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HomeMy WebLinkAboutCO, BP, AFFIDAVIT, APPLICATIONS, & FLOOR PLAN - 05-00105 - Mama K's Restaurant - Tenant FinishZ _ ,-. s `~ w ~ .,~ ~ e~ a ~ o m ~ m ~ ~ ,~ a ~ ~ m c~ c ~~c= o o~ v rv 3 ~ ~~~~~ Z ~ N ~ cD ~ 0 ., -o ~ 3 ~ fl. 3 ~ ~ a C1 C ~ ,. 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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: Special Conditions: Occupancy: 05 00105 International Building Code 2003 ~~v~ f~i (1h{',Pir ~/ c?~i ~ QO Mama K's Restaurant Type V, 1 Hour 175 No Futures Of Idaho Inc 431 W 100 N Blackfoot, ID 83221 Futures Of Idaho 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 wes found to be in compliance with the requirements ofthe code for the group and division of occupancy and the use for which the proposed occupancy wes classified. Date C.O. Issued: December 19, 2005 C.O Issued by: Building Official There shall;be no further change in the e:asting 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 State of Idaho Electrical Department (208-356-48301• G'~---~--~- ` CITY OF REXB URG PF BUILDING PERMIT APPLICATION 19f E ~~IAIN, REXBURG, ID. 83440 Please ca 208-359'3020 X326 If the question PARCEL NUMBER: ~ '` ~ ~ 1V ~ y ® ~ ©Q ~(~-~ SUBDIVISION: ~ t o M G~~ ~ t L L ~4C1 E UNIT# OWNER: '~'~,'~u, ae5 d ~ 1 D ~ ~ PROPERTY ADDRESS: ~o ~ `~ PHONE #: Home OS 00105 Mama K's BLOCK# LOT# CONTACT PHONE # E1;. R ~ ~+ D Work ( ) 'j aq - ~ 3-'v7 Cell ( ) 7 Og - (~ 3 3~ OWNER MAILING ADDRESS: 430 ~ Nt~ wAY a'~CITY: F3 ~~T STATEN D ZIP: ~3Z Z ~ APPLICANT (If other than owner) (If applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) MAILING ADDRESS OF APPLICANT CITY: PHONE #: Home ( ) Work CONTRACTOR: F~ TU, ~ ES MAILING ADDRESS: q 3 a ~ STATE; ZIP Cell ( ) ~ ~A' PHONE: Home# H ~ ~- ~ Work# CITY 13 t= ~' How many houses are located on this property? Did you recently purchase this property? No Yes (If yes give owner's name) Is this a lot split? NO YES (Please bring copy of new legal description of property) PROPOSED USE: G ~ n.. M. E R c ~ a ~. ~ (i.e., Single Family Residence, Multi Family, Apartments, 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 approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. V1i-- ~j Signature of Owner/ N o tit E Cell# 7°`~- 633] STATE l ~ ZIP $ 32 2 l / / DATE 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** 2 ~ C1TY OF ~ - _ _ _ y RE:~Bt..IR~ ~ AMERICA'S FAMILY COMMUM~(Y 19 E. Main (PO Box 280) Phone: 208-359-3020 x326 Rexburg, Idaho 83440 Fax: 208-359-3024 www.rexburg.org comdevna.rexburg.org State of Idaho County of Madison I, Name City Being first duly sworn upon oath, depose and say: Address State (If Applicant is also Owner of Record, skip to B) A. That I am the record owner of the property described on the attached, and I grant my permission to: Name Affidavit of Legal Interest Address 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 herin or as to the ownership of the property which is the subject of the application. Dated this day of , 20 Signature Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: 3 M ~ ~ ~ ~ ~~ Please:complete the entire Application! NAME If the question does not apply fill in NA for non applicable PROPERTY ADDRESS SUBDIVISION Dwelling Units: SETBACKS FRONT SIDE Front Footage (if applicable) Storm Water Length SIDE Permit# SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) First Floor Area Second floor/loft area Third floor/loft area_ Shed or Barn Remodel (Need Estimate) $ Water Meter Count: Water Meter Size: PLUMBING Plumbing Contractor's Name: Business Name: ~ ~~~~r Address yes ~-2~ State Zip Q'3ZZ~ Contact Phone: ( ) ~ g ~ ...~(`,~ Business Phone: ( ) (~ ~! - ~~ ~S' FIXTURE COUNT (including roughed fixtures) _~ Clothes Washing Machine Sprinklers ~_ Dishwasher Tub/Showers 1^ ~ Floor Drain ~_ Toilet/LJrinal Garbage Disposal ~ Water Heater Hot Tub/Spa Water Softener ~_ Sinks (Lavatories, kitchens, bar, mop) Plumbing Esti to $ (Commercial Only) l 5-'91 5 ~S Signature of Licensed Contractor License number D to The City of Rexburg's permit fee schedule is the same as required by the State of Idaho Parcel Acres: Unfinished Basement area Finished basement area Garage area BACK Carport/Deck (30" above grade)Area 4 Please` complete the entire Application! If the question does not apply fill in NA for non applicable NAME F~~w~S VF' ~ D k~-tA PROPERTY ADDRESS (D (g ~ ~' l o u EEtR R~~ ~D Permit# SUBDIVISION pl0~EE1R- ~/`ll-t- /~G-~.