HomeMy WebLinkAboutAPPLICATION - 06-00424 - Airplane Hanger - Lone Bugle LLCCITY OF REXB URG
BUILDING PERMIT APPLICATION
19 E ALUN, REXBURG, ID. 83440
208-359-302O Y326
PERMtl' #
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
PARCEL NUTVTBER:_9?2,iV_3J1
SUBDIVISION:/?(f 7
LAddres.si� is based on the infarmatlon - must be accurate
OWNER NAME:
I
qqle- Lkoe
.
PHONE: #: Vlome (z�) 3 5 %- 22
OWNER MAILING ADDRESS:
EMAIL afhC,C�JIone�i
-(We will provide this for you)
LNIT# BLOCK#
CONTACT PHONE #
PROPEI�:FYl�nv�ss: H en(.? n�l�z CG�e57&.-0P_Z -
LOT# 3a -
q
7/ «u�l� yuJeA Way.
.Hey & A7-- )Vf 7 -
Wank (2a6) 3�6�"� t�'1� Cell
� P ITY: bK� STATE. -I-0 ZIP: 83 yf'O
AP�LIC.flIVT (If other Than owner) TP'. 3 ray?
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APVLI(�,1NTINFORI�IA'I'ION: ADDRESS CITY:
STS"i L; ZIPMEAIL YAX_
PHONE #: Horne ( ) Work ( ) Cell
CONTRACTOR:J/iS0h 4S7'ruc7iolq
iti1rkILING ADDRESS: 6 4 N I16 E
p_ CITY J Y STATE ZIP
PHONE: Home#
— Aid-- Work# 7f 5'-1105 Cell# 7c/:5' 1140K
a�
EMA IL'u-4p7lee IDAHO REGISTRATION#&EXPIRATION DATE RCE - 1,)`67!
How many buildings aire located an this prope-tty? I --- --- -� - -. ..
Did you recently purchase this propettv?CN)'Yes (If yes gimme ovtraner's name) Le
Is this a lot split?O YES Please being copy of new llegadescription of pxoper�y}
PROPOSED use:
(i.e., Single Family Residence,
lud Family,, Apartments.,Remodel, Gary
ge, Commercial, Addition, Etc.)
APPLICANYS SIGNATUREI, CERTIFICATION AND AUTHORIZATION: underpenf r u. I i creby certify � � that I
v. e read this app hcatxon and state that th.c inf n .,,i ti n he:reis Correct and I sw er that anv 1 1i fo rmatxon which abie r
after be 911 ny e in h inns before the
la and oi��� ornm s i -on r the City C cunt for the City f' Rexburg s h all be truth � ind correct. I -agree to coo ,l --w _
� th �ll City rcuhitiol7s and State laws relating
to the 1 j' ect mutter of this af)phc!:a6on and h e rcby authorized rere6 entry tinges of the i t enter n _ on taxabove-mentioned
' � propertyfor �rL��ti����� �������+ NOTE:
dly�:ibuilding official a -revoke � ��t �a t� r�...�� � �� ��� �a �� � r the ���s�or� f the ���:1 T nteate ona1 de � -
cases of arq �alsc stat( ent r srcpr scntation of fiat
in the cation r o c plans on wl� ch the permit or approval was based. Perrmit vold if not started within 180 days. Permit ,
t �T �i if work stops for 180 dad}.
06
Do you pr r t ontafaxcted
email o - Cphoine?.Cycle one
WAIU14ING — BUILDING PE 0' ST BE POSTED ON CONSTRUC
Plan fees are non-refundable arid are paid in fill at the time of applic-atiOnr b lin i
of the plan review fee does not constitute ply
'ca I rl** **Duilding.Pcirinits arc void if
0600424
Airplane Hanger -Lone Bugle LLC
J SITE!
a 1 2005.
e I� does AUG t clear** u06
PuildingSafety Department �4E=_B7/R�
19 E. Main
Rexburg,, 18344
State of Idaho
County of Madison
I,
C*
ty
I
icinellh@rexburg.org
www.rexburg.org
C ify of Rexburg
Phone, .3020
FQL
Affidavit of Legal Interest
Beh-ig first duly sworn upon oath, depose and sad
Address
State
(If Applicant is also Owner of Record, skip to B)
S
IT Y 0 F
R.EXBURG
America's Fami[y Community
Log
5J C_ LO
A'. That I am the record owner of thepropetty described on the attached, and I grant my
petrnission to:
Name Address
to submit the accompanying application peitammg to that property.
