HomeMy WebLinkAboutAPPLICATION - 06-00487 - Pinnacle Security - Storage ShedsBUILDING PEK1lIIT APPLICATION
19 E NLMN RE__\,7LBURG ID. 83440
PERA/11T #
Please completeth.e entire Application!
ly j
208-359-3020 X326
PARCEL NUMBER: �i��I _C51 (We willprovide this for- you)
SUBDNISION: LiNIT# BLOCK# LOT#
�Addressingis based on the infarmation -must be accurate)
OWNERNAME: J A rk4FD C 6A POE tL
PROPERJY ADDRESS:
PHONE #.-Horne
M
CONTACT PHONE #
Sf
� Work � � ��� -��yy yell c
OWNER MAILING ADDRESS: 5/ *K� /sY�S�CITY: %LeXt S11ATE: ZW ZIP: 7-�y�-l�'
Z - !F9 OYA
°r
EMAILs&dr F1 A X
Air
,' A A
APPLICANT (I£ other than owner) .JC6 i :WQ
(Applicant if other than owner, a. statement authorizing applicant to apt as agent for owner must accompany this application.)
APPLICANT INFORNI.A'i'ION: ADDRESS 4V 14CITY:
S4"AA1E GIP 7-:931yz-/0 EMAIL 5:1� bb R
Scc Crrn
PHONE#: Home ( )
Work ( )
�.�►'C•�' fir" ilh.
Cell
FAX
CONTRACTOR:
NLt1ILING ADDRESS: J� � �� �z tz y �..�� CITY �� � X STATE RTq' ZIPS 3�!�!b
PHONE: Cell# S`1V*"e13CC Work#
Fax#
EMAIL IDAHO REGISTRATION # & EXP. DATE ° C 1--o' n ` CJ L'm%>
How many buildings
are located on this property? = _
Did you recently purchase this propet-ty? No Yes (If des dive otivner's name) o- v' e0
Is this a lot split? NCS
Y 11V1'VJL,L UJL'.:
YDS
(Please bn'ng copy of new
0-e-,SU-1gle Family Residence, Nfudfi Fanlily,Apattrnents, Remodel, Garage, Commercial, Addition, on, E t
legal description of property.)
APPf,1CAN11"SSIGNATURE CERTIFICATION AND AUTHORIZATION: Under y of pe 'ury, I hereby cefti� that .I
have rcad thI s application and s, tate, tliat the information hers is correct and I swear that any Muf ti which ray hereafter be given by me i� hean'ngs before the
Planningand ZonmgCox Amis sign or the City Council for the City of Rexb"xg shall bc truthful and correct. 1 a rc e to comply with all C i Ly rcgWations and State laws relating
to the subject matter of this Zap ]kation hereby authoriz ed represent -hives of the Citi' to enter up on the above-mentioned groperty for insp ections purp os es. N OTE:
The building official mav revo ke a pe=- t on approv. al issue d under the provisions o f the 2003 Internati onal C ed c M cas es of any fall e s tatemcnt or rnisrepres entati n of f c t
the application or on the pfns an which the pe=t or proval was based. Peen t void if not started within 180 days. Pest void if work stops for 180 days.
i�ntu ofst DATE
r
Do
yo" -,- referto Nc""'contabtle bfax ems or phone? Circle One
^Y I IT MUST BE POSTED TRUCTI I SITEl
_ Plan fees are non-refundable and are paid in full at the time of application beginning Lanugfy 12005
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
**Building Permit Fees are due at time of application** **Building Permits are void if your check does not cle r. *
'b
Building Safety Department
19 E- Main
Rexburg, 18 3440
State of Idaho
County of Madison
jane11h@rexburg.c-rg
www.rexburg.org
City of Rexburg
Phone.- 208-359.3020 ext 326
Fax: 208.359,3024
Affidavit of Legal Interest
I ) - 5
Name
City
Being fist duly sworn upon oath, depose and saiT:
Address
State
(If Applicant is also Owner of Record, skip to B)
A%
4
1� -$ h JE ti
C1 TY 0 F
America's Fam;Iy C�mmunity
A. That I am the record owner of the property described on the attached, and T gtant my
p crrms sign to:
Name Address
to submit the accompanying application peztaining to that pxoperty.
