HomeMy WebLinkAboutAPPLICATION - 07-00631 & 632 - Schiess & Associates - New Building - Site PlanCITE' OF REX, B URG
BUILDING PERIN2IT APPLIC_1TION
19 L, nLALIN, RLiYI3LRG, ID. 83440
208-359-3020 X326
PAr-\_CEL NUIVI
SUBDIVISION:
LAddressing is based on the information - must be accurate
0 IUVER
Pleas `4
07 00631 ky- 07
063.,-ve� -9 ! � 1,
Site & Bldg Plates
(We udll provide this for 3TO U)
?NIT# BLOCKU
CONTACT PHONE # .
�
PROPERTY ADDR�;SS: �n�'Sjzsi�;�
PHONE #.- Home
Work ( ) Cell ( )
OWNERATAILING ADDRESS:,.71 a�3 1f f"N CITY* —T-7t��J,^,n STATE.�T'�ZIP:�y(,r�
EMAIL
APPLICAYT: (If other th,,in owner)
UL I Other man owner, a statement uthorizi 1ica t to act agent for owner u
ta anthis 1�a.n)
A'D'DT T C A _�,T-`-r T \M VnDA /f A --r-r r% 1\ A DT"NTYU 01 Q
STATEt
EMAIL Y i
�� AX
PHONE #,- Home ( ) Wotk(2t��'rR;3�q - Q�i� i Cell ( )
� CTOR. �
AILING ADDRESS:
PHONE: Cell# Work#
EMAIL
CITY bc_rr STATE� ZIP
F'ax#
IDAHO REG-TST. RX-rTON # & ESP. 1)_�TF
How many buil-dings are locatecl on this propr.
Did yourecendy pthis No CYe:S`jf ysgive w.'s nqme) ep
Is this alot jet? N
0 Sbring 0
ase new l l � �pro_ffer
} . .t:.
PROPOSEDUSE:
(i -C., Single Fa 1v Residence aA3 Remod
.t-,
elm�2 2007,G�,�, . �Lt
Frn
APPLICANT'S SIGN_ckTURE, R-TT-FICATION AND Al-Y-fl-IORiZATION: .[Jnd r pcnal,-y of perj:�jx-y, I heteby cettify thac I
haread thi,� X13 f icat-011 'arid state that tie �� r .ation herein is cariect -and T ����� �:�r that any informati n -which ma , he 'lrtxd ren rrrnsnCity n t� x shall ttlirid t. IF, a .
t tlluct: f Chili i�rtl.il rjri' t�� tt t t r _ #,%ji Yrn. ot
:;.�
in, vgqQff��p
The building official may re— lie a permit on approval issued under the pr v.1'sions, of the 2003 Intcrnatilonal C '-
ir� the r r the 1 n which i F ,. �a ori f ,n .1 c s t tc � ra t or 15rc r�U"Cr1e tion t
in pprD j iv as based. Permit mit NFold if not started Within 180 days. Kermit voidifwork t for 180 days.
i naffs of Ownez/Ap
DATE
Do � u prefer to he cont(Icted by fax, rn
1 4 hone? ;Circle 0 n
WARNI — I I L IN, G PERMIT-MtST BE P I T�} CONSTRUCTION CTI SITE!
Plan fees arc non-refundable and are paid in fell at the time of li at n be
Iginning -1, �Loog,
C'ty of Rexburg's Acceptance of the plan review fee does not constitute plan approval
**Buffding Permit Fees are due at time of application** **Building Permits are p
d if your check does not clear**
Building Safet,y'Depart ent
City of Rexburg
19 E. Moro
Rexburg, ID 83440
State of Idaho
County of Madison
ionelih@rexburg.org
www.rexburg.org
Phone: 2D . 9, ext 3.26
Fax: 208.3,59. 3024
Affidavit of Legal Interest
Af RIC ,E
N--,une Address
s
}
City Stage
Beitag-first duly worn upon oathole, ata -v:
W,
(If Applicant is also Owner of -Record, skip to B)
A. That I am the record owner of the property desc.tibed on the attached, at -ad I giant my
p��t-nissioi� to:
-N,axne
Add.rcss
to submit the mpanNitag applicatiot-,pertqini �
to that property.
B. agree to iridemni Tdefend rand hold Re--vzbijrg Gte aid its emplovees harn-dess from any
claim or Li-,ibility. re5u1a'19 from any dispute as to the statements contained lie�i.n or as to the
o��Fne�:sl-yip of t��e prop ertj T Nvlzich is the subject�.
of the ppliea�an. Dated thl4s dav of 20
�7
Signature
Subscribed and sworn to before ane the dray and year first above wzittexi.
