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CITY O F
Certificate. of Occupancy
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Phone (208) 359-3020 /Fax (208) 359-3022
I~E~.BURG
- ~
Americai Family Community
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:
06 00307
International Building Code 2003
160 W Main St
Business
Type V-N, Unprotected
Office Space
No
Ruddco Llp
160 W Main St
Rexburg, ID 83440
Oakland Construction Company
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
vies inspected on the date listed vies found to be in compliance vuth 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: August 15 (09:33 )
C.O Issued by:
Building Official
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 ire Depa
State of Idaho Electrical Department-(208-356-48301:
C,'ITY OF I~.EXB UI~G
BUILDING PERMIT APPLICATION Please c
19 E MAIN, REXBURG, ID. 83440 If the questi
208-359-3020 X326
PARCEL NUMBER:~}~~~('~~IU~ ~~ J (We
SUBDNISION: UNIT#
r ,-r--- ___ ..
06 003 07
Hospital -All Season Remodel
Addressing is based on the in,~or~nation -must be accurate
OWNER NAME.• C (~ CONT CT PHONE # a -, ~ - C
_~ PROPERTY ADDRESS: ~ t S ~ ~- S Q ~ u ~ -' ~
~ 34$~
I~
PHONE #: Home (~~l51a .,~q ~5 Work ( ) Cell (Zp~ ~°1 ~ - ~1a41.p_
OWNER MAILING ADDRESS:1~~~~o Z ~~D k CITY:. .~ STATE:~ZIP:~H
~; 11
EMAIL11lt~V ~ I~ru 1 pn~`, .3o~,nFAX
'~----~_~ C° tr
APPLICANT: (If other than owner). ~yl(~C~ i SOiJ I+~IPrrO'R.IC,t. ~ (:LSD 1 <',t
(Applicant if other than owner, a statement authorizing applicant to act as agent\for owner ust accompany this application.)
APPLICANT INFORMATION: ADDRESS.. ~ ~r;<f ~ ~ T IQ i rJ CITY:
STATE; ~. ZIP $3~KIf~ EMAIL X Zo
PHONE #: Home ( ) Work (7~~ 3S~I'°14~1 Z Cell ( ~
CONTRACTOR:
MAILING ADD
PHONE: Home#
CITY S~'~ STATE~_ZIP~~
Work#'~6~'~~te~ Cell# ~~_ ~L~- 1 Fax#~b~- ~,,,~- ~5"la
O REGISTRATION # & EXPIRATION DA
1 ac c.o rh
How many buildings are located on this property?
Did you recently purchase this property? l~ Yes (If yes give owner's name)
Is this a lot split YES ,1(Please bring copy of new/ legal description of property)
PROPOSED USE: 1-1 oaQ ~ to 11~, e,,,~a~ ~ n~P~J ~ / ~~ [.~c~r~ o au J~~
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc
~~ cS
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of perjury, I hereby certify that I
have read this application and state that the infom~ation 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 tmthful and correct. I agree to comply with all City regulations and State laws relating
to the subject matter oft ' app ca a,\nd hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE:
The building official may evoke a pernut~ap oval issue under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact
in th~ a®pplication or on a plans on which th8rnit or approval was based. Permit void if not started within 180 days. Perrnit void if work stops for 180 days.
Do you prefer to be contacted bti- fax, email or phone` Circle One ~ ~ ~ U U
WARNING -BUILDING PERMIT MUST BE POSTED ON ,
Plan are non-refundable and are paid in full at the time of applic ginning anuarv 1, 2005.
City of Rexburg's Acceptance of the plan review fee does not top pP'~° 1
**Building Permit Fees are due at time of application** **Building Permit e d if chAc~di t cl
4 -RAA -1-
CITY OF REXBURG I 2
Bl7ILDING ~.AFE'T'~' DEI'AI2ThtEN'I'
~' 19 L. Main (PO Box 280) Phone: 208-359-3020 x326
Arrterica's Fancily' Crrrnrraurtity Rexburg, Idaho 83440 Fax: 208-359-3024
www.rexb°rQ•°rg janellhCa~rexburp.ore
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:
•
Please complete the entire Application!