W
B. I agree to indemra.ify, defend and hold Rexburg City. and its employees harmless fxvm any
claff'n or hability resulting from, any dispute as to the statements contained herr or as to the
ownership of the property which is the subject of the. application.
Dated this
S.19rilature
day of !0 20
Subscribed and sworn to before me the day and year first above written.
Notary Pudic of Idaho
Nly comnlissic)n expirC3-.
3
Please -complete the eiitire Application!
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS Permit#
SUBDNISION
Dwelling Units. Parcel Acres:
SETBACKS
FRONT SIDE.
SIDS BACK
Remvdelrng Your Building%wo e (need Estimate) S
..........
SQUAKEFOOTAG(Shall�SU1'�FACE include the exterior wall measurements of the building)
First Floor Area
4 Second floor/loft areq
Third floor/loft area
Shed or Barn
Unfini.shed Basement area.
Finished basement area
Garage area
Carport/Deck (30" above grade)Area
Water Meter Quantity Water Meter Size:
�'�, Requiredl.f!
PL UMBIN
P].umbitzg Contractor's Name:
Address
Contact Phone:
Business Name:
State
Business Phone: ( )
Email Fax
FIXTURE COUNT finclu&�ipt-rou�hed fixtures)
Clothes Washing Machiize
Dishwasher
Floor Drain
Garbage Disposal
Hot 1'ub/Spa
Sinks
avatones, kitchens, bar, mop)
Plumbing Estimate $
(Carnmercial 0
Sprinklers
Tub/Showers
Toilet/Urinal
Water Heater
Water Softener
Requi"red! Si'gnature of Licensed Contractor Ucense number to
The GO of Rsvbu qs p e rmit fee sch erule is th e same as re quire d by th e S tate of Idah o
ZIP
4
If the question does not apply SIl in NA for nonPlease complete the e11t1iC Application,,I
applicable
NAME
PROPERTY ADDRESS P e r rm't#
SUBDNISION
Re quired!!!
Vtri�I�1��1�7�7
Mechanical Name: Busmen Natne:
Address City State Zip
Contact Phone: ( }
Mechanical. Estimate $
Business Phone: [
(Commercial/ Multi Family (ley}
FIXTURES &APPLIANCES COUNT (SingkFanid-yDwelAng Only)
Fu-rn,qce Exhaust or Vent Ducts
Furnacc/A.tr Condit -'toner Combo
Heat Punip
Air Conditioner
Fwapotative Coo
_ Unit Heater
Space Heater
Dccoirative gas -famed appliance
Incinexator System
Boiler
Pool Heater
Fuel Gas Pike Outlets i�acluding stubbed in or future outlets
rnlet Pressure (Nieter Supply) P5I
Heat (Ci.rcle all that apply) Gas Oil Coal
Mechanic
4
Izinz Calc
Point
Dryer Vents
Range Hood Vents
Cook Stove dents
Bath Fan Vents
to
otheir vcnts & ducts:
F 1 ixeplace Electric Hyd-rollic
tions m
Required! Signature of Licensed Contractor
ive
xst be submitted with Plo
must be shown on n1ans,.
License number
Date
'I 'he 00 ?f B2'Y penwitfee scbedule is the same as required by the State Ida
& Annfication
5
M
Building Safety Department
79 E Man
Rexburg, ID 83440
OWNER'S NAME
PROPERTY ADDRESS
SUBDIVISION
PHASE
Required.�l.f
LUT
Electrical Conttactor's Name
BLOCK
City of Rexburg
Phone: 208.359.3020 x326
Fox. 20B. .3024
ELECTRICAL
��Y ne fits
Address P �'
Cell. Phone (SLE)
.City
jr..r..rr
PerrIlit#
Busixa.ess Name
_Business Phone (21,)S7
Email � W Y��`l' - e -
Electrical Estimate toast of wiring & labor)
i 8
d
,ill
01 TrI,
A 4ii!P>
E UP
SI/
1
RE..X,,,,BURG
CW -
America's Family Community
47z q26
15
- ip -5
� (COMMERCIAL/MULTI-FAMILY ONLY)
TYPES OF INS TALLA TION (R E S I D E N T I AL)
(NeivvResidential includes everything contained rx4thrn the xesiderxtial stxucture and attached garage at the same time)
Up
do 240 ami Service*
201 to goo amp service*
Over x-00 ami Service*
EX-Isting Residential (# of Branch Circua'ts)
-=- T'emparaxy Construcn-on Service, 20D amp or less, one location (for a period not to emceed 1 year)
Spa, Hit Tub, Swimming Pawl
Electric Central Systems Heating and/or Coo g (when not part of a new residential construction peffmi.t
and no additional wiring,)
Modular, Manufactured or Mobile Home
Other Installationst Wiring not speciffically covered by any of the above
Cost Wiring & Labor:
Pumps (Domestic Wateir, I Sewage
Requested Inspectaions (of exist,:'Lng wring)
Temporary Amusement/Industry
*-Includes maxi-
S1 1 t ure of Li
LnsPecttons. Additional inspecluons charged at requested i'nspection rate of per sur.
