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Building Safety Department o�REXBITik, C I T Y O F
City of Rexburg ■1` o
REXBURG
35 N lsr F Phone:208.372.2326 , N E o ,. America's Fa.mily_Community
Rexburg, ID 83440 www.rexburg.org Fax:208.359.3022
Office Hours: Monday-Friday 8:OOam-4:OOpm
Commercial/Multi Family Pre-Construction Checklist
Seismic Design Category—D Roof Snow Load—35 lbs. per sq. ft.
(unless soil evaluation confirms category C) Wind Load—90 MPH
Ground Snow—50 lbs. per sq. ft. Frost Depth—36"
The following items should be completed be oreyou submityour buildingpermit application. INCOMPT.F.TE•
APPLICATIONS WILL NOT BE ACCEP'I ED. ' `
Completion of a Building Permit Application: You may prat this application from our website
www.rexburg.org or pick up a copy at the City Annex building(address above).
Commercial Permits: (the following must be submitted with the Application)
❑ 4 sets of site plans and 3 sets of building plans stamped by a licensed professional
❑ Site plans and building plans in PDF:format most be submitted after plans have been approved.
❑ Structural Calculations stamped b ,a licensed Engineer
❑ Energy Compliance Report:As pe e 2006 IECC, a Compliance check must be completed and submitted
(the comcheck is available online/at w .energycodes.gov).
❑ Page 2 of the Application must inc •e the Idaho Contractor's Registration Number or the exemption form
must be completed and signed, see Page 10.
❑ Page 5 of the Application must be completed and signed by your Plumber.
❑ Page 6 of the Application must be completed by signed by your Mechanical Contractor.
❑ Page 7 of the Application must be completed and signed by your Electrician.
❑ Electrical panel layout and calculations must be included with the building plans. Plans will be
reviewed by the electrical inspector prior to issuance of the building permit.
❑ Emergency Services Construction Permit-for fire related equipment only;to be filled out by the
contractor performing the work.
❑ Exterior Lighting Plan including photometric layout. The lighting standards are included in this packet.
❑ Property Line form needs to be signed by the builder, see Page 4.
Electrical Permits are now issued through the City of Rexburg. See Page 6 of the application.
Remodels: If you are considering a remodel,a _:opy of the bid or estimate for the remodel must be submitted
with the Permit Application.
• 3 set of plans (may need IECC Review)
•Additions—Same as new construction
1
, ___a����'7 CITY OF
-' r o Please Come the Entire Application!
��� REXBURG 1\G If the question does not apply fill in NA for non applicable
m /1'
,.' America's Family Community
COMMERCIAL & MULTI FAMILY BUILDING PERMIT APPLICATION
35 N 1St E, REXBURG, ID 83440
208-372-2326
PARCEL NUMBER: (We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on t s_�.rmation-must be accurate)
OWNER NAME: 0:IC 2 CONTACT PHONE #
lti
PROPERTY ADDRESS: rVL �'v — siik 2- to-
PHONE #: Home ( ) Work ( ) Cell ( ) 2((t`SS 4_ j 2111
OWNER MAILING ADDRESS: [ St _ . t CITY: N V�� STATE:' ZIP: U '
EMAIL t%e_.eitry FAX
APPLICANT (If other than owner) MlUgn
(Applicant if other than owner,a statement authorizing applicant to act ahagent forowner ust accompany 's pplication.)
APPLICANT INFORMATION: ADDRESS ( c 2K W. CITY: AtA-C,
STATE; ZIP g3titk, EMAILe;'''::1� kord( FAX gS9-�' i `]
PHONE #: Home ( ) Work...(:. Cell ( ) .24? 3i 3•.2N2
v,
CONTRACTOR:
MAILING ADDRESS: CITY STATE ZIP
PHONE: Cell# Work# Fax#
EMAIL IDAHO REGISTRATION# & EXP. DATE
How many buildings are located on this property?
Did you recently purchase this property Yes (If yes,list previous owner's name)
Is this a lot split?
9
YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i.e.,Single Family Residence,Multi Family,Apartment Remodel Garage,Commercial,Addition,Etc.)—CIRCLE ONE
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 uildin_• a .y evoke a permit ont approval issued under the provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact
"fm he
pphcati. • .- plans on ch the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
,,,, � 7) c? 26
Signature of Owner/Applicant DA'Z'E / l
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 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
Building Safety Department
OF gEXB URC
CITY OF
City of Rexburg 'o n rV RT mG
�' 1\.C.1V�V 1�
35 N Jot E Phone:208.372.2326 �/�0 America's Family Community
Rexburg,ID 83440 www.rexburg.org Fax:208.359.3022 '"
Affidavit of Legal Interest
State of Idaho
County of Madison
I,
Name Address
City Sta
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record,skip toll)
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 peeing 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
•
Building Safety Department p��E X B U R� C I T Y O F
City of Rexburg i�` �'o
`�,,.� REXBURG
35 N l E Phone:208.372.2326 l � cm,
America's Family Community
Rexburg,ID 83440 www.rexburg.org Fax:208.359.3022
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 revie# In addition to finding existing property pins,legal
descriptions should be checked. The best way to identify-properlY 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 requireits.
