HomeMy WebLinkAboutAPPLICATION - 17-00542 - 784 S 2275 W - New SFRCITY OF
REXBURG
America's 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 Rermit.
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
Initia 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.
Initi s
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.
Ini115
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
ay.
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
IK 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 begirt ONLY when you have received an official Certificate of Occupancy
from the Building Department.
I eo 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.
_lr 1 o The above policies will be enforced to all, regardless if this information is passed on to them or not.
Applicant's Name (print): �' �a talo Serer Signature: �FA- — 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 nextbusiness day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 2/2017
CITY OF
REXBURG
rn�
Amerhnus 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
GG'y?(- Eveq,"
Printed Name
Date
Inspection Hotline—(208)372.2344 w w.rexlurg.org Permit Technician—(2O8)372.2341 Revised 10/2016
CITY OF
REXBURG
Americus Family Community
BUILDING PERMIT FORM 100
Updated! 10/2016
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: ❑ $500
1. Property Oyvner
Name: jCarfGh kjvrry
Address: 'gS`('S.y NYS �1 At, LD1 City: 01,04lJ)f� State: I Zip Code:
—p
Phone: $a'I- 2 -)IV Email:�i"4(2@(GViLhr�.r%lorwq
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #4 and complete the Homeowner's Exemption)
qNo, I am working with the homeowner
2. Applicant
Name: CR Y* -.t_ 46 �� Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name:
3. General Contractor
Name: !�,nvvti c0 a0bbVC- Registration#: 1ti5� Exp.: j2/bl/1-7
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone:.. `-- Email:
General Contractor Authorized Signature: T
//(
� ` � Date: 11T-11:2
A copy ofyour state registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide
a photocopy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
4. Project Description
Address: -1845. 2,1.'15 W -OR- Lot#: (f Block#: 6 Subdivision: SJAA*1e(4je9-(
Project Description:
• Square Feet: Building Total: Z°M'O sq. ft. • # of Water Meters: -A-- Water Meter Size:
o Main Floor:'8�-sq. ft. 0 Fireplace(s) Being Installed? ❑ Yes 0 No
o Additional Floors: IYiXI sq. ft. 0 Hydronic Heating Being Installed? El Yes q No
o Basement:
Finished sq. ft. Building Permitfeesfor new homes are charged based on square
Unfinished sq. ft. footage and the City's estimated valuation. Fordetails on howfees
o Garage aV& sq.ft. are calculated, contact the Building Department There will also be
• Estimated Total Cost:$ - aplan reviewfea totaling 10% ofthe building permitfee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperlury, I hereby certify that I have read this application and stare 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 m comply with all City
regulations and State laws relating to the subject matter ofthls application and hereby authorized representatives ofthe City to enter upon the above-mentioned property for mapectionspurposes. NOTE: The
building oMcisl may revoke a permit on approval Issued under the provisions ofthe 2012 International Code In cases clear false statement or misrepresentation of fact in the application or on the plans on
which the permit or approval was based. Permit void ifnotstarted within 100 days. Permit vold if work stops for too days.
Applicant's Name (print):�� EVCY}fT Signature:! a_ ` �`�� 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.rexburg.org Permit Technician - (208) 372.2341
0
CITY OF
REXBURG
A nericnt Fondly Conunnniry
BUILDING PERMIT FORM 1Z0
U,4P 10120r6
BUILDING APPLICATION
New SFR Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
PermitNm»ber:__ - .0Electrical
Fee Paid
1. properly Owner
Name: sec e�eJ���S
Address: City: State: Zip Cade:
Phone: Email:
Under Idaho BuildbW Code, a homeowner Is allowed to do work car their own home,
Are you a homeowner doing work on your own home?
0 Yes (Skip to #3 and complete the Homeowners Exemption)
0 No, I ant working with the homeowner
2• Electrical Contractor ff
Business:�_lj; eoy EICr.Tf4z fft State License#: Exp.:
Address: city: 1 I rY r, State: rl'�, _ Zip Code: F33J/&
Phone: — — Email; ✓�md11. e�t'��Oµt 4%,eta s?
Contact/Rep. Name: a Phone: mail:
Electrical Conti5ctor4uthorized Signatiirei Date:
A copy ofyour state registration/license is require he on)ile, f lsisthe/irst timeyou have done worle in the City ofReidiurg, please provide
a photo copy ofyour license. Ifyou are unsure 1,� our license Is on file, please check with the Permit Technician by calling (200) 372.2341.
