HomeMy WebLinkAboutALL DOCS - 13-00211 - 21 Winn Dr - Fall River Medical - RemodelCITY OF Certificate of Occupancy
REXBIIRG
tsr --.
Ameri cals Fam ily Co mmunity
City of Rexburg
Department of Community Development
35 N. lst E. / Rexburg, lD.83440
Phone (208) 359-3020 I Fax (208) 359-3022
Building Permit No:
Applicable Addition of Code:
Site Address:
Use and Occupancy:
Design Occupant Load:
Sprinkler System Required:
Name and Address of Owner:
13-00211
tBc 2009
21 WINN DR
Fall River Medical - Remodel
48
No
Rand Robison
503 N 4000 E
Rigby, ld 83422
Contractor:
Special Conditions:
J.B. Kay Construction
Occupancy:Business = 4,740.00 sq. ft.
This Certificate, issued persuant to the requirements of Section 109 of the tnternationat BuitdingCode, certifies that, at the time of issuance, this buitding or that portion of the building that wasinspected on the date listed was found to be in compliance with the requirements of the code for thegroup and division of occupancy and the use for which the proposed occupancy was classified.
Date C.O. lssued: 08 I Za I zOtl
c.o. fssued by: % Buirding Inspector: d, . ,l ,
There shall be no further change in the existing occupancy classification of the building nor shall any structurat changes,modifications or additions be made to the building or any portion thereof until the building Official has reviewed andapproved said future changes.
Mechanical lnspector: =&4., i . /. , u
Plumbing Inspector: -!)n*, f
FireAlarm: nla
Fire Dept./Sprinkler: nla I nla
P&ZPublic Works: nla I nlaElectrical Insoector:
.r-\ f
i/ M* ft ll'4 , /l/'^ ' '"r_ ,, /_J() lWJ l"4qe /ldUorK
CITY OFCity of Rexburg
Phone: 208.372.234t
Fox: 208.359.3022
Office Hours: Monday-Friday 8:00am-4:00pm
comm.r.iul v,rlti Fumilv Pr.-conrtt,r.tiot, ch..klirt
Seismic Design Category - D
(unless soil evaluation confirms category C)
Ground Snow - 50 lbs. per sq. ft.
Roof Snow Load - 35 lbs. per sq. ft.
Vind Load - 90 MPH
Frost Depth - 36,'
r!:!(tyifsinns s!1u!'d b:r:rptt*a bfu.you submit.your buildingperrzit application. TNCIMILETEAPPI-]CAIIOAIJ lT/llf,, NOT BE ACCEPTED.
Completion of a Building Petmit Apptication: Youmay pdnt this application from our websitewww.rexburg.otg or pick up a copy at the city Annex Buildilg (ad&essltove).
Building Sofely Depqrlmenl
www.rexburg.org
commetcial Petrnits: (the following must be submitted with the Application)
E 4 sets of site plans and 3 sets of building plans stamped by a licensed professionaltr
nLJ structutal calculations stamped by a licensed Engineer
f,l Eletgy compliance Regot: As pet the2006IECC, a compliance check must be completed and submitted(the comcheck is available online at www.energrcodes.gov).
[J Page 2 of theApplication must include the Ida=ho Coniactor's Registration Number ot the exemption formmust be completed and signed, see page 10.
P f"*" 5 of the Application must be completed and signed bv your plumber.
? f"*. 6 of the Application must be .ompleted Uy .
? l"*" 7 of the Application must be .o-pl.t"d and s"igneJby your Electdcian.
tr Elecftical panel layout and calculations must be in"t,ro.a with the building plans. plans will betewiewed by the electdcal inspectot prior to issuance of the building permit.tr The Electtical application must inciude engineer stamped drawing"s fot att commercial proiects.tr Emergency services construction p.dt-fot fire related equcontractot performing the work.
E Exterior Lighting Plan including photometric layout. The lighting standards ate included in this packet.B Property Line form needs to ue signed by the builder, see page 4.
Electdcal Petmits are now issued thtough the City of Rexburg. See page 6 of the application.
Remodels' If you are considering a remodel, a coDy of the bid or estimate for the remodel must be submittedwith the Permit Application.
. 3 set of plans (may need IECC Review)
. Additions - Same as new construction
REXBURG
Ame rica s Family Co m mu n ity
REXBURd
c\, *-'**
Am e ricab Family Co mmunity
COMMERCIAL & MULTI FAMILY BUILDING PERMIT APPLICATION35 N 1" E, REXBURG.ID 83440
208-372-2326
PARCE,L NUMBE,R:We will provide this for you)SUBDIVISION:UNIT# BLOCK# LOT#
Ple1se CompUe the Entire Application!
If the question does not apply fill in NA f"r non applicable
A ing is based on the information - must be accurate
CONTACT PHONE #
PROPE,RTY ADDRE,SS, 2\ I .I IN/,1 DfZ.
