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HomeMy WebLinkAboutAPPLICATION - 08-00232 - Taylor Chevrolet - Car Wash Addition.pdfF 04 BUgc U4 C I T Y O F""1 RE)MURG Please Complete the Entire Application! If the question does not apply fill in NA for non applicable '"< •`' America's Family Community' MFD COMMERCIAL & MULTI FAMILY BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID 83440 208-359-3020 X326 PARCEL NUMBER. '� ( We will provide this for you) SUBDIVISION: (We BLOCK# LOT# Addressing is based on the information - must be accurate) O'0 -T CONTACT PHONE # PROPERTY ADDRESS:_ Sl f PHONE #: Home Work /Cell ( OWNER MAILING ADDRESS: �5/i�� �� rs�„� CITY: %� b,/,, STATE ZIP: EMAIL FAX APPLICANT: (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRES CITY: STATE; ZIP EMAIL F PHONE #: Home ( ) Work ( ) Cell ( CONTRACTOR MAILING ADDRESS: 800- Y. /,Z �` t.,/ CITYAv, � STAT ZIPA3 JVO PHONE: Cell#k 3y© t/YY Work# - 3s - 6'6 34[ 6 EMA11-�r's�=y��exC. fe cc�,IDAHO REGISTRATION # &EXP How many buildings are located on this property? v® Did you recently purchase this property? No Yes (If yes, list previous Is this a lot split?( YES (please bring copy of new legal descripl PROPOSED USE: (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commerc Etc.) — CIRCLE ONE APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty ofperjury, 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 offs al 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 e a licatiof or n e plans on which thepermit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. Si e of O /Applicant Do you prefer to be contacted by fax, email or phone? Circle One 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 &nuary 1 Zona '* 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'*'* 2 "1 Building Safety Department flf .FXBUBG City of Rexburg ` 7 19 E. Main ionellh@rexburg.org Phone: 208.359.3020 ext 326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 e<, wFn State of Idaho County of Madison I, Name City Affidavit of Legal Interest Address State CITY OF MURG ow Americas Family Community 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 herin or as to the ownership of the property which is the subject of the application. Dated this Signature day of Subscribed and sworn to before me the day and Year first above written. Notary Public of Idaho Residing at: My commission expires: 20 F, City of Rexburg NAME Q /omad4e 0800232 PROPERTYADD RESS ids: �/D Taylor Chevrolet Car Wash Addition SUBDIVISION Dwelling Units: Parcel Acres: SETBACKS FRONT SIDE SIDE BACK Remodeling Your Building/Home (need Estimate) $, 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 y2 Unfinished Basement are; Finished basement area_ Garage area -arport/Deck (30" above Water Meter Quantity:Al ,Z,4 ����'` )Area Water Meter Size:/� A�.'�" -Requ redmf PLUMBING Plumbing Contractor's Name: ZZ �� Business Name: Address_ s City e,/,�� S tate Zip Contact Phone: Business Phone: Email Fax FIXTURECOUNT /Includingr�hed fixtures) Clothes Washing Machine Sprinklers Dishwasher Floor Drain Garbage Disposal Hot Tub/Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ (Commercial Only) Required! Stnature q tfmature o sed Contractor License number Tub/Showers Toi Water Water S- 2/— el --I- R, Date rd The Bexburg's permit fee schedule is the same as required by NAME PROPERTY ADDRESSElf , SUBDIVISION Required I ff Girc Mate of Idaho Please Complete the Entire Application! If the question does not apply fill in NA for non applicable Permit# 0<9 MECHANICAL Mechanical N Contractor's ame: `%-5"«'i _ t Business Name: Address% �/) �� n/ City °4 State Zi✓p�/`�° 2 Contact Phone:IV ( ) 5q Business Phone: Email �,-/i Fax ---2-&-'2(- 2v5- %r, —/.q< Mechanical Estimate $(Comercial/Multi Family Only) �� +L1 m FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: Decorative gas-fired appliance Incinerator SystemP Boiler t � Pool Heater MAY ~ 9 200$ Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure (Meter Supply) PSI LC-ILLYOF RE Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic Point of Delivery must be shown on Plans, v Required! Signature of Licensed Contractor License number Date The City of Kexburg',rpermitfee schedule is the sameas required by the State ofldaho 9 PAP Builc.w"si Safety Departmem OXBV , F�,y F4 11 19 E Main ionellh@rexburg.org Rexburg, ID 83440 www.rexburg.org OWNER'S NAME PROPERTY ADDRESS SUBDIVISION PHASE LOT BLOCK City of Rexburg Phone: 208.359.3020 x326 Fax: 208.359.3024 Permit# CITY OF REG - — CW - `.. Americus Family f ommunizy Regtdred f.f! _ F CTRICAL Electrical Contractor's Name Business Name�,Yj--� Address V)ya /u, City, �� State, � Zip. CellPhone zr (}� Bujjsiness Phonex;-) % 3— �( Fax cz tt'`t7 '� Email hleaf, I'll 'm/ o'l./r.-._ _ Electrical Estimate (cost of wiring & labor) $ 01 QW (COMMERCIAL/MULTI-FAMILY ONLY) TYPES OFINSTALLATION (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* Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year) Existing Residential (# of Branch Circuits) 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 VAMAY XOther Installations: Wiring not specifically covered by anyCost of Wiring & Labor: $ Pumps (Domestic Water, Irrigation, Sewage)2 2��$ Requested Inspections (of existing wiring) Temporary Amusement/IndustryL-9i t TOF y *Includes a maximum of 3 ins p tions. tional inspections charged at requested inspection rate of $40 per hour. _r Signator of Licensed Contractor License number Date The City schedule is the same as required by the State Signature of Licensed Contract License number Date The City of Kexburg r,Permit fee Schedule it the tame as required by the State of U h. Building Safety Department City of Rexburg 19 E. Main janellh@rexburg.org Phone: 208.359.3020 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 o�XBUR01 CITY OF O REXBURG V 1 \G °". kFa .•' America's Family Community F ION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #: A; -k PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO -rlrrLll.tUN I 1 Business Name Office Address: APPROVED BY: Office Phone Number: (A2_ ) SSG- -"Y State Zip Contractor Performing the Work: Contact Person: _ ' �,1 �� Cell Phone # -LOCATION OF WORK TO BE DONE: Street Address Where Work Will Be Done:`< ell.,,,5�e Business Name Where Work Will Be Done:,,%, Dates For Work To Be Done:ToY Contact Person:1111VII Phone Number: Cell # ( ) PLEASE CHECK THE TYPE OF PERMIT(S) 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 VA SUBCONTRACTOR LIST Excavation & Earthwnrl,- Concrete: Masonry: .e Floor Special Construction (Manufacturer or Supplier) Roof Trusses Floor/Ceiling Joi Siding/Exterior Tri