HomeMy WebLinkAboutAPPLICATIONS, CO, BP - 06-00620 - Galbraith Eye Clinic - Tenant Finishz
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CITY OF Certificate of Dccupancy
1WXIBVR
CW—
America's Family Community
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
Phone (208) 359 -3020 / Fax (208) 359 -3024
Building Permit No: 0600620
Applicable Edition of Code: International Building Code 2003
Site Address: 534 Trejo St " 1400
Use and Occupancy: Dr. Galbraith Eye Clinic
Type of Construction: Type V -N, Unprotected
Design Occupant Load: Business
Sprinkler System Required: No
Name and Address of Owner: Bagley Terry
423 S Yale
Rexburg, ID 83440
Contractor: Dafab Construction
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
was inspected on the date listed was found to be in compliance with the requirements of the
code for the group and division of occupancy and the use for which the proposed occupancy
was classified.
Date C.O. Issued: June 18, 2007 (12:01 PM)
C.O Issued by:
Building Official
There shall be no further change in the existing occupancy classification of the'13Mding 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.
Plumbing Inspector:
Electrical I
Fire Inspector:
`CITY OF REXB URG i
BUILDING PERMIT APPLICATION Please comp 0600620
19 E MAIN, REXBURG, ID. 83440 If the question doe
208- 359 -3020 X326 Galbraith Eye Clinic
PARCEL NUMBER: j „ t,� `0 0 J W/ (We will pro
SUBDIVISION: UNIT # BLOCK# LOT#
Addressing is based on the i nformation - must be accurate
OWNER NAME. • �' �' CONTACT PHONE
PROPERTY ADDRESS:
PHONE #: Home Y4f Work ( ) Cell
OWNER MAILING ADDRESS: y23 &/,, CITY: !4 _STATE: ZIP:
/� a / /j /
APPLICANT (If other than owner) ,�L�fy9f3 C�.�t /yu- /0• 4, 047e
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application)
APPLICANT INFORMATION: ADDRESS $S�-� /�• �� CITY: ���
STATE; ��� ZIP S3ya / EMAL ,�19F�9< f, Es /�E FAX g70.c
PHONE #: Home WK Work ( ) Cell.( - s�9-e-r-rp
CONTRACTOR i 4S
MAILING ADDRESS: A). CITY 2�@�42 �//� STATE ZIP 3 /
PHONE: Home# Work# Cell# Fax#
EMAIL IDAHO REGISTRATION # & EXPIRATION DATE � eif ,"�W /Z �/-
How many buildings are located on this property?
Did you recently purchase this proper N es (If yes give owner's name) D -
Is this a lot split? Jg3 YES (Please bring copy of new legal description of pro r D EC 2 0 �QOo
PROPOSED USE: / rrs/
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Additio Etc. t 1
C�ITYOF REXBURG
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: U nder pen o rl p y I'hei�byt�rt dr
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 ffici iay revoke a pe on approval is ued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact
in the app ' a on o n the plans Vh the p t approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of Owner /Applicant DATE
Do you prefer to be contacted by fax, email or one Circle One
WARNING — BUILDING PE MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid in full at the time of application beginning Ianoary 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 your check does not clear**
2
Please complete the entire Application!
If the question does not apply fill in NA for non applicable
NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
Dwelling Units: Parcel
SETBACKS
FRONT SIDE SIDE BACK
Remodeling Your Building /Home ( need Estimate $ �/ ocd �'�� CC
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area Unfinished Basement area
Second floor /loft area Finished basement area
Third floor /loft area Garage area
Shed or Barn Carport /Deck (30" above grade)Area
Water Meter Quantity: zf4 — Water Meter Size:
Required!!!
PLUMBING / � �
Plumbing Contractors Name :: G� t A ,mss Business Name. .
f Z � 7 'Y
Address � .:5 / S °' � City ��7 State =7 Zi ppy/
Contact Phone: ,(?O) 3J ,7— 3 Y 3 s 7 • Business Phone: (
Email F
FIXTURE COUNT (including roughed fixtures
Clothes Washing Machine
Dishwasher
I Floor Drain
Garbage Disposal
Hot Tub /Spa
Sinks
(Lavatories, kitchens, bar, mop)
) 3.T7 — -Ae1,gf
Sprinklers
Tub /Showers
Toilet /Urinal
Water Heater
oa
Plumb* Estimate $ 6:3_-�rq (Commercial Only)
�Ti
Requiredi Signature of Licensed Contractor License number
The City of Rexburg permit fee schedule is the same as required
Water Softener
1 - 2-- 7-0-0
Date
the State of Idabo
4
Dec, 21, 2006 11:04AM
• No, 3355 P. 2
Vlctie Complete the entire AM) icadoW u*a qw
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PROPLR'X'Y ADIaRESs
Galbraith Eye Clinic
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,,Requifiedlll MULCH IW
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m Contmcwe. N usiitess Novae: "� r
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Contact Phone: 4w) Y– i 4 Busineee Phone:
- - --- .J6v-- -a— �dlL i
) 1' & ry-
R 'r
MW
Uu»icttl Fetiimate (�omu al /Mu1t1 Fatmilq Only)
Mr,r( '6 & APPLMN= COVN - T (di6ggle p Bng Ox*1
S%hsust or Vent Duets
Fu=ce
� )L Puttimce /Air CondWonet Combo I)q= VMM
Heat Pump Raugc Hood Vests
Cools 5twe Vents
Ain Conditioner
Hvapotativc Cooler �.� aatb Nan Vents
o&a tsar vents & ducts:
Unit Hester
Space Heater
Decorative gse -fired appliance 2
Incinerator Syetam D is
Boilers
DEC 2 1 2006
yooi Her —
Fuel G . pi Mzjm in&ding stubbed is or future °u B !-� p F R EXB U R G
Islet Pressure (me= supply) PSI
Heat (Circle all that ap*) &VCd Coal Fuepiace Electric Hydronic
5
Z0'd wo LZ:TT 900Z- TZ -33a
E M AN -03 -2007 10:10 AM DC ELECTRIC INC
0
OM :DRFRB Congtruction FAX NO. :2085294884
piew t eYA . AppHmdon!