PHONE #: Home ( )
OV/NER MAILING ADD CITY: E.\6KV STATE: ID ZIP: B34ZZ
APPLICANT (If other than
(Applicantifothertlranownet'astatementauthorizingapplicanttoactasagentfotownet-.,@
APPLICANTINFORMATION: ADDRESS qfO VIST,+ AVA CITY: TLEX^I)IZC1
srArE; I I) zrp frSL++o EMArr p,,x ZSg - {SiiLl
PHONE #: Home ( )Work (celr( ; \tt*- 2s\4
MAILINGADDRESS. CITY&w&@4-STATE LE-2rc,63!!!Q
PHONE: Cett+ \tt_o - Z.3 \ Lf work#P""* 3f?'f34
EMAIL IDAHO REGrsrRATroN # & Exp. olrr.n rzcr - ugt to I / 4
How many buildings are located on this prop"rqrl
Did you recently purchase this proper,y? @v"s (If yes,list previous owner,sname)
Is this, tot rplit?@ yES (Please bring copy of new legal descdption of property)
PROPOSED USE:
(i.e.,SingleFamilyResidence,MultiFamily,Apartments,Remodel,c,@tc.)_CIRCLEoNE
,1"::":rf,*):rt""t:9)1:y-P;:-t"^1t1|9ATl-o\I, AN? AUTIIORIZATION. under penarty orperiury, r hereby certig, that r;", * ilil' #H:il*;"J.',.',il"PlanninsandZoninsCommissionortheCitua^,,-.:l t^.+r^t.;*,^rD^.-L---^^L-n:jffi::#1z;#::.?1ilr:H:;'"*"?f":.ir;.1fl::1',:9.:::::3;.'.sj:*:,:;:ly.4qli 1;""J"'-*ftlt"J'?'il&Hffffi3,1'.'i"Tl*,0"*'[5trffi:ffffi::y,:#r"'::"":rj-1'::t'::T.:t11,*i1,'l':o':i"ra'cf i"."*;;;;il?.:;;;5i;;;#;;7;:#ffi:ffi:':::'l€ff]The building official mav revoke a permit on approval issued under the provisions .r ,r'" zoo:l",Ji|j;|};;#i,ji;;fi:l,..i',#:t"H:H#f,"..:;rilY iL.,intheapplicationorontheplansonwhichthepermitorapprovalwasbased. permitvoidifnotsterte;'rithinlRora,," D-*:+..^:):c---^-t-,.-,-tin the application or on the plans on which the permit or approval was Permit void if not strted within 180 days. pemii void if work stops for 1b0 d"ur.
Si of Owner/Applicant {r27//3
- - u- ."fi\ DATEprefer to be contacted by fax, email y'pt
"".Llircle One
",",y.H,ilf _;"'"yl:3,,.ffi r,rHi:,lfi "1?'L1?;L1.,H:$"1ff T:#\,,,
Do
_ city of Rexburg's Acceptance of the pran review fee does not co.stitrie pran'fifi-"ovalHBuilding Pemia Fees arc due at time of apptication* *Building Pemits are void iiyo6 Jil."t co"" ,o, "1..t*
Building Sofely Depqrfmenl
City of Rexburg
Phone: 208.372.2326
Fox: 208.359.3022
Affidavit of Legal Interest
State of Idaho
Countv of Madison
I,
Addtess
City State
Being ftst duly swom upon oath, depose and say:
(If Applicant is also Owner of Recotd, skip to B)
A. That I am the tecord owner of the property descdbed on the attached, and I grant my
pefrffsslon to:
Name Address
to submit the accompanying application petaining to that property.
B. I agtee to indemni$', defend and hold Rexburg City and its employees harmless from any
claim ot liability tesulting 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
Signature
Subscribed and swotn to before me the dav and vear fust above written.
Notary Public of Idaho
Residing at:
REXBURG
America\ Family Community
CITY OF
www.rexourg.org
My commission expires:
Buildi Sofely Deporlmenl
Phone: 208.372.2326
Fox: 208.359.3022
Properly 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 tesponsibility to corectly identift on the site plan the location of these
lines in reference to the public right-of-way, othet adjoining property lines, the street, other structures and all utility
lines. The Developer should find propetry 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 pedormed.
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 identiSr property line location is with aland srrvey. 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
guatanteed fot accuracy. If you want to request ^ copy of yout lot, see the front counter at the Community
D evelopment D eparffnent.
I have read and understand the above reouirements.
Signature Date
Printed Name
4
Business
35 North I'r Eosf
Rexburg, lD 83440
Applicolion CITY OF
Phone: 208.359.3020
Fox: 208.359.3022
Please take the time to answer all queslions so thal we can further assist you and your facility Thank you.
What type of business will be performed
Will the business have food preparations?
Will there be any cooking of foods?
Will there be any deep fat frying?
Will you have food disposal on site?
will there be any maintenance or mechanical work in the buildins?
Will there be sumps or floor drains in the facilitv?
Will the business require more parking?
Will the business have any chemicals on site ?
Is this business occupying an existing building?
Yes
Yes
X
Y
-No
No
Yes
Yes
NoX
No-X-
Date
YV\E-DI aNL
Yes__-\_ No
Yes Y No
Yes NoX
Yes No X
Yes-Y No
Yes-X_ No
YesX No
Yes No X
Yes-(_ No
\r\.a-a3t,/{/aa lrgts Signature Phone
Willthebusinessbedoinganyst}tfravo,@tothebuilding?YeslNo
Any changes to the electrical?
Any changes to the plumbing?
Is this business planned to be the same with different ownership?
Will there be a change of occupancy?
that The information that I have provided above is to the best ofrrry knowledge accurole and true.
BuildingSofely Deportmenl
City of Rexburgwww.rexDurg.org
ct"r'Y oF
ITE)<BTIRG
|b
Arnericd\ tsdrni ly C.rmmurt ity35N I'rE Phone: 208.372.2326
Fox: 208.359.3022tD 83440
OWNER'S NAME PAND ROBISONpRopERTy ADDRESS et uJ t N N DQ . permit#
SUBDIVISION VAILE ILJIDL CCIOP
PHASE LOT BLOCK
Requircd!!!Plumbing
PlumbingConftactor'sName NFrpXt *tt0t'( b-rsinessName fZ€X, PLOYABINCI
aaaress \r.rV )-\. Ytrccl^JS'dA(L citv fL*xGlrJ(4 state_t D_Zip d3449
CellPhone 1 S 340 -glf O gr-rsinessPhone( )3fb- Ft110
Fax (
(COMMERCIAL/INDUSTRIAL) Total cost of plumbing system (ConttactedAmount) $ S, O tO. !'
(Includet the cost of mateials inaalled regardlesr 0f the par/ suppfing it. The feu listed undrr thh intpution Qpe shall appl1t to an1 and a// p
not Eecifca@ nentioned elsewbere on thisfonz).
