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Home My WebLink AboutAPPLICATION & DOCS - 06-00046 - Henry's Fork Plaza - Bldg 10OF REXB UR G BUILDTIG PERMIT APPLICATION 19 L MAIN ; REXBURG, ID. 8;440 "'59-30 20 X`32? PERMIT # Please i If the ques PARCEL NUMBER: �.� (�I,,i�-� �� U HenrV�S F`OI'�< P1c�Zi3 Bid� - I Ovio SUBDIVISION: ' - (Addressing is baseton 0!!�ERNA ME: M UNIT4 information -must be accurate M PROPERTY !-ADDRESS: $5 S S PT- CYNT117 44. T -T Z., T •••,•,�, �. •iviiic Work 8/ q,, Cell OWNER MAILING ADDRFS.0%-,qj?<_7 .=�' 2i., EMAIL an'. `,.X --------- 892 C _UATE/0__ZjP:.dj)%-/;e L APPLICANT (If other than owner) 0pplicani if other than owner, a statement authoriz�ng applicant to act as agent for owner must accom an this 1� Y application.) APPLICANT INFORMAT:IpN: ADDRESS CITY: STATE; ZIP EMAIL FAX PHONE#: Home ( ) Word � � Cell CONTRACTOR: 6,e, C_ MAILING ADDRESS: If �c- -7 .47 lD PHONE y llon-i&�� WOrkg 3S3; 8!9/ Celli EMAIL FAX W_ How many buildings are located on this property.? CONTACT PHONE # 44/0 3.. 1 d�ho r, STATE. L�o Zip Y5*.t y z Laid you recently purchase this property.,N yes If yep give owner's name Is This a lot spit? YES(PIease bring cagy of new le�al descrinfic)u of „rnn nn nnn� } i. Sin1ily xx �� ''I ° J i 9 JAND _U n P, 2 4 V!ata,�14.�O�Irl�mer�cia�l�cidition, E .) By APPLICANT'S STGNtf ATURF 7 CERTIFICA-HON AND oa�. that I have read this application and state that the information berein is correct and I swear that any infoll-nation which AUTHORIZATION Under penalty of perjui-y, I hereby certify . ib in hearincys before the Planning and Zon ing Commission r thepity Council for the ' t all i bur hall b truthful i -correct, Ir tl ytt laws r1�t�� i xuponabove-mentioned r j ' for it t�1tion and hereby authorized rrrt tivthe pirp tions Purposes. : Th building�`IcSI rperm* ity t nt r rpr�.� issued under thero�inf thelrtrntina�l in of any false t t m t or i r re nt t� unit r pprov used, niiit �r id i ' f ire t1 r t r� " Permit id �� r stops for 180 days. SiQnature. off' n x' o 1 • �€ , , rpt J-_�p ,/ Dovou prefer t CircleTE l or . WARNING — ]BUILDING PERMIT MUST BE POSTEDN CONSTRUCTION SITE I Plan fees are non-refundable and are paid 'n full at the time offit City of Rexburg's Acceptance, of the plan review fee does'not constitute pla lrltlbeginningiia 2005. uilir rx�it �" u timeapproval oapplication** Permits are void f you check does not clear" CITY c,�r UPQG ANIEKIOVS Fe\MILYC01VWUNITY State of Idaho County of Madison I, tom, Name city ■ Affidavit of Legal Interest 3 g s -7 Address State Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) A. That Y am the record owner of the property described on the attached, and I rant rn Perm Ission to: � 1�'� � � � y elm Name Address to submit the accompanying application pertaining to that property. B. I agree to indemnify, defend and hold Rexburg Citi aid its employees harmless from an claim or lrabxl�ty resu�t�ng from any dispute as to the statements contained herein or as to the owi--iershzp cif the property which is the subject of the application. Dated this day of �,� 24 Signature Subscribed and sworn to before me the dad and year first above written, LYNDA MERRILL NOTARY PUBLIC STATE OF IDAHO MY cOmmassioiri expires: Please complete the e moire Application! If the question does not apply fill in NA for non applicable PROPERTY ADDRESS 4 5 _T��/�, 1z 4 C>t Permit# SUBDIVISION ��, � Dwelling Units: 3 ------ Parcel Acres: SETBACKSsECtt- �S 4,W FRONT SIDE SIDE BACK Remodeling Your Building/Horne (need Estimate) SURFACE SQUARE FOOTAGE.