HomeMy WebLinkAboutAPPLICATION - 06-00364 - Airplane Hanger - Eric MossCITY OF REXB UR G
BUILDING PERMIT APPLICATION
N E MAIN., REXBURG, ID.. 83440
208-359-3020 X326
PERMIT #
Please c
If the quest
PARCELNUMBER: Nv FOR p � W Eric Moss Airplane Hanger
SUBDIVISION: UNIT# BLOCK# LOT4
(Addressing is based on the information - must be accurate)
OWNER NA ME: � � PROPERTY ADDRESS:__
O�
PHONE #.- Home �S) �S�l•a¢�y
OWNF,R MAILING ADDRESS.
CONTACT PHONE #
Work
Cell (oiq)
I T Y el- ,sSTATF,:.i J 7rP•9�,(ltL
EMAIL FAX J ;--- ��
APPLI-CANT (If other than owner)
(Applicant if other than owner, a statement a?
A DPT...�'.,' _
agentorizing applicant to act as �A le nen
ist accompany, this pp]ication.)
�� rLl�-r�rvi iivruKMAl1UN: ADDRESS(,
.�- CITY:
STATE; % "LIP $� EMAIL pAX
PHONE#-. Home
CONTRACTOR:
MAILfNGADDRESS:
PHONE #:Home
EMAIL
How many buildiangsl_
Did you rece
'Is this
PROPOSED USE.(i.e., S'norle Family Res' f
APPLICANT"S SIC
5
Work ( ) Cell
1���
1A STATE ,� a�ZIP,��5�j0
� Cell G21 23--------------------------
T10N # & EXP. DATE Z/
that i have read this
in hearings before the Plar
with all City regulations aj
upon t4e above
-mentionec �. ` ~. a►' s- �P'4 '�
s
provisions
f the
permit
va
, t F :�
�rl djt on E
C,.,,iTY OF REXBURG
DRJZATION:
r Y
tear that any '1nfofrfl'jti n which may hereafter
ty of Rexburg seal I be truthful and correct. I agree-
1 and hereby authorized representatives of the Citv
ffici 1 may revoke a permit oil approVf
-ntation of fact * 11, issued under the
in the aPPlic-ation or oil the plans orl which the
I if work stops for 180 days.
}
iterw"ner//AA npp I i cant
b faxC*rcleDo you prefer to"be contacted DATE
WARNING — BUILDING PERMIT MUST -BE POST -ED ON CONSTRUCTION SITE!
Plan fees aire non-refundable and are paid in fulf at the flme of applic fion begin"ing lilla.im j2
City of Re.0urg"s Acceptance of tile plan review fee does not constitute plan approval 005.
"Building Permit Fees are due at
y I r hone? *
time of applrc tinr"Building Permits are void
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BUILDING SAFETY DEPARTMENT
�%Pjl.eFW >�, CW
41
1 E. M Box 280) Phone: 208-359-3020 x326
.00
Anterica's Family Community Rex -burg, I Fax- 208-359-3024
1,anel 1h Qarexbu rg,. or
Affidavit of Legal Interest
State of Idaho
County of Madison
Name
Cit
Being first duly sworn upon oath, depose and say:
Address
L_
State
k
(If Applicant is also Owner of Recotd', skip to $)
A. That -1 atn the tecotd owner of the properqT described
attached
arm and I girant m
-
k P .
�. 110S
.�'
_ Name ,
Address
to submit the accompanying application pertamingr to that property.,
B. I agree to aindem.m4i, defend and hold Rexburg City and its employees harmless from any
claim o -t habil tty resultmg from any dispute as to the statements contained herj'-n or as to the
ownership of the property which i's the subject of the application.
Dated this
y ��
Subscribe d and sworn to before me the dayand year first above written.
Notary! Public lAaho
Resi&ng at;
My ommiexpires.
20—L-)
3 -r�7 t I 21 1
3
16
1 V4 :000
0 F
EXBURG
C)W
America's Family Community
State of Idaho
County of Madison
Name
amity
W
BUILDING SAFETY DEPARTMENT
19 F. Mqm' (PO Box 280)
Rexburg, Idaho 83440
.%Vww-rexhurg_
Affidavit of Legal, Interest
5
Being first duly sworn upon oath., de -pose and say:
AL _j
Phone: 208-359-3020 x326
Fax- 208-359-3024
jane_11hraqe_x1-)ijM.org
Address
State
(If Applicant. is also Owner of Record, skip to B)
A. That I am the recotd ower of the property d
pern�ssion'*---7-�.���_
I a ^-
tO: t, "I
:L—e-f _'11 � I L,
Name
esciribed on the attached, and I grant my
a ;/�,
Address
to submit the accompanym'g application pextair,ing to that property..
V
B. agree to indemnify, defend and hold Rexburg City and its employees harmless foam any
dau'n or liability resulting fxom any dispute as to the statements cont ' A herit�auic or as to the
ownership of the property which is the subject of the application.