E Up to $10,000 (total cost of system x 0.02) + 60 = $
! Between $10,001 - $100,000 ( (total cost of system - 10.000) x 0.01) + $260 = $
! Ovet $100,001 ( (total cost of system - 100.000) x 0.005) + $1,160 = $
RESIDENTIAL
New: Single Family Dwelling, including all buildings with witing being consftucted on each property. (*Based on liuing space,
see definition below)
tr Up to 1,500 sq ft - $130
tr 2,501 to 3,500 sq ft - $260
! Over 4,500 sq ft $325 plus $65 for each additional 1,000 sq
1.000 sq. ft. or oortion thereofl).
New: Multi-Family Dwelling (Conractots Only)
! Duplex Apartment $260
I Three or mote multi-family units: $130 per building plus $65 per unit ($130 x # of buildings) + ($65 x # of units)
D Existing Residence, and Detached Shop: $65 fee plus $10 per fixtue up to the maximum of the coresponding
sq. ft. o[ the buildins ($65 + ($10 x # of fixtures))
! Gray Water Systems: $tr!10
tr Lawn Spdnklers/Backflow Device: 965
u Modulat, Manufactuted ot Mobile Homes: $65 for sewer and water stub connections
n Multipurpose Fite Sptinklet and Domestic Water Supply System: $65 fee or $4 per spdnkler head, whichever
1s greatef
Sewer & Water
! $38 Sewer Line l$38 Water Line n$65 Sewer & Water- if inspected at the same time
tr $65 Sewet tumaround under house (change from septic to ciry)
MISCELI-ANEOUS
D Plan Check $65 per hour
! Technical Seruice: $65 per hour
! Gas Line: $65
n Water Heater Replacement: $65
n Requested Inspection: $65
! Hydronic Heating: $65 + ($10 x # of manifolds/zones)
xl-iving Space - space within a dwelling unit intended fot human habitation which may reasonably be u 'lized fot sleeping, eating, cooking,
Signature of Licensed Contractor
tr 1,501 to 2,500 sq ft - $195
tr 3,501 to 4,500 sq ft - $325
ft. or oortion thereof ($325 + ($65 x # of additional
Ze>I _S
License number & Exp. date Date
bathing, washing, recreation, and sanitation pu{poses. An unfinished basement is considered part of the living space.
4:' fl<; s+si r-z'z
Building Sofety Deporfmenl
City of Rexburg
Phone: 208.372.2341
Fox: 208.359.3022
Permit#
CITY OF
REXBURG
Am ericab Family Comm u ni Q35N I'rE
Rexburg, lD 83440 www.rexourg.org
OWNER'S NAME, R*XO T?.O8T SOAJ
PROPERTY ADDRESS AI '
SUBDIVISION
PFIASE LOT
Requircd!!!Mechanical
Mechanical Contractor's Name Kfn{r Jo*NSoe.t gusiness Name AeX. PUW\ttl 4
Address \\,rtr N. /6,apr./swltL citv ]EI@?G--State /D zip gsu4o
Cell Phone () Business Phone () 3Sl/- g 11O
Fax( )
(COMMERCIAL/INDUSTRIAL) Total cost of plumbing system (ConttactedAmount) $
(nckdzs the cost of mateialt inxalled regardless of the parE suppfiing it. Tlte feer listed under thh inspution Epe tball Eptl to an1 and a// mechanical
in$allations not Qecifca@ nentioned elseuhere on this fonz).
X Up to $10,000 ftotal cost of svstem x 0.02) + 60 = $
tr Between $10,001 - $100,000 ( (total cost of system - 10.000) x 0.01) + 9260 = g
tr Over $100,001
RESIDENTIAL
( (total cost of system - 100.000) x 0.005) + $1,160 = $
New: Single Family Dwelling, including aII buildings with wiring being constructed on each ptopetty. (*Based on liuing space,
see defrnition below)
! Up to 1,500 sq ft - $130
tr 2,507 to 3,500 sq ft - $260
Signature Contractor
! 1,501 to 2,500 sq ft - $195
tr 3,501 to 4,500 sq ft - $325
tr Over 4,500 sq ft $325 plus $65 for each additional 1,000 sq ft. or portion thereof
($325 + ($65 x # of additional 1,000 sq. ft. or portion thereoO).
It{ew: Multi-Family Dwelling (Con tactors Only)
tr Duplex Apatment $260
tr Three or more multi-family units: $130 per building plus $65 per unit ($130 x # of buildings) + ($65 x # of units)
n Existing Residence, Modular, Manufactured ot Mobile Flomes and Detached Shop: $65 fee plus $10 perxxHVAC equipment being installed up to the maximum of the corresponding sq. ft. of the building
($65 + ($10 x # of fixtures)
MISCELI-ANEOUS
! Plan Check $65 perhour
! Technical Service: 965 per hour
tr Gas Line: $65
tr Water Fleater Replacement 965
tr Requested Inspection: 965
D Fircplace/Solid Fuel Buming Appliance: 965 per inspection
*Lioitg Space - space within a dwelling unit intended for human habitation which may reasonably be u 'lized fot sleeping, eating, cooking,
bathing, washing, recreation, and sanitation purposes. An unfinished basement is considered part of the living space.**Examples of HVAC Equipment-fumace replacement, solar, water heater, etc.
lfu c: - rc/6 'f 'A/- lot
Date
,a)
License number & Exp. date
Buiilng Sofety Depqrtmera CITY OF
35 N. 1s E., Rexburg, Id 83440
Phone - potlzSrl-zozo / Hotline - eo})372-2344 / Fax - e0g)35g-3ozz CiW of Rexburg
owNER's NAME R*l"rr: EoBtso,rf
PROPERTYADDRESS 3"r urlrXrtl Dtr. Permit#
SUBDIVISION \/AAf.t hJ r 0it Acr,dF
PHASE LOT BLOCK
BFXPIBg,
Ameri m\ Fami ly Communi ty
Required!!!ELECTRICAL
Electrical Contractot's Name Qtl*< Lgt <Uvrv+t-l gusiness Name
' c :, ELECY&\C
Address q q {g JODD Sr c'tv t?€!,Bafl.h-state lD zip&,LqlO
Cell Phone () 310 ' 33t2\ gusinessphone(
Fax (
(COMMERCIAL/INDUSTRIAL) Total cost of elecuical system (conttacted Amount) $\ql0,j
(Inc/udetlheco$ofmaterialsintta//edregardlessofthepa@supp/1ingit.Thefeetb$edund'erthisinspectionfpesha//app!toan1anda/le
not tpecifca@ nenlioned elswhere on thhforn).