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N A1�AE �S'h&� t1.,�Yo I"l�C
PROPERTY .ADDRESS 7Re in
SUBDIVISION
208 552 4622
28 2MG 10:1IPM P1
Ii dw gop 1 db nae s Ag is NA #w non
Permit #06 00620
534 Trejo Suite #100 1
Lot 1 Block 1
P.01
Requimdlll
Electrical Contractor's Name Name z c L e- Zte
Address P Box 3 1 l
CCU Phone (0108) 5 a , - 9 9 33 B usiness Phone (a 9) - L ,;[ 4111 Fax (a 0�) _ 155d IY6 Z '2. h.0 de e lec- � c LL / lmdlL dQ
EUcMkml Eatbmst+e (mat dfwWbg & kbof) $ -1 a 009- 0 0 . (Camm+ac UM FM n* Only)
(New aEen&W obi *GW eras a ntwimal ifd& dw tsddlwaW owngtne and satre edgame at tee rams+ dw*)
L: to 200 amp ScsvicO
201 to 400 amp SetvicO
Over 400 ssnp Service*
Saisd ResidentbI (# of BMcb C.itcvite)
'T'empotgsy Constr cdon Service, 200 ssnp or less, ens loc aiicm (€om a period not to exceed 1 year)
Spa, Hot Tub. Swk=ing Pool
ELActsic Centsxl Systems Heatin sad /or Cooling (wbm tat Ftsc of r ww ses&mdal cmumewn peflm t
red no ad&dmg vrid*
Modular, Msaubctamed of Mobile Home
Othat h allsdo".. Wiring not speaibcslly covered by nary of the above
Cost of Widng & l bor: i
PanVs pomes& water, IMPbDO, 8W)
Requmted hupecdons (of existing wiring)
Tempa,nLq Amasement/Induetty
*In&,dw a waziw= of 3 1--specdom. A"dwd izrpredone ch*od at = "dted to" of W per hOut-
L 395
%pmnme of Li wad Coatnktw Ideetuc number
TIN
AWL& Is tie Am sr
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rhft
& SA* ef-1 rlir
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Please complete the ent *Application! If the qw
applicable /
NAME
PROPERTY ADDRESS
SUBDIVISION
0
0600620
Galbraith Eye Clinic
Required.!! MECHANICAL
Mechanical Contractor's Name: : t �i 41 'o Business Name: �Cr� •� �.
�
Address ��D � Ciry ���f State Vic✓ Zi
Contact Phone: Business Phone: ( ) .SZ3' ZR5r
Email &Gd l ZOO !✓VT Fax S/
Mechanical Estimate $ 760' (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
C 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
other similar vents & ducts:
Heat (Circle all that apply) � Oil Coal Fireplace Electric Hydronic
M _
uiredl q ignature of Licensed Contractor license number Date
The City of Kexburg'spermit fee scbedude is the same as required by the State
Dryer Vents
Range Hood Vents
Cook Stove Vents
C Bath Fan Vents
k,
0
9
SUBCONTRACTOR LIST
Excavation &
Masonry:
Roofing:
Insulation:
��
Drywall: let' f � X Z,./,5
Painting: 1 11 /,/ /,
Floor /
Coverings: �'r pz ���d. d` y n A
p'4 lwl S �� .�►y d f
Heating i` / .n si
Electrical:
Special Construction
(Manufacturer or Supplier)
Roof T
Floor /Ceiling Joists:
Siding /Exterior
ez>-7 z a. , l/
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7
�F gEXB URC
� r CITY OF
RL1u7 T�) � BUILDING SAFETY DEPARTMENT
1117 IIJJ 11 \\
19 E. Main St. Phone: 208- 359 -3020 x326
Rexburg, Idaho 83440 Fax: 208 - 359 -3024
America's Family Community
www.rexburg.ore janellharexburQ.orQ
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES /NO
- APPLICANT INFORMATION:
BUSINESS NAME: 7),474415
OFFICE ADDRESS: A- 4/ , —' 5'L IF �� _;rv 4 Rvopr
City State Zip
OFFICE PHONE NUMBER:
CONTACT PERSON: /0y 40e # CELL PHONE #
- LOCATION OF WORK TO BE DONE:
STREET ADDRESS WHERE WORK WILL BE DONE:
BUSINESS NAME WHERE WORK WILL BE DONE: �tco n
DATES FOR WORK TO BE DONE: ,rye TO -- ��/,. -/ a�
CONTACT PERSON:
PHONE NUMBER: ( ) CELL # ( )
PLEASE CHECK THE TYPE OF PERMITS) 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
APPROVED BY:
31