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Home My WebLink AboutAPPLICATION & DOCS - 07-00199-00200 - Teton Communications - Site PlanCITY OF R-EXB U RG BliILDING PERMIT APPLUATiOiV' 19 E MAIN, REXBURG) ID. 8344f) 208-359-3020 X326 PE&IIT # Please complete the entire Application! PARCEL NUMBERM'��i�je will Provide this for you) SUBDIVISION.- UNIT# BLOCK# LOT# (Addressingis based on the infom�ation - must be accurate) OtFATFZ? Xr11-1AAE. �-.06)�<Iliu;•-�;`r�:5 �.�C'CINTA('TPunr.Tu+r , PROPERTY ADDRESS- --,)0 So . "�7 7C� XVok PTIONE #: I-lorneONVNER N-LULING 2iDDRESS S 45r?, a 44 _ U\TAIL . r Cell Ll - - ;, LZ,c C I T Y: -:i� < 3 A1TY._1C11V7'.- jf other than o-wner} (-�Pplicant if oder than owner, a statement authorizing applicaut to actss agent for owne-r must accompany this application.) APPLICANT INFORiNLk-: �TADDRESS C�� STATE; QIP T�,I1fLAIL FAQ PHONE #-- Home Work dell ( ......... ------------- i CON?"RACTOR. IVLI�ILING ADDRES& CITY STATE ZIP PHONE: Cell# Work# Fa -x# EMAIL- IDAHO R.EGISTRATION # & ESP. DATE How many buildings are located' - an this property? Citi you recently purchase this propertyPI,�_.Yes jf des give owner's name Is this a lot split� YES (]Please b r�I-N rInccs of ��ew legal� Pydescn-ptlo.n ot property} PROPOSED USE: slrj � �r�� ::�►Crc� -�„ (i.e, Single Familp Residence, Multi Family, Apartments, Remodel, Garage, Commercial, A ddition, Etc,) APPLICANT'S SIGNATURIE3 CERTIFICATION AND AUTHORIZATION.,ra�t Ot per -tire, -ifhave rcaci i s application std. s ate tett the info ton here-rz r t��a -� 1 t Information which may hereafter° b given b e hearer be -fore the to the I�"�a��7� � �r �r� �y�� u�. fir tiie +fir f Rexburg shall �e ,, t til t ifi T rrY s nda Je c t [.tter of t s app Ix cati o n and hereby autho n ze l represent ti � T s rel to the i to tez -upon the above -men bone d proper. fo r i s t curls The build" of ial ray reeks . pe i under - . NOTE: -• plons of the 0I�:te.�o�a� �� a�� sit�fnr�t �r y�r ��rita ' M e, EcatLon or on the Pl -= rz which the per=t ?r' a r�Val was based. orl of fact P t 1 �f not tar it in 180 days. Pest voicl iFwork atupz; for 180 da �j� Signature o Tyr k DATE 0 vou prefer to be contacted by axii oiplione. Circle . WARNING — BUILDING PE MUST BF, POSTED ON CONSTRUCTION SITE! 1 ti Plan fees rnon-refundable and rpa'ck �� t �% �i� City o f R exbur 's Acc ep tantanc e of the plan r view fee does not co **Building Permit Fees. are due at time Of aPPlication****Building Permits are void if yM7Ce()C0()tE+ W F1 C► � 1' 0-F H"m"hEX8LJRG Building Safety Department 11 It 19 E. Main Rexburg, ID 834-40 State of Idaho County of Madison Name an s 44 W. City janeilhgexburgorg www.rexburg.org City of Rexburg Phone: 2 08.359.302 0 ext 326 Fox: 208.359, 3 02 4 Affidavit of Legal Interest Being first duly sworn upon oath, depose and sad di Address State r#E0 k CITY OF America's Family Comnlunity (If Applicant is also owner of Record, skip to B) A. That I am the record owner of thepzo�erty described on the attached, and I gra nt my perrmssion to,,,�:�' -� r: - r ' �4 N =e "fie Address to submit the accompanying applicahon pertaining to that property. B. agree to f, and hold Rexburg Cess om any aim habilt*tvresultingfrom T dis Pute . t t. Statements t hewn r as to the ownershiptheproperty .0.11 c i the subject of the, application.F Dated thi's P tida-y of .i {^ 20 A f Siginature r11 Subscribed and sworn to before me the day and year first above written. I'`Zotary Public of Idaho Resl'(:hng at - My Commission expires., 3 AOO"N Please complete the entire Application! If the question does not apply fi11 in NA for non applicable NANf E C - PROPERTY ADDRESS SUBDIVISION Dwelling Units: Pa Acres: SETBACKS FRONT SIDE SIDE BACK Peffnit# Re'n0de-Eng Your BuA&j7g1,ffome (need Estimate) $ SURFACESQUARE "0Tj4 GE.