HomeMy WebLinkAboutAPPLICATION, BP & MULT DOCS - 08-00578 - T-Mobile Cell Tower Replacement04 4EXB URC
�; CITY OF
tr o Please Complete the Entire Application!
REXBURG
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America's Family Community
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COMMERCIAL & MULTI FAMILY BUILDING PEI Cell Tower Replacement
19 E MAIN, REXBURG, ID 83440
208 - 359 -3020 X326
PARCEL NUMBE �X�?%'',�� I (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
is based on _the information - must be accurate
PHONE #
PROPERTY ADDRESS: n ( r
PHONE #: Home ( ) Work
OWNER MAILING ADDRESS:
EMAIL FAX
Cell (
CITY: STATE: ZIP:
APPLICANT (If other than owner) 7
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompan this application.)
APPLICANT INFORMATION: ADDRES 1_T �� ��� A It- 3� CITY: ('
STATE; ZIP _ "D) EMAI (l✓�,� FU1 � FA ' � ✓h g 1 — 6 _ `� �}G
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR
MAILING ADDRESS:
PHONE: Cell#
Work#
CITY STATE ZIP.
EMAIL IDAHO REGISTRATION # & EXP. DA
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes, list previous owner's name)
Is this a lot split? 0 YES (Please bring co �17,, y of new legal description of property
PROPOSED USE: c�� U 1 �.f ✓G i i 1 I ►1 inli n c 1)nnQ IF
(i.e., Single Family Residence, Famil�, Apartments, Remodel, Garage, (:o' n4nercial, Addition, Etc.) [WWL.V (5NE
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under en r re
have read this application and state that the information herein is correct and I swear that any information which may hereafter be ve It h gs } e ee RU
P and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply witlrafl -ettp t� his g
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 2003 International Code in cases of any false statement or misrepresentation of fact
in the application lans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Signature of Owner /Applicant RT-
Do you prefer to be contacted by fax mail r phone? Circle One
WARNING — G PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non - refundable and are paid in full at the time of application beginning hmu&rX L 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
Fax#
0913012008 14:50 City of Rexbtw08) 359 -3022
(F08 356 3022 P.0021002
OWNER AUTHORIZATION AGREEMENT
Market:
Salt Lake
Site Number:
SL01403
Site Name:
Rexburg City
Site Address:
12 North Center
Rexburg ID, 83440
RE: Property described as: approximately 12 North Center Street, Rexburg Idaho 83440 (the
"Property") City of Rexburg, Is the owner of the Property (the "Owner°') and has the authority to enter into
a lease agreement with T- Mobile West Corporation ("Company ") concerning the portion of the Property
that Company seeks to occupy.
Owner hereby grants Company and its agents a revocable right to enter the Property to perform any
reasonable tests that Company deems desirable to determine the feasibility of constructing and operating its
communications facility upon the Property, including but not limited to 1) radio frequency testing,
2) soils testing; 3) on -site feasibility assessment; and 4) filing of zoning applications (the "Access Right").
Owner may revoke the Access Right at any time by delivering written notice to Company by certified mail,
return= receipt= requested, =at the followingaddi esS T�ltilotfile WbstTorpora
2625 S. Plaza Drive Suite 400
Tempe, AZ 85282
Attn: Leasing Administrator
This notice will be effective three (3) days after actual receipt by Company, provided, however, that
Company may still enter the Property to remove any equipment it has placed there.
Owner further agrees to cooperate with Company in obtaining, at Company's expense, all licenses and
permits or authorizations required for Company's use of the Property from all applicable government and/or
regulatory entities (including, without Iimitation, zoning and land use authorities, and the Federal
Communications Commission) including appointing Company as agent for all land use and zoning permit
applications, and Owner agrees to cooperate with and to allow Company, at no cost to Owner, to obtain a
title report; zoning approvals, variances, and land -use permits.
Company agrees to repair any damage to Property caused by Company's use of the Access RighL
Company further agrees to indemnify, defend and hold Owner harmless from and against any and all
damages, losses and expenses arising out of or resulting from any claim, action or other proceeding that is
based upon any negligent act or omission or willful misconduct of Company or its employees or agents,
arising in connection with the Access Right.
EACH PARTY ACKNOWLEDGES THAT THE OTHER HAS MADE NO REPRESENTATIONS OR
COMMITMENTS THAT A LEASE AGREEMENT CONCERNING THE PROPERTY WILL BE
ENTERED INTO IN THE FUTURE.
T- MOBILE WEST CORPORATION
BY:
Name: 0"J 14L fMa �S
Its:
OWNER: CtTYOFRMURG
By: W . ' /y
Name: J014 / Er � - xt it.
Its: Pt �il ►r_ I�ot j2.