B Up to $10,000 (total cost of system x 0.02) + 60 = $
tr Between $10,001 - $100,000 ( (total cost of system - 10.000) x 0.01) + $260 = $
tr Ovet $100,001 ( (total cost of system - 100.000) x 0.005) + $1,160 = g
Small Wotks (Conftactors ONL\): $10 fee for wotk not exceeding $200 in cost and not involving a change in
service connections. Does NOT require inspection.
RESIDENTIAL
New: Single Family Dwelling, including aII buildings with witing being consttucted on each ptopetty. (*Based on liuing space,
see definition below)
tr Up to 1,500 sq ft - $130
tr 2,501. to 3,500 sq ft - $260
! Over 4,500 sq ft $325 plus $65 fot each additional 1,000 sq ft. or portion thereof ($325 + ($65 x # of additional
1-000 sq. ft. or oortion thereofl).
New: Multi-Family Dwelling (Contactots OnIy)
n Duplex Apartment $260
D Three or more multi-family units: $130 pet building plus $65 per unit ($130 x # of buildings) + ($65 x # of units)
tr Existing Residence, Modular, Manufactuted of Mobile Flomes, and Detached Shop: $65 fee plus 910 per
branch cLcuit, up to the maximum of the corresponding sq. ft. of the building ($65 + ($10 x # branch circuits))
! Centtal Heating/Cooling Systems: $65 When NOT part of new residential or FIVAC permit with no additional
Wiring
tr Spas, FIot Tubs, and Swimming Pools: $65 fee for each trip to inspect
Pumps-Watet, krigation, Sewage (each motot)
tr $65 up to 25HP n$95 - 26 to 2o0HP l$130 over 200 HP
MISCELLANEOUS
! Tempotary Consftuction Services ONLY: 200 amp or less, one location (for a period not to exceed 1 year) - $65
tr Tempotary Arnusemenc $65 fee plus $10 per ride, concession or generator
tr Irdgation Machine: $65 for center pivot plus $10 per tower of drive motor
tr Technical Service: $65 per hour
I Plan Check $65 per hour
n Requested Inspection: $65
*Living Space - space within a dwelling unit intended for human habitation which may reasonably be utilized fot sleeping, eating, cooking,
An unfinished basement is considered part of the living space.bathing,
3sztl 5-28-/3
ture of Licensed Contractor License number &date Date
tr 1,501. to 2,500 sq ft - $195
n 3,501 to 4,500 sq ft - $325
Bu g Sofety Deporlme
1: N. 1" E., Rexburg, Id 83440 City of RexburgPhone - Q08)359-3020 / Hotline - e08)372_2344 / Fax - e}g)3ils_3022
street Address where work will Be Done: 7 | t") t xt N Dr. .
D--^:-^^^ l,T--, rvri
R::11."::U,"T. wlere work yrl l. Do,n9: - notDatesforWorktoBgDone: f 't3- 7/ti To
Contact Person:
TtL ^-^ ^ r.T_, -__ tPhone Number: ( )Cell#( ) \rr.-nS14
B_nxRqq
Amerkab Family Communig
Requircd!!! FIRE SHRINI(LER
Fire Sprinkler Contractor's Name:
Business Name
Address City
Cell Phone (Business Phone (
Fax( )\................-
(COMMERCIAL/INDUSTRIAL) Total cost of fire sprinkler system (Contracted Amount)
$_
(ncludes tlte cost of nateials installed regardlus of the pa@ sapphins it Thefees listed under this inspertion Apesball EplJ to an1 and allfre alann insta/lations not $enftattl,-iruiourd els'ewhere on thisforn).
11 Up to $10,000 (total cost of system x 0.02) + 60 = $I Between $10'001 - $1001000 ( (total cost of s)rstem - 10,d00) x 0.01) + g260 = gn over $100,001 1 (totul .ort of r),rt.r., - 100,00b) x o.obs; i gt,too = g
MISCELLANEOUS
tr Existing Inspection Base: g60
n Re- Inspection: 965 per trip
n New construction $l per sprinkler head ($21000 maximum) number head
ture of Licensed Contractor License number & exp. date Date
Bui Sofety Deportme
35 N. 1.t E., Rexburg, Id 83440
Phone - Q08)359-3020 / Hodine - Q08)372-2344 / Fax- e0B)359-3022
LOCATION OFWORKTO BE DONE:
Street Address Where Work Will Be Done:
Business Name Vhere Work Will Be Done:
Dates for Vork to Be Done:
Contact Person:
To
City of Rexburg REXBURG
Ame ri cal Fomily Co mmunity
Phone Number: ( )Cell#( )
Required!!!FIREAIARM
Fire Alarm Contractor's Name
Business Name
Address City State zip
Cell Phone () Business Phone (
Fax( )
(COMMERCIAL/INDUSTRIAL) Total cost of fire alarm system (Contracted Amount)
$---
(ncludes the cost of mateials installed regardless of the pa@ suppbng it The fees listed under tbis inspection Apeshall Epfi to an1 and allfre alarm installations not specifca$t nentioned elsiwhere on thisfonn).
