HomeMy WebLinkAboutAPPLICATION - 17-00586 - 1086 Horizon - New SFRCITY OF
REXBURG
Amenrni Family Community
j
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 per t.
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
Initials 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.
'(f a building is occupied without receiving a signed Certificate of Occupancy, citations may be issued and the occupants
may be evicted.
Initia s
A Certificate of Occupancy will not be issued without digital copies of the As -Built Plans.
o It is the Applicant's responsibility to turn in digital copies of the As -Built Plans when the project is completed. No
11-YAYI Certificate of Occupancy will be issued without these plans.
I itn ials
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.
o Required inspections can he 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
Initla be removed in order to perform the electrical rough in inspection,)
Construction on any project can begin ON 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 Billiding 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
authorities from the City of Rexburg. Any approvals can be verified by calling (208) 372-2341.
It is your re spo 'bill to inform anyone on your project of the above policies. All sub -contractors will be held to this
standard wi no exceptions.
o The above policies will be enforced to all, regardless if this information is passed on to them or not
In ial
Applicant's Name (print): ow_ V as ti- Signature: _ ate:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspecdt)Ulfquests called in after 8 AM will be scheduled for the next business day.
Inspecti on Hotline -(288)372.2344 w .rexburg.org Permit Technician -(288)372.2341 Revised 2/2017
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CITY OF
REXBURG
tn,
Amenrds rnnAy 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.
Printed Name
9`16'-1)
Date
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016
OQ yBXBUgOf' C I TY OF
REXBURG
Amerfcds Family Community
BUILDING PERMIT FORM 100
updatod 1012016
BUILDING PERMIT APPLICATION
New Single Family Residence
1
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: /b t0" d' IUIcjt_ia t764M
Address: L470 Gu 4 60.5.
'.-
City: A'-"0 f!:) State: _42�( Zip Code:�3 _
Phone: V-10Ts- 3� 12i'
Email: MAm./t Q Gp7 79Uc-k.• to &A -
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?
M;Vles (Skip to #4 and complete the Homeowner's Exemption)
❑ No, l 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 ofyourstate 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/ile, please check with the Permit Technician by calling (208) 372-2341.
4. Project Description
Address:/0 � 140 MI L0 1 -OR-
I1
Lot #: 1 -1 - Block #: _ Subdivision: t;4 4:)
Of U L -h — /O PM 1aSil- 7-
Project Description:
0
• Square Feet: Building Total: Z-18 sq. ft.
• # of Water Meters: _ Water Meter Size:
o Main Floor: 3rp'Isq. ft.
• Fireplace(s) Being Installed? -FL Yes ❑ No
o Additional Floors: ^ V - sq. ft.
• Hydronic Heating Being Installed? ❑ Yes9l No
o Basement:
Finished so. ft.
Building Permitfeesfor new homes are charged based on square
Unfinished—Z—" q sq. ft.
footage and the City's estimated valuation. For details on how fees
o Garage 'ZI W sq. ft.
are calculated, contact the Building Department. There will also be
• Estimated Total Cost: $ &W /L
a plan review fee totaling 10% of the building permitfee.
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 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 corroM 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 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
if not stated within 180 days. Permit void if work stops for 180 days.
Applicants Name (print): /r►� w-CALL'-egnature: u�'�L � Date: 7 -0 -fir
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests ca din er8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341
C y!%B UqQ
CITY OF
a
REXBURG
Amerk4 ramify Community
BUILDING PERMIT FORM 110
Upda1M 10/2016
BUILDING APPLICATION
New SFR Mechanical
1
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Mechanical Fee Paid
1. Property Owner 1� y�/
Name: ft k, Ui LIL �,C-46e---
Address: ZWZD W % S O City: A&*(30 , State( ZipCode:$S
Phone: " t — 3Z I-126 I Email: /A A r (L Q 4c AT '*tu c k - eh ft
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?
6A16(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: Phon : Email-
Mechanical
m ' Mechanical 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 (200) 372-2341.
3. Project Description l
Address: /D !c 16 OR- Lot #: / Block #: _ Subdivision: _ /0 Uiii, of tBJ
Description of work: _ /LtW
❑ SFR Construction: sq. ft.
• Feesfor new construction are charged by squarefootage: Up to 1,500 sq.ft. = $130 + $65for each additional 1,000 sq. ft or
portion thereof.
o Up to 1,500 sq.ft = $130. Up to 2,500 sq,ft. t. = $195. Up to 3,500 sq. ft = $260. Up to 4,500 sq.ft. t. = $325, etc. (i.e. a
home with 3,675 sq. ft will be charged $325)
17 Number of Fireplaces: I
• Note that fireplaces are not included in square footage costs and will be charged $65 per inspection.
❑ Hydronic Heating:
• Note that hydronic heating is not included in square footage costs and will be charged and additional $65 + ($10x # 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 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 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):
Date:/—n-1)
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection Ferldsts called in after 8 AM will be scheduled for the next business day.
Inspection Hotline - (2 08) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341
CITY OF
REXBURG
-- - CW___ --
Amerkai Family Community
BUILDING PERMIT FORM 12
uv .1M 212ov
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:___9A%ZV< 21-K)e ZjJ
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 section 3 of this application and complete the Homeowner's Exemption page as well)
Cl No, 1 am working with the homeowner
2. Electrical Contractor
Business: `Fe;;A924 F/ILTR 14', State License #: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: q �"� Phone: Email:
Electrical Contractor Authorized Signature: 2241—COY l a,4 � 1, Date: T- P14.�� /
A copy ofyour state registration/license is required to be frlort e. 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 die Permit Technician by calling (208) 372-2341.