•
Building Safety Department
City of Rexburg
19 E. Main janelih @rexburg.org Phone: 208.359.3020 ext 326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
O4 STAB UR
CITY O F
° R
w. n America's Family Community
Affidavit of Legal Interest
City
Notary Public of Idaho
Residing at:
My commission expires:
3I
State of Idaho
County of Madison
I,
Name
Address
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.
•
Building Safety Department o � A EXeU R �
y r CITY OF
City of Rexburg 'x .nEXB mG
0 11.G V 1\
19 E. Main ionellh @rexburg.org Phone: 208.359.3020 ext 326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 America's Family Community ` "'°
Property Lines
Each site plan that is submitted to the City of Rexburg for the Building Permit process requires that property lines
are shown accurately. It is the Developer's responsibility to correctly identify on the site plan the location of these
lines in reference to the public right -of -way, other adjoining property lines, the street, other structures and all utility
lines. The Developer should find property pins that are still available at the lot in question. If these pins do not
exist or have become unrecognizable then a new survey should be performed.
Accurate property line information is a must for a timely review. In addition to finding existing property pins, legal
descriptions should be checked. The best way to identify property line location is with a land survey. The City of
Rexburg has aerial photos and a parcel line layer that can be checked, but they are only a tool and are not
guaranteed for accuracy. If you want to request a copy of your lot, see the front counter at the Community
Development Department.
I have read and understand the above requirements.
Si ature
\AA 1 6-
Printed Name
Date
E
i f
Building Safety Department
City of Rexburg
19 E Main ianellh @rexburg.org
ID 83440 www.rexburg.org
Phone: 208.359.3020 x326
Fax: 208.359.3024
04 g6XB (JR
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U� G
C I T Y OF
RE XBURG
America's Family Community
Remodeling Your Building /Home (need Estimate) $ Gco
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: Water Meter Size:
Requ, red.!!f
PLUMBING
Plumbing Contractor's Name: Business Name:
Address City State Zip
Contact Phone: ( ) Business Phone: (
Email
Cl thes Wash
w ing Machine
aser
Dis h
Floor rain
Garba Disposal
Hot Tub Spa
Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $ (Commercial Only)
Required! Signature of Licensed Contractor
Sprinklers
ub /Showers
ilet /Urinal
Wa er Heater
Wat Softener
License number
Date
E
u
EXBU
Building Safety Department �; °�� R ° o
City of Rexburg » °
19 E Main ionellh @rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
C I T Y O F
REXBURG
Cy___
America's Family Community
OWNER'S NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
PHASE LOT BLOCK
Required.!!f
MECHANICAL
Mechanical Contractor's Name: Business Name:
Address City State Zip
Contact Phone: ( ) Business Phone: ( )
Email Fax
Mechanical Estimate $ (Commercial /Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling
Air Conditioner Combo
He t Pump
Air onditi
Eva orative Cooler
Unit eater
Space Heater
Deco tive gas -fired appliance
Incine for System
Boiler
Pool He ter
Fuel Gas 'pe Outlets including stubbed in or future outlets
Inlet Pressu (Meter Supply) PSI
Cook
Bath
other
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Required! Signature of Licensed Contractor License number
ust or Vent Ducts
Vents
Hood Vents
Stove Vents
Vents
vents & ducts:
Date
0
0 •
Building Safety Department o 4REXBUR C
City of Rexburg
19 E Main janellh @rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
C I T Y OF
REXBURG
America's Family Community
OWNER'S NAME
PROPERTY ADDRESS
SUBDIVISION
PHASE
LOT BLOCK
Permit#
RequlredMf
ELECTRICAL
Electrical Contractor's Name it I I Business Name
Address City State Zip
Cell Phone ( ) Business Phone
Fax ( ) Email
Electrical Estimate (cost of wiring & labor) $ ( COMMERCIAL ONLY)
(Includes the cost of materials installed regardless of the party supplying it).
TYPES OF INSTALLATION
(New Residential includes everything contained within the residential structure and attached garage at the same time)
RESIDENTIAL ONLY
❑ *Up to 1,500 sq ft - $72 ❑ *1,501 to 2,500 sq ft - $120
❑ *2,501 to 3,500 sq ft - $168 ❑ *3,501 to 4,500 sq ft - $216
❑ * *Over 4,500 sq ft - $216 plus $.04 /sq ft: sq ft total
❑ Existing Residential (# of Branch Circuits) - $40 plus $10 per circuit: # of circuits
❑ Multi -Family Only: # of units per building - $120 /bldg + $60 /unit
❑ Services: Alterations /Repairs that require utility disconnection. (Estimate applicable for commercial).
❑ Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year) - $40
❑ Spa, Hot Tub, Swimming Pool - $40 plus $40 grounding grid where applicable
❑ Electric Central Systems Heating and /or Cooling (when not part of a new residential construction permit
and no additional wiring) - $40
❑ Modular, Manufactured or Mobile Home - $50 plus $10 per circuit
❑ Other Installations: Wiring not specifically covered by any of the above:
Cost of Wiring dam' Labor.• S (Includes the cost of materials installed regardless of the party supplying it).
