HomeMy WebLinkAboutAPPLICATION - 06-00433 - 159 S 3rd E - Remodel-vTY OF KEXBL�AG
BUILDING PERMITAPPLIC:ITION
19 E MAIN, RE�'BURG, ID. 8341n
ru
208-359-3020 X326
PARCEL NUMBER:
Please"
If he, que,
SUBDIVISION:
(Addressing is based on. the itlformattof1 - must be accurate)
OWNER NAME
�
' PROPERT'Y ADDRESS:
r
-DLTCN
IL
06 0043,3
lig S 3rd E -Window a R- I C
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UNIT#`BLOCK# LOT#
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�,v��n fi: Horne -1-J
Work ( )
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11 OWNER MAILING ADDRESS:�S�73�,.I ,tCell
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t7
C
`'il Y:
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EMAILYLL�-�STATE:�_Vj ZIP: ���t'�D
AV I I 1A -F-V
C---v�FAX
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authoriz,
1119 applicant to act as agent for owner must accompany this application-}
APPLICANT IIVFORMATrQIV: A RESS
ST.1TE;
ZIP- FAX.
r
PHONE #: Home � � _
Work ( )
Cell (
C0IVTRACTOR:
ft7,
7ev
t iN .�� ---- —=-� ----- _--
DiAILING ADDRESS: (6�'(S L��� �
CITY
STATE T ZIP L1,0
PHONE #-P Home Work
Cell �y:;a-rA OfAIL%,
FAl�
•,�; -�
IDAHO REG
........................ I......",",,--.......
..Zlwne
—
How v
C3
---,--- __-� ISTRATIaT`T # 8 EXP. n
s are located on this property? o iA -AP
� _ _
'Jlct you -recently puxchase this propert�r?No iff vesolVp �,t�T„�,.�c r.....� _. �i ` . - -
Is this a lot split;)
PP npr c -v r-%
NO YFS np i AC21 1--. ,L/ � � 0 JjUJLjjU) . t VVI
Copy ot new legal descrIption Of prope
ty)
W
S.
in.91c Famflv ResIdence
d FanAyq Apartm htsRemodell Garage5 Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE CED" -r -RJZATION: Under penofty of pe
that I havc -read this application and JLX, -L CATION AND AUTHO-
state that the info-rmation her fmry, I hereby certi(y
hean'n�,,-.q before the Planning and Zoning Comnliss,' cm is correct and I Swear that any information which rnay he
on or the G reafter be
ity Council for the C- giverl bv, me in
City. regular -ions a n a Mate laws rely 1�y of Rexburg s -h be- truthfud and cor_rect. I agre
Aing to the *subject matter of this aPPlication and hereby authorized, rep:vesentafives of the C' _c to comply with afl
mentioned PrOPertv WInspections,
The bu'ld' f Ci it to enter upon the above -
purposes. Nam. I Ing Of I "at may revoke a perm'
International Cod " �fi it 0a approv-z�
of
Cases of any f2lse statement or issued under the
misre e rovi lons of the 2003
based. Perm' 'I'd if not ed tatiOrl Of fact in the application or on the plans on which the
it� i f pCrMIt O -r approv-g Was
t within 180 day -s, Per L t if work stops for 180 days.
W
.,00f
ature o
cant
Ijo JTOU P-reter to -be coi-itacted bxv f�y P fn -ei -kip DA
4J'
1-Y -01-1crF 1Ircie
WARNING BUILDING PERMIT 4
1nd arMUST BE POSTED ON CONSTRUCTION SITE!
Man fees are nOn-Ifundable- ae paid n full at the'time of applica 0
tion beg"nn"ng janart, 1 40-05-1
City of Rexburg"s, Acceptance Of ffie plan review fee does not constitu
*Building Perruit Fecs are due at time Of application** "Building PC'Jrmitsare te plan approval
void if your check does, not clear**
K
Bu'lold�,,g Safety Department
C ify of Rexburg
19 E. Micro
Rexburg, 183440
State of Idaho
County of Madison
r,
Name
W
jonellh@rexburg.org
w w. r r . ori'
Phone: 208.359, 3020
F; .. 3,,59, 3024
Affidavit of Legal Interest
Address
at
�c-uag luST auly sworn upon oath , depose and�'say:
(If Applicant is also Owner of Record.skip to B
A. That I am the record owner of the proper descnbed
petmission to: o
Name �
to submit the accompanying application pertaining to aha
B. I agree to M*detnm Y) dt�f
end and hold Rexburg Citv,
q
REXBUR,G
Americas Fafnily " mummy
on the attached, and I grant mti-
-Address
roperty .
