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Home My WebLink AboutAPPLICATION - 06-00124 - 293 Susan Dr - Additionk CITY OF REXB U R G � UILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 208-3-59-3020 X322 PARCEL NUMBER: PERMIT # Please ca If the questic 0600124 293 Susan Dr Addition - Jensen SUBDIVISION: jitKS �at�R UNIT�BLOCK# L 0 T# / Z (Addressing is based on the information - must be accurate) AaA��MAM� PROPERTY ADDRESS: Z, °J CONTACT PHONE # 357 - u cl 9 i PHONE #-. Home Q.�S� 3�� • 0,96wi Work Cell (�—• - OWNER MAILING ADDRESS:,, DR _ CITY: Rc.x,qej,e( STATEID ZIP: YYYL10 EMAIL FAX APPLICANT (If other than owner)n�� (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application) APPLICANT INFORMATION: ADDRESS11-1j •, �' dq�rRlur� STATE; =0 ZIP r?L///0 EMAIL PHONE#: Home (ZOS-) CONTRACTOR: 55� • 0 15 Work MAILING ADDRESS., CITY PHONE: Homeg Work# Cell# EMAIL How many buildings are located on this properly CITY: A"-,�gaz(� FAX Cell (AS) Ylo7,- WAR /S1Z mid you recently pYi�ase this property?No Yes (If yes give owner's name) Nel- Is this a lot split? kra (Please bring copy of new legal description ofproperiy) PROPOSED USE: �,�j,�� Ge, Single Family Residence, Multi Family, Apartme. Remodel, Garage, Commercial, Addition, Etc.} APPLICANT" S SIGNATURE, CERTIFICATION AUrider nit f prui , .reby crtif that I have read thi's application and state that the 1-nformation herein i's correct and I swear that anv 1'nforrnat1 n which ma�,- err be given by nie in he�irincys before the Planning and Zoning Commission or the City Council for the Cite of Rexb u"'r hally � truthful and correct. I agree to comply witb all Cite regulation.s and State laws relafing to the subject matter of th.ts application -and hereby authorized representatives upon the above-mentioned property for inspections purposes. NOTE: The building official mav m.revoke a pei7ni'tissued provisions the 2000 _hl .at on i Code in cases of any false t t ment or misr r nt tion fft�application ' n the or mi the pluns on which the not started within 180 days. Pen -nit void if work stops for 180 dav . mature of C3V�RerlApplicant Do you prefer to be contacte d b -v faxonmahg" Circle — I 'Lim -LN Jr IVI I I M U N I' BIL V 0 S TE 0 ON CONSTRICTION SITE I Plan fees are non-refundable and are paid in full at the time of application be i n rein anu 2005. Cid of ebur acceptance of the plan review fee does not constitute plan approval 'Buidding Permit Fees are due at time of application""Building Permits are void if you check does not clear" DATE 66 'r F1 W CITY OF EMR = M 4 1 T, XB U R4G,, AMERIces FAMILY CONIMUNITY State of Idaho County of Madison 11 City io 19 E. Ma -In (PO Box 280) Rexburg, Idaho 83440 www. rex b u rq Affidavit of Legal Interest Being first duly sworn upon oath, depose and say: 0 0-4 State (If Applicant is also ()caner of Record, skip to B) That I am the record owner of the DrODertv d permission to: Phone: 208-359-3020 x326 Fax,. 208-359-3024 comdevC@'rexbuM.orq A escribed on the ;wgr np hed nnd f Address to submit the accompanying application pertaining to that property, 0 B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any claim or liability resulting fromany dispute as to the statements contained herein or as tow' the ownership of the property which zs the subject of the application. ion,. Dated chis� day of �-��,� , 1 -1 , 20 06 r 1k e I% - Signature Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho M Residing at: �i My commission expires: .0� Please complete the entire Application! If the question does, not apply fill in NA for non applicable NAME'�1�'1�- —.1A -Rf-t4 .. PROPERTY ADDRESS .;�� SUBDIVISION Qv-rc pem-iitg Dwelling Units: Parcel Acres. n�A SETBACKS FRONT——AIA, SIDE A14 SIDE BACK �!