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Home My WebLink AboutAPPLICATION - 08-00207 - 1125 & 1127 S 2nd E - New SFRCITY OF KEXB UKG BUILDING PERMIT APPLICATION Plea 19 E MAIN, REXBURG, ID. 83440 If the 208-359-3020 X326 � W fi , PARCEL NUMBER rrra �r�, u 08 00207 n! 1125 & 1127 S 2nd E -Stevens ale SUBDIVISION: & `�aE UNIT# BLOCK#_LOT#_ (Addressing is based on the information - must be accurate) yWiyL'1'[IWuII1L.1' , 7--_,OEuS CONTACTPHONE# 701 - 7 31 1 PROPERTYADDRESS:_ PHONE #: Home ( 3 31 X Work OWNER MAILING ADDRESS: =�4 m a CITY: Cell ( )_ -7 61 0, STATE: ZIP: EMAIL FAX___3 S-(. - 31) `T APPLICANT (If other than owner) S 4m e (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS STATE; ZIP EMAIL PHONE #: Home ( ) Work ( ) CONTRACTOR. MAILING ADDRESS: CITY PHONE #: Home ( Work ( Cell ( ) TE ZIP EMAIL FAX IDAHO REGISTRATION # & EXP. DA How many buildings are located on this property? Did you recently purchase this property? No yes (If yes give owner's name) n Is this a lot split?Nr0 YES (Please bring copy of new legal description PROPOSED USE: Tc.),, AJ L42 AA (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, r' '- i/ ),ILO.2 Ib 7 0F RAX RtR APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Linder 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 days. Permit void if work stops for 180 days.41 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 TanyACE1, 2005 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 clear** ` t BuhQ.k. ig Safety Departmei �_ efgaxsuRG j CITY O City of Rexburg U 7 REXBURG 19 E. Main jonellh@rexburg.org Phone: 208.359.3020C%%° Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 �NE4 America' Family Community Affidavit of Legal Interest State of Idaho County of Madison Name Address IC6sP-�— Y -1413 - City State Being first duly sworn upon oath, depose and say: (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 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 C� day of M AP -LI 20 �Q Signature Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: 3 04/26/2007 19:02 FAX _. V t, 1U. LVV I 0:1yAlYl - �Aease c0111plete the end Application! NAME "t STS, Es,sS PROPERTY ADD! CRSS �, p SUBDIVISION cLi cA, ^Foy Darelling Units: Parcel Acxes: I L._Coo 5b F +. SETBACKS FRONT S SIDJ SIllE BACK v ,RemodeEng YozzrBuB&vg1Hotnc (need Estimate) No; 4099 P. 009 - SURFACE S QVARE FOOTAGE: (Shall include the exteriar wall meas=Qents of the builr3.ir..?) First FlOor Area 3 0 qo --- UnEmished Basement area_30q,0 Secced floor/loft area. 0 � Fir�ed basement uea . Third ilodr/loft area 0 Garage ar Shed or Barn Carport/Deck (30" above wrade)Ares Water Meter QuaYttity. Wates' Meter Size•12 �i - RequiredAMI PLUMBING p Plumbing Contraetoes Name: k L' o o Business Name: 1`�1� J l'u. 6.41 Address City Site Zip Contact phone ( )— ' % i Business Phone: ( } 5 A -M - }✓ Fax_ J�J� ' $ "Z"1 t,� ► +NX , .' . . . , _ Clothes Washing Machine Dishwashcc Floor D.nk Galbage Disposal Hot Tub/Spa I✓ �_ Sirtks (Lavatories, kitchens, bar, mop) E w E -SplitE Tub ' ets APR 2 6 2001 T /Unl wate C I Uer4iY OF RE Water Sof -== Plumbing Estiamate $(C4MMERCiAL/ ULTi•FAVMy ONLY) sipatuue of Licensed Contractor License Number& L3xpization Date Bate The Cly of Bac=�f a dr46&i6la it dw,rage as 7ydnrd '�V j'4V Starr f idaLo 04/2tip I. U iivul F0 Lylily) 131002 Lb - 4099 P. Please complete the en Applictio? NAME i D -� PROPER -f X ADDRESS SU$DMSION V A Of &J �..5 ,� •c Tb E 4a Required. m MEC,11"Ar""CAL Mecbanzcal Ensiness Nameieoaf- d Adckesa City Srate Zip— Cell Phone ( ) usiaess Phono ( ).3 S &_ & 7 7 D Fay ( ) Em 1Mecliianical estimate (Commercial/Multi Family Ouly) FIX7U2Z—r,9 &APPZ.L4NCES COLWT (5'ngle FAM rlpLhV&byg 0-&7) Furnace L l Fumsce%A:ir Condstionet Combo Seat Pump Air CosaditiorxeT Evaporative Cooler Urdt Heater Space Fester Decorate gas-fired appliance mein== System $oilcz - Pool Hca= i4? Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Ptesuute (Meter Supply) PSI Exhaust or Vent Ducts Dt7ee11t5 .Range Hood'V'enfis Cock Stave Verats Bath Fan Vents other similar v=ts & ducts: Tgat (Cixcle a:li that apply) (&"s� Oil Coal Fireplace Electric Hydropic i' APR 2 6 2007 r 1: CITY O r 1- of _,:M must •i 1 w i 1 •: 'r / j IUVU= Of w. z'beGty of iGxbxrg'r=fee Wedwh u th, raxr is 9��' r6,,Sra& 5 1 Y �' ■ t t t t t t t t t t t t t t t t t t� t t� t. t t t t t. t t t t t. t t t. t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t t� SUBCONTRACTOR LIST Excavation & Earth Concrete: f0&fq-* 1 4 Z , -3 i' Masonry: i.1 �yv$ Roofing: + 15 0 "1 Insulation: 6-o"16 Drywall: !l I' A a Painting: LSE Floor Coverings: Plumbing: 1: It to /"),I f C Special Construction (Manufacturer or Supplier) Roof Trusses: 5 l ock M p®.e,.j I -S Floor/Ceiling Joists: T- JJs S i S Siding/Exterior Trim: 6 &-- (. r.j "i Other - 8 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 Title 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 that the above information is true and correct to the best of my knowledge. Signature Print Name Date I