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HomeMy WebLinkAboutAPPLICATION - 11-00435 - 668 Meadowbrook Street - Basement FinishBuilding Safety Department City of Rexburg 35 N l.' E Phone: 208.372,2326 Rexburg, 1D 83440 www, rexburg. org fox, 206, 359, 3022 Affidavit of Legal Interest State of Idaho County of Madison Ic Vr-l.` Name ' `v z5y ' Being fust duly sworn upon oath, depose and say. � pexs Uk, stip rd CITY U k ' 1EXBUR\ Ahlerira!yFanitislpCammur, 7 2 ;lie T dress �C;! (If Applicant is also (owner of Record, skip to B) A. That I am the record owner of the property described on the attached, and I grant my permission to: Name Address to s„ 6nit the aacccrnpa �y^ .a.... <. 1 r r b Yk—CIA4avai rc-itauiuig W that propeity. 13. T 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 b Cy dayofC_�ud�G 20 l -� Subscribed and sworn to before me the day and year first above written. Notary expires: TOO [P] XVd SS:LT TTOZ/70/7.13 CALIFORNIA JURAT WITH AFFIANT STATEMENT '$ See Attached Document (Notary to cross out lines 1-6 below) See Statement Below (Lines 1-5 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 State of California County of SuAfff M!%"commm"onum . -1. SaW C 5 2015 Place Notary Seal Above Signature of Document Signer No. 2 (if any) Subscribed and sworn to (or affirmed) before me on this Q rl day of 1 ICS 0e.120b E -f , 20-14-, by Date Month Year (1) t :10hc , Name of Signer proved to me on the basis of satisfactory evidence to be the person who appeared before me (.) (,) (and (2) IStU 1 Name of Signer proved to me on the basis of satisfactory evidence to be the peron who app red before me.) Signature ignature of otary P W OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Further Description of Any Attached Document ' e Title or Type of Document: 1 Q LUJ Document Date:1 'V Number of Signer(s) Other Than Named Above: N oil>- RIGHTTHUMBPRINT OF SIGNER #2 ©2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 • www.NationalNotary.org Item #5910 Reorder: Call Toll -Free 1-800-876-6827 xBJJ q f7 CI1Y OF RE" RG �' America's Family Community ENEO Please Complete the Entire Application! If the question does not apply fill in NA for non applicable RESIDENTIAL BUILDING PERMIT APPLICATION 35 N VE, REXBURG, ID 83440 208-372-2326 PARCEL NUMBER (We will provide this for you) SUBDIVISION: UNIT# (Addressing is based on the information - must be accurate) Dwelling Units: Parcel Acres: PROPERTY ADDRESS: o6 BLOCK# LOT# CONTACT PHONE s3c) 300 — PHONE # : Home ( ) Work ( ) Cell (SI) !300 --9317 OWNER MAILING ADDRESS: QTY: �� u b , ( kN rATE: CRZIP: EMAIL APPLICANT (If other than owner) (Applicant if other than owner, a statement FAX to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS r- �_kNc,, L1 c _- Yj Y 0C k CITY: ?,(, k bu Y n STATE; `t` WiA Q ZIP�_� U EMAIL �s� PHONE # : Home ('W6) -3576- -19 Work t 16, -Y 3 all (tis) t Jc)� _ i S ;:� 00_1VTRf1C7'0R MAILING ADDRESS: PHONE #: Home ( EMAIL How many buildings are located on CITY Work ( ) STATE ZIP Cell ( FAX IDAHO REGISTRATION # & EXP. DATE property? Did you recently purchase this property) No Yes Of yes, list previous owner's name) Is this a lot split? NO YES (Please bring copy of new legal description of property) PROPOSED USE: (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AL TI'HORIZATION. 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 2003 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 Idays. Permit void if work stops for 180 days. !-7 / l/ Signature of Owner/Applicant DATE 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,/<rnrim1_200f City of Rexburg's Acceptance of the plan review fee does not constitute plan approval ""Building Permit Fees are due at time of application" *,'Building Permits are void if your check does not cleael 2 35N 75t Rexburg, ID 83440 Building Safety Department City of Rexburg Phone: 208.372.2326 www, rexburg, org Fax: 208.359.3022 CITY O F REXBURG dv Americas Family Community Remodeing YourBuilding/Home (need total constructions estimate, excluding fire, electrical, plumbing, and Mechanical valuations) $ Residential SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) First Floor Area Second floor/loft area Third floor/loft area_ Shed or Barn Commercial Construction Type: _Unfinished Basement area _Finished basement area L4 app Garage area Carport/Deck (30" above