�
CLS11n or 11abil ty resulting frnm anT7 .4;��,,,+„ .... �_ �,_
J
m
ep1c�4�ees harmless
from any
d5 Lc, ane stat�mcnts contained herein
ownership of the property which is the subject of the app
bated this
signature
t
capon.
Subscribed and swore to before me the day and year first above written.
Notary Public of Idaho
i Residing tMY cormTLiss'
ion exp1res. ----------
.-
20
the
3
IMWWA� %
P` -lease complete theentire A
if the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Dwelllling u nits: . ..... Parcel Acres:
SETBACKS
P -RC NT QT"u j
Pexmit#
..........
Remodelx�g Your BuildrngllHarneneed EstYt-xa.ate ) 0 �'
FOOTAGE: (,S,-ha]J include the extSURFACE SQUARE
First Floor Area
Second floor/loft area
Third floor/loft area
Shed or Barn
Water Meter Quantity:
Required.!!
asuretnents c)fr g�
in
L'nfinished Basement area—
Finished basement area
Garage area,
Carport/Deck (30" above grade)Area
OVater Meter size:
Plumbing Contractor's Name: Business Name:
Address
Contact Phone:
E-mail
-City State Zip
Busfness Phone
Fax
FIXTURE COU1VTinclu roucrh-'I`fixtures
Clothes Washing Machine
�� Dishwasher
------- Floor Drain
Garbage, Disposal
�. Hot Tub/Spa
Sinks (Lavatories, kitchens, bar,, mop)
Plumbing Estimate$ (Cvmmercia n1y)
Signature of Licensed Contractor
The GO of Rexburg
Sprmklers
Tub Showxa-g-o �a.
r%
} .F m Toile t/U
Water Heater
'Watex Softener
License -Niumber& ExPiration Date Date
s permle is thesame as required bv the Siate ojjrdaho
11
I
I
11
Please'comP lete t
applicable
NAMF
PROPERTYADDRESS
SL"BDNISION
he entire Applic
ation' If the question does not apply fill in NA for non
Petrrut#
Mechanical Contractor's Name;
Business Name:
riuuress C1
�Vlluacz rnone: Business Phone:
Etnail
i' .
e;
o-,
i?
� Mechanical Estimate $(Conimercial/Multi FamilOnINAY
FIXTURES & APPLIAZVCES COUNT �s
Furnace
Furnace/Air Conditioner Camber
Heat Pump
Aix Conch6oneir
Evaporative Cooler
Unit Heater
Space Heater
--------- Decorative gas-fired appliance
Incinerator System
_
Boiler
Pool Heater
ingle fn_ wed
g on JX)
Exhaust r Vent Ducts
Dry.Vents
Fuel Gas Pipe Outlets including stubbed in or future owlets
Inlet Pressure (11 -deter Supply) PSI
Range Hood Tents
Cook Stove Vents
Bath Fait
NTents
other sirnilar vents & dints:
He -at (Circle alI that apply) Gas Gil Coal Fireplace Electric vdrc)iuc
Mechanical Sizina-Calculatiom,
Point of Delive
S191'ature of Licensed Contractor
TI)e O of &x
ust be submitted with -PInne. ft, e
must be shown on plans.,
License number
Date
Yrme schedule s the same � � ,�
� fie zeof ba
��p
ication
9
3
2
Please complete the Cnt. � Applicat"
ion! I£ the question doe ' �t apply fill in NA for non
applicable
NANoTE
PROPERTY ADDRESS
SUBDIVISION
.Re qulred.!!� E�LECTRICAL
Petrm-t#
Electrical Contractor'
s Name � P- J->-;-c�.-� � --.-�,.[::.�-,��• �_.�- Business Name1.7
Address
C."ty State Z4p�
Cell Phone Business Phone � )
Fax ( Em"
Electrical Estimate (crest of wiring �4c, labor} $
(Com.niercial/Multl Family Only)
7-TPES OF-r1vsrALr.ATraN.-REsrv-E�vr�r.�
(New Resrdential,includes everythi,�xg carrtained vf 4thin the residexttial structUre and -attachedgarabae at the same ximC
Up
to 200
amP,
Service*
201
to 40D
amp
Setvice*
Over 400,arrip Service*
_ Existing Residential (# of Branch Cl—rcults)
Tcmipora-ty Construction Service, 2O0 amp or Tess, one location (for a period not to exceed 1
