HomeMy WebLinkAboutAPPLICATION - 07-00540 - 824 Griffin St - New SFR-,��m�- was
CI�"orRE,,,VB UAG
BLILDING PEAMIT APPLICATIO
19 E 1lLNIN, REXBURG, ID. 834=30
208-359-3020 X326
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PARCEL N"�Ca��� 1�(j
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U SO
(Addressing is based on the lnformat%on - must be accurate)
OWNER NAME: vie✓ate.
PROPERTY ADDRESS: YY
ri
Griffin St -Andrews
JNIT# BLOCK# c9 LC)T#z:��
CON"fACT PHONE #
PI IONE #: Home (fig ) 3s r-Ucy 2 Work ( ) —Cell( )
OWNER VLULING ADDRESS CITYr,'6e04UY STATE:.Xn'LIP:
EMAIL Rtk.
APPLICANT (If other than owner)
(Applicant if other than ozun,er, a sra�emcnt authorizing appli.cant to act as agent for owner must accompany this application.)
APPLICANT INFOKIIV�TION: ADDRESS4CITY
STATE-
ZIP EMAIL FlAi-xi,
PHONE#: Home ( ) Work ( ) Cell ( )
CONTRACTOR: h" s?S
IvLALILING ADDRE
ss3
CITY�S
TATE TO ZIP�'3YVLZ
PHONE #-. Hoine �;�u�} 7_%:� -'�=c`� 51 W70 rk Celi � J
EMAIL FAX IDAHOE REGISTRATION#& EXP. DATE I?L C �1i(;i
Hove many buildings are located onthis property?
Did you recendy purchase this propertyP No(YDesIf yes, dive owner name} tAl. �• �G��`sF-�--t
Is fl -lis a lob splWND) YES (Please, b��r�� cop�r e�� �e�� legal descrit�ti�n C)f nrr1rzPrr�rl
c
PROPOSED USE:� r�
(i.e., �ingle Fannilv Residence,
Fam11 } � rtr nt , Remodd, Garagc, CommercialAddition,Etc.
APPLICANT'S SCERTIFIC
Afi'I
N AND AUTHORIZATION' L'nder pcnalty
that I have read th's ap 1i.AtIon and state 0 -i -at tli c MLform a#i on herein is correct a:ud T swcax that any in fb ix-x� Li��i� l�i�l� x�� �. htPr��r��i �� �.
h� before � ��lannirl �.nd on or�rni,ven by me in
�l� � � � urs � the �� �� F.�ur � -s r
s hal e truthful and correct. I agree to comply with all
Cita: relations and State laws relating to the subject matter of this application and hereby authorized r s � ,
r �t t 11 . City to enter upon theabove-
-
ment-toned propertyfor ��NOTE:st��s u��� ��: e building of.�i�l � r revoke permit ���� approval real i��a� ���� �h� � �_
�' I � � � iti aons of the 2003
International Cede in cases of any fals'c stat rnen t or mi:srepr s entation o f fact i� the application or on the1
crit iter Xihirx18 0 day s . I'rt i if rt fcr.
�r..
t ZIZ_L'A�� / t"
14=pd&O'
i*gnature of ri r , pl icant DATF
Do you prefer to be contactedby fax, email adMUST
Circle Oi'ARNING — BUILDING P E POSTED ON CON !
Plan fees are non-refundable and are paid in full at the time of application beginning
, ,;
City if exr �s Acceptance f
the plan fevie fee does not constitute plan approval
**Bulldiing Permit Fees are due at time of application** Building Permits are void if your check does
not clear**
Please compIcte the entire Application!
NAT,ffi Cqmc1i-lP,
PIKOPERTYADDMS 11 .-
SUBDIVISIONN�•��,�., o« �
SETBACKS '9
FRON SIDB SIDE $.t).CK
Remo defing Yo urBuilding/Homme (ne ed R S fimte) �
11
StMFACE SQUARE POOTAGEN {Shall include the esmaoz will m=suxements of dze buAdirW
Fwt Floor
Second floor/loft
'3"!-&d �l�a�r�i�ft aria
Shvd at Nm
Uvfir�shed 33memmCage
Einished bmemmtr
G=p im
Cuport/Deck (3(Yabo%ve
Water Metrr Quanfitr-, Midsizemm .6- -
p1wnbing Co
Addm-n-,3��
ntraaa?s Name:
Contact Phone!
f clod)kswas , bu, impowumbMEAMMOMENEWL
rv�l I �e
Dishwasher
Flow JD=W
i
Gaxbagc DlspoW
Q
Hot Tub/Spa
s
$inks Primims, Idtchens, bar, mop)
6
Ly-lulu-F.l
b900 'ON
Name:
din
Business Phone: (,;�p$�
rF�
u
Sprinklers
TUb/Sho
Tije/ jj,�,w
Water HeAter
Water softtner
$
(COMMRCJAL/MULTI-FAMILY OT*ZLV).
s'.
