HomeMy WebLinkAboutAPPLICATION - 19-00056 - 642 Trejo St - Basement Remodel�61 Ifo CITY O F
REXBURG
America's Family Community
M On�Dn, �i,pho-n i v
Building Safety Department
City of Rexburg
35 North 1St East
R nv
Idaho 83440
SINGLE FAMILY RESIDENTIAL REMODEL APPLICATION CHECKLIST
The following items should be completed before you submit your building permit application.
*Reasonable accommodations will be made upon request.
Submit the Following Documents:
0' 2 sets of building plans drawn to scale
❑ Include the following as applicable: Floor Plan, Sectional Views, Mechanical Layout, Stair Details, and any details
required to illustrate special construction.
❑ Digital Plans (PDF Format- can be submitted by USB, CD, or Dropbox)
❑ **Copies of any Contractors' State License if not on file already.
Complete the Following Forms:
Ze Permit Policies Acknowledgment signed.
,0' Building Permit Application signed by a registered General Contractor.
2r Mechanical Permit Application signed by a registered Mechanical Contractor.
❑ Electrical Permit Application signed by a registered Electrical Contractor.
❑ Plumbing Permit Application signed by a registered Plumbing Contractor.
,,0 Subcontractor list completed.
10-1, Homeowner's Exemption signed, if Homeowner is doing work on their own home.
,ET" Affidavit of Legal Interest signed by owner, if applicant is not working directly with owner.
)211 Notifications Distribution List.
Subdivisions: If you plan to build in a subdivision please check the Rexburg Development Code for any
requirements such as property setbacks, architecture board approval, etc.
This information is available at http://rexburg org/pages/development code.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341
Revised 10/2016
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C i TY o f Building Safety Department
1EXBtaG BUILDING PERMIT FORMCI
102 ty of Rexburg
— 0W — Updated 10/2016
America's Family Community
35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Single Family Residence Remodel
Permit Number: Zoning:
Application Fee Paid: ❑ $100
'operty Owner.
Name: p� r �1G•Y1) DY1
Address: _ Z.17Q jlli Ck1`(Jl,�r-(� 4 t }} City: �QY11'►e i�i(,iL , tate: �_ Zip Code: LI 33 CO -
Email: M - L.( 46 - I} SACS Email: j
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 w.. and complete the Homeowner's Exemption)
0 No, I am working with the homeowner
Name: J &0- - }--L� Role: (Owner, Tenan to tc.)
Address: i -S Z, S �� l„ -e 17City: - �"Re.,,r U: -•, State:
Phone: _ �og-'�(„-� 3�r -_C" _ Zip Code:
E _ 3ti`1
mail:o` c s r .n a; r C o
Contact/Rep. Name:
3_ General Contractor
Name: - Registration #: I&L - 312.1'4 Exp.:21 JCi
Address: 10 cS - 11 Yo0. 1 AveJ City:I( State:
Phone: 2 - ?(p - 331—Zip Code:
Email: I
Contact/Rep. Name: Phone: Email:
General Contractor Authorized Signature: Date:
A copy ofyour state registration/license is required t e on file. If this is the first time you have done work in the City of Rexburg, please provide
a Photo co,Pv ofvour license. If you are unsure if vour license is onfile, please check with the Permit Technician by calling (208) 372-2341,
< t iJCJCrlotionn
Address: Ln4Z I rt'
Project Description: �rjPr�-t Y�xYI C• -Lbxvk Gut e doors 111 SIi ((,g
• Estimated Total Cost: $ b 0 0
• Check All Included in Scope of Work:
❑ Mechanical Work Cost: $Soo ❑ Electrical Work Cost: $_s oo ❑ Plumbing Work Cost: $ ZOC�o
Note: Any contractors involved will need to fill out their respective application.
• Fireplace(s) Being Installed? ❑ Yes W No
Building Permit fees for remodels are charged based on cost The application fee applies toward the fee total. For details on how fees are
calculated, contact the Building Department There will also be a plan review fee totaling 10% of the building permit fee.
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 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): Zit tX— �/��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 Hotline - (208) 372.2344 www.rexburg.org
Permit Technician - (208) 372.2341
,` µt x N t *r
n �` Building Safety Department
REXBURG City of Rexburg
1�. 35 North 1s�
inir.k„, f,tM1h (,vnnr,,��er, East
Rexburg, Idaho 83440
Affidavit of Legal Interest
State of Idaho
County of Madison
Name Address
! ttDrtt, �'I( 1, , '
City
State
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B
wyZ rz�c Suet}�e�b�. � Ic�c,.4tio 3�►c}0
A. That l am the record owner of the property described -on the attached, and I grant my permission to:
EGk� S.Rct ,fro cr,�.hy�G Gt},, z0 a3
Name Address 1 J
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 _ 20k—
Signature
Subscribed and sworn to before me the day and year first above written.
4-pectlon Hodine -(208 3722341
of Idaho
Residing
My commission expires: _ 113 - n - 7 r, 4_\
W%'W rexhurgnrg Permit Technician - (208) 372.2341
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uF a� C i T Y o P Building Safety Department
REXBURG City of Rexburg
`y35 North 1St East
America's Family Community
Rexburg, Idaho 83440
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete:
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Floor Coverings:
Plumbing:
Heating:
Electrical: C'� „0..s .� e— G
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceiling Joists:
Siding/Exterior Trim:
Other
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016