! Up to $10,000 (total cost of system x 0.02) + 60 = $! Between $10,001 - $100,000 ( (total cost of system - 10,000) x 0.01) + g260 = g
n Over $100,001 ( (total cost of svstem - 100,000) x O.ObS) + g1,160 = g
MISCELLANEOUS
I Plan Review per Hour: $65 per hour
! Re- Inspection: 965 per trip
tute of Licensed Contractor License number &. date Date
lO
SUBCONTRACTOR LIST
Excavation & Eathwork:l(twv ceNsrzu orvlJ
Masonry:
Roofing:
hrdrdor,
DW"[,
PrhtuS'
Floor
Covedngs:
Pl*bhg,
H""tug G
El..*i.d'
Special Construction
(Manufacturer or Supplier)
Roof Trusses:
Floor/CeilingJoists:
Siding/Exterior Trim:
Oft"tt
E,XE,MPTII
ONS FROM STATE, RE,TRATION
As ofJanuary 7'2006, the city of Rexburg can no^longet sell permits without having a copy of your stateregistration numbet or.your exemption from the st"t."..gr.t
"'tion.
please send a copy of your state registration orfill out this form showing yo* "*i-ption and send it u& yo* license renewal or your next permit apprication.
currendy state licensed pursuant to Title 54Idaho code, chapters:3 Architects,
1 0 Electrical Contractots/Joumeyman,
1 2 Engineers,/Surveyors,
19 Public works contractors (exempt from fee only registtation required),26 Plumbing/Plumbers,
45 Public lrorks construction.flanagelent Licensing Act (exempt from fee only registtation required), or50 Installation of heating, ventilation-and air .o.raitioiirg ,yra.-,Employee or volunteer of a licensed contractor or part oi an edocational cwriculum ot nonprofit charitable
Ta-q with no wages or salary
E'mployee of a uS Govemment agency (State, city, county, or other municrpariry)Public Yfrt doing consttuctiorr,trirrt.rrrnce, ordeveloplent to its own businessInvolved with gas, oil or mineral operations
Supplier doing no installation or fabricating
Contracting a ptoject or proiects with a total cost less than $2000operation of a farm ot tanch of construction of agdculture buildings exempt frorn Idaho Building codeAny type of water district operations
$7ork in rural districts for fire prevention purposes
3ffilHiJ'"t:,'AXX'"tTffi,P,'T::[:r conttacts with a resistered contractor to do work as long as
owner ot lessee of cornmetcial property pedorming maintenance, repair, alteration or constfuction on thatPropefry
Real estate licensee/property managet acting within Idaho codeEngagrng in the l"ggmg industry
Renter working on th-e propetty where tr"{ Tr.: wrth the prope*y owners approvalconstruction of a building used for industrial chemicar pr'"..lrirrg per Idaho codeconstruction of a modular building (defined by Idaho ioa.;io be moved out of state
I hereby certiS' that the above information is true and corect to the best of my knowledge.
o
GIS
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Signatue
Pdnt Name
*BuildingpemitFeesaredueattimeofapplication# sBuildingPermitsarevoidifyourcheckdoesnotclearw
35 N lv E
Rexburg, lD 83440
Building SofetY DePorlmenl
City of Rexburg
www.rexburg.org
Phone: 208.372.2326
Fax: 208.359 .3022
Affidavit of Legal Interest
State of Idaho
County of Madison
I,
AddressName
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
perrrusslon to:
AddressName
Dated this day of
Srgnature
Subscdbed and swotn to before me the day and year ftst above written'
Notary Public of Idaho
Residing at:
IY OF
RSXSTIRCr\r'
,,lmerir'rli; J"knlilv ('b8?fl ililltI
to submit the accompanpng application pertaining to that proPerty'
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any
claim or liability r.*lrirrg from any dispute as to the statements contained herein ot as to the
ownership of the pfopefty which is the subject of the application.
20
My commission exPtres:
c I'l Y {'t }'
REXBURG
{b....,.
;lmerir.r;'s lhntfit t.'#rlfl ,lJui{y
35N lnE
Rexburg, lD 83440 www.rexburg.org
Building SofetY DePortmenl
CitY ol Rexburg
Phone: 208.372.2326
Fax: 208.359 .3022
Properly Lines
Frach site plan that is submitted to the ciry of llexburg For the Ruilding permit process requires that property lines
arc: slrorr,'n accurately. It is the l)cr,elcrpet,s responsibilit,v t<l correctly idcntify <>n tlre site plan tlre lrrcati<ln t>f tircscl
lines in reference to the public right-of-rvay. other adioining property lines, the street' other structures and ail utilit,v
lines. The Developer shoulcl tind property prns ti-rat are still a'ailable at the lot in question' If these pins do not
exist or have become unrecogni.zable then a new sufvev should be performed'
Accurate properry line informauon is a mLrst for a umery re'iew. rn additjon to findrng existing properry pins, legai
clescriptions shoulcl be checkcd. Thc best $,ay to icle'ti$, propcrfty linc location is with a land survcy' The citv of
Rexburg has aerial photos and a patcel line layer that can be checked' but they ate only a tool and afe not
guaranteed for accuracv. If you wallt to leqLlest a copy of your lot, see the front countef at the commtrnity
l) evelopment I) ePat tment'
I have read and understand the above requirements'
I)ateSignature
Printed Name
Business APPlicotion
35 North I" Eosl
Rexburg, lD 83440
Phone: 208.359'3020
Fox: 208.359.3022
Pleuse take the time to answer all questions so that we can further assist you anil your facility Thank You'
What type of business will be performed
Will the business have food preparations?
Will there be anY cooking of foods?
Will there be anY deeP fat frYing?
Will you have food disPosal on site?
Willtherebeanymaintenanceormechanicalworkinthebuilding?
Will there be sumps or floor drains in the facility?
Will the business require more parking?
Will the business have any chemicals on site ?
Is this business occupying an existing building?
will the business be doing any structural/or remodeling changes to the building?
Any changes to the electrical?
Any changes to the Plumbing?
Isthisbusinessplannedtobethesamewithdifferentownership?
Will there be a change of occuPancY?