Dated this
tUre
ay of
W
Subscribed and swom to before me the day and year first above wriften,
Notary Public of Idaho
Residing at.:
My
commission ices;
zn
20
e
K
I`lease complete the entire Application,',
j� If the question does not apply 511 in NA for non applicable
NAME I%k Al.,- A 0 5 5
PROPERTY ADDRESS � �tr� �r% Pern-iit#
SUBDIVISION
Dweffing Units: Parcel Acres:
SETBACKS
FRONT SID E SIDE Br1CK
Re-mode-fing YourBuildinglllome (need Estimate) $ 41
SURFACE SQUARE FOOTAGE.- (Shall incline the extexiof wall measurements of the building) M1 --
First Floor Area '�� JC �-� � _ _ Unfinished Basement area W-W���-
Second floot/loftarea— ./`t Finished basement areaThltd floor/lofta-rea Alpt Garage: area �
Shed or BarriCa-rport/Deck (30"above grade)Atea
-------------
Water Meter Quantity
Water Meter Size:
P.-LrUMBING
Plumbing Contractor's Name:
Business Name:
Address CitNT}
Contact Phone.- Business Phone:
Email Fax
FIXTURE COUNT fin clu din
tou he7 d �xtutes
Clothes Washing Machine
Dishwasher
Floot Drain
Garbage Disposal
Hat Tub/Spa
Si'Lnks
(Lavato-ties., kitchens,, bar,, mop)
Plumbing Estimate $
.req!
Sprinklers
Tub/Show,
Toilet/Uric.
Water Heat
(Commercial Only)
Sigriature of Licensed Contractor License numb -r
The GO of R -? Y mi e schedule s the savve as re the
wal
Please complete the enth c Application! If the y„e9t;on does,
..tet apply fill in NA for non
applicable ,�'i
NAME
1�k ��T� �
PROPERTY ADDRESS
SUBDIVISION
Required!!!
Mechanical ContrfactNatne: /V Business Name:
Address
Cid_State IP
Cont,qct Phone: Busm'iess Phone:
E ail Fax
Mechanical ]Estimate $
(co
FIXTURES & APPLIANCES COUNT
Furnace
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Ufn't Heatcr
Space Heater
Decorative gas-fired appliance
Incinera,tox 5ystem
Boilex
Pool Heater
ercial/mu ti Family Qn�y�
Single Family Dwellirlg only)
Exhaust or Vent Ducts
Similar fixtures or Appliances
Fuel Gay Pipe Oudets including stubbed in or future outlets
Inlet Pressure (14ieter Supply) PSI
I Leat (Circle all that apply)
Gas Oil Coal Fireplace
El c tr1c
Diryer Vents
Range Hood Vents
Cook Stove en s
Bath Fan Vents
- other imilt vents & ducts :
Mecham*cal Sizing Calculations must bsubmittedwith Plans &Application
Point of Delivery must be shownon plans.
Reqt11fCd} Signature of Licensed Contractor
License number
Date
The GO of Rexburg 'rprmitfee schedule - be same as rel
q b -1
_y t
_?e.'Vta,e q1 _'Yal
uired
5
6
10
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Av
r �a
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F
EXBBUILDING
URG
19 E. Nfain St.
Phone: 208-359-3020 x326
ric i Comma e , Idaho Fax: 20 -359-3024
° .rr
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llhr
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO
-APPLICANT INFORMATION•
BUSINESS NAME:
OFFICE ADDRESS:
APPROVED BY:
nr.
Ci[y
OFFICE PHONE NUMBER: (�)_
CONTACT PERSON: i�'t^.,
-LOCATION OF WORK T
BE DONE:
e
State
0:06-7 _7 ( o:�n
Zip
CELL PHONE # (42n ) ys7 - o -7-76
STREET ADDRESS WHERE WORK WILL BE DONE:
BUSINESS NAME WHERE WORK WILL BE DONE:
DATES FOR WORK TO BE DONE7'Q
CONTACT PERSON:
PHONE NUMBER: (_)
CELL(2_ai(;)7cc_--7�
PLEASE CHECK THE TYPE OF PERMITS) YOU ARE APPLYING FOR:
❑ AUTOMATIC FIRE -EXTINGUISHING SYSTEMS
❑ COMPRESSED GASES
❑ FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT
El FIRE PUMPS AND RELATED EQUIPMENT
❑ FLAMMABLE AND COMMBUSTIBLE LIQUIDS
❑ HAZARDOUS MATERIALS
L1 INDUSTRIAL OVENS
0 LP -GAS
Li PRIVATE FIRE HYDRANTS
El SPRAYING OR DIPPING
El STANDPIPE SYSTEMS
C�
LICANSIGNATURE DAi7E'
6
It
Excavation & Earthwork:
Concrete:
Masonry:
Roofing:
Insulation:
DiywalL•
Painting:
Floor
Coves
Plumbing:
Heating:
Electrical:
Roof Trusses:
Floor/ Ceiling Joists:
Siding/Exterior Ttim:
Other:
SUBCONTRACTOR LIST
Special Construction
(Manufacturer or Supplier)
7
EXEMPTIONS FROM STATE REGISTRATION
As of January 1, 2006, the City of Rexburg can no longer sell pits ermwithout having a copy of your State
registration number or your exemption from the State regtstrati 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 nextermit application.
p pl'
(Thus list is a summarization of Idaho Code Tide 54 Chapter 5205, for full definitions of these exemptions please
see the State's website at www.ibol.idaho.orry/rr)nt.},t-ml
❑ Currently State licensed pursuant to Title 54 Idaho Code, Chapters;
3 Architects,
1.0 Electrical Contractors/Journeyman,
112 Engineers / Surveyors,
19 Public Works Contractors (exempt from fee only registration rewired),
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 QTS Government agency (State, City, County, or other municipality)
❑ Public Utility doing construction, maintenance, or development to its own business
❑ Involved with gas, oil or mineral operations
❑ Supplier doing no installation or fabricating
❑ Contracting 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
F]Any type of water district operations
❑ 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 is not 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
❑ Engaging in the logging 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
I hereby certify that the above information is true and correct to the best of my knowledge.
Signature
Print Name
Date
0