Spa-, Hot Tub, Swimming Pool
Electric Central Systems Heating and/or Cooling {when not part of a new residential construction permit
and no additional wring} �
Modular, Manufactured or Mobile .Home
Othe-t Installations: Wiring not specifically covered by any of the wave
Cost of Wiring & Labor: $
Pumps (Domestic Mater, lrrigation., Sewage)
--------- — Requested Inspections (of existing wiring
Temporary Amusement/Industry
*Includes a maxum of 3 iris ec ,
Addition -al ln-sPectioias charged at requested t-nspection rate of $40 per hour.
Signature of Licensed Contractor
License number
Date
The 'i o
f Re
�_�_ same as required by the Stale of Tiro
2
SUBCONTRACTOR LIST
�,xcati=anon & Earthwork:
Concrete.
Masonry:
Insula i
n --
D.t-vswall:
Paintm'cr*
Floor
Coverings:
Plumbing:
Heating:
Fl.,fectncal:
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/Ceilan� j Qists:
Sidin / Ex � o
I g ten -r Tri -in:
tether:
1EXEMPTIONS FROM STATE REGISTRATION
his of January 1 , 200G, the City of Rexburg can no longer sell permits without ha�ri
regtstration number or your exem�t�on from rhe State registration. Please send a o� � ofpou.r ry of � e State
fill out this forth showing dour exemption and send it with your license renewal oryour nextpern-u't ���s�ration or application.
(TI -lis list is a summarization of Idaho Code Title 54 Chapter 520.5. for full definitions of these exemptions see the State"'s website at �t,���%7.i�ol.z�aho. /C tions
p s please
El Cur-telitiv State licensed pursuant
0
0
0
u
0
0
O■
0
X
to Title 54 Idaho Code, Chapters:
tG1114GtrL5)
1 � Electrical Contractors/Jou-tTleyinan,
12 Engineers/Surv-eyors,,
1 t) Public Warks Contractors (exempt fromfee only tea s�rati_an required),
26 Plumbing/Plumbe-ts.,
45 Public Works Construction Management Licensing Act (exempt from fee only regisrratzon re used or
5� Installation of heating, ventilation and air conditioning systems � �'
Employee or volunteer of a licensed corztxactat or part of an educational curriculum o� nonprofit charitable
activity with no wages or salax�T
Employee of a CJS Government agency, (State,Gty, County,, or other municipality)
Public Utility doing construction, maintenance, or development �o its own }ausiness
Involved with gas, mil or mineral operations
Supplier doing no installation or fabricating
Contracting a project or projects wtth a total Cast less than $2000
operation of a fatm or ranch or constrrucixan of agriculture buildings exemnt from MAlin r a
Any type of water district operations
Work in rural districts for fire prevention purposes
o
Owner who performs work on awe property or contracts with a registered contractor to do work as longsthe property is not for resale within 12 months a
Oxk'rner or lessee Of comrnercial property perforn=g maintenance, repair, alteration or construction on that
Propert�
❑ Real estate licenses /property manager acting within Idaho Code
Ll Engaging in the lagging industry
❑ Renter working on the roperty where they- live with the property owners approval
171 Car�struction of a building used for industrial chemical processing per Idaho Code
❑ Constr�xct�on of a modular builcling (defmed by Idaho Code) to be moved out of state
Y hereby certify that the above information is true and eorxect to the best of My knowled9e.
�Srgnature Date
Paint Name