduled for the next business, day,
Inspection Hotline (208)372.2344 wwwmburg.org Permit Technician -(208)372.2341 Revised March,2016
Building Safety Depadment
35 N. In R, Rexburg, Id 03440 City of Rexburg
OWNEWS NAME _
PROPERTY ADDRESS
Permit#
Watet Metet Quantity: *#******"****Watef Meter Size:
quired f9
Plumbing
ci ry ov
REXBURG
...... C, .-. .
Am:d1.*R' ay CbninmOy
Plumbing Contractot's Name 1�C—'\ Business Name 1�o�eSY,U�- Dlombsnk
Address SW'F E SonnosAv, 2ood'tl City_A4m o State aotann Zip4Z�lol„
Call Phone (2oS) G'3.5-1866 BusluessPhone ( )
Fax( 'Iloxnm CAM
(COMMERCIAL/INDUSTRIAL) Total cost ofplumbiug system (Contmeted Amount) $
(fnr/ndettbe rou (j),ntennbint/oiled ngmdleu of/be fnitynrfplyG:g i/. The fru lidednndn•yblriutprclion y)e rbnll appy to my curl allylmnbl:tg instelladont
col r0er)17m/lymentioned elfnubenae Akf rw).
❑ UP to $10,000 (total cost of system x 0.02) + 60 = $
❑ Between$10,001-$100,000((totalcostofaystem-10,000)x0.01)+$260=$
❑ Over $100,001 ( (total cost of system —100.000) x 0.005) + $1,160 = $
RESIDENTIAL
Nenv Sfngle Famit:Dn eIDng, incAtdinya!lbuildineos ndtb ndtingbeing constrvctedan esNtptoperOs (•Based onhWng space,
sae definition below)
❑ Up to 1,500 sq ft - $130 ❑ 1,501 to 2,500 sq ft - $195
❑ 2,501 to 3,500 sq it - $260 ❑ 3,501 to 4,500 sq ft - $325
❑ Over 4,500 sq R $325 plus $65 for each additional 1,000 sq ft. or porilon thereof ($325 + ($65 x # of additional
1.000 sq. ft. ornordon thereo(1),
New., hfulrf-Fsmlly.btrelGnp (Contractors Ont
❑ Duplex Apartment $260
❑ Three or more multi -family, units: $130 per building plus $65 per unit: (8130 x # of building4 + 065 x # of milts)
❑ Existing Residence, and Detached Shop: $65 fee plus $10 per fixture up to die maximum of the corresponding
sq. ib of the building (865 + (810 x;4 of faxmrrsu,
❑ Gtay WAtet Systems: $130
❑ Lawn SpAtildets/Saolcilow Device! 865
❑ Modular, Manufactured of Mobile Homes: $65 for sewer and water stub connections
❑ Multipurpose Fire Sprinlder and Domestic Water Supply System:$65fee or$4 per 6pdnitlet head, whichever
Is greater
Server & wAtet
❑ $38 Sewer Line ❑$38 Water Line ❑$65 Sewer & Water- if inspected at the same time
❑ $65 Sewer turnaround under house (change from septic to city)
MISCELLANEOUS
❑ Plao Cheo1v $65 parhom
❑ Technical Service: $65 per hour
❑ Gas Linet$65
❑ Water heater Replacement: $65
❑ Requested Inspection: $65
❑ I{ydtotde Heating:$65+($iOx#ofmmnlds/zones)
*Living Space —space within a dwelling unit Intended for human habitation which may reasonably be udhed for sleeping, eating, cooking,
bnthingy stiipg,tecreftaon, and sanitation putposes. An unfinished basement is considered part of the living space.
License number &
CITY o r Building Safety Department
U REIXBURG City of Rexburg
nv 35 North let East
Axrenwe FanJfy Connnmefg
Rexburg, Idaho 83440
Subcontractor List
Excavation & Earthwork: 1- ( P (e 61 17, C 6 V a " hr7 i Yl C,
Concrete: R (Af K lGtnd f,vylCV-e j-1? i"C
Masonry: 9W i-14V-tc[ Ski Q CU—n h a C 11 V, n 1 0 C.
Roofing; RM G bve- s I- COv-OeA-Ovt' rM
Insulation: (A G 1 n S u( (A -t-,:
Drywall: �) CIr'y w01 1 1
Painting: C)¢-VlQr\ cte.sj t) I`nt
Floor Coverings "f Wy i- Cc4-e ".Vicl L -t -C .:
Plumbing: 4-M e-5 k a't_ ,Y? i "f m b l h q
Heating: ^' 1 'A F Ni 0�2rn
Electrical: Ig U h .lair ci e�
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists: _
Siding/Exterior Trim:
Other:
Inspection Hotline 1208]3]2.2344 rajW.rextiurg.org Permit Technician C208)3Y2.2341 Revised Marth,2016