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Home My WebLink AboutAPPLICATIONS & AFFIDAVIT - 06-00538 - Abbey Lane Apartments - CarportCITY OF KERB UKG ''00 BUILDING PERMIT APPLICATION Please 19 E MAIN, REXBURG, ID. 83440 208-359-3020 X326 PARCEL NMBER: &J V &�5�� 1 SUBDIVISION: UN is oases on me mtormanon - must oe 0600538 Abbey Lane Apts-Carport BLOCK# LOT# PHONE # 209 — 6 4 3 — PROPERTY ADDRESS: ti37 3 1/ 1,2 IQc-XbKq PHONE #: Home 41$) et 3 — 93.90ork Cell( ) 35;0-/42-b OWNER MAILING ADDRESS: 133,2 Al 1 B00 t:- CITY: %t- r'7'cf.'Oh STATE:,Z-I;�ZIP:--0-3`!SO EMAIL FAX APPLICANT: (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS CITY: STATE; ZIP EMAIL FAX PHONE #: Home ( ) Work ( ) Cell ( ) 5 MAILING ADDRESS: Y40 -01'. o e CITY l'idli i-n ' 6333L PHONE: Cell# Work# Fax# 20 8 — — 3 S 8 / EMAIL IDAHO REGISTRATION # & EXP. DATE v How manv buildin¢s are located on this property? Did you recently purchase this propettyKI�o Yes (If yes give owner's name) Is this a lot spli NO YES (Please bring copy of new legal description of property) PROPOSED U e r rT �o .— :AS C �S j;e yc % S h r- r (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenalty of perjury, I hereby certify that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me in hearings before the planning and Zoning 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 laws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above -mentioned property for inspections purposes. NOTE: 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 the app6ration or on the plans on which the permit m approval was based. Pemtit void if not started within 180 days. Permit void if work stops for 180 days. Signature of Owner/. Do you prefer to be contacted by fax, email or phone? Circle One Id/;26/ DATE WARNING — BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITEI Plan fees are non-refundable and are paid in full at the time of application beginning Tanuary L 2005, 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 clear" Building Safety Department City of Rexburg 19 E. Main janellh@rexburg.org Phone: 208.359.3020 ext 326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 Affidavit of Legal Interest State of Idaho County of Madison I, Name City Being first duly swom upon oath, depose and say: A. Address State (If Applicant is also Owner of Record, skip to B) That I am the record owner of the property described on permission to: Name Address to submit the accompanying application pertaining to that property. F;O pEXEUgC,' o CITY OF REXBURG Amedwl Family Community attached, and I grant my B. I agree to indemnify, defend and hold Rexburg City and its emplc claim or liability resulting from any dispute as to the statements ct ownership of the property which is the subject of the application. Dated this Signature day of Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: mess from any herin or as to the 3 Please complete the elThre Application! If the question does not apply fill in NA for non applicable NAME PROPERTY ADDRESS SUBDIVISION Dwelling Units: Parcel Acres: SETBACKS FRONT SIDE SIDE BACK Remodeling Your Building/Home (need Estimate) $ Permit# SURFACE SQUARE FOOTAGE. (Shall include the exterior wall measurements of the building) First Floor Area Unfinished Basement axes Second floor/loft area Finished basement area Third floor/loft area 55 ea t' _ Barn or BaCeck (30" above Water Meter Quantity: �u t j' "''' Water Meter Size: RequiredLY PLUMBING Plumbing Contractor's Name: I Business Name: Contact Phone: ( Fax FIXTURE COUNT (including roughed fixtures Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal Hot Tub/Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ (Commercial Only) y State Zip Phone: ( ) Sprinklers Tub/Showers Toilet/Urinal Water Heater Water Softener. Requiredl Signature of Licensed Contractor License number Date The City of