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Home My WebLink AboutAPPLICATION - 07-00570 - 343 Talon Dr - Basement FinishCTL Y OF KEXB URG B['ILDING PERMI`i' APPLICATIO\ 19 E bLr1IN, RE-_\,,.7,".BURG, ID. 83440 208-359-3020 Y326 Please If the qut PARCEL NUMBER: 0�,1i�'�(i1 C I SUBDIVISION: � �17'e � �� (zkddressing is based on the information - must be accurate) OWNER NAME: PROPERLY ADDRESS: t pt '7)Y"3 la -10 C. 0700570 It 343 Talon -Basement F inish UNIT# BLOCK# LOT# PHONE#: Home 4cie)-i T_( le. Z3 Work ( ) OWNER NLAILING ADDRESS: CON-11ACT PHONE # i CITY: LAL LL610k cm STATE: ZIP: APPLI(__-.ANT (If other than owner) (applicant if other than owner, a statement authorizing applicant to act as agent for owner mast accompany fl-iis appli.cation.) APPLICANT INFORMaTION: ADDRESS CITY. ST ATE; PHONE #: Home GIP EMAIL FAX Work ( ) Cell( ) CONTRACTOR-. MAILING ADDRESS: CITY PHONE#: Home Work 'ENLUL FAX I17AHC7 G S R -A 0 # EYE How many bufldings are located on this property? 4 Did you recently purchage this prop erty-?: No,Yes ��f�.�es, list previous owner name)_ Is this a lot split? 'NQ YES (Please bring copy of new legal description of property) PROPOSED USE: Vie} i.e., Single racy Residence, iNfulti Fanvly, Apartments, Remodel, Garage, Commercial, Addition, Etc.) DATE ZIP APPLICANT 7IG1 TATURE', CERTIFICATION AND AUTHORIZATI0N that I have reed this � � � � � application do and tate, that the forma tion herein i rr c t and I swear that n in fo r anon ch may hereafter be givenT hearings before the Planning and Zoning Com ssi n or the t . Council for the tT f Rexburg shy be truthful ' and correct � �� to �ornl. with all City re l ti n s and tate lis rely ting to the subject e t matter o f t� i sp con and hereby authorized representatives o the City to enter upon the above- mentioned pr p rt for , I e tonsur os s. Th building offs i 1 may x- �� t �� aro1 issue��d�� t� rc�visions International ,ode -n cases of any f s e statement or rr�srepresentatton of fact ill the application or on the plans n which the eF as based, Permit void if not started within 180 daycid 'f work stops for 180 days. Signore o Owner/Applicant ....i_ - DATE D -o you refer to be contacted by f � etnnA e� G le One0, Phon trc WARNIN — ISI DIN BRIT MUST BE POSTEDON N T CTIO IE! Plan fees are iimi-refundable and are paid in U at the- firne of application beginning & - 2005. City of Rexburg's Acceptance f 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 oes not clear** 01 M Buoildi-, g Safety Department City of Rexburg 19 E. Main Rexburg,, 183440 State of Idaho County of Madison 'a n ellhrexb car . o r www.rexburg.,o.rg Phone: 208,3 9.3020 Fox, 208.359.3024 Affidavit of Legal Interest City Being first duly sworn upon oath, depose and say: Addiress State (If Applicant is also Owner of Record, skip to B) 6 I TY 0 F REIUUR Ow American Conitnunity A. That I am the retard owner of the property described on the attached, and I grant my perrD-tssion to: Name Address to submit the accompanying appli.cattQn pertaini-ng to that property. B. I ogrce 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 fih.is Signature day of , Zp Subscribed and swain to before me the day and year first above written. Notary Public of Idaho Residing at: My C mmi signire r. Please complete the entire Applicationf, NAME �i u%�"� (.l�+(� �inn�t of i�l`�iUJ PROPElUY ADDRESS 3�l SUBDIVISION wond— D (i vi IX i Perrm,t# Dwelling Units: Parcel .Acres: SETBACKS FRONT SIDE SIDS BACK R em o deEng Yo ur B ildinglHon e (n e e d E stimate) � �Li SURFACE SQUARE FOOTAGE: First Floor Area Second floor/loft area Third floor/loft area Shed or Bain Water Meter Quantity., Regzrired.!f! PLUMBING �n Plumbing Contractor's Name: (Shall include the exterior wall measurements of the building) Unfinished Basement area Finished