HomeMy WebLinkAboutAPPLICATIONS - 17-00645 - 762 S 2275 W - New SFRCITY OF
REXBURG
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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 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 Official may remove the red
Intag. If the red tag is removed by anyone but a City Official, citations may be issued.
No buildin maybe occupied without receiving a signed Certificate of Occupancy.
tr 0 If a building is occupied without receiving a signed Certificate of Occupancy, citations maybe 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 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
�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.
0 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.
I -e- 0 The above policies will be enforced to all, regardless if this information is passed on to them or not
Initials
Applicant's Name (print): Signature: �t� Date: [0/1* -7
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 Revised 2/2017
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CITY OF
° REXBURG
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Americas Family Community
Affidavit of Legal Interest
State of Idaho
County of Madison
Name �p ,
F"� 'J r�
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 1st East
Rexburg, Idaho 83440
P2b)
Address
/J0
State
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
day of -fD— r .2017
Signature
Subscribed and sworn to before me the day and year first above written.
DARCEY E. VALERIO
11 lli
NOTARY PUBLIC
STATE OF IDAHO
Inspection Hotline - (208) 372.2344
�rcRN
Notary Public`QUO
Residing at:
EX V 96
U
My commission expires:
w .rexburg.org Permit Technician -(208)372.2341 Revised 10, 2016
CITY OF
REXBURG
AmericA 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
:t-grd-1r -Wan.
Printell Name
Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised 10/2016
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°„ ' REXBURG' BUILDING PERMIT FORM 100
(7410Upd,h 1013016
Americds Family Community
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 0
Name: �ner
ay+0h'neC Homs -3
Address: t1l S• `JcZeOt Jst-YV N t! lJg 1�qbt City: 1k Q- r State: I D Zip Code: S --104 to
Phone: SaGis Email: ey 0? V-1 Yfi h n,�4 hoart--
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)
'F No, I am working with the homeowner
2. Applicant p/
Name: Ga site b DV Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name:
3. General Contractor 11 _
Name: Registration #: I `I S1 Exp.: 12/3 V/T
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
General Contractor Authorized Signature: Date: A V
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.
4. Project Description
Address: -OR- Lot #: $ Block #: t8 Subdivision: SQ-tYN)O e OS— Q4
Project Description:
• Square Feet: Building Total: 1'61 C sq. ft. • # of Water Meters: Water Meter Size:
o Main Floor: "13 r1 sq. ft. • Fireplace(s) Being Installed? 13 Yes R No
o Additional Floors: l0'10 sq. ft. 0 Hydronic Heating Being Installed? O 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. For details on howfees
o Garage 64'4%0 sq. ft. are calculated, contact the Building Department There will also be
• Estimated Total Cost:$ oplan reviewfee totaling 10% ofthebuilding permitfee.
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that I have read this application and state that the Information herein is correct and 1 swear that any
Information which may hereafterbe given by mein 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 ofthis application and hereby autheriud representatives ofthe City m 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 crony 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 Too days.
Applicant's Name (print):�CtT a E✓V_n ph Signature: — e � Date: _LV_ )�2
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
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CITY OF
o 'ft Ta ,BURG BUILDING PERMIT FORM 13�
Y 11P� uN.va lepras
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Arnericn5 FmnityCamnumly
BUILDING APPLICATION
New SPR Plumbing
Building Safety Department
City of Rexburg
35 North 1st Bast
Rexburg, Idaho 83440
For Office Use
Permit Number: b Plumbing Fee. Paid ,
1, Property Owne`
,
Name: �C preyI axis
Address: City: State: Zip Code:
Phone: Entail:
Under Idaho Building Code, a homeowner is allowed to do work on their olvn home.
Are you a homeowner doing work on your own home?
0 Yes (Skip to 83 and complete the Homeowner's Exemption)
D No, l am working with the homeowner
2. Businelbing Cplriracto` j n� .n. � c. PZ I�-[-/15-%,�
Business: v 25�rt� I'" tl.� � � State License N: xp•:
Address;3%�if3 ,+� 5•'c GGr:ft! AI+TeKa ��S te: 1 Zip Code: 0
Phone: X08 5'3i /' O Email: /o a '.c a+n�+"n2 see .
Contact/Rep, Name: Aad or Unite Phone: Em il:
PlunibiegContraef6rAutlioi'Izei signaim'e: c c Date:
Acopy ofyourstate registration/llceuseIsrequired to eonple.Ifthlsis)lrstUmeyouhavedoneworklittheCityofltexburg,pleasoprovide
a photocopy ofyour license. lfyou are misure Ifyon' license Is on file, please check with the Pornilt Technician by calling (200) 3722341.