Rexburg i permitfee schedule is the same as required by the State of Idaho iS 13 Please complete the entice Application! If the question does not apply fill in NA for non applicable NAME PROPERTY ADDRESS Permit# SUBDIVISION Requitedffl Mechanical Contractor's Name: Contact Phone: ( Mechanical Estimate $ MECHANICAL Name: Phone: ( Family Only) FIXTURES & APPLIANCES COUIVT (Single FamdyDwelhr. Furnace Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas -fired appliance Incinerator System Boiler Pool Heater Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure (Meter Supply) PSI Only) Exhaust or Vent Ducts Dryer Vents Range Hood Vents B pok aStove Vents a Fan Vents other sltnilar vents & ducts: Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic Point of Delivery must be shown on plans. Requiredl Signature of Licensed Contractor The License number icbeda/e is The xame as the State Date 5 Bull 19 E Main Rexburg, ID 83440 OWNER'S NAME _ PROPERTY ADDRESS SUBDIVISION PHASE ] Required!!! Electrical Contractor's Name Cell Phone ( ) Fax ( ) Safety Department City of Rexburg jonellh@rexburg.org Phone: 208.359.3020 x326 www.rexburg.org Fax.,208.359.3024 BLOCK ELECTRICAL Electrical Estimate (cost of wiring & labor) Name Phone ( ) C I T Y OF REXBURG Ameriwk Family Community (COMMERCIAL/MULTI-FAMILY ONLY) TYPES OF INSTALLATION (New Residential includes everything contained within the reside\one ached garage at the same time) Up to 200 amp Service* 201 to 400 amp Service* Over 400 amp Service* Existing Residential (# of Branch Circuits Temporary Construction Service, 200 ampn (for a period not to exceed 1 year) Spa, Hot Tub, Swimming Pool Electric Central Systems Heating and/or Cooling (when not part I ew residential constmction permit and no additional wiring) Modular, Manufactured or Mobile Home Other Installations: Wiring not specifically covered by any of the above Cost of Wiring & Labor: $ Pumps (Domestic Water, Irrigation, Sewage) Requested Inspections (of existing wiring) Temporary Amusement/Industry *Includes a maximum of 3 inspections. Additional inspections charged at requested inspection rate of $40 per hour. Signature of Licensed Contractor The License number rehedale is the same as the State Date CZ Building Safety Department City of Rexburg o 19 E. Main janellh@rexburg.org Phone: 208.359.3020 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 CITY OF REXBURG (v Amerirai Family Community APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO -APPLICANT INFORMATION: Business Name: Office Address: Office Phone Number: ( )_ Contractor Performing the Work: Contact Person: Street Address Where Work Will Be I Business Name Where Work Will Be Dates For Work To Be Done: Contact Person: Phone Number: ( 1 APPROVED BY: City Cell Phone # To Cell # State Zip PLEASE CHECK THE TYPE OF PERMITS) Y ARE APPLYING FOR: ❑ AUTOMATIC FIRE -EXTINGUISHING SYST S ❑ COMPRESSED GASES ❑ FIRE ALARM AND DETECTION SYSTEMS AN RELATED EQUIPMENT ❑ FIRE PUMPS AND RELATED EQUIPMENT ❑ FLAMMABLE AND COMMBUSTIBLE LIQUIDS ❑ HAZARDOUS MATERIALS ❑ INDUSTRIAL OVENS ❑ LP -GAS ❑ PRIVATE FIRE HYDRANTS ❑ SPRAYING OR DIPPING ❑ STANDPIPE SYSTEMS ❑ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES Applicant's Signature Date ......... ........ ............................ ...................... .................. .....t VI SUBCONTRACTOR LIST Excavation & Floor Special Construction (Manufacturer or Supplier) Floor/Ceiling J Siding/Exterior EXEMPTIMS FROM STATE RECfSTRATION 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.idaho.gov/cont.htm) ❑ Currently State licensed pursuant to Title 54 Idaho Code, Chapters: 3 Architects, 10 Electrical Contractors/Journeyman, 12 Engineers/Surveyors, 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, 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 ❑ 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