The Cwt* of RiwhwZ fas d&fx& ;.r r1w "M
jr
ar
��ir.a'a-etdl Datc
DNISAP]d AHSI1OH
AOS: � coot
r
0
El
I
19 E Main
e .a 44
OWNER'S NAME
PROPElYl`Y ADDRESS
SUBDMSION
Jnt)eKh&0xbV
F T ire 7d7 ig
C#Y ci ftxwrg
208.350-3020 XX26
.359.304
PHASE LOT
_
Requ,�red�!�
Mectdad Can. tractoes N.=�xc
Address
Cell Phony (2pg)
E.�,EG'?'RIGAL
I F
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REzYL13URG
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Peri-nj*t #07,00540
824 Griffin St
;>
l77. iee>� cl,tY �m mn �t Statc �,1i �� Zip
Fax (16 %)
Elmtric-.d Estitn (coat of wiring & �� (C0MMERCLkL/MULTj.pAMLy ONLY)
""TPE
SOFDVSTAUATION
�l.m�'��et �t�•�r�+thix� �a �d wr'atliit� � i�ett�irlatr�� andsetachedg"age it the sxme a,ue)
_...�
U
P ro 200 sunp Service*
CP
201 to 400 =p service*
0vcr4W=p&rvice,*
Temporary Construction Scrvice, 200 np or less, onc jaca
tion (for a petiod not to exceed 1 Y=)
Rxi!idng Residen (# of Branch Ckcuits)
Sp� 14ot Tub, SPool
Elimbdc C. eni[m1 Syste= Heafing /or Coolibg [whit :10c pert of ra new tcajdential c� crurcicm �rsmit
at�d m �rlc�iti�r,aal wtiri
Modular, Manu&ctwed or MoUe Hawse
Other InstaUstions: Win-ng;nOt specificsMy covemd by any of the above
Cost of Wiring & Libor, �
...
Pumps (D-urnestic Water, Ir�g��on, Sewmr'7-1
.._
Requested Inspecti(MI; (of sfiirig wiring)
T'n-Int)0ftry AmusementAndusay
nr4xiinum C& 3 m"SPrCdum- A-, Lmpcq;twns rhargcd at requestw UWWOOn MW of $40 per hout
Tim Ci
x prn�r1�re r6adw/e �r Abe imr 4J
L.'A ; E T 0 F, 0
ON XUA
.., 2
Date
by I6r State of Idaho
• Building Safety Department
City of Rexburg
1EMain
Rbr, ID 83440
NAME
PROPERTY ADDRES
SUBDIVISION 44me
Regutred!!!�
0 0
r6
janelih AIrexburgorg
www.rexburg.org
Mechanical Contractor's Nar F
Addie cW y
Cell Phone: (�4)
Fax:
6S/— 575c�x',
'hon p, 208, .3020 x326
Fax: 208.5 .302
NICIAL
hia
Permit#
CITY 0 F
RE)CBURG
Ai&
Business Name:
City r d .�1��7 A114 State i � - Zip �31it /
,Business Phone.
_5�5_--7 � ic/8Y _ Email
Mechanical Estimate $ (Commercial./Multi Family Only)
FIXTURES & APPLIANCES COUNT
Furnace
Furnace/Al'r Conditioner Campo
Heat Pimp
Air Conditioner
Evaporative Cooler.
Unit Header
�..
Space, H
Decorative gas -fixed appliance
Incinerator System
Boiler
S.R rt
(Single Family Dwelling only)
Exhaust or Vent Ducts
Dryer Vents
Range Hood Vends
Cook Stave Vents
Bath Fan Vents
other similar vents & ducts :
1e
Pool Heater
Fuel {Gas Pipe Cutlets including stubbed in or future outlets
Heat (Circle all that apply) Gas 0'.1 Coal Fireplace Electric IIydronic
Mechanical
Sizing Calculations must be submitted with Plans & A
Point of Delivery must. be shown on plans.