-(Shfl include the exterior mall measurements of the building) First FloorArea - - unfi- -rr.ished Basement area Second floor/1-oft gr -6. Finished basement area Third floor/loft4r"ea Garage area Shed or Barn - --_--_-- - _ Caiport/Deck (3(Pabove gra-de)A-rea Water Meter Quantity:r• o_ s �r F:.;. � y •�8 �.. J?eq0 uredl.! � Plumbing Contractor'-"': Address Contact'Phone: Email S:7 bar, rrzoP) to $ (Commercial 0 Water Meter Size: BusinessName; state ZIP Phone: �. Sprinklers Tub/Showers Toilet/Urinal .` X -Vater Heater -%- mater Softener Required! Signature of Licensed n tract Th e 'License number D -.q t "N sr edak f the same s _i -?.ho _. _. . w Please co lete theMPentire 1 t e question does not apply fill in NAfvr non 1; Aft omh I NAME PROPERTY ADDR.ES 6VIl" f volz� Z 11�ub]L IVISIOTS Regulred.!!f Mechanica]; Contraetoes Name: Address j Contact Phone: ( li Mechanical Esti Business Pr (Cvnunercial/Multi f "��U APPLL4 d ` bj IF rnr r� ace /Air Conr -Combo Heat Pump Air Citi r F vaporaetivelCooler --Unit Heater eater space , H _.,.�„ Decorative gas-fired appliance ............................... ............ IncifielratUr System Boiler WN ---------- - � Pool Heater (Srrzgle Fan�Y� Permit# tate Zip 7y) aust or Vent Ducts ryes Vents ge Hood Vents .�,.� Cook Stove Vents I Bath Fan Vents �. orher s1killar vents & ducts: Fuel Gas Pipe, outlets including stubbed in or future outlets Inlet Pressure (Afeter Supply) PSI Heat (�ircle all that apply) M 90 ;% echanical 1.9 1 11.11" Poin Required! signaturle of Li. .sed Contracto_r 0 FireplaceElectrc Hpdrorzic Liceasc nuiubcr laps. Date The CIO of Rexburg 'f pemutfee schedule is the teat;; e 4u requmd 151 1he Slate qf Idaho lication z Building Safety Department iw�A 19 F MOM .Rexburg, ID 83440 OWNER'S NAME www.rexburg.org City of Rexburg Phone: 208.3.59.3020 x326 Fox:208.359.3024 PROPERTY ?ADDRESS SUBDIVISION PT -LASE LOT BLOCK tedif/0!/ Electrical Contracto Address Cell Phone ( Fax Ele -1 - mail Permit# Business Name ass Phone LEE40 I TY 0 . URG Ow Amerka'sFamily L-)junlV Z i COMMERCIAL/MULTI-FAMILY ONLY) c taw 'thin the residen dal s&ucwreand a tta ch ed g r a t the S arn C jim C) Up to 200 amp SefvIce-* 201 to 400 amp Service* �. Over 400 amp Service* Existing Resident(Al (# of Branch Circuits) Temporary Construction Service, ��30 arnp or less, �n� l�ca�ian for a periad not to exceed I year) Spa, Hot Tub.,, Swlming Fool Electric Central Systems Heating grid/or Coolfflg (when not past of a new residential construction gemut and. no additional wi_�ittg) Modular, Manu famired or Mobile Home .,_ Other Installations: miring not specificallyr coverbyth ed any o� e above Capt Of Wi�ng & Labor: Pumps (Domestic Nater, Irrigation, Sew -age) Requested .Inspections (of existing wiring) Ternp0ry Arne -q ern rpt/ indu istry of W per .our. Suture of Licensed Contractor License number Date The F � 'S hsrequired b,v Ibe State ofTdaho on Building Safety 19 E. loin Rexburg, JD 83440 }ane 11h @rexb urg. o rg www.rexburg.org City of Rexburg Ph one. 208,x'59.3'020 Fav 208.359-3024 APPLICATION: °'CONSTRUCTION PERMIT" CONSTRUCTION PERMIT ff $50.00 FEE PAID: YES/NO PERMIT APPROVED: YES/ NO -APPLICANT INFORMt1TION• Business Name, % �,,, � � - ,,. V SOffice Address, Office Phone Number: (�-G.1') S„ Contractor Performing the Work, Contact Person, ,-LOCATION OF WORK TO BE n(1 APPROVED BY: w.