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Home My WebLink AboutAPPLICATION - 06-00533 - Avonlea Apartments - 9 UnitsCI"I'Y OF KEXB URG BUILDING PERMIT APPLICATION 19 E NLUN, KEYBURG, TD. 83440 208-359-3020 X326 I'ARCEI. NL?NiBER, SUBDIVISION: (Addressing Is based on the in£ormarinn - M11qf 1,%1a .,��,...,«e� Pleas F. Pv� PROPERTY ADDRESS: PHONE #: Home OWNER MiIII,ING ANDRE EMAIL FAX Work, ( 06 00533 Avonlea Apts-9 Units 'k— X YJNI"T# BLOCK#LOT# CONTACT PHONE # CITY: Cell ( ) ---'-J STATE -44) ZIP. Al'I'LICANT (If othei than owner) (Applicant if other than owner. a Statement authonzing applicant to act as agent for Owner must accompany this application.) APPI41CANT INFOR.MLkTIDN: AD17R�,SSCITY: STAL'TE, ZIP EMAIL TAS PHONE #: Home ( 0. Work ( Cell ( ) NLr1ILING ADDRESS: CITY PHONE: Cell# Work# ENLAIL IDAHO REGISTRATION # &EXP. DAT How many buildings are located on this property% _'Z/ Did you recently purchase this pxflpettv� No ps (T4,7P is nXT 74-14- ' t Is this a lot split, NO -D-D CA -D .7 8A V 4 0 11C111 11L ) YES (Please, hrin rn niF no-a-xv, I T A (i.e., Single Fan-fflv Residence A-Julti Farm-ly, A art .0 inents, Remod ton of N ell -Garage..- Commercial, Additio,�I&C.) STATE ZIP 15 APPLICANT'S STGNATURE� CERTIFICATION AND AUTHORIZI11 -rl avc lead Lms a plica ,PJ tion and state that the rM PLa-mung and ZOning Comrrj�sslon or th tv Ll to the subject mffiatter of diis applica "I a 2L The building ocial may revoke PC on l) rc M the aPPlication or on the PI) S o C " T 2 1 h the , c :; l�� , 3M X �I by ce fy 0 i,a L I tion herein is correct and I swear that any inforrnation which rmy hereafter be given by me in heartng� before the Or the, City of Rexburg shoffl be truthful and c;orrecL. T a ,gree to cornply with A City regulations and State lawsrelating thorized representatives of the City to enter upon the above-mentioned propemp, for inspec i il issued under the provi 1 tions puToses. NOTE: isions of the 2003 Intemationai Code in cases of any false:statement or misrepresentation of fact iat or approv!2d was based. Perm't void if not starttip. Within 180 days. Pest vold if work stops for 180 days. 2,14F S1911atMe of wn r Apph ant ant DA ..0 Do you Prefer to be co -tacte by fax email or phol.... Cle itc One WANT 3— BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE! Plan fees are non-refundable and are paid in full at the time of application begitining kalug I 42005. City of Rexburg�s Acceptance of the plan ireview fee does not conmatplan approval **Building Permit Fees are due at time of application** **B-uilding Permits are void if youf cbeck does not clear** 2 %-1 3 (i.e., Single Fan-fflv Residence A-Julti Farm-ly, A art .0 inents, Remod ton of N ell -Garage..- Commercial, Additio,�I&C.) STATE ZIP 15 APPLICANT'S STGNATURE� CERTIFICATION AND AUTHORIZI11 -rl avc lead Lms a plica ,PJ tion and state that the rM PLa-mung and ZOning Comrrj�sslon or th tv Ll to the subject mffiatter of diis applica "I a 2L The building ocial may revoke PC on l) rc M the aPPlication or on the PI) S o C " T 2 1 h the , c :; l�� , 3M X �I by ce fy 0 i,a L I tion herein is correct and I swear that any inforrnation which rmy hereafter be given by me in heartng� before the Or the, City of Rexburg shoffl be truthful and c;orrecL. T a ,gree to cornply with A City regulations and State lawsrelating thorized representatives of the City to enter upon the above-mentioned propemp, for inspec i il issued under the provi 1 tions puToses. NOTE: isions of the 2003 Intemationai Code in cases of any false:statement or misrepresentation of fact iat or approv!2d was based. Perm't void if not starttip. Within 180 days. Pest vold if work stops for 180 days. 2,14F S1911atMe of wn r Apph ant ant DA ..0 Do you Prefer to be co -tacte by fax email or phol.... Cle itc One WANT 3— BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE! Plan fees are non-refundable and are paid in full at the time of application begitining kalug I 42005. City of Rexburg�s Acceptance of the plan ireview fee does not conmatplan approval **Building Permit Fees are due at time of application** **B-uilding Permits