3. Project Description
Address: '1VAS • ad7� w -OR- Lot#: to Block#: 8 Subdivision: Suynrnjn(fie)C (—
Description of work: Nr Li eaa-M7IAT^v
0 New SPR Construction: �, W-0 sq. If.
tees fornew construction are charged bysquare footage.- Up to 1,500 Sift. = $130 +$65 for each additional 1,000 sq. ft. or
portion thereof.
o Up to 1,500sq.ft.=$130. Up 02,500sq.ft.=$195 Up to3,500sq.ft.=$260. Up to4,500sq.ft.=$325, etc .(i.e.a
iloone wlth 3,675 sq. ft. will be charged $325)
❑Spas/Pools/Generatm•s:0 Yes IV No
a Notethatspos/pools/generators are not Included insquarefootagecosts and will becharged $65per Inspection.
APPLICANTS SIG NATURIF, CCIVI'IFICATHIN AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I )live read this application and state that the Intel matlon herein
Is Carnet and I swear that any Information which mayhereaaer be given by Ina In hearings before the planning and Zoning Commission milia City Council for tlw Cltyof Rexburg
shall be truth Fiji and correct I agree to comply with all Guy regulations and State laws tainting to thasubjecl nedlevorthlsappllcatlou and belebyaalborized representatives of the
City ie enter upon the abuve-tncuttoncd properly for luspeclions purposes. NOTE: Tho bulidlog of ictal rely revokoo peanitou approval Issued under the provisions of the 2012
I chili tlmud Cade In cases ofany false statement or misreprosentatlon of fact In the appllcatlau oron tho plans on %vhlch the permit or approval %vas based. Permit void diad
started within 100 days. Permit void if veal kstops for 100 days.
Applicant's Name (print):I'Ck�e1r't Signatm•e:�J lfbf— Date: /S//7
Inspections mmsl be called lin before SAM on the day the Inspection Is I equesled. InspacUon requestscalled lin after 0 AM will be scheduled far the next business day.
Inspetlian llalllne- (208) 3722344 w%vnv.rexburg.org PennttTecludclan- (200) 372,2341
CITY OF
REXBURG
cw—
A2nedm5 Pam(ly Comm wniy
BUILDING PERMIT FORM 110
Upd24dl4/2016
BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North let East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Mechanical Fee Paid
1. Property Owner
Name: St C (Ct/I01.) 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, l am working with the homeowner
2. Mechanical Contractor
Business: &MAri RK,I. *wL4State License #: 017-5-5-7— Exp.: S }I $
Address: o City:�- state: y,ry Zip Code: 'Z,'
�'iZ
Phone: % -- Z Em il: 17 fb 4W 00 Mnet iAA G e
ContacVRep. Name: 4t� I Phone: - •L Email• 04-644 e( s( +
Mechanical Contractor Authorized Signature: Date: -
Acopyofyourstateregistration/license is required to be onhle. Ifth/sIs thilffirstilmeyou havedone workin the City of Rexburg, please provide
a photocopy ofyour license. Ifyou are unsure tfyour license Is on file, please check with the Permit Technklon by calling (208) 372-2341.
3. Project Description
Address: -l$ul S- aA-7S vJ -OR- Lot#: Block#: db Subdivision: 5JMy"et2L119ri
Description of work: NL,J Coa4i!Ld 'r
❑ SFRConstrtfction: 3 DL -W sq. R.
• Feesfor new construction arecharged bysquarefootage: Up to 1,500sq.ft=$130+$65foreoch additional 1,000 sq.ft. or
portion thereof.
o Up to 1,500 sq. ft =$130. Up to 2,500 sq. ft. =$195, Up to 3,500 sq. ft. = $260. Up to F 500 sq. ft. =$325, etc. (i.e. a
home with 3,675 sq. ft. will be charged $325)
❑ Number of Fireplaces: 0
• Notethatffreglaces are not included In squarefootage costs and will be charged $65 per Inspection.
ElI lydronic Heating: 5
• Note that hydronk heating is not Included In squarefootage costs and will be charged and additional $65+($IOx#of
manifolds/zones)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and state that the Information
herein Is correct and 1 swear that any Information which may hereafter be given by me In hearings before the Planning and Zoning Commission or the City Council for the City or
Rexburgsllallbetrutbfilandwrrect. i agree to comply with all City regulations and slate laws Ielating tothe subject matter orDirs'appikatlon and hereby authorized
I epresentatives of the City to enter upon the above-mentioned property for Inspections purposes, NOTE: The building official may revoke a permit on approval Issued under the
provisions of the 2012 International Code in uses of any falsesmtement or misrepresentatlon of fact in the application or on the plans on which the permit or approval was
based. Permit void if not started within180days. Permit void lfworkstops for 180 days.