Phone DateApplicants Signature
I Certify that The inJbrmation that I have provided above is to the best of my knowledge accurale and true'
O Yes
$ Yes
$ Yes
S Yes
Q Yes
S Yes
O Yes
$ Yes
S Yes
$ Yes
O Yes
O Yes
Q Yes
$ Yes
ONo
ONo
ONo
ONo
ONo
ONo
ONo
ONo
ONo
ONo
ONo
ONo
ONo
ONo
{:i'l { {.}*,
}{'HX }3LJId{:- .:v
4t[,'.:f ?I;r I-:r],i,lf {.:&*rr" tltt irl'35N lJE
Rexburg, lD 83440
OVAIER'S NAME
PROPERTY ADDRESS Permit#
SUBDIVISION
PFIASE LOT BLOC
Building Sofety Depqrlmenl
Phone: 208.372.2326
Fox: 208.359.3022 www.rexourg.org
City ol Rexburg
Requircd!!!
Plumbing Conttactor's Name
Address
see defraition below)
n Up to 1,500 sq ft - $130
n 2,501to 3,500 sq ft - $260
I Over 4,500 sq ft $325 plus $65 for each additional
Plumbing
Business Name
State.-------ZiP
n 1,501 to 2,500 sq ft - $195
I 3,501 to 4,500 sq ft - $325
1,000 sq ft. or pottion thereof ($3ZS + ($65 x # of addiuonal
City
Cell Phone
Fax
Business Phone
Em
(COMMERCIAL/INDUSTRIAL) Total cost of plumbing system (ContractedAmount) $----.----
(Inc/udutheco$ofmateiakinsta/ledregarl/essofthepat1Japp/Jin8r.in,1ut;'nio,iertbisinrpection!petba//@pftoaranda//plun
nol speifca@ mentioned ekewherv on this fonn).'
"
Up to $10'000 (-total cost of system x 0 02), + 60 = $
n Between $10,001 - $100,000 ( (total cost of system - 10,000) x 0'01) + $260 = !
nOvet$100'001((.totalcostofs)'stem-100'000)x0'005)+$1'160=$
RESIDENTIAL
Ncw: single Fanily Dwelliag, includiag all buildiags with witing bcing cotts*ttcted oa cach ptopetty. (*Bascd on liuing spacc'
1.000 sq. ft. or Portion thereo0)'
New: Multi-Faaily Dwclliag (Coaazctots Only)
n Duplex APartment $260
I Three or more multi-family units: g130 per building plus $65 per unit: ($130 x #-of buildings) + ($65 x # of units)
n Existing Residence, and Detached Siop, $65 fJe plus $10 per fixture up to the maximum of the corresponding
sq. ft. of the building ($65 + ($10 x # of fi-xtures))
I Gray $fater SYstems: $130
n Lawn Spdnklers/Backllow Device: $65
I Modulai, Manufactuted or Mobile Homes: $65 for sewer and water stub connections
n Multipurpose Fire Sprinkler and Domestic Water Supply System: $65 fee or $4 per sprinkler head, whichever
15 gfeater
Scwer & V'atet
n $38 Sewer Line n$38 Water Line l$65 Sewer & Water- if inspected at the same trme
I $65 Sewer turnaround under house (change from septic to clty)
MISCELI-ANEOUS
I Plan Check $65 Perhour
n Technical Sewice: $65 Per hour
n Gas Line: $65
I Water Heatet RePlacement: $65
n Requested InsPection: $65
n Hydronic Heating: $65 + ($10 x # of manifolds/zones)
*Living Space - space within a dwelling unit intended for human habitation which may teasonably b_e utilized for sleeping, eating, cooking,
bathi.r!, *urhirrg,^r..r.ation, and sanitution purposes. An unfinished basement is considered part of the living space'
Signature of Licensed Contractot License number & ExP. date Date
Building SofetY DePortmenf
CitY ol Rexburg
Phone: 208.372.2341
Fox: 208.359.3022
crtY 0t
REXBI.IRG
{'tEr
rtfi snru'J lirrlily {irnrul*tity
35N I'IF
Rexburg, lD 83440 www.rexburg.org
OVAIER'S NAME Permit#PROPERTY ADDRESS
SUBDIVISION
PHASE LOT B
Requircd!!!Mechanical
N{echanical Contractor's Name Business Name
Address City State-Ztp-
Cell Phone
Fax
(COMMERCIAL/INDUSTRIAL) Total cost of plumbing system (contracted Amount) $---
,nclude s the cost of materialt tn$alled regardhtt 0f the patA ,oppb,ag ir. ilrr lru tlrtriuoier this inspution Ape rhail apph to art and all mechanical
installations not $ecifca@ nenlioned ekewhere on thh forw)
r up to $rb,ooo irso sosrcftvil,ls x o o-z) + 60 = $
n Between $10,001 - $100,000 ( (total cost of iystem - 1Q"090) x 0'01) I $299 :-l
I over $100,001 i (total cosi of s]'stem - 100.000) x 0.005) + $1,160 = $
RESIDENTIAL
New: single Faaily Dwclliag, iacluding all buildings with witing beiag coastuctcd on each ptopetty' (*Based oa liuing spacc'
see defrnition bclow)
! Up to 1,500 sq ft - $130 I 1'501 to 2'500 sq ft - $195
n 2,501to 3,500 sq ft - $260 3'501 to 4'500 sq ft - $325
n over 4,500 sq rt't:zs plus g65 for each additional 1,000 sq ft. or portion thereof
($325+($65x#ofaddiuonall.000sq.ft.orportionthereo0).