3. Project Description
Address: OR- Lot h:e�Block#:46 Subdivision: S'jrhme✓1q*g2i
Description of work: %`1e''J cl-
0 New SPR Construction: I S 1 r sq. ft.
• iteesfornewcotlstrvtetlw;nrochargedbysgumefootage:Uptol,500sq.)t.=$130+$6.5Jbreachad<IlNonn11,000sg.)Lorportlon
thereof.
o Up to 1,500sq.ff.=$130. Up 02,500sq.f.=$195.Up1o3,500sq.ff.=$260. Upto4,500sq.f.-$325, etc. (i.e.ft
home hvlth 3,675sq. ft. tvlll be charge(1$325)
❑ Hydronic (In -floor) Heating:0 Yes Ir0
• Note Not lWdronlcheathlg lsnotlncluded In squmefoologe costs and will be charged $6.4♦($Iox O ofmmnfoids/zones).
APPIACANT'S SICNATURF., CERTIFICATION AND AUTHORIZATION: Under penallyotporfury, I hereby ear111ylhat l love read this application and slate that the information herein
Is correct and I swear [lint ally Information, winch only horenAerhe given by new In hearings berate Ilse planing and Zonnnti Caminlssio, or Ilia City Coonlctl for the City of texbttrit
Fllall IIC Inllhrlll illi Cary `rl. I agree to comply with all City regtdal Ions and State lows relntlllg to the subject onaIter or this application and hereby nuthinke111epYC5en1a11VOF of the
City to onto, upon the nllove-oenlloned property for Inapwlinns purposes. NOTE The building official may revoke permit oil approval issued under ilia provisions or Ilia 2012
International Code In cases fany ralseslnlament or n0erepreseutallnln offact In leo application oron the plans on which Ilio penult or approval was based. Permit void lhlnt
sotledwlthlWlmdnys. Pernnit void lfwnrk slops for loo days.
Applicant's None (print): J'a rWt-EUerU"_ —Signature: �R >z — Date: 1%`lipWf
hnspedlons most be called in before U AM on the day Ilia Inspection Is requested. Inspection regaesls called In after U AM will boschoduled far Iho next business day.
Inspudion Ilollino- (200) 372.2314 www.rexhurg•nng Porndt Technician -(200) 3722341
CITY OF
REXBURG
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Americn3 Mrnib• Co ns unfry
BUILDING PERMIT FORM 110
aod.w tones
BUILDING APPLICATION
New 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 Own r
Name: G P(eVt�JS.
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. Mechanical Contractor f WL
Business: bwWWtr, State License lh O/ Z SS Z Exp.: S j/
Address: c ' City: Stat : YkP Zip Code:
Phone: �0• Em II: O 4' t .00 6040, d
Contact/Rep. Name: !N 1 Phone: 2 Email:
Mechanical Contractor Authorized Signature: r _ 1 Date: -
AcopyofyourstatereglstrallonflicenseIs required to beonfile.ifthisIst firsttraeyouhavedonewarkfittheCityofRexburg,pleaseprovide
a photo copy ofyour license. lfyou are unsure Ifyour Ifceilse is on file, please check with the Permit Techn lelon by calling (208) 372.2341.
3. Project Description pp
Address: OR- Lot M.2,Block#:bSubdivision:
Description of work: Nevi 1b,Mc
❑SFRConstruction: l$)T sq. ft.
• Feesfornewconstructionarechargedbysquarefootage:Upto1,500sq.A-$130+$65foreachadditional1,000sq.f.at
portion thereof.
o Up to 1,500 sq. jt. = $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. R will be charged $325)
❑ Number orFireplaces: 0
• Not, thatfireplaa�
ces are not included (it squarefootage costs and will be charged $6S per inspection.
O Hydronic Heating: _h1/
• Note that hydromic heating Is not Included In squorefootage costs and will be charged and additional $65 + ($10 x #of
inanifolds/zones)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penaltyofperjury, Ihereby 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 on, 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 n elating to the subject matter orthlsappllcatlon and hereby authorized
representatives of the City to enter upon the above-mentioned property for Inspections purposes. NOTE: The building official may revoke a perm It on approval Issued under the
provisions ofthe 2012 1 ottmational Code In cases or 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): alit &D 6. SO n Signature: 1 OL KJ �� Uate: ) A -_1 1_Q
Inspections must be called In before SAM on the day the inspection Is requested. Inspection requests called In after B AM will be scheduled for the next business day.
