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HomeMy WebLinkAboutCO, APPLICATIONS, AFFIDAVIT, & MAP - 05-00417 - Radiance Hair & Tanning Salon - Tenant Finish 04 gBXB URG ti~ l9 ~,~ o s ,, a ~, ,. ?N£O ~ CITY O P I~EXI3URG Americn's Family Community CERTIFICATE OF OCCUPANCY Department of Community Development 19 E. Main St. / Rexburg, ID. 83440 Phone (208) 359-3020 /Fax (208) 359-3022 Building Permit No: 05 00417 Applicable Edition of Code: International Building Code 2003 Site Address: 669 Pioneer Rd Use and Occupancy: Radiance Hair & Tanning Salon Type of Construction: Type V, 1 Hour Design Occupant Load: Commercial Sprinkler System Required: No Name and Address of Owner: Thirds Louis Etux 2191 S 550 W Syracuse, UT 84075 Contractor: Futures Of Idaho Special Conditions: Occupancy: Business, professional or service, restaurants less than 50 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 thes inspected on the date listed sties found to be in compliance vuth the requirements ofthe code for the group and division of occupancy and the use for v~hich the proposed occupancy vies classified. Date C.O. Issued: February 1~.~.298~i~03:4~jM) C.O Issued by: Building 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 Depar~fr~enty?~-~-~'%,% LeL.¢~~1 Fire De State of Idaho Electrical Department CIlY OF.REXB URG , PERMIT # B.tiILDING PERMIT APPLICATION Please complete the entire Application! 19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable 208-359-3020 X322 ~~-~, `` PARCEL NUMBER:~~1~9V ~-~ ~~~ ~~ (~ (We will provide ~ot~' /~ „ _ SUBDIVISION: (~~ o N E E R ~' L L L A E ~'CTNIT# (Addressing is based on the information -must be accurate) OWNER: CONTACT PROPERTY ADDRESS: PHONE #: Home OWNER MAILING ADDRESS: EMAIL FAX f Pll r~ ~~URr± 05 0041.7 I iatt aiin dun `I'utlarlt ~''lllltill-1'ic~neer ~Za APPLICANT: (If other than owner) F K,'L ~l,Y~-~S p ~ l o Pt t-~o / ~ F~ W ~t ~ rJ S Vt„ (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must a company this application.) APPLICANT INFORMATION: ADDRESS ~ ~ l,J 1-~1,W ~y 2p CITY: ~ k ~"f STATE; ~ ~ ZIP $ 32 ~- I EMAIL FAX ~~~ ~' ~ ~`1 PHONE #: Home ( ) Work (,~~ 7 8 S - L 337 Cell (~e~ 7 6 `~1 - l0 3 3~ CONTRACTOR: F' ~1,'j- (x,12..-E S ~ ~ ~ D ~ t~10 MAILING ADDRESS: S ~ wl,~ CITY STATE ZIP PHONE: Home# Work# Cell# EMAIL FAX How many buildings are located on this property? Did you recently purchase this property? ~ 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: L' O /U1 M E 12 G l a L (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under pena-ty of perjury, I hereby certify that I have read this application and state that the information herein is correct and I sweaz 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 stazted within 180 days. Permit void if work stops for 180 days. ('1 , ~ ~/ r ~ /~ Signature of O /Applicant DATE Do you prefe be contacted by fax, email or p ?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 Reaburg's Acceptance of the plan review fee does not constitute plan approval Work ( )_ - ~~~, CITY -~ ~ ~ REXBLIR~ q~+~,~~ AMERICA'S FAMILY COMMUNF(Y Affidavit of Legal Interest State of Idaho County of Madison I, , 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 property described on the attached, and I grant my permission to: Name 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: 2 ' **Building Permit Fees are d ~ time of application** **Building Permits are ~f you check does not clear** Please complete the ere Application! If the question does not apply fill in NA for non applicable NAME PROPERTY ADDRESS SUBDIVISION Dwelling Units: SETBACKS FRONT SIDE SIDE Remodeling Your Building/Home (need Estimate) $ SURFACE SQUARE i00~TAOGE: (Shall include the exterior wall measurements of the building) First Floor Area ~ ~ Unfinished Basement area Second floor/loft area Third floor/loft area Shed or Barn Finished basement area Garage area Carport/Deck (30" above grade)Area Water Meter Count: Water Meter Size: BACK Permit# Required!!! PLUMBING Plumbing Contractor's Name:... K ~ {~T ~~ ~ D'~~usiness Name: ~ ~ ~ ~ Address City ('p , ~ 1°s I-~SState ~ ~ Zip~~~1 Contact Phone: (~~~ a d ~ `- ~ a- S ~- Business Phone: ( ) Email FIXTURE COUNT (including roughed fixtures) _~ Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal Hot Tub/Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $ S p po ,1T1~ (Commercial Only) Water Softener Required! 