HomeMy WebLinkAboutAPPLICATION - 07-00461 & 462 - Airport Self StorageCITY OF R -EX -BD U_RG
BL;II,DING PERMIT :1PPLICATION PIC.
19 E NLUNI REXBURGID. 8-6440
208-359-3020 X326
PARCFL NUNIBER
t
f
SUBDI-VISION. •
(Addressl'no- 1e inrm-'.--must be accurate
0 WNF R ALTA/jr- C_.
PKOPERTY ADDRIENS.���
PHONE #. Uoine
OWNER M:1LI,ING ADDRESS:
F;VL-IILG'rr'�fr�ir�r�� i
t^A
07 00462
Airport Self Storage
_( We uriU provide this f,,,,: you) - —
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on!
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CONTACT PHONE #—Y.17
Work
Cell 7
L C TTV'Pe
.
^� F ^
•JF
FAX
APPLJCANT_ (If other than owner)
(Apphcant if other thar1 owileY, a statement autho1�izing applicant to act a5 agent for owner must accompany this application_)
APPLICANT INFORATATION: ADDRESS_
—ZIP
JMAIL Fi)LX
PF C NF t�m "r_1k+_V
Work
' r colvrrrAcrox:
II MAILING ADDRESS: C
PFIONF_: Cell#
ENLAIL I
How many building LAC)
APPLICANrS SIGNATURECED q-1
JA� I FICATION AND AUTHORIZATION:. er have :read tNS Application and state that the Offnatit� herexn � correct and I sr that penalty �"�'�u# I hereby cejtttf that T
fori of exbur��
�I b i.il� �`
to correctI agree to comply � �� �� armLys before the��� ������� matter �� t�i� ���ica�on hereby utho�e representatives � �� �t in oval issued Under the provisions of the 2003 Intema Property for
the applica r on the p1q,,.,gZEch the perrnit or -aPPfoval was based. _?e=it vold 1 tional Code in Cases of any fi2se -statement or misrepresentation of fact
not started witbin 180 days. I-ejmitvCqd if work stops for 180 days.
r
Cell
Work# Fax#_
ars locatect on this property,
YOu -recently p-Litchase this prooert No 61_�es_
L Y. It! SAf yes
give owner's
name
-is rnis a lot split?0 YES (Please ging copy of new legal description of ptoperqr)PROPOSED USE: -
(i -e., Single Family Residence, I'.iulri Family, Apaf:rments, Remodel, Gara�e: Cnvn,-„sap .-,,,1 A A
tip
S, k I �Ie
1911 tllte/of Owner/A
Do YOU ptefer to be colit2cted by fax,, email or plionep Circle Orle
WARNING — BUILDING PERMIT MUST BE POSTED ON CONS'
Plan fees afe non-refundable and are paid in full at the time of a lication N
City of Rexburg�os Acceptance of the plan review fee- does 110t constitl
**Building Permit Fees are due at tirne of application** "Build- -wl-
DATE
"1"114
BLOCK#
—LOT
Ch 6Poe4 nit cw*
� � �� REXB
URG 12
Please complete the entire Application!
\ If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADD-REASS
SUBDIVISION
0I Nor .111
Dweffing Umts:_ Patcel
Acres: J r r
SETBACKS
FRONT SIDE S1DE BACK
R e- tn o de- Ung Yo i z- r B i zildingl, ffo- rn e (need F,, timate} �
Petmit#
SURFA�'.E SQUARE FOO TA GE.P- (Shall include the exteriox wall measurements of
First Fluor Area
Second floor/loft area
Third floof/loft area
the bi-Edding)
Un ished Ba nt area
Fmished basenient area
Gara.ore,iNCL f
shed or Bates
Catport/Dexk above
ity.