are void if youf cbeck does not clear** 2 19 E. Main Rexburg, ID 8344 State of Idaho Building Safety Department jonellh@rexburg.org www.rexburg.org City of Rexburg Phone: 208'.359.3020 ext 326 Fax. 208.3.59.3024 Affidavit of Legal Interest Beingfitst duly. swornu pon oath, de -Dose. and sav:L ii Address State REX-BURG Amen�� Family mmun (1f Applicant is also Owner of Record, skip to B) A. That I am the record owner of the propertye described on the attached, and I gtant my permission to: Name Address to submit the accompanying application pertanung to that property- B. I agree to indemnify, defend and hold Rexburg Citi and its employees harmless from a0 ny claim or liability resulti�ag froin.- any dispute as to the statements contained herin o� as to the °wnership of the property which is the subject of the a��licatic�n. in Dated di -is Subscribed and sworn to befoxe rye the day and firstyear above written. Notaq Public of Jdaho Res'ding at: MY CoMrfiLission ex yes 3 C Plea's- e complete the e.Lt NAME PROPERTY ADDRES SUBDIVISION 0 sire Application! apply fill in NA for non applicable Dwelling Units: Parcel Acres: SETBACKS FRONT SIDE SIDE BACK Rerxxadeling Your Building -/dome (need Estimate) $ SURFACE SQUARE FOOTAGE: First Floor Area Second floor/lo Third floox/loft Perrxu't# (Shall include the exterior wall measurements ments of the builcling) i shed Basetnen 1411il nt area �,o G ara.�I Shed or Barn .— '`- Carport/Deck (30" above grade)Area Water Meter Quantity. Water Meter Size,, Plumbing Contractor's Name: $usiness Name: Address City State ZIP Contact Phone: Business Phone: ( Email Fax FIXTURE CDTJTNrT�.tticlzrdrnj27 -ro Clothes Washing Machine _� Dishwasher Floor Dxain �� Garbage Disposal "t" Hot Tub/Spa Sinks J--Javatori es,, kitchens, bar inop) P1uYnbing Estimate $ hed fxxtures (CommercialOn1y} Sprinklers �_ Tub/ShUwers Toilet/Urinal ._.��, Water- Heater -7--�U. Water Softener Required! Signature of Licensed Contractor License number Date Tke G�,y of Rexbiir ' is 1he ,,,e , ,,d �y o th e S ia to f -f)o o E Please complete the ent�Abnlicatinnl applicable NAME PROPERTY ADDRESS SUBDIVISION RequiredLl.� If tie question does. not apply fill in STA for non MECHANICAL Peirrm't# Mechanical Contractot's Name: Address _.0 State ZID Contact Phone: (� ) Business Phone: Email Fax Mechanical Estimate $ (Commercial/Multi Family Only) FIXTURES& APPLIANCES COUNT (Single Fan%ily Dwelling Only) ]Furnace Exhaust or Vent Ducts Furnace/Al'r Conditioner Combo He -,,It Pum, p Air Conditioner Evaporative Cooler Unit Heater _4.(0^ace Heater 9 v WF Decorative gas-fired appliance Incinerator Svstenj J Boilet Pool Heater Fuel Gas Pipe Outlets including stubbed in or Future outlets Inlet Pressure (Meter Supply). PSI Heat (circle all that apply' Meeh Coal FireP la DtTer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other smear vents & ducts: Electric � Hydroruc oint of Reqi�.li'+�(�t Signature of Licensed Contractor efive License number Tr ',� erms� )6 e r � • o,.-rS fee- j ame as req uimrhe State ojldab oldo 5 Building Safety Department `SBLA% 19 E Main Rexburg., 183440 jcinelih@rexborg.org www.rexburg.org OWNEWS NAME PROPERTY ADDRESS SUBDIVISION PHASE LOT BLOCK City of Rexburg Phone., 208.359.3020 x326 Fax: 208.359.3024 Required.!! ELECTRICAL Perrnl,t# x� p a CITY F IEXBURG _— �— C AmericamdyCommunity Electrical Contractor's Name Busm'ess Name Address C1tY---------,State Zip Cell Phone ( ) Business Phone ( } Fax Electrical Estimate (cost of Wiririg & labor) $ 4 (COM MERCIAL/MULTI-FAMILY ONL TYPES OFINSTALLATION(RESIDENTI-AL) (New -Residential-Includes evetythr'ng con tarrled warthitz the residential stxucttzre and arta Up to 200 amp Service* .