N ew: Muhi-Faaily Dwelliag (C oadz ctots OnIy)
I DuPlex APartment $260
nThreeo,*o,"*ot.i-familyunits:$130perbui1dingplus$65perunit:
n Existing Residence, Modular, M.r,rrf^"tored oi Mobil" flon., and Detached Shop: $65 fee plus $10 per
**HVAC .qJpr".", t.i.rg inrtuil.d up to the maximum of.the correspondrng sq. ft. of the building
($65 + ($10 x # of fixtures))
MISCELI-ANEOUS
n Plan Check $65 Per hour
I Technical Service: $65 Per hour
n Gas Line: $65
I Watet Heater RePlacement: $65
I Requested InsPection: $65
n Fireplace/Solid Fuel Burning Appliancer $65 per inspection
xliving Space - space withrn a dweiiing unit intended for human habitation which may reasonably 6s utilized for sleeping, eating' cooking'
bathing, washing, fecfeatlon, and sarutation PufPoses. An unfirushed basement is consideted part of the living space
iJn*ufiprc. or iivec Equipment-futnace replacement, solar, water heater, etc'
Signatute of Licensed Contractor License number & ExP. date Date
Building Sofely DePorlmenl
CitY of Rexburg
- 008\359-3022
To
$$sssq
Arhljdi fu $ii} {irryi*,&ft ifi35 N. 1$ E., Rexburg, Id 83440
Phone - (208)359-3020 / Hotline - (208)372-2344 / Fax
Business Name Where Work $fill Be Done:
Dates for Work to Be Done:
Street Address Where WorkWill Be Done:
Contact Person:
Phone Number:Cell #:
Requircd!!!FIRE SPRINI<LER
Fire Sprinkler Contractor's Name:
Business Name
Address City State_zip_
Cell Phone Business Phone
Fax
(COMMERCIAL/INDUSTRIAL) Total cost of fire sprinkler system (contracted Amount)
$_
(ncludes the cost of materials installed regardless of the pa@ sappfiing it. Therter hsted under this inQection Ape'tha//
appl1 to an1 and a//fre alann installations not specficallt mentioned elseuhere on thisforrz).
n Up to $10'000
tr Between $10,001- $100'000
u Over $100'001
MISCELLANEOUS
I Existing InsPection Base:
D Re- Inspection: $65 Per triP
(totat cost of system x 0.02) + 60 = $
( (Iotal cost of sj'stem - 10,000) x 0'01) + $260 = $
( (total cost of system - 100.000) x 0.005) + $1,160 = $
$60
tr New construction $1per sprinkler head ($21000 maximum)number head
nature of Licensed Contractor License number &date Date
guitOing Sofety Deporfmenl
Clty of Rexburg
35 N. 1s E., Rexburg, Id 83440
iil;.^- itb8jlig' #zo / notri"" - Qos)372-2344 / Fax - Q08)3se-3022
Dates for Work to Be Done:To
REXIIURC' -- --" tl&t ^'
AmrlriG'$ I'iiar;t (ilrr$aDit'
S".., Itddress Where $fork Will Be Done: -
B.rrin..s Name Where Work Will Be Done:
Contact Person:
Phone Number:Cell #:
Requircd!!!FIRE 'AL'MM
Fire Alarm Contractor's Name
Business Name
City State._-----ZiPAddress
Cell Phone Business Phone
Fax
(C0MMERCIAL/INDUSTRIAL)Totalcostoffirealarmsystem(ContractedAmount)
$-
(ncrudes the cost oJ-materiars instalred regard.res of the pa@ suppfiing it. The fees listed under this inspectioft aPe
shar app[t to an1 ,ri'rtip* ararm insiallatiou"oot $tri?*ti1-ientioned elsewhere on thisforz)'
D UP to $10'000
tr Between $10,001- $100'000
n Over $100'001
MISCELI-ANEOUS
(.total cost of system x 0'02) + 60 = $
i x 0.01) + $260 =-$
i i.t.,^f *" "r rl","t t - iOo.oobl x 0'005) + $1'160 = $
il Plan Review Per Flour: $65 Per hout
n Re- InsPection: $65 Per triP
nature of Licensed Contractor License number & exP' date Date
,'oo
SUBCONTRACTOR LIST
Excavation & Earthwo
Concrete:
Masonry:
Roofing;
Insulation:
Drywall
Painttng:
Floor
Coverings:
Plumbing:
Heating:
l-lectflcal:
Special Construction
(Manufacturer or SuPPlier)
Roof Truss
Floor/Ceiling Joists:
Siding/Exterior Trim:
EXE,MPTIONS F'ROM STATE, RE,GISTRATION
As of Janua ry 1,2006,the city of Rexburg can no longer sell permrts without having a copy of your State
registration number or your exemption. from the StatJregistration. prease send a copy of your state registration ot
f'l out this form showrng your exempro. urJr.rrd it wrir, your license renewal or your next permit application'
(This list is a summar rza,onof Idaho code Title 54 Chapter 5205, for fu[ definitions of these exemprions please
i.. th. State's website at rvww'iboi'idaho'gov/co't'htm)
!CurrentlyStatelicensedpursuanttoTitle54IdahoCode,Chapters:
I Architects,
1 0 Electrical Contractors/Journeyman'
I 2 Engineers / SurveYors,
1g public works contractors (exempt from fee only regrstration required),
ffihT:''}*rl}33jli;.0"n Management LicensingAct (exempt from ree onlv registration required), or
50tnstallationofheating,ventilationandalrconditioningSystems
n Employee or volunteer Jf u [c.nr.d contractor or part oi r.r .d.r.utional curriculum or nonprofit charitable
activiry with no wages or salary
I Employee of a US Government agency (State, city,.county, or other municipallry)
! Public Utility doing constfucuon, -ui,,t.,,u,,.., or development to its own business
u lnvolved wrih gas, oil or mineral operations
tr Supplier doing no installation or fabricatrng
! Contracflng a Pro,ect or pro,ects wrth a total cost less than $2000
! operaflon of u furot r^n.h o, .o*t*.tion of agriculture buildtngs exempt from Idaho Building code
! Any tpe of water disttict operations
n \Work in rural districts for lte prevention purPoses
tr owner who performs wotk on own ProPefty of contfacts with a registeted contfactor to do work as long as
the propertyl' "ot for resale within 12 months :. 1^^^^-^ -^nnin o'ttot on that
nownerotlesseeofcommercialpropetyperformrngmaintenance'tepair'alterationofconstfucflon