41
Signature of Licensed Contractor
0
License number
0
Dale
The 04, o` bu iAg "s rip 't fee scheduleis the same as reqiiiredby the at
e of Ido ho
lication
CITY OF REXBURG
NlECHANICAL PERMIT APPLICATION
] 9 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
PERMIT #
Please complete the entire Application',
If the question does not apply SII in NA for non applicable
PARCEL NUMBER:
SUBDIVISION..:.��- �r �� L
{Addressing is based on the information - must be accurate}
(We will provide this for you)
1NIT# BLOCK# q. LOT# Z�
CONTACT PHONE #
PROPERTY ADDRESS:
� PHONE #: Home CJ�'� �'"G - ��"'�2 Work ( ) Cell ("� �✓5� " 2-� S
OWNER MAILING ADDRESS: UV I'Hua
EMAIL FAX
�-G
STATE:�Z11P:�
2
APPLICANT: (If other than owner
(Applicant if other than owner, a statement authoTizing applicant to act as agent for owner must accompany this li 'lon.),
APPLICANT INFORMATION: ADDRESS
STATE;
all
CITY:
EMAIL FAX
PHONE -#.- Home ( ) Work
CONTRACTOR,:
k
( } Cell
MAILING ADDRESS: e0r I?e)jc CITY i �/
STATE 7 ZIPS
v t
PHONE: Home# )OP—�o!-oss/Work# Cell#
EMAIL
FAX
Tow many buildings are located on this property?
Did you recently purchase this property? No.DIf yes give owner's name}
Is this a lot spit? YDS
PROPOSED USE: �L
(i.e., Single Fam lv Residence,
K. fl"Aler
(Please brincy copy of new legal description of property)
'ult�i Fani ly, . a . nt. ,Remodel , Garage., i r�� r gal, Addition Etc,
APPLICANT' S S IGNAT E� CERTIFICATION AND AUTHORIZATION: U �.��r ����rt �I ��_.T�
u , J fir -bey certify that I have
read thl's appl1cat 1 on and state that the 'info r matjon herein i s corr ct and I s wear that any i n fomiati on which may hereafter be given by nye -in hearings
and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I armee to compty with all City rep. lat'111s and State, laws
relating to the
spa bje t matt r of this .ppli ti on and Kirby authorized representatives of the City to enter upon the above-mentioned property for inspections npurposes.
NT The
bUddilIg Official may revoke a pen -nit on approval i sued under the Provisions of the 2003 International Code. in cases of any false st t ent 1` '
. �sr-t�sr�t�tr�� fait in
the a- pi ion or c onwhich the permit or approval based. Permit id if
f � t started � tb r� � f � � t ���� �� � top s for 18 0 day s
.
Signature of Owner/Applicant
Do you prefer to be contactedy fax., eti--iail or phone ?C.ircle
N — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in ft ll at the tine of application beginning
City of xburg's Acceptance of tbe plan review fee does not constitute plan approval
Building Safetv -Jepart ent
City of Rexburg
19 E. Main
Rexburg, ID 83440
State of Idaho
County of Madison
T,
R-e-�4 xtfio MF
City
janelih�&,rexburg.org
www.rexburg.org
Phone, 208. t;
Fox., 208,, 359.3024
Affidavit of Legal Interest
Being first &1Y sworn upon oath, depose. and say:
A.
Address
P � d
State
(If Applicant is also Owner of Record, skip to B)
iV6
edIL
JFJ.AWLIP
7
Y
IRG
�1 EXBL.,..
(W
Arnerica� Famitv Commum"ty
That I am the re cord owner of the property described an the attached, and Z grant my
perrmssion to:
Name Address
to suUxnit the accompanying application pertaining to that property=.
B.Iagree to indemnify, n and hold Rexbu%y City nd its employees harmles,-.--,.
claim r hability resudting fromT dispute as to the statements containedher r as to the
ownership of the property which 'is the subject of the application.
t tis - L . -_.
_ ?�
Signature
F
4
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing ar:
My commission expires..
3
Da'La.,/Time: Oct.24, 2007 3 : 5 -4-L i" M
F I
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Mode
5216 Memory IX
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TX Rp s u I f
Destination
Rocky Mtn Power
PcasoT
for
error,
E.
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Hang
u p fD-r 1'rn e fail
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No
answer
E-5'
Exceeded
max, E—mi 1
size
FMO
Report (Oct, 24. 2VU7
54PM)
Paye
Result Nl,-)t Sent
p , 1 0
E. ) Buff
E. 4) No fats i m i I e connection
4uliding 5a€ed'yr pepp-a
cam#
ti .p� �.
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B VSTA U -A
M1 to 4DO amp Saviwv
Chw 400
� Terry -truc" " .
Spa., HrA TA qadn�g pool
r MI d nc MDb& Flom
ca-Ist Of WI&T &
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CfiY IDIp
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Permit 4'07 00540
824 Griffin St
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