Signature Date
Printed Name
4
FROM :ACTION MECHANICAL FAX NO. :208 357 3896 Aug. 13 2010 01:44PM P3
08!1212010 19:39 City of Rex (208)359-3022 (FA`s 356 3022 P.002/002
Building Safety Department a LAC II i y.�°T.�___
City of Rexburg . .,,�,° REXBURG
v,,
35 N 10 I' Phone:208.372.2326 ^"., � '�o Amerleak Family Community
Rexburg,ID 83d40 www.rexburg.org Fax 208.359.3022 '4'0
OWNERS NA1vI ,A-1 At%.l / C� n: : /3v I L-j t Ni a" 3
PROPERTY ADDRESS Permit#
SUBDIVISION
PE-LASE LOT BLOCK ._ .
Required!!! MECHANICAL .�
Mechanical Contractor's Name:A.GT 1(Lwi_11,t SX 4• C G.Business Name: ''\. S N t bt .401%1
Address P, 0. g,o- V City Era-Ll t�._�/ _State t _'7.ip 4!3':7. .
Contact Phone; (ZOO 357-3439 Business lone: ( )
Email A(.flO J 4- I OA. 1.1 E^T E+ax 'tl';'WJ�7 33`7 ..... __
(p2,400 /pee C 'ri V.e134-717ern ;,`' 1 h[ S/'s0/t'
Mechanical Estimate$�' (Commercial/Mu' '!j' `1 dig Oniq
I
FIXTURES&APPLLAIVCES COUNT (Single .;!. ' ►welling Only)
Furnace _t Exhaust or Vent Ducts
a,f ,
Furnace/.Air Conditioner Combo k L Dryer Vents
Heat Ptunp `''t ,1 _____,,,,,___.Range Hood Vents
a���n�;. ..5,p1p-
,,,. � g
1 Air Conditioner ., R. Cook Stove Vents
Evaporative Cooler Ij9�4� !� �� Bath Fan Vents
"i1
Unit Heater �,, other similar vents&ducts:
I
Space Heater
Decorative gas-Fired appliance
incinerator System ,
2 Boiler
Pool I-lcatcr
2- Fuel Gas Pipe Outlets including stubbed in or future outlets
■ Inlet Pressure (Meter.Supply) PSI
Heat(Circle all that apply) Gas Oil Coal Fireplace lllectri
.,. , � A
0-o93e5 e -i3 -10 ,,
_....,......
R! lured! Sign e o;Licensed Contractor License number Date
1
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FROM :ACTION MECHANICAL FAX NO. :208 357 3896 iii Aug. 13 2010 01:43PM P2
08/12/1010 1528 City of RexbW(208)359-3022 (PAW 356 3022 P.0011002
i
Kt A i\Jc a ' .. L• . .�}. . .
Building Safety Department 0,0„.u,,,, C, r v O N
Z..., ,$_Cy of Rexburg j
REXBU G
U1
~
35 N 14 k Phone:208.372.2326 �'.•,„,„ Atnerfn6 Family community
Rexburg ID 83440 www.rexburg.org Fax:208.359.3022
1 Remodeling Your Building/Home(need Estimate)$ (a./(\.
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor.Area Unfinished Basement area
Second floor:/loft area Finished basement arest.___ _. ._
Third floor/loft area Garage area
•
Shed or Barn Carport/Dec (30"above gtade)Area •
gym..,.,.. k-1::1':I::Y.1'M�I:��:y:�: �; .,,��!i9f� ..__.�.....,.. --.._.,.., s-° _. �_-.�..,,.�
Water Meter Quantity: -' WatE cter Size:
Q ty 1 .01, u;, ,
1
;r..1i„
Required!!! ,!
eI '�`P
PLUMBING �;,;,.,
Plumbing Contractor's Name:M.'-1-t A 4 .. O t 8 41 usiness Name: r ti i 1 i i 1 . .
. Addtess P•1).- BO k v '_r R� nr�?�n6� r City 5 F�-F t. .- y _..State I OA r 1 ip eoz74-
Contact Phone: (lob Jr8q'^7Jg3.''=i�.. ., Business Phone: (?.4�j 357 309.E
Email A0.'n-1�i^S td.LC,?A. 1 Fax " gi� _...
FIX "U_R WOUNT(itchidingroughed i
1 Clothes Washing Machine Sprinklers
Dishwasher I Tub/Showers
Floor Drain _— 'I'oilct/Urinal
Garbage Disposal Water Heater
Hot Tub/Spa Water So(tcncr
2.. Sinks
(Livatrties,kitchens,bar,mop)
Plumbing Estimate$,_;. rn (Commercial Only)
NMI 1
.0.3
Reg •I Signature qiiip_ed Contractor License number Datc
5
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Building Safety Department �0 aEXBfRge C I T Y O F
City of Rexburg 1 7 'o )(BURG
wa
35 N 1st E Phone:208.372.2326 ''<,,,„E of America's Family Community
Rexburg,ID 83440 www.rexburg.org Fax:208.359.3022
Remodeling Your Building/Home (need Estimate) $ ct( ,1 t`-7 4
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:
Required!!!