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any
claim of liability resul.drig from any dispute as to the statements contained herin ox as to the
ownership of the property which is the subject of the application.
Dated this day of 3 zo
Signature
Subscribed and sworn to before me the day= and year first above written.
Nota_nTP-Liblic of Idaho
0
Residing .t;
my Commii
3
Please complete the eiatire Apphcation!
NAME Lon
/Ifi
�questivn does not aPPxY � �n NA fir non applicable
Oe
PROPEItTY ADDRESS q?l L Kepcflo
SUBDIVISION c � Ail'
Dwelting Units: IVA Parcel. acres:
SETBACKS
FRONT �y SIDE
SIDE
.L✓u y
C iT
Pertnit#
RemodeAng YourBuit&nglHome (need EstImat-e) $ N11
SURFACE SQUARE FO 0 TA GE.- (Shall include the exterior wall measurements of
First Float Area
Second floor/loft area
`l'hind floor/loft area
Shed ot Bain
Unfinished Basement airea
the building)
Finished basement area N)q
Garage area _/
Carport/Deck (30" above grade)Area Ali
Water Meter Quantity: = -: r sig : r �_r n .
- Watrtr 31e
Reou-mied. .!�
PLUMBING
Plumbing Contractor's Name: H-OhLe
Addrcs.s 766N. Y�c��sToht
Contact Phone:
Email
/0/wn 1.0t, +#Irwe:
35G- `d"77o
FIXTUR,v. COUNT (includ
j9 ro u4e
9rhedfixtures
Clothes Wasbing iN-Iachine
Dishwasher
Floor Dram-
Garbage
Disposal
Hoy Tub/Spa
1 sixiks
(Lavatories, kitchens.,, bar, mop)
Plumbi
a
Estimate $ � 1 ` (Commercial
*awe of Lcensed Contractor
_a The
xburg she
city
usincss Natne:
Business Phone: (�65)_
Fax 3:576- 17
Only)
sprm ets
State Zip
l- �77v
Tub/Showers
Toilet/urinal
I Water Heater
Water Softener
01
Ucense number _' / D
rmitfee Schedule Is the same cis required by fheStale o ld4o
4
Please connplete the Application*' If We question does nnta"tihir 4;H in apply
&Z for nonapplicable
NAME Lon.e �;
PROPIiRTY ADD E S
SUBDIVISION /1fX�
T
Mechanical Contractor's N . . :
-_ --0 -
Addr
;1 [/ovsm�c t>rvy.
l
orrz ����'
I3usu�ess
i?, U -M
city / t ��
State
TfJ Zip
Contact Phone. (qc ) � �& � e5 7 7C)�iusiness9770
Phone: (z�). 3J'�� �'
Email Fax :5`6` 7 7.6
Mechanical Estimate $ C) (Commercial/Multi
A Family Only
FIXTURES & APPLIANCES COUNT
Furnace (Sing/e FamilyDwelling Only)
Exhaust or Vent Ducts
Furnace/Air Conditioner Combo
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas -Erred appliance
Incinerator System
B oilex
Pool Heater
Fuel, Gas Pipe Outlets including sta
Inlet Pressure (Meter Supply) psi
gybed in 0-t future outlets
— Dryer Vents
Range Hood Vents
Goole Stove Vents
Bath Fan Vents
- other sitnilar vents &duets:
Heat (Cixcle all that apply) Ga Oil Coad. Fireplace Electric Hydropic
Required! Signa f Li,,,,sed Contractor License number Date
The GO of Rexbur,9'spermitfee schedwle 2S the fame ar r
b he Stale L?f
_Y't daho
z
Bu'ild'ing Safe
ty Department
19 EF Main
Rexburg, ID 83440
ioneIlh@re.xburg.org
-r. re xb urg. c r
C ity of Rexburg
Phone: 208-359-3020
Foy' 20$.359.302
RE.JX.BURG
Was ily
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
� PERMIT APPROVED: YES/ NO $50.00 FEE PAID:
-APPLICANT INFOR
Business Name,
Office .Address:
Office Phone Number:
Contact Person:
TION:
pty
-LOCATION OF WORK TO RF.