If the uestion does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Dwelling Units: Parcel Acres:
SETBACKS
FRONT SIDE SIDE BACK
Remodeling Your Building/Home (need Estimate)
SURFACE SQUARE FOOTAGE.' (Shall include the exterior wall measurements of the building)
i /,
ij First Floor Area "t ~, ~9' Unfinished Basement area
Second floor/loft area Finished basement area
Third floor/loft area Garage area
Ij Shed or Barn Carport/Deck (30" above grade)Area
i~
Water Meter Quantity: ~ e~ Water Meter Size: ~ ~. ~ ~S~"11~.~
Regr.~ired.!!f
1'L UM.BING o~~ ~
Plumbing Contractor's Name: Business Name:~it~A~~f'n i'~~tc
Address ~4 ~ ~ , ~~ e. ~'C1u~s. 0 City L }' State C Zip ~y 0~
Contact Phone: (~) Business Phone: (2pgj) ry- ~a. - 4C~. ®~
Email ~ M L Fax 2b ~`1 ' S ~.~' ' ~ ~ (.,Q
FIXTURE COU1V7' (including roughed fixture
Clothes Washing Machine
Dishwasher
Floor Drain
Garbage Disposal
Hot Tub/Spa
_~_ Sinks
(Lavatories, kitchens, bar, mop)
Sprinklers
Tub/Showers
Toilet/Urinal
TT Water Heater
Water Softener
Plumbing Estimate $ ~..S~D~~ (Commercial Only)
-- ~~ AAA, ~ q ~ F'It
Requir Signature of Licensed Contractor License number Illate
The City of Rexburg s permit fee schedule is the same as required by the State of Idaho
4
Please complete the enti~Application! If the question does~t apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
other similar vents & ducts:
__
Required.!! MECHANICAL
Mechanical Contractor's Name: ~ ~ SQ Business Name:
Address ~~ ~o yt11 o~-p,,~_ City ~ ~ Oy
State C Zip ~ 9,
Contact Phone: (~~) _ 1 ~ O 4 Business Phone: (~)!~ - 4..q~
Email ,I` Fax 2s7 ~ - ~1Q~ - ~ 1 (~ ~
Mechanical Estimate $ (Commercial/Mufti Family Only)
FIXTURES & APPLIANCES 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
Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that ap y) Gas it Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans
.~ oa
~ ~~ 2~3- /~.4 ~=, l~
Req ~ ~ Signature of Licensed Contractor License numlaer
The
Dryer Vents
Range Hood Vents
Cook Stove Vents
~_ Bath Fan Vents
schedule is the .came as
Permit#
Date
the State of Idaho
5
•
~~ ~ ~ C~ I "1' Y C) F
,, ~ ~~,~ {~ BtiII..,I)INCi SAFETY I)EP.ARTMF;NT
N ~ 19 E. Main St. Phone: 208-359-3020 x326
'<, $,,
timericu'.c ~arrriiy Ct~tnnrurar`ty Rexburg, Idaho 83440 Fax: 208-359-3024
$"~ ~ ' wtvw.rexburg~ janellh aC~,rexburg.~
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO
APPROVED BY:
-t11 1 L11it11V 1 iivrvlcly 11V1~1
BUSINESS NAME: 4 ~so~
OFFICE ADDRESS: ~~ h
c,ty
OFFICE PHONE NU~~ER:
CONTACT PERSON: I~ Iq-~~
Mate zip
. q~ ~
CELL PHONE # (Z~)~ 13 -~.1 1 '~
-LVVAl1V1~1 yr wvitl~ v lSL". 1JV1VLi:
STREET ADDRESS WH RE WORK WILL BE DONE:
BUSINESS NAME WHERE WORK WI L E DONE:
DATES FOR WORK TO BE DON ~ o
CONTACT PERSON: ~ ,~ ~
PHONE NUMBER: (~~81 rF
~ ~, ~~~
TO
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
0 SPRAYING OR DIPPING
^ STANDPIPE SYSTEMS
^ MPOR~RY I~IEMBRANE STRUCTURES, TENTS, AND CANOPIES
t ~
P IC TS SI ATURE DATE
..........................................................................................
6
•
SUBCONTRACTOR LIST,
Excavation & Earthwork:
Masonry:
Drywall: ~ (/_~c%Shc. ~~ .r ~~i TKt
r
Floor
Electrical: ~ hCQi~Gf ~ IG .1'ii
Special Construction
(Manufacturer or Supplier)
Roof
Floor/Ceiling Joists:
Siding/Exterior
: ~ ~ Page 1 of 2
JaNell Hansen
From: mharrison@MMHnet.org
Sent: Thursday, June 22, 2006 2:43 PM
To: JaNell Hansen
Subject: Re: All Season Sports Blg
Dear JaNell,
Thanks so much for your patience. I love the fact that you are helpful and looking out for our best interests. You
deserve a raise!!!!!
Her are the materials costs for the project.
PlumbingHVAC $4,500
Electrical $2,000
Acoustic Specialties $6,149.88
Total $12,649.88
Please let me know what the cost of the permit will be and I will get the check down to you ASAP!
Thank you again and I look forward to hearing from you soon
Marc Harrison, Project Manager
Madison Memorial Hospital
Office # 208-359-9812
Ext. 4012
"JaNell Hansen" <janellh~rexburg.org>
To <mharrison@mmhnet.org>
06/22/2006 11:49 AM
Hi Mark,
Subject All Season Sports Blg
I'm just checking with you on the All Season Sports Building remodeling estimate. Have you had a chance to get
that information yet? I know you are very busy with the hospital expansion but I was thinking about it an wanted
to check on it.
6/22/2006
I will be here until 4 pm today and 1 pm tomorrow (Friday).
Thank You,
JaNell Hansen
Building Safety Coordinator
Phone: 208-359-3020 ext. 326
Fax: 208-359-3024
Email: ianellhna,rexburg.org
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1:49:37 PM ET - 6/22/2006
Page 2 of 2
6/22/2006
~.
•
1
License Confirmation
Date: 12/1
Record Inquiry - Browsing
• Bureau iPWC Public Works Contractors Licensing
License Type __.__-. ,.. __._._.._~.._~_.Y..._~____, .___._--.__... _... _
C C -Contractor ._.-._.-,
License Number 12259 'Status PWC - RE, Expires 09/30/05
License Issued 1/8/1968 ;Method UnAssigned 000000
Class
AAA-4(09110,06100,09250,09500,03500,02220,10270,
Type(s) of Construction
Company Name .Acoustic Specialties, Inc.
Address 1 ':PO Box 4135
City/State/Zip ;POCATELLO, ID 83205
Phone Number (208) 233 - 2694
Bureau of Occupational Licenses
Department of Seif Governing- Agencies
The person named has met the requirements for registration and is
entitled under the laws and rules of the State of Idaho to operate as a(n)
CONT~C~~~ NESS
r 44''`x` ~ ° ~~~a
ACOUS SINC
MI N
'_ wa
POC ~ C~ 1
.:sF++~
Rayo~obsen RCE-5070 01/24/2007
Chief, B.O.L Number Expires
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