� T_ let ciw .4 C) C I'T Y REX BURG Atnefica' Family CornnjuniV -State /I Cell Phone # (_) NR• Street Address Where Work Will Be Done: Business Name Where Work Wifl Be Done, Dates For Work To Be Done: To 17n in ta 1-v + or L r J -Phone Number: ( Cell # (�) 0 PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR: ry/:t� L-!S7its^.J % f3 iccd<_ LJ AUTOMATIC FIRE -EXTINGUISHING SYSTEMS Ll COMPRESSED GASES zip Ll FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT '-� FIRE PUMPS AND RELATED EQUIPMENT L FLAMMABLE AND COMMBUSTIBLE LIQUIDS L HAZARDOUS MATERIALS iJ INDUSTRIAL OVENS L LP -GAS U PRIVATE FIRE HYDRANTS '' SPRAYING OR DIPPING L -i !J STANDPIPE SYSTEMS I TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES V.9 Applican Si -a gp� 'ure Date on Enaw RN MUIMUMISMS Ron NORMA wwanam MEMO MEME RONSON EDO Mason REMOM on WRION06*Rwom mat 7 SUBCONTRACTOR LIST Excavation & Earffiwork: Concrete-. _Masonry-. Roofing: Insulation: Drywafl: P�intin�: Floor Coverings.. Plumbing: Heating. Electrical- Special Construction (Manufacturer or Supplier) Roof Trusses. - Flo or/ Ceiling joists.- Slditig/Exten'or Trim: 0ther: 8 EXdMP IONS FROi /I STATE REGISTRATION As of January 1, 2p4f, the,Ci1 ty of Rexburg can no longer sell permits without tfiout having a copv of your State registration number mber or your exemption from the State, registration. Please send a co of vour state registration or fill out this form shaving your exemption and send 't i with your license renewal or your next perr"Ut application. (This list is a summarization of Idaho Code, Tifle 54 Chanter S" ? n 1; -Fr r i; , I i A -r-e see the State's -vvebsite M X ont.htm) %1- 111 VJLI�� L-) Ultse exeMPtionS please Currently State licensed pursuant to Title 5-4 Idaho Code, Chapters: .1 Architects, 10 Electrical Contractors/Joume��man, 12 FngM"eers/SurveYo-rs, F 1'�) VuDilc Worl s Contractors (exempt from only regIstra-hon required), 26 Plumbing/Plumbers, .1? 45 Public Works Construction �Iar�a�en�ent Licenszn� Act (e�pm„r-Frr-, ry +,�vl i n_ __ �. 5�D Insta.11at�on of heating, ventilation'and ' C-.� r C.,11- y JL 1281 s Lrd LiLon requirea).,, or �;mployee or volunteer of a licensedair conditioning systemsF contractor or paw of an educational curriculum or nonprofit charitable activity withno xvr I ab% -a orZha al-) Employee of a US Govemm.ent'agency (State, City, Public Ut�.lity doingCourity., or other municipality) constmctionl. maintenance or development to its own business Involved with gas, oil or mineral operations 0 Supplier doing no installation or fabricating 0 Contracting, a project orprojects with a total cost less than $2000 11 Operation, of a farm or ranch or, Construction of agriculture buildings exempt from Idaho Building Code L3 Anv type of water distzict operations Work M' rural districts for fire prevention purposes Owner who performs work -on own prflp�rty= -L-or contracts With a re the property g�stered contractor to do work as long as is not for resale withl'n 12 months Owner or lessee of commercial property performing maintenance, repair, alteration or con property struction on that Real estate licensee/property. manager actLngJd�n Idaho Code o W1 Engaging in the logging industrrr Renter working on the property' where they Iive with tfie property owners approval o Canstructian oda building used for Industrial chemical processing per Idaho Co -de 0 Construction of a modular building (defined by Idaho Code) to be moved out of state, I hereby ce4i-fyt-hat the ab0.. , e in£ormat-tan is true and correct to the best of my knourledge. -C. W Signati2re -C-1A Date PL%17t Name I 55 cd • r~" C) ru PEOLZ 1011 CD a io � . vim;.. • �. PEW ommpd olso et AEM l- 4 ti tY5 I QrQ PEN m WD d ryesgpPYa�. dYr d __tt Y � . vim;.. • �. PEW ommpd olso et AEM l- 4 ti tY5 I �m._ 9! �- A� CL n fmmk0 CD �y m CD N I C i f - I ��,� iW ke Wo. � �-A LIZ CM) r-rs � CD fD CL e-- m Paw JIM - CD Z74 CZD bUld 46 i y4� ��s}' FaeM'+t 4M �i ;. 