grade)Area Occupancy Type: SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) New Construction sq. ft. Commercial Remodel sq. ft. Commercial Addition sq. ft. Utility, Misc. Private Garage sq. ft. Storage sq. ft. �Llulti Family/Single studentHousing sq. ft. per unit Manager Unit sq. ft. Buildii j Safety Department 35 N. 11, E., Rexburg, Id 83440 City of Rexburg Phone (208)359-3020 / Hotline (208)372-2344 / Fax --(208)359-3022 OWNER'S NAME PROPERTY ADDRESS SUBDIVISION PHASE LOT BLOCK Permit# ctry of REXI3URG Americas Family Community RequiredY �'L�'C�RICAL Electrical Contractor's Name Business Name Address City State Zip Cell Phone ( ) Business Phone ( ) Fax ( ) Email (COMMERCIAL/ INDUSTRIAL) Total cost of electrical system (Contracted Amount) $ (Includes the cost of material in tatted regardless of the party supplying it. Tbefees listed under this inspection type sball apply to aly and all electrical installation not specifically mentioned elsewhere on this farm). ❑ Up to $10,000 (total cost of s4tem x 0.02) + 60 = $ ❑ Between $10,001- $100,000 ( (total cost of system - 10,000) x 0.01) + $260 = $ ❑ Over $100,001 ( (total cost of system - 100,000) x 0.005) + $1,160 = $ Small Works (Contractors ONLY): $10 fee for work not exceeding $200 in cost and not involving a change in service connections. Does NOT require inspection. RESIDENTIAL New. Single Family Dwell -mg, including allbuildings with wiring being co-Wrrseted on each property. ('Based on haw- space, see definition below) ❑ Up to 1,500 sq ft - $130 ❑ 1,501 to 2,500 sq ft - $195 ❑ 2,501 to 3,500 sq ft - $260 ❑ 3,501 to 4,500 sq ft - $325 ❑ Over 4,500 sq ft $325 plus $65 for each additional 1,000 sq ft. or portion thereof ($325 + ($65 x # of additional 1,000 sq. ft. or portion thereof)). NeweLlulta=FamilyDling/Contractors Only) ❑ Duplex Apartment $260 ❑ Three or more multi -family units: $130 per building plus $65 per unit: ($130 x # of buildings) + ($65 x # of units) ❑ Existing Residence, Modular, Manufactured of Mobile Homes, and Detached Shop: $65 fee plus $10 per branch circuit, up to the maximum of the corresponding sq. ft. of the building ($65 + ($10 x # branch circuits ❑ Central Heating/ Cooling Systems: $65 When NOT part of new residential or HVAC permit with no additional Wiring ❑ Spas, Hot Tubs, and Swimming Pools: $65 fee for each trip to inspect Pumps- Water, Irrigation, Sewage /each motor/ ❑ $65 up to 25HP ❑$95 - 26 to 200HP Li $130 over 200 HP ! MISCELLANEOUS ❑ Temporary Construction Services ONLY: 200 amp or less, one location (for a period not to exceed 1 year) - $65 ❑ Temporary Amusement: $65 fee plus $10 per ride, concession or generator ❑ Irrigation Machine: $65 for center pivot plus $10 per tower of drive motor ❑ Technical Service: $65 per hour ❑ Plan Check: $65 per hour ❑ Requested Inspection: $65 "Living Space - space within a dwelling unit intended for human habitation which may reasonably be utilized for sleeping, eating, cooking, bathing, washing, recreation, and sanitation purposes. An unfinished basement is considered part of the living space. L__ Signature of Licensed Contractor License number & exp. date Date '1 Building Safety Department 35 N. 1St E., Rexburg, Id 83440 Phone—(?oR)319-3n*)n / Hntlini- .-. OWNER'S NAME PROPERTY ADDRESS Water Meter Quantity: City of Rexburg Permit# *************Water Meter Size: CITY OF ° REXBURG -- - CIAO — - a America's Family Communily RequiredW 1'l�mbing Plumbing Contractor's Name Business Name Address City State Zip Cell Phone ( ) Business Phone ( ) Fax ( ) Email (COMMERCIAL/ INDUSTRIAL) Total cost of plumbing system (Contracted Amount) $ (Includes the cost of matetiais installed regardless of the par y supplying it. Thefees listed under this inspection type shall apply to any and all plumbing installations not specifically mentioned elsewhere on this form). ❑ Up to $10,000 (total cost of system x 0.02) + 60 = $ ❑ Between $10,001- $100,000 ( (total cost of system - 10,000) x 0.01) + $260 = $ ❑ Over $100,001 ( (total cost of system - 100,000) x 0.005) + $1,160 = $ RESIDENTIAL New- Single FamilyDwellizg, including allbuildings with wynv.