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Home My WebLink AboutREXBURG BUILDING APP - 08-00298 - 957 S 12th W - High Plains Drilling - Tenant Finishpp,xgUR ,yoQ cs C I TYO f u c REXBURGL 0800298:1 America's Fammily Community High Plains Drilling Tenant Finish COMMERCIAL & MULTI FAMILY BUILDING PE SUbnvtted 6/20/08 19 E MAIN, REXBURG, ID 83440 208-359-3020 X326 PARCEL NUMBER: 'PPFA 2CiH-2iaiQ5a (We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# (Addressing is based on the information - must be accurate) OWNP-R NAMR: CONTACT PHONE # PROPERTY ADDRESS: 95-1 S � atia : PHONE #: Home ( Work ( Cell ( OWNER MAILING ADDRESS: CITY: STATE: ZIP: EMAIL F APPLICANT: (If other than owner) I& Cf lror 3 ct,ollit, (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS 2/6 e 116o A CITY: f n 4' STATE; i�o ZIP uy3' EMAIL FAX PHONE #: Home ( ) 317-2gSC1 Work ( CONTRACTOR: 54r.,fv ti, e,6at MAILING ADDRESS: PHONE: Cell# Work# EMAIL ' IDAHO REGISTRATION # & EXP. Cell ( How many buildings are located on this property? / Did you recently purchase this property? Q Yes (If yes, list previous owner's Is this a lot split? NO YES (Please bring copy of new legal description of p TE ZIP PROPOSED USE: (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc) — CIRCLE ONE 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 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 t a permit on approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact N the hcatio t l whi t approval was based. Permit void if not started within 180 days. Permit void ifworkstops for 180 days. �/ Signature of Owner/Applicant DATE Do you prefer to be contacted by fax, email or phone? Circle One WARNING—BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE! Plan fees are non-refundable and are paid in full at the time of application beginning r matyl• 2005 City of Rexburg's Acceptance of the plan review fee does not constitute plan approval **Building Permit Pees are due at time of application** "Building Permits are void if your check does not clear** 2 Building Safety Department o arxaaA� C I TY OF City of Rexburg 'a n TXBT mG l�.t� V 1\ 19 E. Main jonellh@rexburg.org Phone: 208.359.3020 ext 326 CW— nmerim's Family Community Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 Affidavit of Legal Interest State of Idaho County of Madison '/-84115 Name Addtess City State Being first duly sworn upon oath, depose and say:—Z"(--Z'.'/ (If Applicant is also Owner of Record, skip to B) A. That I am the recor owner of the property described on the attached, and I grant my permission to: /« S C/i&o%t ?/6s v yup H 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 herin or as to the ownership of the property which is the subject of the application. Dated this yc�} Ar� day of 20A!5W Signatuie Subscribed and sworn to before me the day and year first above written. J, 4� i ►sai Z Notary Public of aho VBLIC'. a Residing at: �6�q�rOF11 QP O My commission expires: Building Safety Department City of Rexburg 19EMain jonellh@rexburg.org Phone: 208.359.3020 x326 Fax: 208.359.3024 Remodeling Your Building/Home (need Estimate) $, C I TY OF REXBURG OL Americas Family Community SURFACE SQUARE FOOTAGE. (Shall include the exterior wall measurements of the building) First Floor Area Unfinished Basement area Second floor/loft area Finished basement area Third floor/loft area Garage area Shed or Barn Carport/Deck (30" above grade)Area Water Meter Quantity: RequiredLY PLUMBING Water Meter Size: Plumbing Contractor's Name: Business Name: Address City Contact Phone: ( ) Business Phone: ( ) Email Fax FIXTURE COUNT (including roughed fixtures) Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal Hot Tub/Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate (Commercial Only) Sprinklers Tub/Showers Toilet/Urinal Water Heater Water Softener Requiredl Signature of Licensed Contractor License number Date The City of Rexburg'spermit fee schedule is the same as required by the State of Idaho 2 eersv Building Safety Department City of Rexburg ° 19 E Main ionellh®rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 OWNER'S NAME PROPERTY ADDRESS SUBDIVISION PHASE LOT BLOCK Permit# RequlredLY MECHANICAL Mechanical Contractor's Name: Business Name: Contact Phone: ( ) Business Phone: ( Mechanical Estimate $ (Commercial/Multi Family Only) FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas-fired appliance Incinerator System Boiler Pool Heater Dryer Vents Range Hood Vents Cook Stove Vents / Bath Fan Vents Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure (Meter Supply) PSI other similar vents & ducts: Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic Required! Signature of Licensed Contractor License number Date The City of Rexburg'spermit fee schedule is the .came as required by The State ofldaho C IT Y OF REXBURG O America's Family Community Building Safety Department City of Rexburg 19 E Main janellh@rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 OWNER'S NAME _ PROPERTY ADDRESS SUBDIVISION PHASE RequiredLY LOT BLOCK ELECTRICAL Permit# C I TY OF REXBURG Cw— Americas Family Community Electrical Contractor's Name Business Name Address City State Zip Cell Phone ( ) Business Phone ( ) Fax ( ) Email Electrical Estimate (cost of wiring & labor) $ (COMMERCIAL/MULTI-FAMILY ONLY) TYPES OF INSTALLATION (New Residential includes everything contained within the residential structure and attached garage at the same time) Number of meters being installed Up to 200 amp Service* 201 to 400 amp Service* Over 400 amp Service* Existing Residential (# of Branch Circuits) Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year) Spa, Hot Tub, Swimming Pool Electric Central Systems Heating and/or Cooling (when not part of a new residential construction permit and no additional wiring) Modular, Manufactured or Mobile Home Other Installations: Wiring not specifically covered by any of the above Cost of Wiring & Labor: $ Pumps (Domestic Water, Irrigation, Sewage) Requested Inspections (of existing wiring) Temporary Amusement/Industry *Includes a maximum of 3 inspections. Additional inspections charged at requested inspection rate of $40 per hour. Signature of Licensed Contractor License number The City of Rexburg s permit fee schedule is the same as the State Date 6 Building Safety Department City of Rexburg o 19 E. Main jonellh@rexburg.org Phone: 208.359.3020 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 APPLICATION: "CONSTRUCTION PERMIT" CITY OF REXBURG Ow Americo Family Community CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO APPROVED BY: -APPLICANT INFORMATION: Business Name: 166- Office Address: �I?s' �✓ z "-° /1zrlus i o y7lelecl City State Zip Office Phone Number: Contractor Performing the Work: 5 Contact Person: Ira) c�W14 Cell Phone # ( ) 1/7 -- -LOCATION /7 ---LOCATION OF WORK TO BE DONE, I Street Address Where Work Will Be Done: S /z Oadt Business Name Where Work Will Be Done: Dates For Work To Be Done: To 0„ (� Vs Contact Person: Phone Number: Cell # PLEASE CHECK THE TYPE OF PERMITS) YOU ARE APPLYING FOR: ❑ AUTOMATIC FIRE -EXTINGUISHING SYSTEMS ❑ COMPRESSED GASES ❑ FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT ❑ FIRE PUMPS AND RELATED EQUIPMENT ❑ FLAMMABLE AND COMMBUSTIBLE LIQUIDS ❑ HAZARDOUS MATERIALS ❑ INDUSTRIAL OVENS ❑ LP -GAS ❑ PRIVATE FIRE HYDRANTS ❑ SPRAYING OR DIPPING ❑ STANDPIPE SYSTEMS ❑ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES Applicant's Signature Date ........................................................................................... SUBCONTRACTOR LIST Excavation & Earthwork: Concrete: Masonry: zllc G Roofing: /0! C --j Insulation: pU4<e,1 Floor Cnverinos: Special Construction (Manufacturer or Supplier) Roof Trusses:_-S-C,4tµA Floor/Ceiling Siding/Exterior 3 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 Tide 54 Chapter 5205, for full definitions of these exemptions please see the State's website at www.ibol.idaho.gov/cont.htm) ❑ Currently State licensed pursuant to Title 54 Idaho Code, Chapters: 3 Architects, 10 Electrical Contractors/Journeyman, 12 Engineers/Surveyors, 19 Public Works Contractors (exempt from fee only registration required), 26 Plumbing/Plumbers, 45 Public Works Construction Management Licensing Act (exempt from fee only registration required), or 50 Installation of heating, ventilation and air conditioning systems ❑ Employee or 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 working 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 tl � ei0foRniotipn is true and correct to the best of my knowledge. Signature Print Name 2r- cJ � Date L9