6•+ �+,eL��a%�• a. � ki a� ' W' '4J xx ��as�y,.y�.�,•'Y,�V�r:'v'y. M:' 2�.se✓r+ri•� y �!1 i mi -1 P-4 I� ftw� Pow t� AN" rD Q -e 1 W' '4J xx ��as�y,.y�.�,•'Y,�V�r:'v'y. M:' 2�.se✓r+ri•� y �!1 i mi -1 P-4 I� ftw� Pow t� AN" rD Q -e CITY OFKE�4B CT�RG BUILDING PERMIT APPLIC��ITION 79 E D741IN, REXBURGID. 83440 208-359-3020 X326 PARCEL NUMBER: I e M ia PER,NL111T # Please complete the entire Application! � - -(We will provide this for j-ou) SUIillIVISION: %9- UNIT# BLOCK# LOT# (AddressinR is b.. �.ased on the information -must be accurate) j"j— — -, ___ l i — - - ------- OWNER A%.:. PROPERTY ADDRESS: 7 _ L ..� C, CONTACT PHONE # j PHONE#., Home ( ) work 2Cell ( ) 11 OWNER ;�L)ILING ADDRESS:� i EMAIL�a�-1 ��t 8 -For. Lo rr.il urrf.'or. S E o irr ff _Cr APPLICAl'1TT: (If other than yawner) (Applicant if other than owner, a statement authorizing applicant to act as went for owner must accompany this application,) APPLICANT INFORMATIO?v: ADDRESS CITY*. STATE ; ZIP E1YL•AIL FAX PHONE#: Home ( ) Work ( ) Cell s_....,.v ._...._ ,,o...._ _��.._... aNTRA C - - - MNLLING ADDRESS: C1,1"'y!I STATE ZIP PHONE: Cell# Work# Fax# ENLkIL IDAHO RIEGIS'TRATIC3N # Sz EXP. DATE How many buildings are located on this proet Dial you recently purchase this property? yes (If yes o«ner's name Is this a lot split? C] 'SES (Please bang copy of new legal descriptioptoperty)n of PROPOSED USE: � _ ��-r �-� tc r i rt r� �� •�� ccs .: �-' (i.e., Single Family Residence, l�Tu].t� Fami1S-, :.'�pa�tments, Remodel, Garage, Commercial,Addit,ion, Etc.) APPLICANT'S SIGNATURE:� CERTIFICATION A � have read this application and s tats. at the mi fo -radon herein Y � �r�� and, I swear that f � . reb ice i t� tha t I 3 - . 1 nning y t� information c� ere -aft , n b e in he ir, 0_re tkc Council For the ; T I r -tall be chful i rrecr. j to the subject matter of t a li a x authorized representatives thepon � 1 ° with all City regul tionsnState relating The din `f" 1 may revoke permit n a rov:al issued under the r is' for inspections purposes. ,,: ons of the 20 3 Irate tion ode in cases f an false tate n int ire t�� application � 1 �� t ��t � � r��F � �ased. _ ��` r��r�tY�� ' fait I�`e t void � f not started Within 180 days. Peri ��Ol f wor topfor 1days.zl> 4tA czm� S19nAture of Owner/Appycant Do vou prefer to 13e, contacted by fax, emailphone�. cle Gne . y _-f W - BUILDINGPE 71 ' BE POSTIED ON CONSTI Plan fees are non-refundable and are paid in full at ithe time of application beg City of . urg' ,&ccept n c sof the plan review fee does not constitut "Building Permit Fees are due at time of application.** **Burs in ertnit are void 12005ja�pp rov�a ��. 