3. Project Description
Address: -OR- Lot #: _ Block #: _ Subdivision:
Description of work: 1jl2G /Jr_W ikiMir—
❑ New SFR Construction: sq. ft.
• Feesfor new construction are charged bysquarefootage: Up to 1,500 sq.ft = $130 + $65for each additional 1,000 sq, ft, or
portion thereof.
0 Up to 1,500 sq.ft = $130. Up to 2,500 sq. ft = $195. Up to 3,500 sq. ft. = $260. Up to 4,500 sq. ft = $325, etc. (i.e. a
home with 3,675 sq. ft will be charged $325)
❑ Spas/Pools/Generators: Cl Yes ❑ No
• Note that spas/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 l 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 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 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.
Applicant's Name (print): R-4 MJ i F I < A MAN] Signature: e. , aA1 110 h—• Date: �1' I' L '!
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.rcxburg.org Permit Technician- (208) 372.2341
CITY OF
REXBURG
Amencu's Family Community
BUILDING PERMIT FORM120
"'.1M m/zms
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: nt"/I. 67CaS "c
Address: .n 'Si City: _ )L> 0U/ice State: ZEC Zip Code:
Phone: 2-O $ - 'tel t'iL t Email: ^ A.s.lt dD CAS r rrYc{ of L
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?
es (Skip to #3 and complete the Homeowner's Exemption)
❑ No, l am working with the homeowner
2. Electrical Contractor
Business: -tM_e Zta, 4 A- I- State License #: Exp.:
Address: l �City: R*_*SO t3 State: MkIr —Zip Code:W
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 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: 14-6 (a K021 -OR- Lot #: /1 Block #: —Subdivision: od.11s,a�
Description of work:
❑ New SFR Construction: sq. ft.
• Feesfor new construction are charged by squarefootage: Up to 1,500 sq.ft. = $130 + $65for each additional 1,000 sq.ft or
portion thereof.
o Up to 1,500 sq. R. _ $130. Up to 2,500 sq. ft. = $195. Up to 3,500 sq. ft. = $260. Up to 4,500 sq.ft. t. = $325, etc. (i.e. a
home with 3,675sq. ft. will be charged $325)
❑ Spas/Pools/Generators: O YesP.No
• Note that spas/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 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 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 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 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)
Signature:Date: 9
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will he scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (2 08) 372.2341
CITY OF
REXBURG
tm,
America's Family Community
BUILDING PERMIT FORM 13 0
upeacaa,o/2ms
BUILDING APPLICATION
New SFR Plumbing
Building Safety Department
City of Rexburg
35 North 151 East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Plumbing Fee Paid
1. Property Owner
Name:i+i*kt- +wc-" arI15v-%—
Address: !&420 LA1 R b d st City: X"By QS State: -Xr-C Zip Coder Vtq
Phone: " E — 351-1U % Email: Mwt-LC- ® C FIT T*Vck • (Q r
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?
.mss (Skip to #3 and complete the Homeowner's Exemption)
❑ No, l am working with the homeowner
Z. Plumbin ontractor %VL /��a�c#
:Business:x [30RlExp.:
Address: City: Reew r=3 State: �n Zip Code:
Phone: Email:
Contact/Rep. Name: PPone: Email:
Plumbing Contractor Authorized Signature: Date: r
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, pleas 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: 10 R 6 /pie Ae " OR- Lot #A Block #: _ Subdivision: I/A114 O 1 ew
Description of work:
❑ New SFR Construction: sq. ft.
• Fees for new construction are charged by square footage: Up to 1,500 sq. ft. _ $130 + $65 for each additional 1,000 sq. ft. or portion
thereof.
0 Up to 1,500 sq.ft = $130. Up to 2,500 sq. ft. _ $195. Up to 3,500 sq. ft = $260. Up to 4,500 sq. ft. _ $325, etc. (i.e. a
home with 3,675 sq. f. will be charged $325)
❑ Hydronic (In -floor) Heating: O Yes -6 No
• Note that hydronic heating is not included in square footage costs and will be charged $65 + ($10x # of manifolds/zones).
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l have read this application and state that the information herein
is correct and 1 swear that any information which may hereafter be given by mein 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 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 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):�Signatu7: Date: 9 —0— f)
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after a 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
Americo} family Community
Affidavit of Legal Interest
State of Idaho
County �^ofMadison
Q�
Name
6 MI -A u�a
city
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 lst East
Rexburg, Idaho 83440
6zg7o WeS� %Cl 6nd-h
Address
a -h 7
State
A. That I am the record owner of the property described on the attached, and I grant my permission to:
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 T 149 J ) -7 day of
20
VVI A. % .&
Signature
Subscribed and sworn to before me the day and year first above written.
T—
N tart' Public of Idaho
BREC WRIGHT
NOTARYPUBLIC Residing at:
STATE OF IDAHO
My commission expires:
Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised 10, 2016
CITY OF
REXBURG
Amerim's 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 of your 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)
1 hereby certify that the above information is true and correct to the best of my knowledge.
Q
Date
Permit Technician -(208)372.2341 v .rexburg.org Revised2/2017
CITY OF
REXBURG
America's Family Community
SUBCONTRACTOR LIST
Excavation & Earthwork: M A. U C- %, N ��
Concrete: C� e'a KLYa--('L.
Masonry:
Roofing:
Insulation: Aclu"ted
Drywall: Ywd 0V.1 (,n/tyAN
Painting:
Floor Coverings: CAj'P*TI%!S
Plumbing:
Heating:
Electrical: &D,4:" 'r i C- C -
Special Construction
(Manufacturer or Supplier)
Roof Trusses: 0 mc—
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 v .rexlmrg.org Permit Technician -(208)372.2341 Revised 10/2016