PLUMBING
Plumbing Contractor's Name: Business Name: c hG i
Address a City State Zip
Contact Phone: ( ) " Business Phone: ( )
Email '0 Fax 357- 3gc f
FIXTURE COUNT(including roughed fixtures)
Clothes Washing Machine Sprinklers
Dishwasher Tub/Showers
Floor Drain Toilet/Urinal
Garbage Disposal Water Heater
Hot Tub/Spa Water Softener
Sinks
(Lavatories,kitchens,bar,mop)
Plumbing Estimate $ :9 I obi) (Commercial Only)
Required! Signature of Licensed Contractor License number Date
5
•
Building Safety Department 4., B`! __ C I T Y O F
City of Rexburg a, 14 REXBURG
35 N 1st E Phone:208.372.2326 '., America's Family Community
Rexburg,ID 83440 www.rexburg.org Fax:208.359.3022 '"`°
OWNER'S NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
PHASE LOT BLOCK
Required!!! MECHANICAL
Mechanical Contractor's Name: Business Name:
Address City State Zip
Contact Phone: ( ) Business Phone: ( )
Email Fax
Mechanical Estimate $�l.'1 L'i C' (Commercial/Multi F#mily Only
FIXTURES&APPLIANCES COUNT (Single family Dwelling Only)
Furnace *::,: Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner ° ; Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents &ducts:
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 apply) Gas Oil Coal Fireplace Electric Hydronic
Required! Signature of Licensed Contractor License number Date
6
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10 O��sURC� 0 C 1�--
De arimeTA �` s j_���R v
gafetll Cary of Rexburg 1W` --
���d�n9 "..�`) America's Family Cacti
Phone:208.372.2326 ,Ko
Fax:208.359.3022
Est E wwv.rexbur9•or9
35D g3��0
Rexbur J- Pe
rnut#
hI d''' 4 ...-
ER S� ��'' BLOCKS _
O EgIY A LOTS
I SUBDIVIS10 —-- I C11L
r ELECTRICAL PSG ELE ,,I -�
Name r. ,t /c' Business am Std Zlp— ,
Apt RfContractor's Name �� City 9�I . , r 1 /
BUSln 7 / Business Ph VC'Y) < vim' r c'r
Office, ;SS r" ��� �: , u
' G' /.ho e
Al Phone (,;?L ) Email Offic �5 d
Cor Fax (1�',Y) $1, -,�`(C� ERCIAL I'
Col cost of wiring&labor) $ '"
ardless of the pad supplying it).
ire Electrical Estimate
(Includes the cost of materials installed reg age at the same time)
Stref structure and att�d
BUSlI TYPES OF INSTALLATION contained within the resdential
(New Residential includes everything \ ONLY
Dates "RESIDENTIAL *1,501 to)0 sq ft-$120
Conta ° 00 sq ft-$220
❑ *3,501 to
Phone *Up to 1,500 sq ft- -$168 sq ft total
❑ ft-$168 # 2 circuits
***Over to 30 0 sq $216 plus$.04/sq '`. $40 10 t total
circuit: +�/unit
° 500 s is -$ plus bld
**Over 4, C'tui )•., $120/bldg PLEAS ° Residential(# of Branch per building-$ ercial
❑ Existing-F Only:# of units "— licat for commercial).
❑ Multi Family require utility disconnection. (E
stimal'p
❑ AL /Re airs that req (for a pe not to exceed 1 year) -$40
❑ Services: y Construction p or less,one location le
Service,200 amp
❑ CO Temporary Construction $40 plus$40 grounding grid where aptial construction permit
❑ FIR ° Swimming Pool-$ P art of a new
❑ Spa,Hot Tub,Swimnv and/or Cooling(when not p f
❑ Fj� Systems Heating EMI ❑ Electric Central System $40 50 plus$10 per circuit
❑ -IAZ and no additional wiring) or Mobile Home $ P of the abo su l in
❑ j j ❑ Modular,Manufactured covered by any is installed regardless of the part' ppy
Az� Wiring not specifically (includes the cost of rn
horse c
❑ INDU ❑ Other Installations:Labor:$ Sewage):Cost of Waring Irrigation, ge) )$40/hr thereafter
❑ LP-GA, Water, g : ,- (l hr minimum
(Domestic❑ Pumps (D wiring) enerator per hour.
(of existing per ride,
❑ PRIV Inspections $10 concessi lion rate of$40 p
A ❑ Requested p $40 plus$ p charged at requested $40 per hour.
❑ Amusement/Industry- ects$1 pet ection rate of$ P
SPRAY] Temporary Am Additional inspections
charged at xequeste
❑ ❑ p um of 3 inspections. Additional inspections STANDl j �
1. *Includes a maximum of 4 inspections. ,�'- .� '
TErjPO1 **Includes a maxim '— Date
License n
e of Licensed Contractor
Signature ___—
1 1
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1c1n� �� —ate