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 Parcel Acres: Fax Sprinklers Tub/Showers ~_ Toilet/Urinal Water Heater 4 Please complete the enti~Application! If the question doe apply fill in NA for non applicable NAME PROPERTY ADDRESS Permit# SUBDIVISION Required!!! MECHANICAL uu ~ Mechanical Contractor's Name: Vi ~ L Ls Business Name: Address City State Zip Contact Phone: ( ) Business Phone: ( ) ;Email Fax Mechanical Estimate $ ~ ~~ ~ (Commercial/Multi Family Only) FIXTURES & APPLL9NCES COUNT (Single Family Dwelling Only) Air Conditioner Bath Fan Vents Range Hood Vents Boiler Cook Stove Vents Decorative Gas Fireplaces Dryer Vents Evaporative Cooler Exhaust or vent ducts Fuel (gas) piping fixtures or appliance outlets Furnace Furnace/Air Conditioner Combo Heat Pump Incinerator Pool Heater Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Space Heater Unit Heater Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. Signature of Licensed Contractor License number Required! Date The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 5 • ~~ C[TY OF RE~BUR~ qa, AMERICA'S FAMfL.Y COMMUIV("(Y APPROVED BY: APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #:_ PERMIT APPROVED: YES/ NO -APPLICANT INFORMATION: BUSINESS NAME: OFFICE ADDRESS: $50.00 FEE PAID: YES/NO City State Zip OFFICE PHONE NUMBER: ( ) CONTACT PERSON: CELL PHONE # ( ) -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: ( 1 TO CELL # PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR: ^ 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 ^ LP-GAS ^ PRIVATE FIRE HYDRANTS ^ SPRAYING OR DIPPING ^ STANDPIPE SYSTEMS ^ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES APPLICANTS SIGNATURE DATE 6 ':.- ~ ~ ~ SUBCONTRACTOR LIST Excavation & Earthwork: ~ ~ ~ C Concrete: '~ ~ T ~ a' E S O fir ~ p ~ HlA Masonry: U o w) ~' Roofing: ~ ° ~ E Insulation: ~-- G S ~ S ~ ~ aT ~ ° ~ Drywall: S'~E N S~ N D +2 y w pt (_ (~ Painting: ~~ ti`p' ~ ~ N p 12y („s 1°~ L <_ Floor Coverings: ~ o ~ ~ Plumbing: per- -`J D ~ L ""rte ~ Heating: {~', ~ 1. (. S Electrical: ~ L ~ u E '(~a t3~ 1,NS Roof Trusses: Floor/Ceiling Joists:_ Siding/Exterior Trim: Other: ~} c~ V c N°tise= Special Construction (Manufacturer or Supplier) ~}oti+~ 7 CI?"~' OF REXB URG • BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID. 83440 208-359-3020 X322 PERMIT # Please com lete th~ mire A lication! P PP If the question does not apply fill in NA for non applicable PARCEL NUMBER: (V~ SUBDIVISION: UNI (Addressing is based on the information -must be accurate) OS 0041.7 Hawaiin Sun. Tenant Finish OWNER NAME: ~ /~tJXktl IU SUl.1..) -_- __~~~,~,~ PROPERTY ADDRESS: PHONE #: Home ( ) Work ( ) Cell ( ) OWNER MAILING ADDRESS: CITY: STATE: ZIP: 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 STATE: PHONE #: Home ZIP EMAIL Work Cell CONTRACTOR: F (,(, ?' lr(.12 >/ S D F' l D ~ >~ d MAILING ADDRESS: 43o W HI ~ (p CITY Q lv ~'~ STATE ~ D ZIP 83zZ PHONE: Home# Work# 7 gs-C~3 37 Cell# ? 0 `j - (0 337_ EMAIL FAX 7 $ S ._ ! Z 43 How many buildings are located on this property? Did you recently purchase this property?~ Yes (If yes give owner's name) Is this a lot split? ~ YES (Please bring copy of new legal description of ~~ PROPOSED USE: ~~ ~~ ~ T ~ A/l P R 0 ~~ ~/~. E IJ~ (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 sweaz that any information which may hereafter be given by me in heazings 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. Pennit void if work stops for 180 days. Signature of Owner/Applicant DATE Do you prefer to be contacted by fax, email or phone? 