HomeMy WebLinkAboutAPPLICATION - 17-00460 - 814 S 2275 W - Kartchner SFRCITY OF
REXBURG
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 ermit.
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
Initi s tag. If the red tag is removed by anyone but a City Official, citations may be issued.
No buildin may be occupied without receiving a signed Certificate of Occupancy.
o If a building is occupied without receiving a signed Certificate of Occupancy, citations may be issued and the occupants
may be evicted.
Initials
A Certificate of Occupancy will not be issued without digital copies of the As -Built Plans.
It is the Applicant's responsibility to turn in digital copies of the As -Built Plans when the project is completed. No
Certificate of Occupancy will be issued without these plans.
Initials
Scheduling inspections is the responsibility of the applicant and their contractor. Inspections need to be called into
the hotline and trot 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
�j 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
Initials 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.
Fz_i_� o The above policies will be enforced to all, regardless if this information is passed on to them or not.
maw
Applicants Name (print): 71 Cl V6P1512/\_ Signature: — 4va"' Date: 8/—
Inspections mus[ 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 Revised 2/2017
CITY OF
REXBURG
Civ
America's Family Community
BUILDING PERMIT FORM100
uPEeW m/2016
BUILDING PERMIT APPLICATION
New Single Family Residence
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Zoning:
Application Fee Paid: O $500
1. Property Owner
Name: RY�eht��f �e
Address: ,1 C. yggpa e tiv,%WA
City:lY�State:�_ZipCode: 83NNJ
Phone: 5a'1- 21111
Email: 41Ayr @ -1r ng, hbng.��,�
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)
tT No, I am working with the homeowner
2. Applicant
\_ ,
Name: �M� ova C
Role: (Owner, Tenant, Contractor, etc.)
Address:
City: State: Zip Code:
Phone:
Email:
Contact/Rep. Name:
3. General Contractor
`- ,
Name: � )L, _ CS i 'U6y C
Registration #: Exp.:
Address:
City: State: Zip Code:
Phone:
Email:
Contact/Rep. Name:
Phone: Email:
General 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) 371-2341.
4. Project Description
Address: all 1 $ . 2 2 7 S W OR-
Lot #: -LBlock #: '9 Subdivision: SJ Mm ar aQ f
Project Description:
• Square Feet: Building Total: t'315' sq. ft.
• # of Water Meters: Water Meter Size:
o Main Floor: TbJ sq. ft.
• Fireplace(s) Being Installed? O Yesiff No
o Additional Floors: 1,-'I& sq. ft.
a Hydronic Heating Being Installed? 0 Yes No
o Basement:
Finished sq. ft.
Unfinished sq. ft.
Building Permitfeesfor new homes are charged based on square
o Garage "i AV 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:$ &'4.1 IV
a plan reviewfee totaling 1045 of the building permitfee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that I have read this application and state that the Information herein Iscorractand 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. 1 agree to comply with all City
regulations and State laws relating to the subject matter of this application and hereby author@ed 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 of any false statement or misrepresentation of fact In the appllcatlon or on the plans on
which the permit r approval was based. Permit void if not started within 180 days. Permit void Ifwork stops for 180 days.
T f
Applicant's Name (print): 1 Q`iQ FVe 1L(elp, Signature: T��'t- Date: g
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
CW-
America's Family community
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 Date
�I�
-I a ra- �Ve rljQ,
Printed Name
Inspection Hot] Ine - (208) 372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised 10/2016
QpC%OUgC
CITY OF
v�
° REXBURG
eti
An.k k Fumd)y Community
Excavation & Earthwork: 1 V
SUBCONTRACTOR LIST
Concrete: I)V (,Qatytal Co CAC**, � 0 1,
Roofing:
Insulation:
Drywall:
Painting:
Building Safety Department
City of Rexburg
35 North 1%t East
Rexburg, Idaho 83440
Floor Coverings: CG r; PYTt Q1 LeC7-
Plumbing:
Heating:
M
Special Construction
(Manufacturer or Supplier)
RoofTrusses: V 2Sr Goreco-j�%ov'.
Floor/Ceiling Joists: 19VY)(- West CoCW;)d' ; Nr,
Siding/Exterior Trim:
Other:
Inspection Hotline -(208)372.2344 wwwxexbur&org Permit Technician -(208)372.2341 Revised 10/2016
spexouep
fila �d CITY OF
a L REXBURG
Iraq, a sa Anudcidh lly Comandly
BUILDING PERMIT FORMZZD
Urd.udmtaasa
BUILDING APPLICATION
New SFR Electrical
Building Safety Department
City of Rexburg
35 North 151 East
Rexburg, Idaho 83440
For otnce use
PermltNuniber: - ;.pElectricalFee Paid
1. Property Ownm
Name; _�(�'�i'lrio-✓'"�Y /�4�
Address: see PI(dvickis City: State: Zip Code:
Phone: Email: _
Under Idaho Buildhen Code, a homeowner is allowed to do war* on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #3 and complete the Homeowner's Exemption)
0No, I am working with the homeowner
2. Electrical Contractor
Business:yrrtG"a/ >Ekrr rtZ eft. State License N: �IB�'8o Exp.:
Address: Y I&A City jR1 / I* C State: I Zip Code: _P3 �sC
Phone: Email: 4�.s���Sn/wrZOµfa.%.Capt✓/
Contact/Rep. 6 Plione: Email;
Blectrfcal CoiifracforAuthorizeil Slgnaturei Date:
A copy afyourslale registraticuotcense is require be ml file. f dsktheftrst thneyou have done work In the City of Rexburg, please provide
a photo ropy ofyoul• license, lfyoc are unsure VAN, license is on file, please check with tire Permit Technkian bycallhlg (200) 372-2341.
