HomeMy WebLinkAboutAPPLICATION - 06-00286 - 375 S 12th W - AdditionIE
CITY OF REXB UR G
BUILDING PERMIT APPLICATION
19 E MAIN
, U-,XBURG, ID. 83440
208-359-3020 X326
PARCEL NUMBER- 'IQ
SUBDIVISION:
PRRMIT Ji
Please (
If the goes
06 00286
375 S 12th W -Southwick Addition
(Addressing is based OR the infomafi,,,,-UNIT#be accurate)_ $LACK#
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PROPERTY ADDRESS:
3 7s'
LOT#
d
C NTACT PTIONE
sU Kt-c� 12 r�
rrAvAE #: Home
(2c� 3� � - 6 6e <if3Work
OWNER MAILING ADDRESS: -3 7 S So
EMAIL
� Cell (,?,L;0 S6Ice
-
FAX
APPLICANT (If other than owner 61k,i .
(Applicant
if other than owner, a stateme �t authorizing e
applicant to act as agent for owner must aecampa.n this applicationt.)
APPLICANT INFJRMA7.�IN
C'T A rrr:. ' E ' r
PHONE#: Home
CONTACTOR:
MAILING ADDRESS
PHONE #: Home
ADDRESS 375 S
••, � nrvitiit�W�h less
CITY:
�a � ieo • P nye
fAX
work ( ) Cell PsFo) 5-41,
CITY STATE ZIP
Work ( ) Celt { }
EMAIL FAQ IDAH 1 0 REGISTRATION # & EBF. DA11-1h"
How many buildings are loccated on thisro ert
p p Y
Did you recently purchase this properly? lNTo Yes (it yes gine owner's name
Is t-% a lob split? �'+I4 . 'SES Please brngico of new
COPY legal description of property}
PROPOSED USE:
Siegle Family Residence IVIult� �'"lot0_e-,
� Family, Apartment, Remodel, Garage, Commercial, Addition, Etc.]
CT MR
APPLICANTO'S SIGNATURECERTI�ICATIOI�TAU11-10RIZATIONe-
� A�c�
that 1 have read this application acid state that the infor�natiot� �ierein is o.�rec�u,d that any �]I�c�er penaIty of perjury, I hereby certify
in hearings before the Panning and Zoning Commission or the City Council for the City of Rexburg �a�be�� truthful and ��� �erea�ter be given by me
with all City regulations and State taws relating to the subject rnatter oithis appl�cat�an and hereby at�thariz�d representatives rect. I agree to comply
upon the above-mentioned property for inspections purposes. NATE: The buildang official may revoke
of the City to enter
p�'4Y1S14n5 of the X003 Internatianal COt�� tri CaSeS of false statement or misrepresentation of fact in 1i -� nder the
permit or ap was based er�nit void if not st d within 1$0 days. Fermat void if work stops for � �L&e#layn��
S�Crre of wnerlApplicant
you prefer to be contacted by fax, email hone?
1VARIVINC — BUILDING PE p Circle one
Pian fees are nor -refundable and are paid in f�Il atBthePO e o#'a p ca CONST ON n 6e
ni City of Rexburg's Acceptance of the plan review fee does riot co�isiitu a u j � RG
*Building Pertt�it Fees are due at time of a liti' uildin Permits are Wold if oar cheek does not ciea*��J
PP X� �� �
Y
3
U
1 "1
Please complete the entire Application!