..�
,Notary Pu lc of Idaho
Residitig at:
I
5 14 0 7;1- R Y i'.
MENEM
IL Ruh
PJj ISL Ic MY comrmsslori expircs,
41MO
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3
Please complete the entire Application!
N,NN/M,
�l�{�.f'I£th/e�question doesnot apply fill in'NA fox iaon applicable. '+L..il\14'I�J� Q. (�L^.�`.1��)( iILT-C 4
PROPERTY Nr_)DR_E
SIT,DIVISION
Ss— i5l POLWO_�_ L wt V?A%
Dwelling U v � r e A �
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SETBACKS
FRC)N1' SIDF.
SIDE
RernodelingYou-tBadtdinglJYame (needJ. . re)
:.
BACK
Pc,rmlt#
.. �'d�'!`ritF�°�',:."�"�'Y'.°�..� �Yr� :�'ff�i`nn=�`�� ►tea®��
SURFACF-4 S
U indiadc the cx�edoj: c)f tht bL�Iding)
17 1 A
Unfi 'A
. ......... .......... .
Second floor/loft arca Fit-iizs.hed baarea
'11. rd floor/loft area. :Vr `. G ar.-ig c a r n,
Sli xCarport/Dtck (30.,.." above grade)Are
Water Meter Quantity:
v:w`I •r ti T
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.� •' `e e■ e w i i ! WaterN4eter Size....'w w
, _�~J_11
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PLUMBING
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LIXTURE COJLI�LT
Clo(hc5 Wac,�Iair�g _Nfi,-t di ifi C
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Di ger
loorD...Ciln
n -). l ers
'rub /SI.-AUw, --ers
T0i1etA5r1n;;',1
t Cr 171 �C
I -lot Tub/Spa V`atu. ,' f Cc n(�-r
_ in 111%
(L-avatones kitchens, brar, rnop)
PlumbingEstimate(Co�m erc alOnly)
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5M
LAN i 11.1L.
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Please Complete the entire Application! If the qucr,�tiorj does inni apply iili in NA for Baan
aypllcable
N A M F,
'PROPERTY ADDRESS �nc C)v l �j Permits
SUBDTVISION VA&A-\. vit ,S r--C-rk- '-Pl4--7�
1l' MECHAIVICAL
i s A*
Mccliw)llcal Contracror's, N;imc:
Addrcs,s
Civr�act �hr.�ne� i }
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flus,111.11C.C5 Phone: .
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mechanicat Estinlate $-Ra�— (Commetci A /Multi Family Only)
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hei us T: oz V e f i
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T"1'U:MA,c-ki/A1r Condinoricl, Combo
I-Jeat pulmp
sir Condidolleic
UnitFicaier
5pncc Ht.A.cer
,ts- fired ,y pl.-
g-z
F
13D01 1,_1 tjt�x.
Dryer vcnts
R4-kngc-Hood Vents
Cook stogy, Vents
Bath 174q?, velats
tie r 5ir at vitnts & d r
Fmcl�ritr GP ipc Quest � .c L(,ubb cl III Or future Oudets
1clet Pre-saire (Nf cter Supply) 1-15�1
Heat i all th t lv� Gas 01'1 Co,,, -LI F�� 1-13!dtonic
j
echarZical Sizin
a
U�'d�lf]n� li"�d1�t he �1't1'7t7'liCate tto-Irl txv1itl-, Mane Rs A
Point of Delive
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lication
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lication
'4
5
19 F parr
Rexburg, 0 8344
ONNINT �R`S NIANIE
PROPERTY ADDRESS
SUBDIVISION �
PHASE
Building Safety Department
City of Rexburg
nll@runt
www.f-exburg,org
Phone,, 208.3 9,3020 x;326
Fax. 208.359.3024
'P ic�2a
LOT I BLOCK I
Jr
T F
U1
/'�"w'w'sm"au�aarfda�+r�vauv. �,: yav'.vlv.tis�.=_:=�—e�.mmnn�nr
U—tr C do 0 d;E EL
WICAL
Electti ntra tor" fi m
Address
Cell Phone (,)b$} 3%L — S`-i�
Fax (�M r?