3. Project Description /
Address: 9P(S 1v'5' \%/ OR- Lot#:�Block#:t Subdivision: S,-iniY-,2r of
Description of work: 1' &.,. hart-..
❑ New SFR Construction: I H) S sq. ft.
I reesfornew construction are charged bysquarefootage: Up to 1,500sq.ft. =$130 +$65for each additional 1,000sq.f,or
portion thereof.
o Up to 1,500sq.f.-$130. Up to2,500sq.ft. = $195, Up 03,500sq.f.=$260. Up to 4,500sq.ft.=$325, etc. (i.e.a
Home with $675 sq, ft. tvlll be charged $325)
❑ Spits/Pools/Generators: 0 Yes R No
a Note thatspas/poots/geueatofs are not Included In squarefootage costs and will be charged $65 per Inspection.
APPIACANTS SIGNATURE, C811'I'IFICATION AND AUTHORIZATION: Under penalty oti erlury, I herebycertlfy that l brave read this application and abila that the Odornatlen lerelm
Is correct and I swear that any Information whkluallyhereaaer be given by Inc in hearings before the Planning and Zoning Coni nlsslon or the Cloy Council for the City of Rexburg
shall be IrulhhA and correct. I agree to comply with oil (:fly regulations and stitolaws relating to the subject uetierof thisappllcatiou and hereby authorized representatives oftle
city w enter upai the above•mon loved property far Inspections purposes. NOTE: Thabulldlmgomdal may revakoo permit uu approval issued under tiro provisions of the 2012
Intrtnnrunel Code In asses orally false statement or ndsrepresenlation of fad In thenppllcallon at no the pines on which the permit or approval was based. Penult volt iDet
started while 100 days. Perak Vold If workslopt for f UO days.
Applicant's Name(print):�CIY�oL e°t'05C,h Signature: T� �i{/�h Date: � Z
Inspections must be called in before 0 AM au the day lire Insyectlon is requested.I ispectlan requests culled In ager 0 A will be scheduled for the next business day.
fitpecllar Notice- (208) 372.2344 www.rexharg.org Pei AID Technician - (200) 372.2341
CITY OF
REXBURG
AnnMcai Family Coonnuady,
Building Safety Department
BUILDING PERMIT FORM 110 City of Rexburg
°'"°10'3016 35 North 1St East
BUILDING APPLICATION
New SFR Mechanical
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Mechanical Fee Paid
1. Propertywrier (�.�
Name: of- 1fv�t P' Y- 1 1 D*"
Address: S -eR RfGv I 04S 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)
"o, I am working with the homeowner
2. Mechanical Contractor I t U(�
Business: of to i. iryl State License #: 01 Z 5S' Z Exp.: S j/
Address: Mvi C- vic, ' City: Stat : 'Lip Code: 'P
Phone: 201, •- "2: - IR -2-1 Em ll: D tcf:0E M aael r dw
ContaWllep. Name: 1 Phone: - Email: +
Mechanical Contractor Authorized Signature:
Acopy ofyourstate reglslration/llcenseIs required toVen/tle.IfthisIst Jlrstthneyou/love done work Inthe City ofRexburg,please provide
a photocopy ofyour license, Ifyour are unsure ifyour license Is on file, please check with the Permit Technician by calling (200) 372.2341.
3. Project Description b
Address: o1 y 5. 2_;i- 5 V OR- Lot #: _ Block M _ Subdivision:
Description of work: Urt, t Hap(b-C
❑ SFR Construction: I $i 5� sq, ft.
• Feesfor new construction are charged bysquorefootage: Up to 1,500sq.f x: $130 + $65foreach additional 1,000 sq.f. or
portion thereof.
o Up tol,500sq.fk=$130. Upto2,500sq.ft=$195. Up 03,500sq.ft.=$260. Upto4,500sq.ft.=$325, etc. (i..e.a
home with 3,675 sq. f . wtll be charged $325)
❑ Number of Fireplaces: 0
• Note thatpreplaces are Hot Included in squarefootoge costs and will be charged $65 per Inspection,
❑ 1lydronic Heating: 0
• Note that hydronic h eathqi Is not included In square footage costs and will be charged and additional $65 + ($10 x # of
manifolds/zones)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that i have read this application and slate that the Information
bereln Is correct and 1 svear that any Information which may hereafter be given by caw In hearings before the Planning and Zoning Commledon or the City Council for the city of
Rexburg shall be truthful and correct. I agree to comply whh all City regulations and Slate laws telallug to the subject matter orthfs tapplintlon and hereby authorized
representatives ofthe City to enter upon the above•mentloned property for Inspectors purposes. NOTE: The building official may revoke a permit on approval Issued under the
provisions of the 2012 International Code In cases ofauy false statement or misrepresentation of fact In the application or on the plans on which the permit or approval was
based. Permit void lfnot started within 180 days. Permit void lfwork stops for 180 days.
