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Home My WebLink AboutAPPLICATION - 06-00358 - 1188 Franklin Dr - New SFRC1Tv0FREXBURG BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 8'.03440 2C8-359-3020 X326 Please If the que, PARCEL NUMBER,-, PERMIT # � 1188. Franklin Dr SUBDIVISION P U4 agy ul�Lj UNIT# BL OCK#LQT# (Addressing is based on the information - must be accurate) OWNER NAME: 6,C 77' PROPERTY ADDRESS: J � �jo e�, CONTACT PHONE #_]J(p -- *Z3 JI! PHONE #: Home ( ) Work ( ) OWNER MAILING ADDRESS: CITY: Cell �5p i • U 13 STATE,-, ZIP: EMAIL FAX APPLICANT (If other than owner) ��. }�` �'t�/'�`�''� k�r��r��It/ (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application,) APPLICANT INFORMATION: ADDRESS qi�' STATE; ► f� ZIP �qD EMAIL _. PHONE #-. Home ( Work CITY: rAX r 14�-v�3 i 4 Cell CONTRACTOR: Y" A,5 Pp ! MAILING ADDRESS: CITE STATE ZIP 1 PHONE,#.- Home ( } Work EMAIL FAX II `� � � iry ESP. DATE ur C How my buildings are located on this property?. Dl*dyou rec � entl� purchase this property . No Yes � Is this a dot split? (� N. YES �P1ea�e brig copy r 44� e V ert y) PROPOSED USE:Ov6111 too � -- (i.e., Single Family Residency, Multi Family, Apartments, RemodelNw�__ ; Garabe, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE1 CERTIFIGATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that i have read this application and state that the information herein is correct and I swear that any inforrz�aiion which may kereaft�r be given by me in hearings before the Planning and Coning commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State taws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned prapert�r far inspections purposes. NATE: The building official may revoke a permit on approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in t Ua permit or approval was lased. Permit void if not started within 1$0 days, Permit paid if work stops for 1 S. Rz-) 5iL 74'� gnatu f �]wner/ApPlic DA Do yo ` prefer to be contacted by fax-, email or phone? Circle One WARNING — BITILDIIVG PERMIT MUST BE POSTED QTY CQriSTR CTIA SITE! Plan fees are non-refundable and are paid in full at the time of application begi nin City of Reiburg's Acceptance of the plan review fee ones not constitute la rKEXB x�Suilding Permit Fees are due at time of application" "Building Permits are Void if _ lw-- E_" URG kQ C1 T EXB taG CVV rlmeraca's Prantfry Community State of Idaho County of Madison I' Name City BUILDIIV+G SAFETY DEPARTMENT 19 E. Main (Pp box 280) Phone: 208-359-302 x32fi Rexburg, Idaho $3440 Fax: 2Q8-359-31724 www. rexbur .ar jarieI1L@,rexburq.orq Affidavit of Legal Interest Being first duly sworn upon oath, depose and gay: Add rens State (If Applicant is also towner of Record, skip to 13) A. That Z am the record owner of the property described on the attached, and I brant my permission to: Name Address to submit the accompanying appficaiion pertaining to that property. B. I agree to indemnify, defend and hold Rexburg pity and its employees harmless from any claim or liability resulting from any dispute as to the siatements contained herein or as to the ownership of the property which is the subject of the application. Dated this Signature day of Zp Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at. My commissionexpi-res... Please complete the entire AP.plication! If the question does not apply fill in NA for non applicable NAME PROPERTYADDRESS JJL4� SUBDIVISION- Dwelling Units: Parcel Acres: SETBACKS FRONT SIDE SIDE BACK Remodeling Your BuildinglHome (need Estimate) $ Permit# SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) First Floor Area z; -5__'_q3 Second floor/loft area Third floor/loft area Shed or Barn Water Meter Quantity: Unfinished Basement area Y Finished basement area Garage areae, r;4 ; Carpoirt/Deck (34'' above grade)Area Water Meter Size* J?equired.f Of Of PLUMBING Plumbing Contractor's Name: W(y Business Name- Address City State Zip Contact Phone.- Business Phone: � ) Email Fax FIXTURE COUNT fincludinz rau,ehed nrtur"Vi E � Clothes Washing Machine � Spfinklers Dishwasher Tub/Showers 'V e�Floor Drain .^ Toilet/Urmnal Garbage Disposal _Water Heater Hot Tub/Spa Water Softener Sinks � {Lavatories, kitchens, bar, map} Plumbing Estimate $ (Commercial Only) Signature of Licensed Contractor License number Date The T y of urg' mi i'sthe am State of1daho 4 Please complete the enti*re Applecat"Oil 1 If the question does not apply fill in NA for non applicable NAME PROPERTY ADDRESS Lagmr, r� SUBDIVISION I 1ktj_, 111 tiil ....................... Required!ff Mechanical Contractor's Name: MECHANICAL Permi*t# Business Name: Address City Stale Zip Contact Phare: Business Phone: ( } Email Fax Mechankal Estimate $ Commercial/Multi Family only} FIXTURES & APPLL4-NCES COUNT Furnace � Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas-fired appliance Incinerator System Boiler Pool Healer (Siegle Family Dwelling Only) ` _Exhaust or Vent Ducts 9 - Dryer Vents i Ranke Hood Vents Cook Stove Vents �i Bath Fan Vents F) Fuel Gas Wipe Outlets including stubbed in or future outlets Inlet Pressure (Meter Supply) PSI Heat (Circle all that apply) eGasOil Coal Mechanical SiZin other similar vents & ducts: Fireplace Electric Hydropic Calculations must be submitted with Plans & A Point of Defive Signature of Ucensed tr ct r License The City #s Permittee scheduleis the same as required by the State QfIdaho li*cation 5 OMEMO ■NEON■ERNE E■■■■■■t■■mammon ■■A ■E■■ RARE ■t■■son ■ ROME MEAN mammas ORE MEN ■■■ MEN SEMEN Excavation & Earthwork: Concrete.0 Masonxy: z Roofing: Insulation: Drywall: Painting: Floor Coverings: � Plumbing: Heating: I Electrical: L r W�= zi Mr - 4" SUBCONTRACTOR LIST EA Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Cefling Joists: TOG Siding/Exterior Tr. other: I" EIR 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 fill out this form showing your exemption and send it with your license renewal or your 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,*1 daho.j�ovlcont.htrn) Currently State licensed pursuant to Title 54 Idaho Code, Chapters: 3 Architects, 10 Electrical Contractors/Journeyman, 12, EngineerslSurveyors, 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 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 Employee of a US Government agency (State,, City, County, or other municipality) Public Utility doing construction, maintenance, or development to its own business Involved with gas, oh or mineral operations Supplier doing no installation or fabricating Contracfing a project or projects with a total cost less than $2000 Operation of a farm or ranch or construction of agriculture buildings exempt from, Idaho Building Code Any type of water district operations ❑ Work in rural distr�cts for fire Preventi&on purposes F-1 Owner who performs work on own property or contracts With a registered contractor to do work as long as the property is not for resale Within 12 months 1:1 aw-ner or lessee of commercial property performing maintenance, rep -air, alteration or construction on that property 1:1 Real estate licensee/property manager acting within Idaho Code F1 Engaging in the logging industry D Renter working on the property where they live with the property owners approval El Construction of a building used for industrial chemical processing per Idaho Code F Construction of a modular building (defined by Idaho Code) to be moved out of state hereby certify that the above information is true and correct to the best of my knowledge. Signature Print Name 7