basement area J� Garage area Carport,/Deck (30" above grade)Area Address Contact Phone: *Water Meter Size: Busines s Natne: State 2�p Business Phone: ( ) Email Fax FIXTURECOUArTfinChldinDr P11110rhOa i7Yr17rPV ) Plumbi Clashes Washing Machine Dishwasher Floor Dtain Garbage Disposal Hot Tub/Spa Sinks (Lavatories, kitchens, bat, mop) Sprinkle:ts e 1 ' Tub/Showers i 1 Toilet/Urinal Estimate $ y {COMMERCIAL/MULTI-F Water Heater Water Softener Signature offdicensed Contractor License Number& Expiration Date The Caty of &xburg'spe itfee _-chedule is the same as required by the State of Idaho Please complete the entire Application! NAME J I ✓h;5 a�bt /i✓in0. ✓V �CIS(� PROPF.RTYADDRESS 3t3 j c,jav,, Pexmit# SUBDIVISION OA, Requiredd.!f 14Techanical Confixactor's Name -Business Name Address CitY Stage zip - Cell Phone Business Phone ( } Fax ( Email Mechanical Estimate $ (Commercial/1Vlulti Family Only) FIXTURES &APPLIANCES COUNT (Single Family Dwelling Only) Furnace Furnace%Air Conditioner combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater �� Decorative gas-fired appliance Incainerator System Boiler Pool Heater 0 - Exhaust or Vent Ducts Dryer'i,TentS Range Hood Vents Cook Stove Vents �_ Bath. Fan Vents Fuel was Pipeincluding Outlets stubbed itz or future outlets Inlet Pressure (Meter Supply) PST other similar vents &ducts: C-) �li� �C�(Y �1 Heat (Circle all that apply) Gas Oil Coal Fireplace El.ectric H Mechanical Sizi �fl oint of signature of 1A_ Censed Conttactor It tions must be submitted with Plans Sc A- ehvery must be shown on nlans. License number Date The C10 of Rexbuq'spermitfee scheduk - the same asrequirej b te f 1,jh, _y the St lication MEN=" Building *vX11 U * Department C 19 E AAcin Rexburg, ID 83440 ioneith@rexburg.org www.rexburg.org 0 OWNER'SNAME�U�(o`h�AOt 4bdVR 1�/�(' PROPERTYADDKESS ?i't� Tn�ov� �� SUBDiV PHASF, ISION � u��l� �,,l�9e W1 A BLOCK City of Rexburg Fhone: 208.359,3020 x326 Fox., 208.359.3024 Home Owner's Name E Address12. Cell Phone (-Z arl), i� Fax ( ) Email City W Permit# %n A CITY 4F REXBURG Ow Am erica 's Famy. ly Com mu n ity 'ICAC PERMIT Home Phone (74) Iq AorjL o, 4o u, k- on, State�_�Zip_Cl) -35 R�L� J Cv TYPES D.F INSTALLA TION (New -Residen Hal in cludes everything con to -in ed within the Tesiden tial structure end a tta che d garage at rhe sam e rime} 010' For power supplier reqW'rements visit XVW%V-r0Ckymtnpo,xver. net Number of meters being M Up to 200 amp Service* 201 to 400 amp Service* Over 400 amp Service* Temporary Construction Set-�Tice, 200 amp or less., one location (for a pexiod not to exceed I yea -0j - � , Existing Residential (# of B.zanch Circuits} Spa.) Hot Tub., Swimming Pool Electric Central. Systems Heat�tig and/or Cao]ing (when not part of a new residential construction permit and no additional wiring) Modular, Manufactured or Mobile Home Other installations: Wring not specifically covered by any of the above Cost of Wiri-ng & Lab -or: $ Pumps (Dornestic Water, irrigation, Sewage) Rcquested Inspections (of existing vvir X1 ing) Temporary Amusennent,lIndustfy Includes a maximum of 3 inspections. Additional 'inspections charged at requested u'ispection rate of $40 per hour. 11 ,7 Signature of Home Owner Date The GO of R-axbUrg"sPenwitfee schedule is llierame as reqtvired by the State of Idaho iw Building Safety Department 19 E Main Rexburg., ID 83440 OWNER'S NAME PROPLRTYADDR SUBDIVISION PHASE Requrredd.!f o n ellh @r urg.car www.rexburg,org zi a BLOCK ELEC if CRY of Rexburg Phone.