Applicant's Name (print):Tarti �i��(ISoL Signature: 1- 7✓ Date: 711
Inspections must be called In before 8 AM on the day the lospecdon Is requested. Inspection requests called In after 8 AM will be scheduled for the next business day.
Inspection Ilotline- (208) 372.2344 www.rexburg.org Permit Technician -(208) 372.2341
CITY OP
REXBURG
rw
Anarlcal FcnnilyConununity
BUILDING PERMIT FORM 130
Ve1N61171016
BUILDING APPLICATION
New SFR Plumbing
Building Safety Departinent
City of Rexburg
35 North 1at East
Rexbtttg, Idaho 83440
For Office Use
Pel'niitNuurber; .13 PlumbingFee.Pald.
1. Property Owner
Name: KrA, 1 �om"-
Address: Stu �fe iJJ5 City: State: Zip Code;
Phone: Eutall:
Under Idaho Building Corte, a homeowner is allowed to do worn on their own home,
Are you a homeowner doing work on your own home?
D Yes (Sklp to #3 and complete the Homeowne's Exemption)
o,1 am working with the homeowner
2,PhuubingCAracto• // 7
Business: CO5 /Nr t�y^` GC State License #: PLS-C-�/s-/7xp•;
Address: 3Y,1A U4. Ae",--- 1 State! :1Zip Code: 0
Phone: 706 5.35- 13r06 Hmall: Ac%'S�o N2y E+tin �i�ocV. C-Cs^a
Contact/Rep. Name: aif o. -Phone: EmeH:
Plumbing ContractorAathiidzed signafare: Date: .3
Acopy ofyourstatereg0tntion/llceaseIsrequired to eonple.tfthlsts firsttlmeyouhavedoneworklitthe6TtyofRexburg,pleasopr•ovide
to photo copy ofyour license, lfyou are ann re (f your license is on file, please cheep with the Permit Techatclmr by callh(g (200) 372.2341.
3. Project Description
Address: Slit S 2 K YV OR- Lot #:_Block#:_Subdivision:
Description of work: IyW t rz"
13 New SPR Construction: I S15- sq. R,
+ Verisfor Deal constractlon are chargrodbysquarefolitage: Up to 1,500sel.ft. = $130 $6.5jitr each addithruial 1,000 sq, ft. direct floor
thereof
or Up to 1,500sq,ft.=$130. Up to 2,500sq.f.=$19.5. Up to 3,500sq.ft.=$260. Up to 4,500sq.ft.=$325, etc. (i.a(I
krone tvlth 3,675sq. f1. will be charged $325)
Cl Hyd onic (in -Roar) Heating: D Yes No
I Note that l(ydroNcheating Isnot Included lit squarefoolngecosts and will becharged $65+($10x1/ofman)folds/zones).
APPLICANT'S SIGNATURR, CRRTIPIr,AT1ON AND AUTIIORIZATIONI Under pallidly orperjury, I bereby certify unit I have read ads application and slate that the Information hurain
Ismrrectru d I swrarlbat any Infnrmallnn which mayhoren0erhe given by Inc In hearings before Ilia Planning and %ailing Commission or the citycouncil for the City of Roxbruff
shall he Inahfnl and maned. 1 agree to comply with all City regaMllons and stale love; relating to Ilio sobject uaaaerollhl, application mul herebynuthedseA ropreseuMllves of live
city to enter 1,11011 the above-menlloned prairmy for losperaon;purposes. NOTE: The bullillogofficial may mveha a permit nu approval issued under line la'ovfdous of the 201'2
Internal hand Code In cases of any falsestntamout or misrepresentation of fact In the nppllentlon or on the plans on whlch (Ito pergdtor approval was based. Permit Vold filter
stnlod wIthiu tf rl days. Perurit Vold IfwnrR slops for Me days.
Appllcant'sNnme(print)f 1 G� _Signature: �r'�``" 4' Dato:_e/7/�,7
Inspections most bucalled In before D AM on the day Chu Inspecllun Is requested. Inspection replesta called In alter CAM will Iso scheduled for the next business day.
Inspectimt ilotllno- (208) 372.2347 wsvw.mxhurgnrg Pennll Teelmialan- (200) 372,2341
C I TY OF
REXBURG
tnr
America's rnmil community
Affidavit of Legal Interest
State of Idaho
County of Madison
I,
Name Address
City U State
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
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. 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
v'�
day Zf!�!5uS+ 1-7
Signature
Subscribed and sworn to before me the day and year first above written.
KARIN V. ANGELL
Notary Public
State of Idaho
Inspection Hotline - (208) 372.2344
otary Public of Idaho (�
Residing at:�
My commission expires: --7"'31- �O
w .rexburg.org Permit Technician -(208)372.2341 Revised 10, 2016