Contractor
W
License number
� r2sl
f
Date
The City df Rexburg's permit fee schedule is the same as requarect 6+y the State of Idaho
9
--t
Building Safety Department
19 E, Main
'r., 183440
ionellh@rexburg.org
www.rexburg.org
City of Rexburg
Phone: 208.359.3020
Fax: 208.359.3024
APPLICATION: " CONSTRUCTION PERMIT"
�kP_1D I
Cf T
REXBURG
America� Family Community
CONSTRUCTION PERMIT #-,
PERMIT APPROVED: YES/ NO $50.,00 FEE PAID: YES/NO
APPROVED BY:
-APPLICANT INFORMATION:
Business Name: '? I , ,,,,,'}v
Of`� � ��K}'t- 15 � cueficeAddress:-t' 2ex i.c.,.4:, :ice( ;K;)'ff'q465
City State Zip
Of�ce Phone Number: ( '�`��' �- -� � c� - �''� ._
Contractor Performing the ''�arl�: �� _ - zi /,;-�zr�`
Contact Person:
-LOCATION OF WORK TO BE DONE:
Street Address Where Work Will Be Donee.
Cell Phone #
5tl Joe) Z'C /Y-11 e
Business'Name Where Work mill Be Dane: r��*X*e" LotF n��_;`�-•�
mates For Work To Be Done-, To
ContactPerson:
Phone Number: (ZcL)F} .�� � ���1 �C�r' Cell ##
'ellc� &/-
PLEASE CHECK THE TYPE OF PERMITS) YOU ARE APPLYING FOR:
❑ AUTOMATIC FIRE -EXTINGUISHING SYSTEMS
Ll COMPRESSED GASES
❑ FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT
Ll FIRE PUMPS AND RELATED EQUIPMENT
❑ FLAMMABLE AND COMMBUSTIBLE LIQUIDS
ElHAZARDOUS MATERIALS
❑ INDUSTRIAL OVENS
❑ LP -GAS
❑ PRIVATE FIRE HYDRANTS
❑ SPRAYING OR DIPPING
F-1 STANDPIPE SYSTEMS
❑ TEMPORARY MEMBRANE STRUCTURES, TENTS,, AND CANOPIES
q plicant's 10F
Signature Date
I■E■■■M.. nog■■■■■■■■.����.f'..............r....����..��....■�.....f....'..���........�
7
U
0
fExcavation
& Ea-rthwotk:4
SUBCONTRACTOR LIST
ar��`i vim.
C'c�c e. rr�°
IL 01
e I
00
Concrete: C Vio- -Z� 074e
2 el
Masonry.
Roofing;.
Insulation:
Drywall:
Faulting:
Floor
C ovexings:
-Ml.
Plumb'g
Heating:
1 1
"JectriciA:
Roof Trusses:
W-1
f
f
/G
Special Construction
(Manufacturer or Supplier)
F1oor/Ceiling Joists: - -
Si.da.ng/Exterior -p-r-tim:
Other:
X MP 10iN S FROM STATE REGISTRATION
As of January 1, 2006, the City of Rexburg can no linger sell pexmits without having a copy of your State
regi.stxation number ox your exemption ftom the State registration. Please send a copy of your state registration or
fill out this foam showing your exemption and send it with yo our license renewal or yout next permit application.