- 208.3,�9.3020 x326 Fox," 208.359.3024 en -s 4 r ID I REXBURG. CW America's Family Comm un electrical Contractor's Name Business Name Address City ______.......State --Zip Cell Phone Business Phone � } Fax Email l tf l Estimate (cost of wiring SLas ,Iabot) $ (COMMERCIAL/MULTI-FAMILY ONL TYPES oF INsrALrA rroly (IVewRestdetltraX,includcs everything con tai�r e d ww*Ain the tesiden ti�l s tru c t ure an d attacherigarage at the S4UM,e time) Number of meters being installed Up to 200 amp Service* 1201 to 400 amp Service* Over 400 amp Service* Temporary Construction Service, 200 amp or less, one ].ocation (for a period not to exceed Existing Residential (# of Branch Cji.rcuits) Spa., Hot Tub, Swimming Pool Vear) J Electric Central_ Systems Heaqhg and/or Cooling (when not part of a new residential construction permit and no additional xviting) / '` Modular, Manufactured or/Mobile H Utlner Installations: Wiring not specifically covered by any of the above Cost of Wiring &Labor: $ Pumps (Domestic Watct, Ixriga#ion, Sewage) Requested Inspections (of existing wiring) TempoWy Amusement/Industry *Includes a maximum of 3 inspections. Additional inspec,tions charged at requested Inspection rate of $40 per hour. Signature of Licensed Contractor License number The GO of Revburg '.r_permitfee x cbedule as the same as reqivired &y the State of Idaho a MI■,■ m IMf EWENERMANN ERNE MEMO ■WEN 0 OMEN EWENN a ERNE ■■ E Room MEMO a BEEN NONE E B N E RERNE OMEN a N E R■ ago SON � SUBCONTRACTOR LIST Excavation & Earthwork: Concrete: Masonrv: Roofing: Insulation:-, 2f,( Painting: v �ej nLn,�� Floor ail 'g,s-: Heating: - E,Iectrica,l: o (;,J Special. Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists: Sieg/Exterior -Trim.- Other: Tm. Other: EXEMPTIONS FROM STATE REGISTRATION As of January 1, 2Q06, the City of Rexburg can no longer sell peti-i-Ats without having a copy o£ your State rega.stration number or your exemption ftom the State tegistratic,n. Please send a copy of youx sate registration or f�Il out this farm showing your exemption and send it with your license renewal or your next perml. it application. (This list is a sumtnaxizatian of Idaho Code Title 54 Chapter 5205, dor fuH delFin'tions of these exemptions please gee the Spate's website at www.ibol.idaho-ov/cont.htm) o Currently State licensed pursuecint to Title 54 Idaho Code, Chapters: 3 Architects, 10 Electrical Contractots/Journeyman, X 0 0 12, Engineers/ Surveyors, 19 Public Works Contractors (exempt from dee only registration reg -Lured), 26 Plumbm'g/Plumbexs, 45 Public Works Construction Management Licensing Act (cxcmpt from fee only registration required), ar 50 Installation of heating, ventilation and air conditioning systems Employee or volunteer of a licensed contractor or pari of an educational curticulum or nonprofit charitable activity with no wages or salary Employee of a LAS Government agency (State, City, County, or other municipality) Public U ty doing construction, maintenance, or development to its own business ❑ Involved with gas, oil or mineral operations ❑ Supplier doing no installation or fabricating 0 Contracting a project orprojects with a total cost Jess than $2Q00 0 10-1 M perafton oak a farm or ranch or construction of ag"iculture buildings exempt from Idaho Building Code Any tope of water district operations Work- in rugal districts for fire prevention purposes Owner tiuho performs work an own property or contracts with, a registered contractor to do work as long as the property is not for resale wiffiiri 12 months ❑ Owner or lessee of commercial property performing maintenance, repair, alteration or cc�nstruction on that property o Real estate licensee/property manager acting within Idaho bode 0 Engagm*gin the logging industry ❑ renter wozkin.g on the property where they live with the property owners approval ❑ Construction of a building used for industrial chemical processing per Idaho Code o Construcfion of a modulax building defined by Idaho Code) to be moved out of state I hereby certify that the above info SiAaak�re t Print Name tion is true and correct to the best of my knowledge.