- (Shall include the exterior or wall measurements of the building) First Floor Asea _ �,�,0 Second floor,11ofl area A Third floor/loft area Shed or Barn --,& Water Meter Quanfiltv- Requited!!! PLUMBING Plumbing Contractor's Name: Address p�� f % �,� Unfinished Basement area Finished basement area Garage area, Carport/Deck, (30" above grade)Area DMFEP 'Water Meter Size: � ' A. ell f—c"eY, r5-- ��e Business Name:- 6� Az- /1(.l IC. Contact Phone- (,)) gay. F, 3 �(, Fmflfl City F State�,p Zip d'1 yo � Business Phone: .2cw., .,,,.,.2 j-� Fax FIXTURE CaU11TT (includi,� r o uorh e d frxiures) -9 Clothes Washing Machine Dishwasher Floor Drain Disposal Garbage Hot Tub/Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate s— 7 75-o (Commercial Only) Jm*.- Sprin1ders 'T a ,V-0 Tub/Show -Lo ....... — 3 ToiletlUrinal m. -o? Water Heater Water Softener Signature of Licensed Contractor The City ofRexburg -'s perl?, License i ber Date ftfee schedule is the same as required by the State, offdaho i 02r/ 14/ 2006 21 0 A IL 13:5,S 1-2a2-745-0,217 HTH COUNTRY Please complete the entire Application! If the q appGceble PROPERTYAl SUBDIVISION co )DR -ESS _ ejlj • S y. IL Requzred!!! Mwlmnical COntmotoes Namp: Addrcss Pok Contact Phone-. dr "-I L-0 PAGE No, 1')J2 1. 111 1,70 Henry's Fork Plaza Big #10 1 tv t - Business Name; 54 Ity �3usirtess Phone.- state_ ZIP Fux Z `S�7-.w O 8 [7 MechanlcW minI WW S / , (C'Q erdaMulti F My 0 1slXT'URES & APPLL4NCES COUNT Fmace Fumace/Air Co onQr Combo Heat Pump ------- Air Conditioner Evaporative Cooler Unit Hester Space Heater DmOrative gas., -&ed ap a r Incinerator Syn= Boiler Pool Heater !M R M w 4rb — in 4,6j ra (Single Fatly DuvIlIng only) Exbaust of Vent Ducts DTyer Vents Range. Hood VWs Cook S ve " - � V ve at$ Bath Pan Vents �.__4______ 134111 simiJar gents & d�Ms,-.h ziimnw fixtures or Appliances 1 -C:> -_ Fuel Gas Pipe pallets including stubbed in or firiiue outlets -Inlet Pressure (Metex Supply) PSI Host (Circle all that apply) Oil Coal Fireplace electric echanical SWng Calculations must b4D submitted with Plans & Application Int of Delivery must be shown i plans, Licmt� Date AC chy'409 .."P +. ft 1110,%Ma as requked by j;i,? S� 3r Xeqf Idah 2 2 Please complete the en applicable NAME PROPEA DRTY SUBDNISION M fix�Application, SS $5�7- Required!!! Mechanical contractor's Name: Address Pc, k- � 2i Contact Phone: If the ue- st"on doeS- Kx�att- y �n �� NA for non IIECJIAJV CAL Pemilgt# r. � r� Busi�ess Name: �c _City State __ (/� Zip sl} Dusiness rnonc: (A.? � V40 Email Yax 7 MI Mechanical Estimate S_.fs"Alo'I (CommerciaUMultFamily Only) FIXTURES & A PPLIAr'�'CES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas -tired appliance Incinerator System Bailer Pool Heater 0 Similar fixtures or Appliances Fuel Gas Pipe Outlets including stubbed in or ftiture outlets _ Inlet Pressure (Meter Supply) PSI Heat Circle all that app I y) (Las -p . Oil Coal Fireplace Electric .Dryer Vents Raabe Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: Mechanical SizCalculations mush be submitted with Plans &A 10ingcation Point of Delivery must be shown on plans.. p� Signature of Licensed Contractor License number Date AC -P City qf RexbHT'g 's perin it fee sche dIlle by th e sale s as required b th rd, este qfj,dho N�IHED 0 bg CITY OF URG cw Am eric Fm. comMunitil BUILDING 19 E. Main St. Rexburg, Idaho 8344 www. rexbur�_ara APPLICATION: " CONSTRUCTION PERMIT" SAFETY DEPARTMENT Phone: 208-359-3020 x326 Fix: 20$-359-3024 Lanellh(drexburci. rq CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/ NO X50.00 FEE PAID: APPROVED BY: -APPLICANT INFORMATION: BUSINESS NAME: OFFICE ADDRESS: City State ZAP OFFICE PHONE NUMBER: ( ) CONTACT PERSON: CELL PHONE # ( ) -LOCATION OF WORK TO BE DONE: STREET ADDRESS WHERE WORK WILL BE DONE: BUSINESS NAME