Pfopefty
n Real estate licensee/property manager acting wlthin Idaho Code
! Engaging in the logging industrY
n Renter working on the pfopefty where they li-v9 with the propefty owners.approval
n constructio" Jr " u"lairg .rr.a for industrial chemical ptocessing pet Idaho code
DConstructionofamodularb.,ilding(definedbyldahoCode)tobemovedoutofstate
I hereby certify that the above information is true and cortect to the best of my knowledge'
DateSignature
Print Name
eIBOLRenewal - Online Renewalso Page 1 of 1
State of ldaho
Sureau Of CIccuPaticnal Licensss
ONLINE RENEWALS (ReceiPt)
^.ap f-w /g4-}{ , 2u-
\WtPY
ReceiPt NL-(=/to t7o
The followlng 15 an itemi?ed rec'eipt for the fess Faid Oniirre fnr vour R[slsTtR[] INTITY CQ|'ITRACT$R licensei regijttation tenewal'
Pl*ase mve 0r plint this page f$r fiji:ure
a**^sit,;n****al procesr. licenselRegistrati+n renewal request r*csivod werdn*sday, lvlay 29' ?013 17:03'
Fees
OnlineTransactionNo'(VUHAA9F394C5): RenewatFee:525.00
Past Renewal Fees: 575'00
Reinstat€ment Fee: 525'00
Other Fees/Credits: 50'00
Total Due(Fees): $125'00
Total Charged To Credit Card: 5125'00
When To Expect Your New License/Registration
y'ur license/registration shoulc bp issued anii majled toyou orlc*th* burean has vefifj*d yoirr renewai requrrenlanrs'
ycu .nay oe requjred to submit addit.ioilFl in{ormation by maii tlefore the r*ne'wai oiyot:r iicenseireglstfation (an be {o*rpleied'
nilrllbaf RC[-18448, &rrd tfansactior] numiror VUHAA9F394C5' whsi v{i$ call th!'bllre"ru'
You ars {inishsd vt'iih th€ license/regi$tration retrewaL proc'es;'
https ://secure.ibol. idaho' gov/elBoLRenewal/RenewalReceipt.aspx 512912013
\1abv
B. Kay
CoDnrolc*
E-lat.?l{'lr?{
-tm.J9t'tttl
ttaun ft!.
r.r!.tt lDtt*L
Permission Letter
' May I6,2OL3
Ywe,do hereby glve Jared B. Kay, owner of J.B. Kay
Constructlon,t" p-rf"r* *-t*" the Legacy Neturork Bulldlng. The properties real
address ls 21Winn Dr., Rexburg iOatto. I also allow Jared to act as General Contractor and I give him the
authority to proceed with the tenant improvements of the building according to the plans and to
perform any actions necessary to proceed with the work in regards to building permits and lnspections
with the City of Rexburg, tdaho, and its building officials'
Best Regards,
Print Name:
@*qsv
a.r.. a.$!..ft. . t.rhl.t. tr.l..r20s.7r6.2374
Date:
13 00211
Fall River Medical - Remodel
06/04/13
Routing: Mechanical & Building
Quinton owens (please review by Tuesday, June l r )
Current Status
Please complete the following:
Done NA
I I Review plans
t r Enter Notes for the applicant under checklist in the workflow
tr n Update result in the Workflow
'{ r Return building plan and this check list to Amanda saurey
Notes: Src"il fe.yp1r1 oyt ilalt^/ BAf &_.y--r.".t /o>,<_
b,/ g;a*e. No H'y/y41 p/a.*s. FurnaLc: sa.ne &Jobsite Copy is on conference table ,,J_"t
&*,7d D_
ad/t/ rE"?1'<,
Done NAtr
tr
13 00211
Fall River Medical - Remodel
6103/2013
Routing: Electrical
Bret Stoddard (Please review by Tuesduy, June I l)
Current Status
Please complete the following:
NA
I Review Plans
! Enter Notes for the applicant under Checklist in the Workflow
I Update result in the Workflow
! Return building plans and this checklist to Amanda Saurey
NA
n
REV
T
o"fi
V
*/
Y
oo/e
M
il
IV1
d
Please indicate time spent in hrs/min reviewing the plans : I tk'
Notes: sfn S*d--"r-\*s,
lTsPEcrrof rrcKEro
fnspection Reguesr RecdBy 4 D^r,Req. By Phone No. 7'u d 7?{Project Pennir No. l? \dZ_llAddress
fnspector's Report O Res. ff corr.
Inspecrion ryp, flnAt bH. j
,rr nr*r *rO.
INSPECTED TE
fNSPEgoR.S ACTfON
fiernoveo lDrsAppRovED
DY nN-fr/A
'/€.o.(FINAL)
flNorAppLrcABLEACTION REQUTRED:
D Fttnf
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Rec't Acknowtedged
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t/:
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INSPECTED 'r
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ACTfoN REQUTRED:
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Signed_--
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ro
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fnspeclion Type
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rNspEcrEDW
fNsPt;eTOR's ACTfoN
d*ppnovon|d4y'PPROvED
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ACTION REQUIRED:
f]DISAPPROVED
DNOTAPPLICAELE D RNAI
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Rec't Acknowfedecd
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lblo. JoD Cop,P'* - f,*.Aorf Coel
O rNspncrroNrrcr<nrl
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TNSPECTTON TrcKETo /
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Rec'l Acknowledged
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Phone No.
Pennit No.
/.i...ji: iri:
INSPECTION TICKE
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Inspection Reguest: Rec d Bv U*"*., ,-Dare {e't | *
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l City of Rexburg Receryt#:227
Date:61t7f2013
--- .. . .- -.urrnttclal ut to $10,000
Tdel Amountllue:
TotalPrYnreat:
Co&: REI$URG -lre{.zn -17 -6J013 aoao&s
1r2937
r529s7
ReceivedBY: aoa&s
Prger I of I
o
I City of Rexburg
f'
Sab Totrl:
TotdAnorntDce:
Totrl Prynent:
Code: REXBURG-fucptl93-29-5 2013 madas
Receipt#: 193
Date:5/2912013
_:yltge zor3
RecdvedBy: -ades