- being constrnictedon eachpmperty. /'Basedoa l ung space, see definition below/ ❑ Up to 1,500 sq ft - $130 ❑ 1,501 to 2,500 sq ft - $195 ❑ 2,501 to 3,500 sq ft - $260 ❑ 3,501 to 4,500 sq ft - $325 ❑ Over 4,500 sq ft $325 plus $65 for each additional 1,000 sq ft. or portion thereof ($325 + ($65 x # of additional 1,000 sq. ft. or portion thereof)). New. r�lislta=FamilylJling/Contractors Only) ❑ Duplex Apartment $260 ❑ Three or more multi -family units: $130 per building plus $65 per unit: ($130 x # of buildings) + ($65 x # ofunits) ❑ Existing Residence, and Detached Shop: $65 fee plus $10 per fixture up to the maximum of the corresponding sq. ft. of the building ($65 + ($10 x # of fixtures)) ❑ Gray Water Systems: $130 ❑ Lawn Sprinklers/Backflow Device: $65 ❑ Modular, Manufactured or Mobile Homes: $65 for sewer and water stub connections ❑ Multipurpose Fire Sprinkler and Domestic Water Supply System: $65 fee or $4 per sprinkler head, whichever is greater Searr e- Water ❑ $38 Sewer Line ❑$38 Water Line ❑$65 Sewer & Water- if inspected at the same time ❑ $65 Sewer turnaround under house (change from septic to city] MISCELLANEOUS ❑ Plan Check: $65 per hour ❑ Technical Service: $65 per hour ❑ Comas Line: $65 ❑ Water Heater Replacement: $65 ❑ Requested Inspection: $65 ❑ Hydronic Heating: $65 + ($10 x # of manifolds/zones) "Living Space - space within a dwelling unit intended for human habitation which may reasonably be utilized for sleeping, eating, cooking, bathing, washing, recreation, and sanitation purposes. An unfinished basement is considered part of the living space. Signature of Licensed Contractor License number & Exp. date Date Building Safety Department 35 X 1S, E., Rexburg, Id 83440 PhnnP / untlina OWNER'S NAME PROPERTY ADDRESS SUBDIVISION PHASE LOT BLOCK City of Rexburg Permit# c I T y O F REXBURG CW Americas Family Community Required.!! Mecl✓ww;7 tl Mechanical Contractor's Name Business Name Address City State Zip Cell Phone ( ) Business Phone ( ) Fax ( ) Email (COMMERCIAL/ INDUSTRIAL) Total cost of plumbing system (Contracted Amount) $ (Tncludes the cost of materials installed regardless of the party upplying it. The fee listed under this in pection type shall apply to any and all mechanical installations not specifically mentioned elsewhere on this fozm). ❑ Up to $10,000 (total cost of system x 0.02) + 60 = $ ❑ Between $10,001- $100,000 ( (total cost of system - 10,000) x 0.01) + $260 = $ ❑ Over $100,001 ( (total cost of system - 100,000) x 0.005) + $1,160 = $ RESIDENTIAL New.• Single FamilyDwellmg, including allbuildings with wiring being constnsctedon eachproperty. /'Basedon hang space, see definition below/ ❑ Up to 1,500 sq ft - $130 ❑ 1,501 to 2,500 sq ft - $195 ❑ 2,501 to 3,500 sq ft - $260 ❑ 3,501 to 4,500 sq ft - $325 ❑ Over 4,500 sq ft $325 plus $65 for each additional 1,000 sq ft. or portion thereof ($325 + ($65 x # of additional 1,000 sq. ft. or portion thereof)). New.-Mlllta=FamilyDwrllaizg/Contractors Only/ ❑ Duplex Apartment $260 ❑ Three or more multi -family units: $130 per building plus $65 per unit: ($130 x # of buildings) + ($65 x # of units ❑ Existing Residence, Modular, Manufactured or Mobile Homes and Detached Shop: $65 fee plus $10 per `HVAC equipment being installed up to the maximum of the corresponding sq. ft. of the building ($65 + ($10 x # of fixtured MISCELLANEOUS ❑ Plan Check: $65 per hour I ❑ Technical Service: $65 per hour ❑ Comas Line: $65 � ❑ Water Heater Replacement: $65 ❑ Requested Inspection: $65 ❑ Fireplace/Solid Fuel Burning Appliance: $65 per inspection FLiving Space - space within a dwelling unit intended for human habitation which may reasonably be utilized for sleeping, eating, cooking, bathing, washing, recreation, and sanitation purposes. An unfinished basement is considered part of the living space. *-"Examples of HVAC Equipment -furnace replacement, solar, water heater, etc. Signature of Licensed Contractor License number & Exp. date Date SUBCONTRACTOR LIST Excavation & Earthwork: Concrete: Masonry: Roofing: Insulation: Drywall: Painting: Floor Coverings: Plumbing: Heating: Electrical: Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/ Ceiling Joists: Siding/Exterior Trim: Other: 9 E XE MPTI Or . FROM S TATE RE GI, -,"ZATI ON 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 Title 54 Chapter 5205, for full definitions of these exemptions please see the State's website at www.ibol.idaho.gov/cont.htLn ❑ 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 that the above information is true and correct to the best of my knowledge. Signature Print Name Date 10