20whc� es �aIe Buil 19 E. Main Rexburg, ID 83440 State of Idaho County of Madison L ch C 1 ding Safety Department Sr lonellh@rexburg.org www.rexburg.org City of Rexburg Phone: 208.359{ 3020 ext 326 ax 208.359.3024 Affidavit of Legal Interest 1y DP c I %_:0 CITY OF RE JXBURG Americas Family Gromity t r � y - State Being fust du��- sworn upon oath, depose and saNf: (If Applicant is also owner of Record, skip to g) A. That I am the teeaner of the propertv describedon the attached, and I rant rte T nu perssian to: � <f �-- ,-. y Address to submit the accompanying applicar-ion pertaining to that propertv., B. Y agree to indemnify, defend and hold Rexburg City and its emplovees harmless from an clan or liability resulting from any dispute as to the stateia�exits contained herin or as �� P, he awnexship of the property,which is the subject of the application. .q. Dated this igna.r day.of Y s Subscribed and sworn to before me the d y and year first above written. Public of Idaho s F My rMi des: 3 I rr Please complete the ciati NAME- re Appl�catior�# If the question toes not a Pplyr fill in NA for non applicable PROPERTY ADD,RE SS 1700 ,Sc, . .? #.,'/ f'��— . SUBDIVISION Dwefling L'ruts: Parcel Acres: c2 i � SETBACKS FRONT QV _P CU eed Esu*imate)W J� BACK Permit# SU)RFACE SQUA" FOOTAGE.-, (shall inc.ludc the exterior wall measurements of the building) First Floor Area Second floor/loft area L'nfinished Basemen rea Finished basement area Garage area Shed or Bari. L----- Carport/Deck (3a" above grade)Area mater Meter Quantity: Required.!! ■ F2 WaterMeterSize: 1Ph-i-mContractor's I� Natne: Busm'ess_ Name- Address Cis State ----------- _ZIP Contact Phone usiness Rhone, Fax- _rl�IU-Kp,. UUUN]r �ixcludinrou hed fixtures Clothes 'Mashing Machine, Dishwasher _ Floor Drain garbage Disposal Hot Tub/Spa Sinks (Lavatories, kitchens, liar, mop) Plumbing Estimate $ (commercial Only) Sprinklers Tub/Showers Toilet/Urina, Watex ..eater Water Softener Required! SIgnature of Licensed C,,ontractor Licelise number Date The CiO .r�, Please complete applicable NAME ko the entijLe App11CatlOri�% ��r �� 6 If the yuesdon does 0 apply 11 in 1Wfor non *ei ez-?Ioe�p? PROPERTY ADDRESS /'Z ov s�. ��,� �- SUBDIVISION . . . ........ .......... .......... Required.►► MECHANICAL MContractor' s Name: �t Pexrnit# Business Name. G Contact Phone: Business 'Phone: Email Fax Mechanical Estimate $(Commereial/Multi Family Only) FIXTURES &APPLIANCES COUNT (Single Family Furnace Furnace./Air Conditioner Combo Heat Pump ,_ Air Conditioner Evaporative Cooler Unit Heater Space Heater Decoxative gas-fired appliance Incinerator System Boiler I Pool Heater Dwe11r"ng Un.1.Y) Exhaust or Dryer Vent. Range Hool Cook Stove Bath Fars V. other smear vents & ducts: Fuel Gas Pipe Outlets including stubbed in ox future oudets Inlet Pressure (Meter Supply) PSI �� Heat (Circle all that apply) Gas Oil Coal Fireplace Electnc dronic ..Mechanical Sizi Point of Delive r must be shown Required! S�gnature0 of Licensed Contractor License number ith Plans &Application nplans. Date The Cly of Rexbur I lStare of Maho 5 I Built�inn crrfo+., ne...,,...�.,,,..._a 19 E Main Rexburg, 183440 jonelfh@rexburg.org www.rexburg.org y lu )JU I I IV t1i 'a nV OWNER'S N."'IE ' 1 PROPERTY ADDRESS SUBDIVISION PHASE I LOT BLOCK Required.!! Eleatical Contracto-r)s Name le City of Rexburg 208.359.3020 x326 Fox: 208.359, 3024 CAWrxlcA T, dr Business Name 14 Pf-E 1 Family jir Address Gt-y, State zi�� Cell Phone Business Phone Fax ( ) Email 1 Electric al Estimate (cost of wiring & labor) $ (C(7MMERCI.AI./MULTI-FAMILY ONLY) I1 T"ES OF INS TALLAT101V (New Residen t-ial rncludes everything carita,cd u*h�.�t� the residential structure and attached ea-tage at the sa.raze trme) Numbeir of meters being installed I3 �i Up to 200 amp SeiX-icze* 201 to 400 amp Over 40D amp Service* _ Existing Residenfial. (# of Branch Circuits) Temporary Construction Senli-ce, 2p0 amp or leis, on location (fot a period not to exceed 1 Spa., Hot Tub, Sw=a=ng fool Electric Central Systems Heating and/or Coo and no additional. mring) Modula, Manufactured or Mobile Home �Lt"19 (u -hen not part of a new residential construction permit E�ther Installations.