HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 06-00067 - 151 S Hidden Valley Rd - New SFRZ
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O4 gEX6(,.,tG,' _ Certificate of Occupancy
ciTY or-
..,,~j ~~~~ City of Rexburg
;,~- -"~" De artment of Communi Develo ment
Americn'sFamityCnmmurti2y p ty p
19 E. Main St. / Rexburg, ID. 83440
Phone (208) 359-3020 /Fax (208) 359-3022
Building Permit No:
Applicable Edition of Code:
Site Address:
Use and Occupancy:
Type of Construction:
Design Occupant Load:
Sprinkler System Required:
Name and Address of Owner:
Contractor:
06 00067
International Residential Code 2003
151 S Hidden Valley Rd
Residential
Type V-N, Unprotected
Single Family Residence
No
Potter Jamison
371.1 Skyline Dr
Nampa, ID 83686
Aggressive Concrete, Llc
Special Conditions: Approx 600 sf of unfinished basement; Finish sidewalk and grade
as soon as weather permits (sidewalk inspection required before
pour).
Occupancy: Residential, single family dwellings, lodging houses
This Certificate, issued pursuant to the requirements of Section 109 of the International Building
Code, certifies that, at the time time of issuance, this building or that portion of the building that
vies inspected on the date listed vies found to be in compliance vtath the requirements ofthe code
for the group and division of occupancy and the use for thhich the proposed occupancy vies
classified.
Date C.O. Issued: February 13, 2007
C.O Issued by:
Building Official
JAM)
There shall be no further change in the existing occupancy classification of the building nor shall any structural changes,
modifications or additions be made to the building or any portion thereof until the Building Official has reviewed and approved
said future changes. .
Water Department: ~ '~- Fire Dep en
State of Idaho Electrical Department (208-356-ds3n~~
<.CIT~ OF REXBURG • PERMIT #
BUILDING PERMIT APPLICATION Please con 06 00067
19 E MAIN, REXBURG, ID. 83440 If the question
208-359-3020X322 ' I~~~ ~;, 151 S Hidden Valley -Potter
PARCEL NUMBER: ~~~~ ~~~ S.7l.s~C~~l1~'~ (We ~
SUBDIVISION: ~ ~tl~ UNIT# BLOCK# c` LOT# L
(Addressing is basec~on the information - u~t be accu~ate~ A _ ~,.~D
O
PROPERTY ADDRESS:
CONTACT PHONE # .~.cs-y-;~-30%3
PHONE #: Home (cif) ~`%z ~ ~3'~~ Work (~~ )
OWNER MAILING ADDRESS:
CITY:
EMAIL,. -~, ~ s ,~, o y ,--~~ c~...FAX .,~'-t ,~r- Y~ 3 -~f s } -
Cell (?~:~) ~yi°~'~'s 3
STATE:~L~ ZIP:
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to ac as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS G L,~ CITY: fC~ ~~
STATE; J ~( ZIP ~/ D EMAIL~~3~~ r ~ .c~,..FAX ~S(- S/%.3 ~_
PHONE #: Home (~S~ ~~G -YC/3t1 Work (Z~~) - i -n 7 7 ~ Cell (ao3) 3S~I -n 7 ~ ~
CONTRACTOR: ,~~ - ; ~ j~ L ~ _
MAILING ADDRESS: LJ~ J~~ L-~• CITY STATE ~L ~ ZIP $'3yy4
PHONE: Home# 3~S/„ - ~/S~3t~ Work# ~S L~ `S~/`.~ `/ Cell# ~.S/-o 7 ~~
EMAIL ,,.-.~r 3y ~ D cO~~FAX ~s~7~- yr/.~ L/ ~ ~ p -`j
~S~rah~c~h ~ ~°G~"-'~1~-9-~
How many buildings are located on this property? f
Did you recently purchase this property? No Ye If yes give owner's name) ~~;,~~~~~ ~,1tt-~.~ ~~c
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: ~'; -.a I ~-- ~~
(i.e., Single Family Residence, Multi Family,
Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT' S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty 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 2000 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or a b .Permit void if not started within 180 days. Permit void if work stops for 180 days.
~~ a~ l~
Sig ture caner/Applicant DATE
o you prefer to be contacted by fax, email or hone? Circle One
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning January 1.2005.
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 you check does not clear**
•
~*~"~ CITY OF 2 _ _ _ ~, _
I ~ f`
~, r
- k~ ~ ~ .~
.~~x~~ 1
+ AMERICAS FAMILY COMMUNITY 19 E Main (PO Box 280) Phone: 208-359-3020 x326
Rexburg, Idaho 83440 Fax: 208-359-3024
www. rexbura. ora comdev(a2rexbura.ora
Affidavit of Legal Interest
State of Idaho
County of Madison
I, ~I ~~~:~5~,~.- ~:~-~-,~-- X71 l :Sk U /- ~ ~ k~r
Name Address
~~~~~
City State
Being first duly 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 prop~~y described on the attached, and I grant my
permission to: "- „` ~ ~~,~ ~W ~ ~~yp
Name Addres~ s ~
to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any
claim or liability resulting from any dispute as to the statements contained herein or as to
the ownership of the property which is the subject of the application.