WHERE WORK WILL BE DONE: DATES FOR WORK TO BE DONE: TO CONTACT PERSON: PHONE NUMBER: ( ) CELL # ( ) PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR: 17 AUTOMATIC FIRE -EXTINGUISHING SYSTEMS ❑ COMPRESSED GASES FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT ❑ FIREPUMPS AND RELATED EQUIPMENT ❑ FLAMMABLE AND COMMBUSTIBLE LIQUIDS ❑ HAZARDOUS MATERIALS ❑ INDUSTRIAL OVENS ❑ LP -GAS D PRIVATEFIRE HYDRANTS P SPRAYING OR DIPPING ❑ STANDPIPE SYSTEMS i� TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES APPLICANTS SIGNATURE nATI= w 000ma ■■o ■momp-■ ■....1 YES/NO 6 4 N�IHED 0 bg CITY OF URG cw Am eric Fm. comMunitil BUILDING 19 E. Main St. Rexburg, Idaho 8344 www. rexbur�_ara APPLICATION: " CONSTRUCTION PERMIT" SAFETY DEPARTMENT Phone: 208-359-3020 x326 Fix: 20$-359-3024 Lanellh(drexburci. rq CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/ NO X50.00 FEE PAID: APPROVED BY: -APPLICANT INFORMATION: BUSINESS NAME: OFFICE ADDRESS: City State ZAP OFFICE PHONE NUMBER: ( ) CONTACT PERSON: CELL PHONE # ( ) -LOCATION OF WORK TO BE DONE: STREET ADDRESS WHERE WORK WILL BE DONE: BUSINESS NAME WHERE WORK WILL BE DONE: DATES FOR WORK TO BE DONE: TO CONTACT PERSON: PHONE NUMBER: ( ) CELL # ( ) PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR: 17 AUTOMATIC FIRE -EXTINGUISHING SYSTEMS ❑ COMPRESSED GASES FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT ❑ FIREPUMPS AND RELATED EQUIPMENT ❑ FLAMMABLE AND COMMBUSTIBLE LIQUIDS ❑ HAZARDOUS MATERIALS ❑ INDUSTRIAL OVENS ❑ LP -GAS D PRIVATEFIRE HYDRANTS P SPRAYING OR DIPPING ❑ STANDPIPE SYSTEMS i� TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES APPLICANTS SIGNATURE nATI= w 000ma ■■o ■momp-■ ■....1 YES/NO 6 i I* Excavation & Earthwork.-,— Concrete; Masonry: Roofing: Insulation: Drywall.0 Pafiatincy,* Floor Coverings: Plumbing: Keating: Electrical: Roof Trusses: 1 Floor/Cei*liong Joists: SImdI'ng/Fxte6or T ether: t IM' -� > 1 4 r0j.5 0 j'. � e SUBCONTRACTOR LIST ! LW— --q;tr- r� Special Construction (Manufacturer or Supplier) M—� 1,1../ 4 4- te r4e '� C- L EXEMPTIONS FROM STATE REGISTRATION As of January 1, 2006, the City of Rexburg can no ianger sell permits without having a copy of your state registration -number or your exemPt'on from the State registration. Please send a co 0 0 copy of your state registration or fill out this for�x showinc)F your exemption an t� d send it with your license renewalnext Perm ion. or your it appicatm1 (This list is a sununarization of Idaho Code Title 54 Chapter 5205, for fall definitions of these exemptions please see the State's website at.vv-�w.ibol-idaho.2ov/cont.htm) 11 Currently State licensed pursuant to Title 54 Idaho Code, Chapters: 3 Architects, 1 0 Electrical Contractors/Journeyman, 1 2 Engineers/Surveyors, 19 Public Works Contractors (exempt from fee only registrat" 26 Plumbing/Plumbers.,, ton require...,,, 45 Public Works Construction Management Licensing Act (exempt from fee gi only re 'stration - required), or 50 Installation of heating, ventilation and air conditioning systems 0 Employee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit charitable activity with no wages or salary L1 Employee of a QTS Government agency (State, City, County., or other municipality) El Public Utility doing construction, maintenance, or development to 'its own business Cl Involved with gas, oil or mineral operations 1:1 Supplier doing no installation or fabricating 11 Contracting a project or projects with a total cost less than $2000- L1 Operation of a farm or ranch or construction of agriculture buildings exempt from Idaho BuiIding Code 0 Any type ofwater district operations El Work in rural districts for firepreventionpurposes