- Wiring not specifically covered bvaliv of the above Cyst of Wiring & Labor- Pul-nPs (Dolnestic Water, Irrigation, Sewage) Requested Inspec6ons (of existing �;xring) Temporary Amusement/Industrye *Includes a maximum of 3 inspections, Additional inspections charged at -requested inspection rate- of $40 per hour. Signature of Licensed Contractor ale GRexburS License number Date rmitfte j- 4 e e Z*s thexame as revai 11,,7 Slate of Idaho 31 92 N 19 E. Main Rexburg, 18344 F Hi'lrlcin qnfAnf ne.,,....�...,..._a ��........J. y VC`.Ju11111CI11 �aE_;eUa� www.rexburg.org City of Rexburg Phone: - F: 208.3,59.3o24 AT'PLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #: $50.00 FEE PAID: YES/NO PERMIT APPROVED: YES/ NO -APPLICANT INFORMATION• Business Name: ! Office Address: . Office Phone Number: (_;Z0 )_ Contractor Performinor the Wnrlr# APPROVED BY: 9 AT" a r 4--t fi S Off 0 CITY E .. - R u. RG xB Ain State zip Contact Persom, •o � Cell 'hone # -LOCATION OF WAK TO BE DONE*• Street Address Where Work Will Be Done: � � . 5'�. Business Name Where Work Will Be Done: � Dates For Work To Be Done: To Contact Person: --;�, Cf , r �, -� [ �� Phone Numbev,. Cell # (_) PLEASE CHECK THE TYPE OF PERMITS) YOU ARE APPLYING FOR: 006/0 cih r` d q 4 t.- / Ll AUTOMATIC FIRE -EXTINGUISHING SYSTEMS El COMPRESSED GASES 11 FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT FIRE PUMPS AND RELATED EQUIPMENT L__] FLAMMABLE AND COMMBUSTIBLE LIQUIDS Ej HAZARDOUS MATERIALS L_j INDUSTRIAL OVENS C LP -GAS Lj PRIVATE FIRE HYDRANTS SPRAYING OR DIPPING STANDPIPE SYSTEMS TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES ,f jrt..jr 're -7 ` /�/ Apphcanes ...........,...,..., Date VA x Excavation & Earth,%vork: Concrete.0 Masonry: Roofing0 : Insudati* Drywall, Floot Coverings: Plumbing: Heating: Electrical: Rood' Trusses. Floor/ Ceiling Joists: Siding/Extel-l'or'11ri Other*- SUBCONTRACTOR LIST n& Special Construction (Manufacturer or Supplier) EXEMPTIGl\TS FROM STATE RECTISTRATION As of January 1 2006, the Citv of Rexburgcan no longet sell permitswithout having a c0PV of Vour State te Stra 91 tion number or your exemPti on from the State registration. Please send a copy of vour state registration or fill out this form sli()wing your exemption and send it 4 with your license renewal or your next p�ermit applicati'on. (This list is a summarization of Idaho Code Title 54 Chapter 5.205.) for fill definitions of these exemptions please see the State's webs' ihol.'dah website o-Z.Ov/cont.htm) k-or— ro Lot ro- 0 0 0 N Curreritl� State licensed pursuant to Title "_4 Idaho Code, Chapters: ,) Architects, 1 0 Electrical Contractors/JQurneyrtnan, 12 Engineers/Surv, evoirs, 19 Public Works Contractors (exempt from fee 0n11T registration reauirec) 26 Plumbing/Plumbers, 45 Public Works Consrruction Management Licensinb -Nct:(exempt fratn fee onlIT registration required), or 50 Installation of heatuxg, ventilation and air conditioning systems 40- Employee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit charitable actljTlty with no wages ox salary Employee of a CJS Govemment agency (State., City., County=, or other munirinalit-v) Public Utility, d oing construction, MaIntenance or development to 10 its own busit�.ess 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 Any tyke of water district -operations. Work in mal districts for fire prey=eiition purposes