f the question does not apply fill in NA for non applicable
NAME
(e.ss 0 4-
-4 4-l�
A
PROPERTY ADDRESS 37.�–
SUBDIVISION 54' Permit#
0
Dwe]ling Units: Parcel Acres:
SETBACKS
FRONT SIDE_ SIDE —B -ACK
Remodeling
Your (need Estimate)$ tom_
SURFACE SQUARE FOOTAGE-, (Shall include the exterior wall measurements of the building)
t�� J�' �' �' ' �'' �: e r -e C.- vp%e�[
r
FIoSt Floor Area
Second floor/loft area
Third floor/loft area
Shed or Barn
Water Meter Quantity:
I f
J?equiredf
0 0 0
Unfinished Basement area
Finished basement area
Garage area
Carport/Deck (30" above grade)A,rea
�"�'�'� * * * * * * �` �` * * Water Meter
Size:
'C
qr IL
let
ct, 'dL 1-.16J C -t -JCy
lNG
Plumbing Contractor's Name:
Address —Business Name:
City --- ....—State ZIP
Contact Phone: Business Phone:
Email Fax
FZX7'URE C'QUN�` includin rou herl �rtures
Clothes Washi*ng Machine
L
Sprinklers ��3'
Dishwasher Tub/Showers
�` "�Ys � �.•� � r �-ls-
Floor Drain Y�� a � s. .�
ToiIetlUrinal
Garbage Disposal �.� �.e
Water Heater 4. Yt-
Hot Tub/Spa P 1 -01
Water Softener �. '�
Sinks � x 7�-res
(Lavatories, kitchens, bar, mop)
Plumbing Estimate S (Com Only)
Signature of Licensed Contractor License number Rate
The city ofRuxburg 's perjnjtje.e schedmle -
is thesame as required b y the- &ate of-tdaho
4
V
a
e complete the entire Application
*1 u
applicable it the �„est;o„ goes „ot apply fin NA for non
NAME ��,� fGss Ski-l,wf c, -4t
PROPERTY ADDRESS 5'� &SUBDIVISION Permit4
R 0
equired. !I
"MECHANICAL k d,Mechanical Contractor's Name: � � �-�'r►� � �� n.�. c..� _
Business Name:
..Address CIF
y State Z�P�
Contact Phone-, Business Phone: �(
Email Fax
Mechanical Estimate $ (Commerdat/Multi Family On y)
FIXTURES & APPLIANCES COUNT
Furnace
Fumace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
------------- . Space Heater
Decorative gas-fired appliance
Incinerator system
Boiler
Pool Heater
Siegle Family Dwelling On&
Exhaust or Vend Dusts
Fuel has Pipe Outlets including stubbedin or future outlets
Inlet Pressure (Meter Supply) psi
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bach Fan Vents
_ other similar vents & ducts;
Heat (Circle all that apply) Gas Oil Coal Fireplacc ElectrlC ydronic
Mechanical SIZIR2Calculat_1
0nS must be submitted with Plans & A
Point of Delivery must be shown nn .,ia„�
Si nn t ur .L i nsed Contractor
}
License number
aHl1 ae
Date -
1'he City Of Rexburg's pe -mit fee schedule is the same as required by the State of Idahv
I ication
5
EXEMPTIONS FROM STAT.EEGISRTRATION
As of January I , 2006, the City of Rexburg can no longer sell permits vvitho
registration nuz�nb�;r or your exemption from the Stale re �st�ation. p ut having a copy of your State
9
or fill out this farm shovving your exempt�on and send rt with ��a�e send a copy of your state registration
applzcat�on. your license renewal or your next permit
(Thi's list is a summarization of Idaho Code Title 54 Chapter 5205. for full defin'
please see the State's website at www.ibo1.idaho.gov/cont.htm) axons of these exemptions
El Currently State licensed pur
3 Architects,suant to � itle 54 Idaho Code, Chapters:
10 Electrical Contra c t orS/JOUrneyman,
12 Engineers/Surveyors
19 Public Works Contractors (exempt from fee only registration re uired
26 PlumbinglPZumbers, q ��
45 Public Works Construction Management Licensin .l�ct exemox� ( pt from fee only registration required,
50 Installation cif he�ting, ventilation and air conditioning systems
C� Emplayce or volul�teer of a licensed contractor or pad of an education
charitable activzty with no w� �P.� ��- C a t a,.�� al currlculum air nonprofit
X
X
I
C
Employee of a US Governmen%_11,
t agency(StateICtY, County, or other municipality)
Public Utilfty doing construction, maior develomentp to itbusIness
pallty�
Involved with gas, ail or mineral operations sown
Supplier doing no installation or fabriacatirig
Contracting a project or projects with a total cost less than $2000
Operat'On Of a frm or ranch or eonstructian �f agriculture buildin s
Any type of water district operations g pi from Idaho
work in rural districts for fire prevention purposes
Building Code
owner wno performs work on flan p�flpe��, o� �����.ac�� ,�,�.�h a registered contractor to do work a
as the property is nat for res�.le wiihin 1 � months s long
Owner or lessee of comme�rciai property performing maintenance, repair, alter
that property p � anon or construction on
Real estate ficensee/prop-eirty, manager acting within Idaho Cade
Engaging in the logging industry
Centex working on the property where they live with the property owners
Construct"
ion of a building used for industrial chemical rocessi �p���v��
Constructde
ion of a modular building (defined by Idaho Code to b�per Idaho Ca
oved aut of state
I herebv certify that the above i
Print Name
ion is true and correct to the best of any knowledge.
,>,O� 'J.
5
.Date
7
o� �tEXB USG
G 7.