Ctrnor AA.7ro.,., [v71..._�
APPROVED BY0
:
NE:
1�Cm, w orK win xe one:
Business lame Where 'Work Will Be one:
Dues For Nark To Be Done:
Contact Person:
Phone Number: (_)
Cell Phone #
To
Cell # (_)
State.
PLEASE CHECK THE TYPE OF PERMITS) YOU ARE APPLYING FOR:
❑ AUTOMATIC FIRE-EXTINGUISHING\WSTEMS
1:1 COMPRESSED GASES
D FIREAJ-ARM AND DETECTION SYSTEMS\1Fc.,
El FIRE PUMPS AND RELATED EQUIPMENT
zip
YES/NO
D RELATED EQUIPMENT
FLA
.MMABLE AND COMMBUSTIBLE LIQUIDS
❑ HAZARDOUS MATERIALS
CI INDUSTRIAL OVENS
Ei LP -GAS
El PRIVATE FIRE 1-fYDRANTS
F SPRAYING OR DIPPING
❑ STANDPIPE SYSTEMS
El TEMPORARY MEMBRANE STRUCTURES, TA--J-,FNTS, AND CANOPIES
APplicant'sSignature
on
SUB -CONTRACTOR LIST
:E;xcavation & Earthwo_rk:
concretem
Masonry:
Roofing:
insulation;
Drywall:
Painting:
Floor
Cove -rings:
Plumbing:
Heating:
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Flo ot/C eiFmg jots ts:
Siding/ Exterior 1'r1m:
tether:
7
EXEMPTIC)l, S FROM S RE(JISTRATION
As of January 1, 2006, the City of Rexbutg can no longer sell permits without having a copy of your State
registration number or your exemption from the State tegistraition. Please send a copy of your state r -'stralfton or
fill. out this form showing your exemp tion and seed it With your license irenew-al or your next p e C-91
rnilt application.
(This list is a sun=arization of Idaho Code Title 54 Chapter 5205, fox full definitions of these exempt -ions please
see the State's website at vr�vNvlbol. Idaho. ov cont.htm)
%--10
F1 Currently State licensed pursuant to Title 54 Idaho Code., Chapters:
3 Architects,
1 0 Electrical Contractors/Journeyman,
12 Engineers/purveyors,
19 Public Works Contractors (exempt frorn fee only registration required),
26. Plumbing/Plumbers,
45 Public Works Construction Manage:ment LicenS�ng Act (exempt from fee only registration requited), or
50 Installation of heating, ventilation and air conditioning systems
F-1 Lmployee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit charitable
activlty,W-Itli no wages or salary
C�
Employee of a US Government agency (State,, City, County-, ox other munic1' ality)
F-1 Public Utiiity cling construction maintenance or development PF] 5 to its own business
Involved With gas, oil or mineral operations
0 -M 1*
F-1 supplier doing no installation or fabricating
F-1 Contracting a project or projects with a total cost less than $2000
1:1 operation of a farm or ranch or construc ' n of agric
r� Any type of water district operations t1-0 ' ulture buildings exempt from Idaho Buildzrig Code
❑ Work in rural districts for fire prevention purposes
F-1 Owner who perfotms work on own property or contracts with a tegistered contractor to do work as long as
the property is not far resale within 12 months
Owner or lessee of commercial pxopeartty performing niaintenance, repair, alteration or construction on that
property
El Real estate licensee/property manager actm'g within Idaho Code
1:1 Engaging in the loggng industry
1:1 Renter working on the property where they live XV.1th the propexty owners approval
1-1 Construction of a building used for industrial chemical processing per Idaho Code.
1:3 Construction of a modular building (defined byT Idaho Code) to be moved out of state
I hereby ceirtlfv that the above information 'd is true and correct to the best of my knawled��,
Signature
Print Name
Date