Bmtaing Code Owner who performs work on o\ -,v -n proper; or contracts with a registered contractor to do work as long as the property is not for -resale within 12 months 17 Owner or lessee of commercial property performing 1-nam'tenance, repair, alteration or construction on that property 0 Real estate licensee/'property manager acting wad-iin. Idaho Code ❑ I�'.ngaging irYthe logging industry, ❑ Renter working on the propert�r where they Eve wid-i the Property owners approval r7 ConStrucaon of a building used fox industria], chemical processing per Idaho Code 11, Construction of a modular bui1d�ng (defined by Idaho Code} to be moved out of state hereby certify that the above �.nformation is true and correct to the best of my knowledge. noso Signature I Print Name ki IVA6 Date 9 Building Safety Department FOF�aa�a U'O 19 F. Main Rexburg, 10 83440 ionelfh@rexburg.org 'far City of Rexburg Phone: 208_359.3Q20 ext 326 k 1 Office Hours.- Monday -Friday 84.00=-4:00pm TY 0 IF -REXBURG .. . . ............. _ CW -- yea - Farni� Comn iT C ommercial/Multi Family Pre -Construction C11eC�Z-11qt Seismic Design Category — D Roof Snow Load — 35 lbs, per sq. it. (unless soil evaluation confirms category' C) Wind Load — 90 MPH Ground Snow — 5 D lbs. per sq. ft. Frost Depth — 3G" Thef0110z�ing mems sh��ld be completed be oreyou submit your ba�ilda,2g�errrlit ��lac�tion. Compledon of Bugding Pe_rmitAppKcadon: You may print this appIication from our website �v�X-qr.rexbur.Orz or pick up a eapy at the City Annex Building (address above). C0Z1LMe-rC-i2JPe.rMi&- (the following must be submitted With the Application) `1�r 4 sets of site plans and 2 sets of building plans stamped UV, a licensed profession Siteplans and buildin laps in PDQ format must be submitted after lens have b Structural Calcula,' ans s�amr�ed bv a licen.-qp1i F.�, Enemy Compliance Rep (the cr�m.eheckis avaflal�.& lighting sectionsP 1 4' +4_-1b. __ J --��vvac iia�,u l4 Li ort: Asper the 2003 TECC, a Compliance check must be completed and submitted le online, at 9.�) Please complete the envelope, mee�.anieal w8...z. vi uiF, 11YYiiL-dlIC312 MU5LF 1f1CIUCle t7.e ICiah0 Cnntrartnr'c R�� must be completed and ii wed, see Page 9. Page 4 afrthe Application must be campleted and swrned bv ur Plumber. Page 5 at the Application muss be completed bv signed b�,- vour.M Mechanical system sizing and des,911- Page 6 of the Application must be completed and sl' tstration Number or the tion form chanical r Electn'c ian. ontractor. .�cc.11GM ia-VOut must be meluded tivid the building pans. Pia -tis will be reviewed by the electrical inspector Przor to issuance of the building permit. Emergency Services Const -ruction Permit 'P Lighting Plan ' E�ectrrcal Permits are now issued through the G�7 of Rexburg. See Page 6 of the application. Remodeits: If yauare considering a remodel, a ep�y of the bid or estimate for the remodel must be submitted With the Permit -App liCarlo n. 2 set of plans (may need IECC Review) Additions — dame as new. construction 11 r June 13, 2007 Tony Hafla Teton Communications.,, Inc. 5 45 S. U tah Circle Idaho Falls, Idaho 83402 X1114 Re: Cell Tower Building hermit Application To whom it may concern, 1 TY 0 F ,REXBURG CW i IenCa� Family Community After.reViewing your proposal for a cellular tower on South 21"d East for compliance "With Rexburg's Coinmunications Towers Otdm'ance 915, we have concluded that a Conditional Use Permit will be required to place a cell tower in this locatton. The proposedlot' Is coned Love Density Residential 1, in which