Dated this ~. s~ day of ~~r~,rc~y 20 ~ ~
~;
Subscribed and sworn to before~rne the day and year'~rst above written.
;:.;~_
.y ~,..; `. ~ c,
`>
rotary Public of Idaho
' _ Residing at: ~-e~~o ~x'
<.
r~
!~j* T 1~1
`~ My commission expires: 2 I f7
~~~~I itj il~ S~'
`e `'
Please complete the a ire Application!
_ If the question does not apply fill in NA for non applicable
NAME J o...-,.. ~ s ~ ~n ~~-~
PROPERTY ADDRESS Permit#
SUBDIVISION ~: ,..f,(~ Va /~
Dwelling Units:
SETBACKS
FRONT
Parcel Acres: ,3
SIDE SIDE BACK
Remodeling Your Building/Home (need Estimate) $ e2~0, o00 . ==
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area b .~,./ Unfinished Basement area
Second floor/loft area Finished basement area ,
Third floor/loft area Garage area-
Shed or Barn Carport/Deck (30" above grade
Water Meter Quantity: ~ ~ * * * * * ~ * * * * * * * ~~1~-
Water Meter Size:
Required!!!
PLUMBING
Plumbin Contractor's Name: ~ ,~ '
g ,~Flr ~~(j,(~ Business Name: /P~ ~ ~ ~
Address ~ O ~ City ~ ~Q State ~ Zip ',
Contact Phone: ( )~ ~~ ~f ~n Business Phone: ( ) ~S~ lyf ~
Email ~~~ Fax - ~ 77"~
FIXTURE COUNT (including roughed fixtures)
~ Clothes Washing Machine (~' Sprinklers
~_ Dishwasher ~_ Tub/Showers
~ Floor Drain ~ Toilet/iJrinal
~_ Garbage Disposal 02 Water Heater
O Hot Tub/Spa p Water Softener
~ Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $ (Commercial Only)
-TSignature of Licensed Contractor icense number I~ to
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
1 ase com lete the enti~A lication! If the question does3ot apply fill in NA for non
P e p pp
applicable
NAME ~~,,,,,~; s e ~ ~s ~ ~
PROPERTY ADDRESS Permit#
SUBDIVISION /~~~~-~- u~. ~•
Required!!!
MECHANICAL
Mechanical Contractor's Name: /~j~OJ/~r ~/~~'j1 a~ r-~ ~ ~~G ~/i sines Name:
Cit ~ /~~/' State ~ ol_
Address ~Q Qom 7 S~ y ~ ~ ~
Contact Phone: ( ) ~~ - ~ 7 7 ® Business Phone: ( )
Email
Fax .3~' ~77d
Mechanical Estimate $ (CommerciaUMulti Family Only)
F RES & APPLIANCES COUNT (Single Family Dwelling Only)
~~ Furnace ~ 5 C ~_ Exhaust or Vent Ducts IS
Furnace/Air Conditioner Combo \ ~ Dryer Vents .S
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
~_ Decorative gas-fired appliance t ~
Incinerator System
Boiler
Pool Heater
Similar fixtures or Appliances
~' Fuel Gas Pipe Outlets including stubbed in or future outlets lr~
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric
Range Hood Vents
Cook Stove Vents-
Bath Fan Vents Z~'
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~O
Signat e f Licensed Contractor
The City of Rexburg's permit
License number
Zip ~ 3 ~Q
lam'
~ s~
_~~
z - Z - o.~
Date
schedule is the same as required
the State ofldaho
r •
^^~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~t~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
SUBCONTRACTOR LIST
Excavation & Earthwork: lA~,?L r~l~.h fob ~G~-~r~b ---
,~
Concrete: ~~{~l~sJ.~c~~ ~,o~l.~.~- G-~L~
Masonry:
Roofing:
Insulation: ~~G~~/ f 7~
Drywall: ~~~ ~.L ,~ryy~,~j
Painting: ~~i~'s ~~~-~~
Floor
Coverings: ~„ ~ ..L S
Plumbing: /L~ ~-.r ,/~c~.~,~ l~r.~/.~ /7~.~i,~,~~
Heating: ~ ~ ~
Electrical: ~~~~,~ ~/~G~,,% f`
Special Construction
(Manufacturer or Supplier)
Roof Trusses: L~/~~~, l,,/~~S ~-
Floor/Ceiling Joists:~l ~~f
Siding/Exterior Trim: ~~~ l~LS
Other:
• .
EXEMPTIONS FROM STATE REGISTRATION
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 Date
Print Name