a FK A a a Lel a Owner who performs work on owny orcontracts s wiP P eftro with a registered I contractor to do work as -long as the property is not for resale within l.2 months Owner or lessee of commercial -Dronertv nerfnrmiii rnninfia-n - - . on that property -�- ---., & LuldLion or conSILruction Real estate Iicenseelpropei�y manager actingwithin Idaho Code Engaging in the loggxng industry Renter working on the property where they live With the property owners approval Construction of a building used for industrial chemical processing per Idaho Code Construction of a modular building (defined by Idaho Code) to be" moved out of state 1 hereby certify that the above infgxmation is true and correc h 0 the best of my knowledge. �ignature Print Name Date I r CITY OF rkEXBU..RG Re. WM Site Plan Checklist Application Information Appticant: xA P:honeFAX: 3lill i - <Y 7�... Applicant's Address: Ciiy: ST: dip: Project Address: 5,5- Recorded 0'wner- ---,r Retarded Owne Address: _3 5-) Development Information FAX. 11-:1Phone: 'Y�2� 6Y��i� . J, 9F city:ST.- 2J zip:, . LJ I - Site plan must be drawn to scale, be legible and also be submitted electronically if possible. L7 2. Adjoining streets labeled, EJ 3. Right-of-way vacation and width, curb to curb widths and sidewalk location. J 4. Building location, sq footage and dirnen�ions, with distance to property lines and distances Ll s. L1 6. U T J s. J 9. El 10. U 13. 014. 17. U 1512 ❑ 16. 17. Ll 18. ❑ 19. between buildings. _ Show existing and proposed easements. Existing utilities (waterlines.,, sanitary sever lines, manholes, storm drains). Proposed utilities includ�.g tie in location to existing serv16 ices and new easements. Proposed storm drain and sanitary, sevUez- el�vatxans(for pipe invert -odes ani ' Storm drainage plan for parking lob and roof areas, vviih ca].c�Ia�o� � � .�-: Fire hydrants and fire suppression Innes (including tie to City Innes L] Sprinkled LJ Not Sprinkled Indicate Fixe apparatus access. Parking including parking lot, drainage arrows, dimension of iota numbers). Landscaping (type and iotas area, including dimensions). Trash facilities. North Arrow Drawing to Scale, includina graphic scale I I v2x 1if possible). Proposed street irxzprvvements (curb, gutter, sidewalk, pavement, etc. Legal description of proposed building site included. Percent of lot covered by building or paving caliated. LJ 20• thaw 10% snvvv storage area. El 21. Distance of enhances from sheet corner indicated' . • ��reen roves, and total ❑ 22. Current Vicinity Mai_ (S 1/2x 1 I ") at 1" = 300')Scale5 �howulg location of the property. �NQTE: SITE PLANS MUST BE COMPLETE AND SU13MITTED F'',,D t REVIEW �THE PROJECT WILL BE PLACED ON THE PLANNING & ZONING AGENDA. � III 3 CittJ, o f Ri I j r .01P W. 06 00046 Hel1ry'S Fork Plaza - Bldg 10 �.,,�,�,��ss u��LCRtcov�, C2ycest�ov�,v►,a�re (For the purpose of wustewatev penxrittiK y) :Lqb Typebus��,,ess .01 of or 2. W%CC f�%s [�us�v�,ess b co0 Kill 1`1 � ��,�` �' � Zoos 6',�! .0avL,d t�pC Of food prep 3• What t Pe o f food pYeparatiovi, or coorztn�q wUL be L�owO N1, -�_ WUL t�ere 0 t TY -0L v.3? wil,L the,facE[.Lt� have fooal c{isposaC Are. fou a b�csGn,ess A to 0c, st�stewt.s? �, ,� �LlMliillll a 1A, exist�4tia� bu%�cti�n,r� A.-Iii . I or ? Ott view (-J * faci,Cit �. W�I,t g. Will 9- WiL6 r�our bus��,ess jpp ca� age? des Novi ties stod operate Sear rouVI, z Y A � '' No there be av�,� grease traps or s�r�,p� at tie c%I.�tt�? Yep No vt so• v✓�C there be awl types o f at tl��s fac%L%t�u, othertl�ar�,, h0Lts�ehcLeav�,Ev,,�IT t t ere nn so�ut%o�,s? � �- t�, wt,av�,u f�lctuY�wa� o products f at t1�is ��? YeS No IV �4�p�ic� r�.ts �ic� r�.�tu.r� f 'PAte I III