HomeMy WebLinkAboutAPPLICATION - 17-00443 - 234 S 3rd E - Remodel SFR to DuplexCITY OF
REXBURG
rti
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
SINGLE FAMILY RESIDENTIAL REMODEL APPLICATION CHECKLIST
The following items should be completed before you submit your building permit application.
*Reasonable accommodations will be made upon request.
Submit the Following Documents:
❑ 2 sets of building plans drawn to scale
❑ Include the following as applicable: Floor Plan, Sectional Views, Mechanical Layout Stair Details, and any details
required to illustrate special construction.
❑ Digital Plans (PDF Format- can be submitted by USB, CD, or Dropbox)
❑ **Copies of any Contractors' State License if not on file already.
Complete the Following Forms:
❑ Permit Policies Acknowledgment signed.
❑ Building Permit Application signed by a registered General Contractor.
❑ Mechanical Permit Application signed by a registered Mechanical Contractor.
❑ Electrical Permit Application signed by a registered Electrical Contractor.
❑ Plumbing Permit Application signed by a registered Plumbing Contractor.
❑ Subcontractor list completed.
❑ Homeowner's Exemption signed, if Homeowner is doing work on their own home.
❑ Affidavit of Legal Interest signed by owner, if applicant is not working directly with owner.
❑ Notifications Distribution List.
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 http:llrexburg.org/12ages/development-code.
Inspection Hotline -(208)372.2344 v .rexburg.org Permit Technician -(208)372.2341 Revised 10/2016
C IT Y OF
REXBURG
Aai mra's Family (nnununity
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
initial: Official may remove the red tag. If the red tag is removed by anyone but a City Official, citations may be
issued.
No building 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.
mitrals
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.
J 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
Im ials put up, the inspector may require the sheetrock to 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. These documents must be signed by the appropriate authorities from
the City of Rexburg. Any approvals can be verified by calling (208) 372-2341.
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.
itials
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.
�als
Applicant's Name (print): �/ f Signature: Date:
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.iexbLirg.org Permit Technician—(208)372.2341 Revised 10/2016
CITY OF
REXBURG
OV
America's Family Community
BUILDING PERMIT FORM 1�2
"da ud 10/2016
BUILDING APPLICATION
Single Family Residence Remodel
Building Safety Department
City of Rexburg
35 North 111, East
Rexburg, Idaho 83440
For Office Use
Permit Number: Zoning: Application Fee Paid: ❑ $100
1. Proper �vIIer
Name: ` 0IQ.Ke_. Dr Gt%7'�l S
Address: 2 3`l er` 3 = Eos City: State: I D Zip Code:
Phone: 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?
AB'Ye-s (Skip to #4 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
2. Applicant
Name: Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name:
3. General Contractor
Name: 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 timeyou 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 DgsVio S, 1 Li
Address: LL ��
Project Description: fLeAco &at.,L� 4L4gk&p
• Estimated Total Cost: $Ui 6W o
• Check All Included in Scope of Work:
❑ Mechanical Work Cost: $ ❑ Electrical Work Cost: $ ❑ Plumbing Work Cost: $
Note: Any contractors involved will need to fill out their respective application.
• Fireplace(s) Being Installed? ❑ Yeso
Building Permit feesfor remodels are charge based on cost. The application fee applies toward the fee total. For details on how fees are
calculated, contact the Building Department There will also be a plan review fee totaling 1096 ofthe building permit fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the Information herein
is correct and I swear that any Information which may hereafter be given by me in bearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correct I agree to comply with all City regulations and State laws 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. Permitvoidifnot
started within 180 days. Permit void ifwork stops for 180 days. rt
Applicant's Name (print` t�'Jw k (�r S Signature( C^sY.fifi� Date: 7 3�
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
Amcrica's ramify Community
BUILDING PERMIT FORM 111
..M 10/2016
BUILDING APPLICATION
Remodel SFR Mechanical
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Mechanical Fee Paid
1. Property Omer
Name: IoI IGS W } ((c S
Address: City: State: Zip Code:
Phone: Email: _
Under/daho Building Code, a homeowner isallowed 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)
❑ No, I am working with the homeowner
2. Mechanical Contractor
Business: State License #: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
Mechanical Contractor Authorized Signature: Date:
A copy ofyour state registration/license is required to be on file. If this is the first timeyou 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.