Water Meter Quatit" . �-.4,:'. Water Meter Size:
Plumbing Contractor's Name: ��I �'i`� Btisiness Name;
Addrcq,s-s citv,S�at�
Contact I:1hone: � } Business Phony: ( }
Etnail F
FIXTURE COUNT il&nprrhedf
ytt
Wr
-------------------- — Clothes WaShing Machine
Dishwasher
I'loor Dr
Garbage Dospasal
Hot'"'fub/Spa
Si-nks
(Lavatories, 16tchens., far, mop
Plumbing Estimate $ (Commercial Only)
Sprinklers
r1'ub/Shourevs
Toilet/ Urinal
latex Heater
Mater Softener
Required? Signature- of Licensed Contractor License number
_-TIJB Cil�o of Re_xburg'f perrnzt fee ,rcheda�le i.r the same as required &� the State of Idaho
11
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- -••w•• •W vMl V 1' vG`.J UI 111w"11 /AE=`B R\
19 E Main
Rexburg ID 83440
OWNE,,R-'S KAME
PROPERTY AL
SUBDIVISION
PHASE,
janellh@rexburg.org
www-rexburg.org
C ity of Rexburg
Phone, 208` 359.302.0 x326
Foxy 208.359.3024
V
DRESS _
r - f=t
wr
LOQ`12
BLOCK
electrical Contractor's Name
t'x,ddress
co
�� State
Cell Phone Business Photic ( )
Business Narue
Fax
� Email
SME0
N%
C1 T
kEY BtTG
Atnenc4 Family Comtijun,ty
Zip
Electrica,l Estimatemate {cost of wring & labor} $1`" , _ , (COMMERCIAL/MULTI.FAMILy ONLY)
TYPES OF IN,5TALLATION
(New Res!denHal .ineludes evcxythjog contained Tvrthzn the residential structure an affachcdga��a c a �- t the same time)
t�e)
Number of meters berg mstalled
Lip to 200 imp Sctvicc*
201 to 400 amp Service's
Over 4U0 amp Service*
Existing Residential (# of Branch Circuits)
�.� Temporary Construction Service, 200 ramp or Tess, one location fox a period not to exceed 1
---------------- Spa., Hot Tub., S-kVnnnNn9 Pool
year)
---------- . Electric Central. Systems Heatm'g end/or Cooling (when not part of a new .residential cacastn3ction permit
and no additional r�riring� p
.� �Manufactured oz Mobile, Home
Other Installations: Wiring not specifc�.11y cnIrPrP� �,�r 3.,z, �,� �.�.� ..I._ ---
Ce^►et ,-.-F jY7:y:... � o _ r r ,n.v 1 � — — • —y....,. �.•I {-L}' k -pi �..[iG 'et 1..1V Vi;
vVJ L Vl VV 171119 0 L;kq[]pk-�
Pumps (Domestic mater, Irrigation, Sewage)
Requested Inspections hof existing wearing)
Temporairy Amusement/Industry
*Includes a rrYaxirntun of 3 inspections. Additional inspections charged at requested inspeGtiozz rate of $40 per hour.
Signature of Licensed Contractor License number
The Citi m� f `kxburg's permii�e sc��edule is the same as required by Me State ofI�ir Date
6
Please complete the entire Applica
IL
applicable
4
NAME �";�r �� a .�f 1 v�j j
PROPERTY ADDRESS�'�- , . i��
SUBDIVISION L��f.fi-v,�l- ('�_.,,..,�,.�-.�
Requited.!!
#1flllr Ifthe question
dves� t apply fill *n NA for non
MSCI -1
.:1
Permit#
-less Name:
Mechan'c,al Contlractors Natne:
usil
Add-tess C1* tAIT
Contact Phone: B . usli i less Phone: —State Zip
Etnail Fax
Mechanical Estimate $�Cornmercial/MultiFami
FIXTURES &APPLIANCES C(Single F
Furnace
r u.t_nace/Afr Conditioner Combo
Heat Pump
Air Ctanr.htioner
Evaporative Coolex
Unit Heater
Space Heater
Decorative gas -Fired appliance
Incinerator System
Boiler
Pool Heater
Dwelling DnlYj
Exhaust or Vent Ducts
Fuel Gas Pfpe Quticts inclu�.�.�gs stubbed in or future outlets
Inlet Pressuxe (Meter Supply) PSI
Heat (Circle all that apply), Gas Oil Coal Fireplace
Dryer Vents
Range Hood V S
Cook Stove Vents
Bath Fan Vents
other sl*
Electric Hy-drofuc
vents & ducts :
10
Signature Required!
4 ignature of Licensed Contractor
-2 an �
License number
lari.s.
Date
J be City of Rexburg -Is penwit fee schedule is lbe some as required by the State of Idaho
5
M
Building Safety tvnt aF4ExBUa
�
�Q°o
19 E. main
Rexburg, 18344
State of Ida o
County of Madison
Name
ionellh@rexburg.org
www.rexburg.org
City of Rexburg
Ph on e : 2 08.3,59.3020 ext 326
Fox+ 2.08.359.3024
Affidavit of Legal Interest
B eing fist d-��ly sworn upon oath, depo
(If Applicant is also
- . 'That I am the record
t
errn-ts s io n to:
Address
State
and r.
REXBURG
ma � Fatuity Community
Owner of Record, skip to B)
ownex of the
Pt6t)erty d�scxibed on the attached, and I giant my
a
to srihmit the accompanying application pe-ttalning to
t property-.
B. I agree to indemnify, defend and hold Rexburg G�
clam or liabiRty tesulting from any dispute as to the
and its cmployFecs harmless from any
owizersnlp ox tne ptoperty which is the subject of the
Dated chis
Subscribed and svwoxn to before me
tatements captained herrn ar as to the
t)lication _
Re siding at:
My conUmssion expixes:
91
79 E. Main
Rexburg, 18344
Building Safety Department � pF µExflUkC
U A�L
rexb r
www.rexburg.org
City of Rexburg
Phone:
208.359.3020
Fax:
208.3,59-3024
APPLICATION: cc CONSTRUCTION PERMIT"
� CONSTRUCTION PERMIT #:
—APPLICANT P
Business Name:
Office Address,
lhE1) 1
I
REXBURG.