Applica esName(print): IAf�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 [Iodine- (208) 372.2391 www.rexburgorg Permit Techniclan- (208) 372.2341
CITY oP
MBURG
cW
mraatnk enunyComnumtry
BUILDING PERMIT FORM 130
ups,uarcyrors
BUILDING APPLICATION
New SFR InIumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Perni)t Number; 10 plumbing Nee Patd
1, Property Owne • n
Name:
Address! City: State: Zip Code:
Phone: Emall:
Under Idaho Building Code, a homeowner is al/owed to do wof•h on their own home.
Are you a homeowner doing work on your own home?
❑ Yes (Skip to 93 and complete the Homeowner's Exemption)
❑ No, l am working with the homeowner
2. Pill mbing . Director /
Business: OIZ - /ti,6e' '` LZ- StateLicensell: P1—&.-C—Il5-1zxp.:
Addres'-"C Gin.' ; _ A'+"'"o_-1 state: Zip Zip Code; ii yC1
Phone: 7°E 5-35- /' U2) Email; %re�r5lc•'� 4rwE�^�' �S'Loc. ec -.
Contact/Rep. Name: ✓- e Phone: ECIA 1:
PhinibingConti'actorAutliot•Iz6dSigna[ure; to: 3
A copy ofyour state registration/license is required to he on f)le. If this is pest thneyou have done work hl the City of Rexburg, please provlflc
a photocopy ofyour license, ifyou are unsure Ifyourdlcense is are fila, please check with the Permit Tecluriclon by crinhig (200) 372.2341.
3.13roject Description
Address: �� l S • aa�S Y✓ OR- Lot Block 4: $Subdivision:
Description of work: LQ vi&C-o f.0 i u A - .I
17 New SFR Construction: BI -0 W sq. ft.
Fees for new construction are charged by.cquarie footage: Up to 1,500sq, ft. = $130 + $65 for each acklillonn11,000 sq, ft. or portion
thereof
o Up to 1,500sq,ft.=$130. Upta 2,500sq.f.=$195. Up to 3,500sq.ft,=$260. Up to4,500 sq.ft.=$325, etc. (It'.(I
home with 3,675 sq.R. will be charged$325)
❑ Hydronic (In -Boor) Healing: ❑ Yes M No
0 Note that hydivilic hearing is not Included In squorefootage costs and will be chaped$6.5+($10x ilofmanTolds/zones).
APPLICANT'S SIGNAODRe, CGRTIPICATION AND AUTHORIZATION: under peu:dtyofporlury, l berebycorlify that i have read tills application and state unit lbe Information here in
Is catract and I swear thntnny Informatan which may hereaAer be given by the in hearhigs beforu the Plaunlug and Zo ibiliCi n mission or Ihn City Coandl for Iho Clty of Roldairg
slmll be trutbad old carred. I agree to comply will, all city rcgalal Ions and State Imus relating to tum sableet molter or this application and hereby m0lrorixed ropresentatl ves of file
City to enter upon the nbove•mwdinned Praporty, far fimpallong Purposes. NOTg: The building official may revoke permit Mt approval Issaed under the provisions of tile 201
Internatlonal Cade lu cases efany raise statement or misrepresentation of fact In the application or on the plans on which ilia permitor approval was based. Permit void irto t
staved with n 1110 days. Permit void If work stops far Ino days.
Applicant's Name (prhlt)I �ar� G r3 _ Signature: �`LDate;
Inspecllons aatst be called In before n AM on the day Ino Inspection Is raptestod. inspection requests railed In after 0 AM will he schedrdcd for the next business day.
Inspedioo IIndian- (200)372.2344 www.rekbarg,ory, Pei wil Teehnlcimn-(200)372.2341
CITY OF
REXBURG
Aurerieat Family Comnum8y
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete: 1�V ck\ctYld C0(\CAr6AJ. , o 1,
Masonry:
u
Roofing: CJm C� � �5 Coypoyl5k�-,r,
Insulation:
Drywall: _
Painting: _
Floor Coverings: ce � Pe7v- o iee-A-
Plumbing:
Heating:
Electrical:
Q
Special Construction
(Manufacturer or Supplier)
Roof Trusses: Gororo-�.. ,
Floor/Ceiling Joists: I t IL West Co C
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 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, SGL— Irci L VehS��n gi S i S. `Jews J'7 l f�^^a S k Z� I
Name Address
KZA40V 05 /0
City UState
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
A. That 1 am the record owner of the property described on the attached, and 1 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 + (0(')—
day of ��V5'} 20 /7
Signature
Subscribed and sworn to before me the day and year first above written.
DREWTHURMAN
NOTARY PUBLIC
STATE OF IDAHO
Inspection Hotline- (200) 372.2344
Notary Public of Idaho
Residing at: Fw\s t -T_�
My commission expires: MY COMMISSIONFXPIRE8•
Api+Y 11,
wwwacALirgorg Permit Technician -(200)372.2341 Revised 10, 2016