(This list is a summarization of Idaho Code Tile 54 Chapter 5245, for dull definitions of mese exemptions please
cont.htm)
see the State's website at ww-Nv.ibo1.1dah0.!V0V
❑ Curtently State licensed pursuant to Title 54 Idaho Code, Chapters:
3 Architects,,
10 EAlectrical Contractors /i oum, eyman,
12 Engineers/Surveyors,
19 Public Works Contractors exempt froin fee only registration required},
26 Plumbing/Plumbcrs,
45 Public Works Construction Management Licensing Act (exempt ftoim fee onliT registration required), or
J
50 Installation of heating., ventilation and air conditioningsystems
❑ employee or volunteer of a licensed contractor ot past of an educational curriculum or nonprofit charitable
activity with no wages or salary
❑ Employee of a US Govemmentagency (State, pity, Countvo, or other municipality)
❑ Public Utility dot'ag construction, maintenance, or development to its own business
❑ involved with gay, oil or mineral operations
❑ Supplier dom'g no installation or fabricating
❑ Contracting a project or projects with a total cost Icss than $2004
0
peration ot a farm or ranch or construction of agriculture buildings exempt from Idaho Building Code
Any type -of water district operations
Work ix�. rural districts for fire p-revention purposes
❑ Owner who performs work on ovum property or contracts with a tegistered contractor to do work as hong as
the property is not for resale within 12 months
❑ Owner or lessee of commercial property perforMIJ"Ig maira.tenance, repair, altexation or construction on that
property
❑ Real estate licensee /property manager acting Nvithin Idaho Cade
0 Engagingin the logging industry.
❑ Reciter working on the property where they lire with the property owners approval
11 Construction of a building used for industrial chemical processing per Idaho Code
01 Construction of a modular building (defined by Idaho Cede) to be moved out of state
I hereby certify that the above information is sue and correct to the best of my knowledge.
Signature
Print Name
Date
WE
Building Safety Department
19 E. Mara
Rexburg, ID 83440
Site Plan checklist
Application Information
Applicant: ?--% n� U Ac
Applicant's Address: mar` 5
Project Address: 5i 5�
www.rexburg,.org
!a
Z:� -.5t,iS-5-f-
City of Rexburg
Phone: 208.359.3020
Fax. 208. 59,3024
Permit Number:
CITY Oar
REXBURG
America's Family Comntunio
. AX5�5�4S
C laty qP 1,7eyX,0 STO zi
Recorded Owner: �t:.yk-eA Ct+R*PP E_ 1,4L Phone:
Recorded owner Address: City: Rex • -
Development Information
FAX:
ST:
Zip: &3Y4v
0.010 �1. Site plan must be drawn to scale, be legible and also be submitted electronically i f possible.
t 2. djoining streets labeled.
3. Right-a�-way location and width, curb to curb widths and sideway location.
�-�Building location, sq footage and dimension -,s, with distance to property lines and distances
b6ween buildings,,
U`5.
ham existing and proposed easements.
utilities (waterlines, sanitary sewer lines, manholes, storm drains).
al -7: . oposec� utilities including tiein location to existing services and new easements.
8. Proposed storm- drain and sanitary sewer elevations (for pipe inverts at manholes and catch basins).
L.# 9. orm drainage plan for parking lad and roof areas, with calculations.
10. Firs hydrants and fire suppression lines (including tie to pity lines).
❑ Sprinkled 0 Not Sprinkled
11. lcate Fire apparatus access.
2. Parking (including parking lot, drainage arrows, is, of lot, distance between taws, and total
numbers).
D 13 'andscaping stype and total area, 'including dimensions),,
14. Trash facilities,
El 15. North Arrow
LJ 16. Drawi&ng to Scale, including a graphic scale (1 1 V2x 17"' paper if possible).
LJ 17. Proposed street improvements (curb, gutter, sidewalk, pavement, etc.
LJ 18. Legal description of proposed building site included.
❑ 19 rent of dot covered by building or paving calculated.
L;f: nI.Diktance
ow 10% snow storage area.
� of entrances from street corner indicated.
22. rrent Vicinity Map. (8112 x 1 F) at I'q'— 30d' scale, showing location of the property.
3. Lighting Plan
�NQTE: SITE PLANS MUST BE COMPLETE AND SUBMITTED FOR REVIEW BEFORE THE PROJECT WILL BE.
PLACED ON THE PLANNING & ZONING AC;ENDA. �