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 Regburg's Acceptance of the plan review fee does not constitute plan approval CITY: FAX 3 ..~ cl-nr ©~ ~.~:xBUR~ AMERICAS FAMILY COMMUWTY ,~ ,~,, ~,, Affidavit of Legal Interest State of Idaho County of Madison I, , 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 property described on the attached, and I grant my permission to: Name 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: 2 **Building Permit Fees are d time of application** **Building Permits are v~f you check does not clear** Please complete the ere Application! If the question does not apply fill in NA for non applicable NAME PROPERTY ADDRESS SUBDIVISION Dwelling Units: SETBACKS FRONT SIDE Parcel Acres: SIDE BACK ~; Remodeling Your Building/Home (need Estimate) $ 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 Unfinished Basement area Finished basement area Garage area Carport/Deck (30" above g Water Meter Quantity: **************** Water Meter Size• Required!!! PLUMBING Plumbing Contractor's Name: ~E ~"~ T ~E u D EL-~p~siness Name: A ~ ~ K PL l.~M,e l Address P . ~ ~ $ O X, ~ ~~7 City ~ D ~'~L (.S State 6 ~ Zips Contact Phone: ( ) Business Phone: ~q) dl,Ob -17-~~ Email FIXTURE COUNT (including roughed fixtures ~~ Clothes Washing Machine Dishwasher ~' Floor Drain ~' Garbage Disposal " 6 ~ Hot Tub/Spa _~ Sinks (Lavatories, kitchens, bar, mop) Fax ~~~ Sprinklers ~J~ Tub/Showers Toilet/Urinal Water Heater Water Softener Plumbing Estimate $ ~~ ~~ (Commercial Only) ~ - 117 3 ~ 2 ~z.°r ~~S Requ~ ed! ignature of Licensed Contractor License number Date The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 4 • Please complete the enti~Application! applicable NAME PROPERTY ADDRESS SUBDIVISION If the question does apply fill in NA for non Permit# Required!!! MECHANICAL Mechanical Contractor's Name: ~-- -e ~"` / Business Name: /~• ~~~ ~~ rl, ~•v+^,r~/ f Address ~ ~ ~O ,~ ~~,,~~..~.-t City~d j~ State c~ Zip~G Contact Phone: ( ) s~ 1- 33I .$- Business Phone: ( ) ;~~ e'1 - 9 7 (-' Email Fax v~ Mechanical Estimate ~ ~ ' (Commercial/Multi Family Only) FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only) Air Conditioner Bath Fan Vents Range Hood Vents Boiler Cook Stove Vents Decorative Gas Fireplaces Dryer Vents Evaporative Cooler Exhaust or vent ducts Fuel (gas) piping fixtures or appliance outlets Furnace Furnace/Air Conditioner Combo Heat Pump Incinerator Pool Heater Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Space Heater Unit Heater Mechanical Sizing Calculations must be submitted with Plans & Application o' t of Delivery must be shown on plans. ` ~ ~ sJ`1 ~ Sign re of Licens ontractor License number Date Requir The City of Rexburg's permit fee schedule is the same as required by the State of Idaho 5 • ~~"s GTY OF RE:~Bt,IR~ AMERICA'S FAMS.Y COMMUNITY APPROVED BY: APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #:_ PERMIT APPROVED: YES/ NO -APPLICANT INFORMATION: BUSINESS NAME: OFFICE ADDRESS: City OFFICE PHONE NUMBER: (_ CONTACT PERSON: • $50.00 FEE PAID: YES/NO State Zip CELL PHONE # ( ) -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: ^ 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 ^ LP-GAS ^ PRIVATE FIRE HYDRANTS ^ SPRAYING OR DIPPING ^ STANDPIPE SYSTEMS ^ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES APPLICANTS SIGNATURE DATE TO 6 1 l 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 O = ~ ~[,,/~\/~ r ~ ~ r.HFC:KFn RY~ MDG DRAWN BY JPS DATE: ` ~ \ ~ \ P L T O TT ~_~ 1 L 1 1 V : 9/30/05 THIS DRAWING IS PROPERTY OF TETON DRAFTING ~ °m -{ P P~'i D R A 1' T I N G S E R V I C i DATE REVISIONS BY SERVICES IT IS NOT TO BE REPRODUCED OR TO BE USED FOR ANY CONSTRUCTION EXCEPT AS HEREIN INDICATED WITHOUR THE EXPRESS NRI77EN CONSENT HAWAIAN SUN ~~ Z L pJ . TETONDRAFTINGSERVICESASSUMESNOLIABILITY FUTURES OF IDAHO O Z O 136 SOUTH STATE STREET SHELLEY IDAHO 83274 BEYOND THE PRODUCTION OF THESE PRINTS. ALL INFORMATION CONTAINED HAVE BEEN EXCLUSIVELY PR REXBURG, IDAHO m , PHONE (208}357-2420 FAX (208)-357-2419 OVIDED BY THE CUSTOMER AND HAVE BEEN ACCEPTED AS IS.