~ Dwelling Units: SETBACKS FRONT Front Footage (if applicable) Storm Water Length Parcel Acres: SIDE SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) First Floor Area ~~ b~ 0 S Q F T Second floor/loft area Third floor/loft area Shed or Barn Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above grade)Area Remodel (Need Estimate) $ 2~9 Water Meter Count: Water Meter Size: PLUMBING Plumbing Contractor's Name: ~ ~ W ~ P L lit, /k. t3 I u (9' Business Name: Address State l ~ Contact Phone: ( )(Q $ I ~ $ L ~ S Business Phone: ( ) FIXTURE COUNT (including roughed fractures) )C Clothes Washing Machine C Dishwasher ~O Floor Drain ~_ Garbage Disposal Hot Tub/Spa _~ Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ S, on ~ • ~ (Commercial Only) Water Softener Signature of Licensed Contractor License number Date The City of Rexburg's permit fee schedule is the same as required by the State of Idaho SIDE BACK Sprinklers Zip g 3 2 Z l Tub/Showers Toilet/LTrinal ~ Water Heater 4 Please„complete the entire Application! If the question does not apply fill in NA for non applicable NAME PROPERTY ADDRESS SUBDIVISION MECHANICAL Mechanical Contractor's Name: Address Contact Phone: ( ) Permit# Business Name: State Zip Business Phone: ( ) Mechanical Estimate $~ (CommercialilVIulti Family Only) FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas-fired appliance Incinerator System Boiler Pool Heater Similar fixtures or Appliances Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure (Meter Supply) PSI Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. Signature of Licensed Contractor License number Date The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 5 ~~ CITY OF RExBUR~ ~~*~ AMERICA'S FAMILY COMMUNITY 19 E. Main St. Rexburg, Idaho 83440 www. rexbu rg. org Phone:208-359-3020 x326 Fax:208-359-3024 cdd@rexburg.org APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #:_ PERMIT APPROVED: YES/ NO -APPLICANT INFORMATION: BUSINESS NAME: OFFICE ADDRESS: city OFFICE PHONE NUMBER: (_ CONTACT PERSON: APPROVED BY: $50.00 FEE PAID: YES/NO CELL PHONE # Zip -LOCATION OF WORK TO BE DONE: STREET ADDRESS WHERE WORK WILL BE DONE: BUSINESS NAME WHERE WORK WILL BE DONE: _ DATES FOR WORK TO BE DONE: CONTACT PERSON: PHONE NUMBER: ( ) CELL # PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR: ~l AUTOMATIC FIRE-EXTINGUISHING SYSTEMS ^ COMPRESSED GASES ^ FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT ^ FIRE PUMPS AND RELATED EQUIPMENT ^ FLAMMABLE AND COMMBUSTIBLE LIQUIDS ^ HAZARDOUS MATERIALS INDUSTRIAL OVENS Q ^ LP-GAS ~ ~, ^ PRIVATE FIRE HYDRANTS ^ SPRAYING OR DIPPING ^ STANDPIPE SYSTEMS ^ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES ~ ~$ 0 APPLI NTS SIGNATURE DATE TO State 6 . ~ ' . SUBCONTRACTOR LIST Excavation & Earthwork: Concrete: Masonry: Roofing: Insulation: Drywall: Painting: Floor Coverings: Plumbing: Heating: Electrical: Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists: Siding/Exterior Trim: Other: 7 50' - 0" 22' - 0" 28' - 0" ~~ .J ...,,..,... `ti'4i .' ~ ~_, -.., ~ v .,, z , .,4 m ~_ _ _ 1 m ' O ,,'^^ Y' c -1 ~ A A ~ ----- -------a -------- I ~ - ~- ~ ~ ~ I o ~ ------- __ ----_____ • ~ • I- ~ _ (~ - -, A \// ~ ~ 1 15,-0" 1 ~ . (~ ~/~ ~ ' v > ~1 < 1 " .. ~. i ti., ,` P~ `,.,, '/3 ~ I . r 00 O T 10.-4„ 6._4.. A \.I ~- 5' _ 2~, ~~ y I-------------- ~ I ,. _ I .,~ I w i i~ ~ a ~~~ ti ~ ~ o ~ ~ _L_- ---- - o ~ - - ~ -------~ --__L._ . __ __ ~ - - ~ -- (Z O ~ o _ .__ , I '~ yt . ~J p ~ - - v -- - - ~g - -- ~°- ~ ~ ~ ~ , ~ ~~ ® ~ --- S?"' - -- --- ~tr-- ~ ~ ~ ~ I ~ ~ ----- _ ---- --- ---- ~- B.. ---_ _- -- N ,-6~-4" 4~- N ~ ~ ~ N ~ K ~.~ ~ I a, ~ a e ~ i `~ 1 ~ ~ ---. ~_____ ~__ I i ----- _--- - - - ? S f,-t El.. i 72'-6" 19'-6" 4'-6" 13'-6" COPYRIGHT ~ TETON STRUCTURAL ENGINEERS P.C. 2005 O _. ~ T E T 0 N CHECKED BY: MDG DATE: = fit Ffl A N O O ~ j \ CI rP T7 T T /'1 T T ~ "1 DRAWN BY DATE : BSG REVISIONS 04/04/05 BY THIS DRAWING IS THE PROPERTY OF TETON STRUCTURAL ENGINEERS P C Mama K~S -i cn 177 oO T 7 p T E E ~ [ TJ A T E TT ( IJ ll~, l-I l~ lJ 1Uf'1L 1V LT 11V Ll , . . IT IS NOT T08E REPRODUCED FUTURES OF IDAHO ~ ~-R Z A PROFESSIONAL CORPOR4TION OT TO BE USED FOR ANY CONSTRUCTION EXCEPT AS Q O HEREIN INDICATED WITHOUT REXBURG, IDAHO m 136 SOUTH STATE STREET SHELLEY, IDAHO 83274 RI1N EN PHONE (208)-357-2420 FAX (208)-357-2419 CONSENT O 7E STRUCTURAL ENGINEERS, P. C.