Inspection Notlha- (209) 372.2344 www.rexburg.org PennitTechnlcbn-(200) 372.2341
CITY OF
REXBURG
tti
Aumrfea'slke fly Cannnanhy
BUILDING PERMIT FORM 12011
urlauase/rasa
BUILDING APPLICATION
New SFR Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
Por Office Ike-
PermitNumber: ❑ Electrical Pee Paid
1. Property Owner
Name: so—c t�JS
Address: City: State: Zip Code:
Phone: Emalif
Under Idaho Building Code, a If anneowner 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)
17 No, I ant working with the homeowner
2. Electrical Contractor f
Business: S!yA ra)f 61et Nz tit_ State License#: �����' Exp.:
Address: Y //6, City: tP IPis 11 State: r-6 Zip Code: F35!;,✓3
Phone:– Email: ✓ qi,d 11�!5P J ^e IOaN.a%, C. ALI
Contact/Rep. Nanle: —Ph—e- Email:
Electrical'Co: " torAuthorizedSignattirei Date:
A copy ofyour state registration/Ifcense is regrdre be on file. f iffs lstlrefirstthneyou have done work In the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure t our license is of file, please check with the Permtt Technician by callhtg (200) 372.2341.
3. Project Description
Address: -OR- Lot#Block#: vSubdivislon: S0Vy%Yric 66nQ
Description of work: j/eW Tire—
❑NewSFRConstruction: b) sq. sq. it.
e peesfornewcotistructfolareclrargedbysqumefootage:Uptol,500sq.ft.=$130+$65foreachndditlonni1,000sq.ft.or
portion thereof.
o Up to 1,500sq.f.=$130. Up to2,500sq.f.=$195. Up to 3,500sq.ft. = $260. Up 10 4,500sq.ft,=$325, etc. (ie.a
home wlth 3,675 sq. ft. ivlli be charged $325)
• Spas/Pools/Generators: O YesV No
e Notethntspns/pools/genernrors meant Included In squarefootage costs and fvlll be charged $65 per Inspection.
APPI.ICAN'rSSIGNATI)RI?,Celt•1'IFICATI()N AND AUTHORIZATION: under penally of perjury, I hereby certify (flat l have read this application and state that Ilia Information herein
Is correct and 1 swear that any Information which unity hereaRer be given by um In hearings before the Planning and Zoning Commission or the City Cmmcll for the City of Rexburg
shall be lrolhful And correct. I agree to comply with all (3ty regulations and State laws relathig to tile subject m:dlerof this application unit hereby authorized representatives of the
City to eatm'up0rr tine abuveanentloned properly far bsspectlons purposes. NOTE: The bulldhigomcial may revokes permilmi nppruv d Issued under the provisions of the 2012
International Mile In cases ofauy false sudemmnl or wha epresentzllon of fact in the application or on the plans on which litepennil or approval was based. 1'erndl Vold If not
started within 100 days. Penni) void Ifwork stops for 100 days.
Applicant's Name (print): / �Y'LE✓Jl�lp� Signature:/< vR� Dnte:.__J(l7
�—
Inspeclluos must be called fn before 0 AM all the they file Inspection is requested. Inspection request&called In after 0 AM will be scheduled Act tile next business day.
lnspecllon pliable - (208) 372.2344 www.rexOnrg.org PermltTedwidau-(200)372.2341
epE%EUq°
CITY OF
v�
REXBURG
c
Amvlml Fumily Conon My
Excavation & Earthwork: 1 l
SUBCONTRACTOR LIST
Concrete: -` ,I ('QCtYIA 6(\(N&k,t, 1 0 [, V
Roofing:CJ�(� \��5� Coy Q0fe' Wr , Y
Insulation:
Drywall:
Painting: \ e'A\ n -e— oe$i 5V'
Floor Coverings: CG -r; QeA— QICeot—
Plumbing:
Heating: ty
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses: Vim) (. w21sr Ca(�eo oY.
Floor/Ceiling Joists: \L\jq-�'± CocWpLa-&k,�.
Siding/Exterior Trim:
Other:
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
1i in
Inspection Hotine-(2011)372.2344 www.rexburg.org Pennit'I'edudcinn-(20H)377.2341 Revised 10/2016