� 201 t0 400 am.p Service* Ovcr 40Q amp Service* t the same time) Exisdng Residential (# of Branch Circuits) Temp o-tary Construction Service,, 20Q amp or less, one location (for a pciriod not to exceed 1 yea -T) Spa.., Hot Tub, Sing Pool Electric Central Systems Heating and/Ur Coohng(When not part cif z newrestr�ential construction permit and no additional wirii3g) Modular., Manufact-Lited or lelobile Home Other Installations: Wiring not specifically, cavere Cost of Wiring & Labor: $ Pumps (Domestic Water,, Irrigation, Sewage) Requested Inspcctions (of existing wiring.) Temporaty Atnusetnent/lnd-Listry d by any of the above *Includes a maximum of 3 i-nspections. Additional inspections charged at requested inspect -ion rate of $40 per hour. Signature of Licensed Contfactor ldcense number Date Tbo 0 o Re S M 1 feefehedlyle ithe same as required , the State o. al :.o Building Cafety Department LAI ia�BR1111,11,11 19 E. Main Rexburg, 183440 janeYh@rexburg.o,rg www.rexburg.org City of Rexburg P 208, 359.302 Fox. 208.359.3024 APPLICATION: cc CONSTRUCTION PERMIT" Business ki 88 111X" ddress: Office Phone Number: (� Contractor Pe-arforming the Contact Paxson: Cell Phone # -LOCATION OAF WORK TO BE DONE:, ASLO RE)(BURG America' Famrdy commurrity CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/ NO $50.00 FEE PAID,* YES/NO F k. APPROVED BY:.. Street Address V Business Name' Dates For Work Contact Person: Phone Number: PLEASE CHECK THE TYPE OF PERMITS) YOU ARE APPLYING FOR: >-�-'AUTOMATIC FIRE -EXTINGUISHING SYSTEMS El COMPRESSED GASES FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT !7 FIRE PUMPS AND RELATED EQUIPMENT L-1 FLAMMABLE AND COMMBUSTIBLE LIQUIDS El HAZARDOUS N UTERIALS INDUSTRIAL OVENS El LP—GAS ❑ PRIVATE FIRE HYDRANTS SPRAYING OR DIPPING 1-1 STA PE SYSTEMS 11 T P R�tY MEMBRANE STRUCTURES, TENTS, AND CANOPIES App- is agr ate f - / . ■ W R i M r. ■EAR & ■ . O N NEEM MEMO *ANNE DOME MEMO WOMEN MEMO ENME NUNN w ERNMEMME MOMME � ■ ■ >� ■ ■ 7 excavation & Eatthwork: Concrete: Masonry: Roofing: Insulation: Drywall: P ainting: Floor Cove=9s: Plumbing: Heating: Electrical: Special. Construction (Manufacturer or Supplier) Roof Trusses Floor/Ce- , Joists: Siding/Extetior Trim: Other: EXEMPTIGIIS FROM STATE REG-LSTRATION As of January 1, 2006, the City of Rexbuxg can no longer sell permits without havingistra i a Copy of your State re gi- t-lon number or your exemption from the State registration. Please send a copy of your state registration or 4 fillout this form showing your exemption and send it With yTour license renewal or your next perrxiit application. (This list is a summarization of Idaho Code Title 54 Chapter 5205, for full defiriitions of these exemptions please see the State's website at www.ibol.idaho. civ cant.htm F-1- Currently State licensed pursuant to Title 54 Idaho Code., Chapters: 3 Architects, 1 0 Electrical Contractoxs/Journeyman, 12 Engineers/Surveyors, 19 Public Works Contractors (exempt from fee only registration tequired), 26 P"lumbing/Plumbers, 45 Pudic Works Construction Management Licensing Act (exempt from fee onl� Y T El 50 Installation of heating, ventilation and air conditioning systems reg'sttation required}, or Ei mployee or volunteer of a licensed contractor or part of an educational curriculum or non IP rofit charitable activity with, no wages, or salary 1:1 F1mployee of a LT5 Government agency (State, City, County, or other tnunicipahty) El Public Utility doing construction, maintenance, or development to its own business 0 Involved with pcs, oil or Mineral operations 1-1 Supplier doing no installation or fabricating D Contracting a project or pzojects xvith a total cost less than $2000 L] Operation of a farm or ranch or construction of agriculture builclings exempt from Idaho Building Code ❑ Any type of -\x�rater district operations 10 El Work in rural districts for fire prevention purposes )i( Ownet 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 o Owner or lessee of commercial property performing'ralteration ot const-ruc 'ti Maintenance, -tepl. aon on that property El Real estate Jicensce/property manages acting within Idaho Code ❑ Engaging in the laggingindustry ❑ Renter working on the property whete they live With, the ptopeM owners approval F-1 Construction of a bLilcling used for industrial l chenu'ca . processing per Idaho Code El Construction of a modular building (defined by Idaho Code) to be moy ed -out of state I hereby certi£yT that the above in€ormation is true and correct to the best of my knowledge. Signatuxe Print Name Date 9