3. Project Description
Address:
Description of work:
❑ Remodel Cost: $
• Feesfor remodels are charge by cost:
o First $10,000 = 2% + $60. From $10,000 to $100,000 = 1% + $260. Above $100,000 =.5% +$1,160. i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 196 of the remaining $5,000 = $260 + $50 = $310 total fee
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that l have read this application and state that the information
herein is correct and I swear that any information which may hereafter be given by me In hearings before the Planning and Zoning Commission or the City Council for the City of
Rexburg shall be truthful and correct I agree to comply with all City regulations and State laws relating to the subject matter ofthis 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 underthe
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 If work stops for 180 days.
Applicant's Name (print):
Signature:
Date:
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.rexburgurg Permit Technician - (208) 372.2341
CITY OF
REXBURG
tar
Amerim's Family Community
BUILDING PERMIT FORM 121
uvd,md 1012016
BUILDING APPLICATION
Remodel 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 ygyner
Name: �17� �C.il C S
Address: City: State: Zip Code:
Phone: 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 #3 and complete the Homeowner's Exemption)
❑ No, 1 am working with the homeowner
2. Electrical Contractor
Business: State License #: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
Electrical Contractor Authorized Signature: Date:
A copy ofyour 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.
3. Project Description Ky
Address: { c� 1 Swt Le ti Qtr—^�� I j�GiilG`
Description of work:
❑ Remodel Cost: $
• Fees for remodels are charge by cost.-
0
ost:0 First $10,000 = 295 + $60. From $10,000 to $100,000 = 196 + $260. Above $100,000 =.5% +$1,160. i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = 5 IO total f(�
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that l have read this application and state that he information herein
is correct and I 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 Iagree 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 if work stops for 180 days.
Applicant's Name (print):
Date:
Inspections must be called in before a 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
�v
Ameriwk ramify Community
BUILDING PERMIT FORM 131
a',aoe 1012016
BUILDING APPLICATION
Remodel SFR Plumbing
Building Safety Department
City of Rexburg
35 North 1Bt East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Plumbing Fee Paid
1. Property Owner
Name:
Address: City: State: Zip Code:
Phone: 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 #3 and complete the Homeowner's Exemption)
❑ No, l am working with the homeowner
2. Plumbing Contractor
Business: State License #: Exp.:
Address: City: State: Zip Code:
Phone: Email: _
Contact/Rep. Name: Phone: Email:
Plumbing Contractor Authorized Signature: Date:
-
A copy ofyour 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.
3. Project Description
Address:
Description of work:P, P
O
El Remodel Cost: $ t
• Fees for remodels are charge by cost:
o First $10,000=296+$60. From$IO,000 to$100,000=19'o+$260. Above $100,000 =.5% +$1,160. i.e. Work costing
$15,000 will be charged $60 for the first $10,000 and 191, of the remaining $5,000 = $60 + $50 = $110 total fae
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that he information herein
is correct and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correct I agree to comply with all City regulations and State laws 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. Permitvoldifnot
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print):
Signature:
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
^ REXIiLTRG
04
America's Family Community
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete:
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Floor Coverings:
Plumbing:
Heating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists: _
Siding/Exterior Trim:
Other:
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016
CITY OF
REXBURG
America's Rim Iv 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 of your State
registration number or your exemption from the State registration. Please fill out this form showing your
exemption and send 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.
Za 17
Sigt ure Date i
Print Name
Permit Technician -(208)372.2341 w .rexburg.org Revised 10/2016
CITY OF
REXBURG
r1.r
Amerlm4 Family Community
Affidavit of Legal Interest
State of Idaho
County of Madison
1,
Name
City
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
Address
State
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
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
Signature
20
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing at:
My commission expires:
Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised 10, 2016
C I T Y OF Building Safety Department
REXBURG City of Rexburg
CW 35 North 1st East
Arneriw' Family Community
Rexburg, Idaho 83440
DISTRIBUTION LIST
Please provide the names and emails of anyone who should begetting automated updates for this project:
Review Notes
Name:
Email:
Name:
Email:
Name:
Email:
Name:
Email:
Name:
Email:
Inspection Tickets
Name:
Email:
Name:
Email:
Name:
Email:
Name:
Email:
Name:
Email:
I aspection Hotime- (208) 372.2344 www.rexbtirg.org Perm it Techniolan-(208)372.2:341 Revised 10/2016