commumcations services is listed as a cc�ndirional usc. Staff can only administratiti=eadditionalprove additional antennas on cxzsting towers, replacement of existing towers, towers in industrtA or heaver comtnercial areas, and other similar situations. In addition to the Information* ed following information s eget application, the quiris te edf -r review: 0 A complete 'inventory of existing towers.,, antennas,,r sites of anterinas that are either W1thin the Jutisdiction the City. of Rexburg xvitbin one n-ffle of 'the b ordet th.creo `, including specific informationIt the location, height,anddesignF. r. 0 Copy of A required franchises quiLire r the constniction and/or Operat-ton of a XVI'Lreless communication t T. A scaled siite} plan cl - +9 location, anheight the ptoposed tower, on-site land uses and zonm'g,, classificaiung, Master Plan tion of the site and A ptoperu''es it the a 11 pficable distances set forth in ion , a .cent � � y structures,access', setback3 froi-n property lines, elev. ation dtawhigs of the proposed tower and any other tOP09ta-phy, site elevations Legal. description of the parent tract and leased paircel (if applicable). The (_;etback chstance bet�veen the proposednearestresidenna* tIUffl., platted residentially i ones properties,and unPlatted properties. T ary Lelkness Planningand Zoning Admin F ID 8344 0 P 0. B Qx 280 l� )Ol4e (206 .3020 e, `. 1 l i v , ' 339. '. e ,g. o • The separatiort distance from other towers described in the inv, enfory of e�sting sites submitted, including identification of the type of construction o#' the existing tower(s) and the otiuner/operator of the exismag towers), if known. • A landscape plan shr�`vitl� s��c�fic larldscape materia. -Is. • Method of fencing, finished color and 10 if applicable, the method of camoufla and illumination. 6 kl- A description of compliance with Sections 4(c), (d), (e), (0,,, (9)y 0).5 0)) and (m), 7(b)(4)a 7l'_))(5) of the Corritnun-Ications Totivers Ordinance and all applicable federal, state or local laxvs. * A notarized statement by the applicant as to whether construction of the tntver will accommodate collocation of additional antennas for future users. 0 Iden6fication of the entities providing the backhaul netwo-rk for the tower(s) described in the application and other cellular sites owned or operated by the applicant in the municipality=. * A description of the slutability of the use of existing towers,, athex structures of altCrnative technology not requtring the use of towers or structures to provide the services to be provided through the use of the proposed new tower. • A description of the feasible location(s) of future tourers or antennas within the City of Rexburg based upon existing phvsical, engin�e�ing, technological or geographical lirnitations iia the event the proposed tower is ejected. .ru plans submitted must be certified bya licensed, professional engineer. Attached is a Conditional Use Perrmt application as well as a Grapy of the Corntnumcations Towets Ordinance 915 dor yourreview. Please CO -11 if you have any questions. Sincerely,, Planning & Zoning Depattment f Lelkness Pha xe -and ZotungAdmiristrator 1 { JIrla . f r � � 11 83440 PhMe (208) 359,3020 314� (20 9) 3_59.3022 ,gagi@rexbMIX. Org )v,7m) rexburg. o,)� 0 Madison County 1 City of Rex ' GIs Page I of I WF e -w 4' r✓✓ .ti: 17 Y , DISCLAIMER: This map is intended for display purposes only and is not intended for any legsl representations. hftp://gisliniranetlarrcimslprintable.aspx?MapURL=http.11agentsmithloutput/arcIMS a ents...