C-) o"%L3 l
so �
8 59 S N el.l.owstone-
urines Nai-ne
l �e,-E2ic_
_CS ta te`+L, z ip
Business Phone 0&3) �'25`-/—�"%�Tj[
Ema�
ell
�'I
(C
ElectricalEsti t ��� ��� � � � �
=50 OMA/IERCIA- L/NIULTI-FAMILY
TYPES OF -12VS TALL4 T.102V
(?VewRcs1de,nda1 -in cm des eveiyt
residen'tiRlstWeture and attached-z"Fz 3
UP t0 2Q0 arnp Service*
201 to 40U arnp Se�vi.ce�=
..� Over 4a0 amp Se
rvice'�
Existing Residential (# of Branch Circuits)
- —
Temporary Construction SenTice, 200 arnp ot lass, one location (far ra period not to exceed 1 vcar)
Spy, Hot Tub, Swimming Pool
Electtlk Central Systems Heating jr� �N hcn not) ff of a n ew xesiden 6 n I tri 1r,tir�I-I +'N r% 4 -
and no Oddiaonalire
Modular
d � lobtle
.,, Manufacture
Othe-r InstaLtions: Wiring not specific�i,.Jl
Cost of NT/'iririg & Labor:
Pumps P0_t-rjC'qqC Water, 1rj_-_tgation,, Sewage)
Requested Inspectiolls ex's til r'ing)
Temp ora ry Amus cme�.t/I�adus dry
Inc tides a maw-lum of 3 inspections. Addi'6onal inspections Char .
jj Iu ccs ii sptin rate r hou,
11
F'hContractor
License number
to
Tile GO Of RexbmIX'sperlivitfee scbedule if 1hesame as required the State of Idaho
bi
6
i
:
r
memory
Date/T�me: Dec,28, 2007 10:�k9oAM
F 'I I e
N o I
Ma d e
5�49 Memor
y Tx
"`t
TX Result .Report (Dec. 28, 200/' 10:39AM)
h
esti na n
RoCky V.tn Power
Result
P. 1 OK
e a s o 7 f r a r rro r
E. 1) Fang up or 1 i n e faLrE. 2 E�,,
EJ ) No answe r E. ) No faCS imi 1 e connect ion
E.5) Exceeded max. E—ma i t size
Building Safety Department
19 E 140fp jonemQ'a bb g PJ 8�: 2DEaWZ020426
Rem kywvv 'J
24
CITy_C
REXBURG,
— __
OWNET - Permit #07 0063
PROPERTY ADDRRSS-
SUBDIVISION
r Schiess & Associates Mkor
BLQCK 8 5w 9 S Yellow stone
M - TRI-c2a
Elcr-Ldcal C0.n1:iMCtC)?,S Nmmmac�L-b-t A, �44 Lt'�
Cd, P-bant
Business P-11ofn ODE)
_
TYPES _F7.J AL.T_4.r
� r+''MtN1iR&4u day ffCrAM wAk62 fhe .gar. &,1dE_-u rsfnci a. .at ac,&ed
231 to CID amp i&'
�' -ar 4Matnp Scl
i
"Te Pordt om ir-e, 200 tmp or Vis} one locate fttt a period not to Mored l ±ar.
S�pa, I -I Tub, Swann tng Ej
J
sprems_+fir Conhog whan norp&-t oi: a -,r_.W :ri-_1&tt;alk5��C p�F �F
�+ Leiial win
�.� = 0 E' Lr, Murm is ed or lob& Homme
"Iring nQt SPO�H CRUY c t -d by any of the above
Cil of Wire
Pumps (Domestic Vater, Irrigatibn. vagi
I,r�,ir
a< rrx --zna i' p �i .. r+ i � pecto I� at rrqt d i , crx a� r € per Ixvu .
-•• �4
of
T& C.A. �P.07�,
s&" & & Z- j
gage
Nat Sint
f
Excavation & Earthwlork:-
Concrete: if I
Mas :-,,---,.
Roofing:
Insulan*011-:
Drew l,:
Floor
}r11
Plumbing:
Heating:
ltrl.
Roof T-ru:
w
SUBCONTRACTOR LIST
A
t.