State of Idaho
County of Madison
I TY OF
EXBURG
eric y Family Conimunity
f BUILDING SAFETYDEPARTMENT 1
19 E. Main (PO Box 280)'
Rexburg, Idaho $3440
www.rexburg ora
Affidavit of Legal, Interest
Phone: 20$-359-3020 x32
Fax: 208-359-3024
i9-D-e--1f—N—@rexbur a. o ra
19 E le /I e "A"' . .I- J -�-- 1�
Li7:e- 1? 6, 11§ 37
'S
Name Address /2
PiN
City
State
Being first duly sworn upon oath, depose and say:
(If A.ppI�cant is also Owner of Record, skip to B)
A. That I am the record owner of the pr
permission to:
Name
operty described on the attacheda aid T grans12
my
/Va 3 7
Address
W.
to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and held Rexburg pity and its employees harmless
claim car liability -resulting fromany dispute as to the statements c ntaYne from any
the ownership of the property which is the subject of the app Iicatzon. or as to
Dated this
S
Signature,
_ day of
r
20 C�
Subscribed and sworn to before me the day and year first above written,
Notary Pubic of Idaho
residing at:
MY COMMission expi4
0
IS k�,,
O
GRANT DEE
irL
FOR VALUE RECEIVF.,D, RUELAND E. 'WARD and ESTELLE WARD, husband
and wife, of 3 75 S. 12th W., Rexburg, Idaho 83446, ("Grantors"), do hereby grant, bargain,
confiml, and convey unto RUEL-116,NDWARD and ESTELLE WARD, Trustees, or their
successors in trust, under the RUELAND & ESTELLE WARD LIVING TRUST, dated July
23, 200:, 375 S. 12t1� W., Rexburg, Idaho 83440, ( "Grantee"), the following described real
property located in Madison County, State of Idaho, to wit:
Parcel One:
Parcel Two;
Bcorinn'i.ng at the Northwest cor-ner of the SW'/4 of Sec. 25,'Tw6 N.
Rcye. 39 E.., Boise Mer., and rul�ning thence East 436 Feed; thellee Soth
30Q feet; thence Nest 43G feet; #hence North 30U feet to the point of
be ggnnI.n9.
Beginning at a po'�It whlch is 436 feet East of the Northwest corner of t
S W/40f Sec. Z5, Twp. 6 N., Rhe. 39 E,, Boise .tiler., and running thence
Easterly 758 feed along a fence H11C wh'ch}� is oi-� the so�� �i�e ence
irrigation canal to a point on the East side of an it-rigation ditch;°fan5outherly a?5 deet; ther�ce Westerly 75$ feet to a Naz-ti�- thence
td�ei�ce Noi-therlYaIar�� lin-eSouth fend �1r�e;
� said fend, feet to the po'
nt of �e�inz�1�-�g.
Contains 5,66 acres, 111at-e or less.
SAVING AND EXCEPTING THEREFROM- Be'Iinningat the West coi-�Zel- of Sec. 25, Twp.6 N.,Rge. qUai-ter
E,, Boise mer., and �-uniiing thence S89054146"E
499.00 feet Tong the quarter secfiotl Iine; t�.�c��ce S00`00133"E 166.90S88°IQ'S I "�'� 499 feed to the s�ct�on Zine; i}.3e���e NOU°QS'��_�� feed; thence
s�c:tic�r� Ii�7e to t��e point o.�'beginnin�. 183.50 feet alonu i��e
TOGETHER WITH and irlcluding all improvements thereon and
appurtenances and hereditanients there�znto belonginglI��eiudirIr a��Parcel �?ne, less t��e exception t}�erefi•olz�. � °��r- residence home o��
Grant Deed . J
age I of
Instrument ## 3054s35
REXBURG, MADISON, IDAHO
2443-07-251 C3:'42:00 Nfl. of P �
Recc�fd�+r d #v : RlGBY THFi�CF1ER 9�s: 2
MARILYN R. RA5MUS5 N
Ex-C)€flciQ Recorder Dip Fee: 6.00
Excavation & Earthwork:
Concrete*
a
Masonry:
Roofing:
Insulation:
Drywall:
Paintmng:
Floor
Coverings:
Plumbing:
Heating:
Ar!V
NA -
A!A
SUBCONTRACTOR LIST
Cur
Electrical:
L
Roof Trusses:
Floor/Cefling Joists:
Sidl*ng/Exterior Trim m:
Other:
Special Construction
(Manufacturer or Supplier)
co--�X e � I
0