{ Remodeling Your Building/Hnme (need Estimate) $ '� SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) First Floor Area Second floor/loft area I Th*rd floor/loft area Shed or Barn ul Water Meter Quantity `,�,� required!!! PLUMBING Plumbing Contractor's Name: ACA Unfinished Basement area Zqo Finished basement area AIA Garage area _A_(14 Carport/Deck (3 0" above grade)Area WaterMeterSize# /JA It 0 _N 0 Business 11 W Address City State Zip Contact Phone: Business Phone: ( ) Email Fax FIXTURE COUNT (including roughed frxturesl Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal Hot Tub/Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ (Commercial Only) Sprink-Xers Tub/Showers ToiletlTJrinal Water HP_....ater Water Softener Signature of Licensed Contractor License nurnb_er Date The it (�fRexburg "s permitfee schedide is the Same as i-itby the State Qf1daho Please complete the entire Application! If the question noes not apply fillin Nn for non applicable 0 NAME N, PROPERTY ADDF,SS-F0 SUBDIVISIO\ �S � Required.111 Mechanical Contractor's Name: Address MECHANICAL City I_k� _ . o f business Name: Contact Phone: Business Phone: � Email Fax- Mechanical Estimate $ (Commereial/Mttlti Family Only) FIXTURES & APPLIANCES COUNT (Single F Furnace Fumace/Air conditioner Combo Heat Pump Air Conditioner Evaporative cooler Unit Heater Space Heater Decorative gas-fired appliance Incinerator System Boiler gaol Heater State Zip amity Dwelling only) exhaust or Vent ]ducts Similar fixtures or Appliances Fuel Gas Pipe Outlets includina, stubbed in or future outlets Inlet Pressure (Meter Supply) PSI Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Dryer Vents Range Hood Vents Cook Stove Vents Bath Fay Vents other similar gents &. ducts: Mechanical Sizing Calculations must be submitted with Plans & Application Poi*nt of Delivery mush be shown on plans,, Signature of Licensed Contractor License number Date The City of Rexburg °s permit fee schedule is the .same as requiredby the State of fclrxho M EXEMPTIONS FROM STATE REGISTRATION As of January 1, 2006, the City of Rexburg can no longer sell permits without having a copy of your state registration number or your exemption from the State registration. Please send a copy of your state registration or fi11 out this form showing your exemption and send it with vour license renewal or vour next permit application. This list is a summarization of Idaho Code Title 54 Chapter 5205, for full definitions of these exemptions please see the State's website at www..*ibol.idaho.gov/cont.htm) El Currently State licensed pursuant to Title 5 )4 Idaho Code, Chapters: 3 Architects, 10, Electrical Contractors/Journeyman, 12. Engineers/Surveyors, 19, Public Works Contractors (exempt from fee only registration required), 26, Plumbing/Plumbers, 45, Public Works Construction Management Licensing Act (exempt from -fee only registration required), or 50, Installation of 110 heading, ventilation and air conditioning systems ❑ Employee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit charitable activity with no wages or salary 11 Employee of a US Government agency (State, City, County, or other municipality) El Public Utility doing construction, maintenance, or development to its own business El Involved with gas, oil or mineral operations D Supplier doing no installation or fabricating F-1 Contracting a project or projects with a total cost less than $2000 F -Operation of a farm or ranch or construction of agriculture buildings exempt from. Idaho Building Code Ll Any type of water district operations 11 Work in rural districts for fire prevention purposes Owner who performs work on own property or contracts with a registered contractor to do work as long as the property, isnot for resale within 12 months Owner or lessee of commercial property performing maintenance, repair, alteration or construction on that property ❑ Real estate licensee./property manager acting within Idaho Code 1:1 Engaging in the logging industry L Renter working on the property where they live width the property owners approval F] Construction of a building used for industrial chemical processing per Idaho Code F1 Construction of a modular building (defined by Idaho Code) to be moved out of state I here if t the above information is true and correct to the best of my knowledge. OLI Signature Date Print Name ■■�■■ ;■■■�■■moi■i■■ii■■#■■■■i■■■■■■Ent■■■■■i■r■■■■■■N■■■E■■'■■a0■■■■zKEE■■i■MIN ■iii■E■■=E■■E■f Excavation & Earthwork:: Concrete: Masonry. 0 SUBCONTRACTOR LIST ��C Roofing: �: Insulation, Drywall. Paintiffing, 11 floor Coverings: Plumbing: Heating: L "� Electrical: +51"'F Roof Trusses: Floor/Ceiling Joists. Siding/Exteri*or Trim: Other: h'? c F -e -K- r, Special Construction (Manufacturer or Supplier) L9�S