Cw
rneri : 's familyCopir"Unity
PERMIT APPROVED: YES/ NO $50-.00 FEE PAID: YES/NO
APPROVED BY:
FORNMTION:
Office Phone Number.
Contractor Performing t
Contact Person:
N
r�
City
State
Zip
Work:
Cell Phone # ( )
ter- WORKTO BE DON�:
Street Address Where Work 'll Be Done,*
business Name Whe�e work 'll Be Done:
Dates For Work To Be Dane: To
Contact Person:
Ph -one Number: (__)
Cell # (_)
PLEASE CHECK THE TYPE OFPER IT(S) YOU ARE APPLYING FOR:
El AUTOMATIC FIRE—EXTINGUISH G SYSTEMS
Ll COMPRESSED GASES
F-7 FIRE ALARM AND DETECTION SYSI'
MS AND RELATED EQUIPMENT
D FIRE PUMPS AND RELATED EQUIPM T
1-1 FLAMMABLE AND COMMBUI,TTBLE LIQ IDS
❑ HAZARDOUS MATERIALS
❑ INDUSTRIAL OVENS
-F LP—GAS
PRIVATE FIRE HYDRANTS
I I SPRAYING OR DIPPING
El STANDPIPE SYSTEMS
0 TEMPORARY MEMBRANE STRUCTURES, TENTS, AN4 CANOPIES
Applicant's Signature,
AMERMAN 0 a NAME ORENr MEMO OM■■ a OREN no i ■■ w OEM" or MAKE n■■■■ MEN
7
F,xc,iw:ation & Earthwc)rk:
concrete:
Masonry
Roofing:
Insulation:
DnTwall:
Painting,
Floor
Coverings:
Plumbing:
Heatm`g:
Electrical:
-Roof Trusses:
Floor/Ceiling Joists:
Siding/Ext,e -'
io 1 r :
Other:
SUBCONTRACTOR LIST
Special Construction
(Manufacturer or Supplier)
EXEMPTIONS FROM STATE REGISTRATION
As of January 1, 2006, the City of Rexb-ung can no Iongrer sell permits without having -a cOPY of yo ur State
-registration number ot your exemption Exam the state registtation. Please send a copy of your_ state
fill out this fo�zn showing your exemption anlicense
registration or
d send it with our re-newal Or your next permit appficationA
(This list zs a summarization of Idaho Code
see, the State's website at cv-r
X
W
LEI
[a
14-1
X
X
10-1
IN
Tide 54 Chanter 5(15 fr,,p -rii A 4r -d _ �.,
V
-a ons or mese exeraptions please
ont.htna)
Currendy St -cite licensed pursuant to Title 54 Idaho Code, Chapters:
3 Architects,
10 Electrical Contractflxs/Journeyman,
12, Engineers/Surveyozs,
19 Public Works Contrar-t-on, - - ..
26. Plumbing/Plumbers, ...,;� jL-L-LF e on -Ly registratton requtted ,
45 Public Works Construction Management Licensing Act (exempt farom fee only registtation tequi-red), ot
50 Installation of heating, ventilation and air conditiom-tg systems
Employee or volunteer of a licensed contractor or part of an educational cu -ticulum or nonprofit charitable
activity- with no wages or salary
Employee of a LTS Government a e ge - sdcl n c T (State City,. CauntY, or o tb ev f -n
Pub1ic U ttfttyo d
oing construction, maintenance, or development to its own business
Involved with gas, oil or rnmeral operations
Supplier doing no installation or fabxicating
Cantractmg a pto)*ect or projects with a total cost less, than $2000
Operation of a farm or ranch or construction of zcig-riculture buildings exemDt from Tdnlin ]Riiiltli,
�. r�.a„
-zvny type of -water disttjct operations
Work in rural districtsa for fire prevention Dumoses
Ownex who pexforms wotk on own property-�or contracts With a registered contractor to do wotk as Ian as
XV-1th'
the property is not for resale within
12mnnths g
owner or lessee of commercial propexty performing maintenance, repau, alterationor construction on that
property
Real estate IicenSee/property manager acting witbin Idaho Code
❑ Engaging m' the logging industzy
❑ Renter working on the property where they, livewvith thepro��rty owneElConsfixuc�ion
owners approval
of a building used for industtial chemical processing per Idaho Code
El "
Construction of a modular building (de{med b y Idaho Code) to be moved out of state
here
",b certify that the above information is true and co-r-rect to the best of my knowledore
S Fr t Z-- Us
iWe
Pmt Natne
to
9