LA
Floor/Ce1hLagjc)1StS:'
sidirig/ E xtetior -'"Frim:
Other:
V-) fA ec,
('Gi:-1�n'
Gt
Special Construction
(Manufacturer or Supplier)
RA -Codl- +1 f
X 4
w
0
H
4r
EXEMPTIONS FRO, -1 STATE REGISTRATION
As ofjanuai� ?006, the CitTofRexburg can no longer stil per ` havj`ng1-1 t _\Vlthotit Cq )T your M
reg'stration nw-riber iStatete-gistration. Please send a copy of your state j:eglstration
fiffl our ttlis form sho-%�'in - your exemption 9"
and sendit -%v'th )7our license renewal
(This list is a. sumt-narization of Idaho Code Title 54 Chapter 52Q5, fot fug. definitions of these e�empti.ans please:
see the State's -\vebsite at �u�u��r.ibo�.ida�zo.���� /cont.htrr,l
MW
El
D
F1
El
El
El
0
Cutrently State Hcenpursuarit t
Ti Idaho .. Ch-acoters:
Ar t t ,
10 ElectrIC211 C0ntr'cjCt0rS/J0UfjjC)TM,,j0,
12 En i
gineers / S ut-vr
19 Public Work q l,r}1-1 i'�":1 ['fl )f -.Q f!a'CT PtYltli' 4�i_lliM �F.10 .._...�_� .... �, _i"_�' _ t♦
26 Plumbing/ Plumb efs, e ona e onj..Y requireci)-,
451 Public \.V orh-S Collstr`ct'on Maneq-gemcf2t Lice'-sil-19 Act (exempt trom fee- only registration required), or
50 Installation e ti , ventilati.ori aril rain conditioninz w
stems
Employee- vol t t f licensee ��trt r � ,. -r pa t f n educational rr � tcharitablet
cttve 1 ty lth no Nvages or
E,rnplovee of a US Government CC)Urjt�% other mum' r
D I-% I LT 1�-; I A
-c- Of evew ment 'Lo AS ()WI-I1'nall C. P i)usiness
1 nvlv ed V.ath gas, oil or n-ilnml operations
Supplier i no last-Aadon or fabTicath-le.;
t C
Contracti'ng ea proje.ct r proiccts witb a total coc,;t less than $1200
Operation of a farm or ranch or & construction of ag:rlculture btdldings exempt from
Anv type ofwater district operations
Work, in rural distri
cts for fire Pre�rendon purposes
ho Building Code
❑
0�vner who perfo-tins work on ours propert�7 of contracts with a registered contractor to da work as Long as prop e�-ty is not fog presale withi��. 12 months
❑ Owner or lessee Of commercial properry performi-no- z-nairitenfarice, repair, alte�.on or construction on that
propertyr-a
❑ Real estate hcciisee/propettv, 1-na1jager acting \vithzn Idaho Code
❑ Engaging in the loggliag iridustzy
o Renter working on the property where they live with the property owners approval
❑
const:ruction of a building used for'ndustfial chemical Processing per Idaho Code
D
Construcdon of a modular buildi'tig (defined by Idaho Code) to be moved out of sate
I hereby eerti�T that the above infort--nation is true and correct to the best of my knowledge,
Signature
P rl" n t Name
a t
9
Building Safety Department
City of Rexburg
Rexburg ID 83440
janelih @rexburg, org
%www# r urg, r
Phone: 208,359,3020
Flox.4 208-359.3024
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
$50.00 FEE PAID: YES/NO
PERMIT APPROVED: YES/ NO
-APPLICANT INFORMATION•
Business Name:
(iffice Address: 7/03 �. 'I o-\
Office Phone Number: (.
Contractor Performing the
Work:
oc
Contact Person,,'�-� Cell Phone #
-LOCATION OF WORK TO BE DONE.
Street Address Where Work Will Be Done -11
Business Name Where Work Will Be mane:
Dates For Work To Be Done., To
Contact Perswn: 0
V,
Phone Number*. ��6
APPROVED BY;
A..',5.-
City S to to Zip
III
PLEAS -E CHECK THE TYPE OF PERMIT(S) You ARE APPLN71NG FOR:
E, AUTOMATIC FIRE-EXTINGU'll-')
114, j, LJ
❑ COMPRESSED GASES
11 FIREi-1LARM AND DETECTION SYSTEMS AND RELATED �QUIP1b1ENT
FIRE PUMPS AND:RELA
f- ED EQUIPMENT
❑ FLAMMABLE AND CQMMBUSTIBLE LIQUIDS
C' HAZARDOUS MATERIALS
�7 INDUSTRIAL OVENS
,�] LP -GAS
L PRIVATE FIRE HYDRANTS
C SPRAYING OR DIPPING
El STANDPIPE SYSTEMS
❑ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES
1 d
Applicant'sj
�ii
gnatur
1-01 JR.
In N N E N z A
0 M 5 0- N.X
DatI6
0 Nunn M MRSKM N SENA E "RENIffmaoffinal Effn WROMME
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