❑ Pumps (Domestic Water, Irrigation, Sewage): horse power
❑ Requested Inspections (of existing wiring) - $40 /hr (1 hr minimum) plus $40 /hr thereafter
❑ Temporary Amusement /Industry - $40 plus $10 per ride, concession or generator
*Includes a maximum of 3 inspections. Additional inspections charged at requested inspection rate of $40 per hour.
** Includes a maximum of 4 inspections. Additional inspections charged at requested inspection rate of $40 per hour.
of Licensed Contractor
License number
Date
7
Building Safety Department U s x , jLf.xBv,e City of Rexbur g 19 E. Main janellh @rexburg.org Phone: 208.359.3020
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
CITY OF
REXBURG
..._...__.._.__ --
Americas Family Community
APPLICATION: "CONSTRUCTION PERMIT"
CONSTRUCTION PERMIT #:
PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES /NO
APPROVED BY:
Business Name:
Office Address: 1'1 J
city I State Zip
Office Phone Number:
Contractor Performing the Work: tr'A 1)
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: o
Contact Person: _Xk
Phone Number: ( )
Cell # ) !'2r ��_
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
pplicant's Signature Date
• .
SUBCONTRACTOR LIST
Excavation & Earthwork:
Masonry:
Floor
Plum
W
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor /Ceiling Jois
Siding /Exterior T
Other:
0 .
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.
(Phis 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.btm
❑ 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
Print Name
Date
10
0 0 M - 5 �-
JaNell Hansen
From:
JaNell Hansen
Sent:
Thursday, April 30, 2009 8:16 AM
To:
'White, Jared'
Subject:
RE: T- Mobile Cell Tower in Rexburg
Thanks for the update. It's not a problem to keep your permit open. I will extend your permit for 90 days and check with you
around the first part of August.
Have a good day,
JaNell Hansen
Building Safety Coordinator
Phone: 208.359.3020 ext 346
Fax: 208.359.3024
-t T'Y C
REXBURG
CW
From: White, Jared [ mailto :Jared.White67 @T - Mobile.com]
Sent: Wednesday, April 29, 2009 3:35 PM
To: JaNell Hansen
Subject: RE: T- Mobile Cell Tower in Rexburg
Janell
It is still on our list to build but probably won't be until 3' quarter and ev*n that is not a guarantee. If it is easier feel free to
cancel and I will reapply once we are closer. Sorry for any inconvenience'
Thank You,
Jared White
T- Mobile
Site Aquisition Coordinator
801 - 232 -0953 Mobile
801 - 816 -4460 Fax
121 election rd Suite330
Draper, UT 84020
6ared.white67@t- mobile.com
From: JaNell Hansen [mailto:janellh @rexburg.org]
Sent: Tuesday, April 28, 2009 1:58 PM
To: White, Jared
Subject: T- Mobile Cell Tower in Rexburg
Hi Jared,
It's been a little while since I've heard anything from you regarding permit 08 00578. Has this cell tower replacement been
canceled or is it still planning to be completed? Please send me know the status of this project so I can update my file.
Thanks,
JaNell Hansen
0 .
JaNell Hansen
From: White, Jared [Jared.White67 @T- Mobile.com]
Sent: Tuesday, November 25, 2008 11:02 AM
To: JaNell Hansen
Subject: RE: City of Rexburg Building Permit
JaNell
We are replacing the existing city tower located behind the city buildings on main and center. We will be removing the
existing pole replacing it with ours and putting the cities existing equipment on the new tower. Jon Millar is the person we
have been working on this with and we do have an executed lease with the city.
0
Thanks
Jared White
From: JaNell Hansen [mailto:janellh @rexburg.org]
Sent: Tuesday, November 25, 2008 10:32 AM
To: White, Jared
Subject: City of Rexburg Building Permit
Hi Jared,
I received your package today regarding the T- Mobile cell tower. Is this a new tower or are you adding to an existing tower?
Is the tower located at 12 N Center and are you working with John Millar on this project? Are you leasing the ground from
the City?
Sincerely,
JaNell Hansen
Building Safety Coordinator
Phone: 208.359.3020 ext 346
Fax: 208.359.3024
60'. C I ° Y F
REXBURG
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•
i
JaNell
I have filled out the app to the best of my ability, as most of the info doesn't apply. In
addition we will have a contractor that does the work he will pull and pay for the permit
but I need to have it approved and an estimated cost of the permit before I can have the
job bid which is why I submit it. Please let me know if you have questions or need
anything else.
Thanks
Jared White
801 - 232 -0953
pEC"E
WOV "
CITY OF RF1`BURG