HomeMy WebLinkAboutAPPLICATIONS 2 - 06-00146 - Westwood Theatre - RemodelEl
W,
UR
gTcX.B
C�
I
/"am -N,,. F
i
BUILDING SAFETY DEPARTMENT
CW
19 E. Mair (PO Box 280) Phone-. 208-359-3020 x326
mea's Family CommunitY
Rexburg, Idaho 83440Fax: 208-359-3024
..r xbur janell �r xbur . or
Affidavit of Legal Interest
State of Idaho
County of Madison
dame
City
Being first duly sworn upon oath, depose and say:
Address
State
(If Applicant is also Owner of Record, skiff toB,)
A. That I am the record owner of the property described an the attached, and I brant my
permission to:
Name Address
to submit the accompanying application pertaining to that property..
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any
claim or liability resulfing from any dispute as to the statements contained herin or as to
the ownership of the property which is the subject of the application.
Dated this day of , 20
Signature
Subscribed and sworn to before me the dad and year first above vvrittem
Notary Public of Idaho
Residing at.
My commission expires:
3
F
�o
I T
I tl w ftlyl Tte
BUILDING SAFETY DEPARTMENT
19 E. Main . Phone: 208-359-3020 x326
Ow Rexburg, Idaho � o Fax: 208-359-3024
America's Family l Community ,
APPLICATION2
: " CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO
"'L"pl INkcalsollm E - I
-APPLICANT INFORMATION;
BUSINESS NAME:
OFFICE ADDRESS:
City State Zip
OFFICE PHONE NUMBER: ( )
CONTACT PERSON: CELL PHONE # ( )
-LOCATION OF WORK Tor 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:
❑ AUTOMATIC FIRE -EXTINGUISHING SYSTEMS
❑ COMPRESSED GASES
D FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT
❑ FIRE PUMPS AND RELATED EQUIPMENT
❑ FLAMMABLE AND COMMBUSTIBLE LIQUIDS
❑ HAZARDOUS MATERIALS
El INDUSTRIAL OVENS
1-1 LPwGAS
Fl PRIVATE FIRE HYDRANTS
C. SPRAYING OR DIPPING
11 STANDPIPE SYSTEMS
Ll TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES
APPLICANTS SIGNATURE DALE
MEMO ■ IMMERAIMER E ONE ■ MOEN NEER E EARN NEON E MOEN ■ ■ ■ E E MAIMMIMER ■ KENN Boom MIMMIM E r #IMM mans IMAIMEM MEN M 0 MEMO REN
6
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete:
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Floor
-P
Coverings.
Plumbing:
Heating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
F1oarlCeiling Joists:
Siding/Exterior Trim=
Other:
W
7
EXEMPTIONS FROM STATE REGISTRATION,
A.s of January 1, 2006, the pity 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 fill out this form showing your exemption and send it with your license renewal or your next permit
application.
This list is a summarization
zation of Idaho Code Title 54 Chapter 5205, for fall definitions of these exemptions
please see the State's website at vPvvw.ibo1.idaho.g,ov/cont.htm)
07
FE -1
Currently State licensed pursuant io Title 54 Idaho Code, Chapters:
3 Architects,
1 0- Electrical
Contractors/Journeyman,
12 Engineers/Surveyors,
1 9 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 heating, 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
F-1 Employee of a US Government agency (State, City, County, or other municipality)
Ll Public Utility doing construction, maintenance, or development to its own business
F1 Involved with gas, oil or mineral operations
F] Supplier doing no installation or fabricating
71 Contracting a project or projects with a total cost less than $2000
F1 Operation of a farm or ranch or construction of agriculture buildings exempt from Idaho Building. Code
L1 Any type of water district operations
F1 Work in rural districts for dire prevention purposes
Ll Owner who perfarms work on own property or contracts regi
a with registered stered contractor to do work as long
as the property 'is not for resale within 12 months
F-1 Owner or lessee of commercial property performing maintenance, repair, alterationor construction on
that property
1-1 Real estate licensee/property manager acting within Idaho Code
F-1 Engaging in the logging industry
F-1 Renter working on the property where they live with the property owners approval
F1 Construction of a building used four industrial chemical processing per Idaho Code
1:1 Construction of a modular building (defined by Idaho Code) to be moved out of state
1 hereby certify that the above information is true and correct to the best of my knowledge.
Signature Date
Print Name
r';
1
Attention
inspection Hot Line
�r���I�I�J�J
for an. insvection. Buildin
--,Permit Number is required when,
you call.
*Pleasenotify
all your sub co
1 1 � i' 1 1
Ab.
Thank you,
Building Department
0