HomeMy WebLinkAboutAPPLICATION - 17-00283 - 470 Physical Plant Way - BYUI - Hinckley RemodelCITY OF
REXBURG
OW
Ameriwd Family Community
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
COMMERCIAL REMODEL/TENANT IMPROVEMENT APPLICATION CHECKLIST
The following items should be completed before you submit your building permit application.
*Reasonable accommodations will be made upon request.
Submit the Following Documents:
❑ 3 sets of building plans - stamped by a licensed professional.
Include the following as applicable
❑ Foundation Plan, F/oorjoist Layout, Floor Plan, Roof Layout Truss Details, Sectional Views, Front, Back, and Side
Elevations, Mechanical Layout, Stair Details, and any details required to illustrate special construction.
E3 Electrical panel layout and calculations included with building plans.
❑ Exterior Lighting Plan including photometric layout.
9 Structural Calculations (if applicable) - stamped by a licensed Engineer
❑ Digital Plans (PDF Format- can be submitted by USB, CD, or Dropbox)
13 "Copies of any Contractors' State License if not on file already.
Complete the Following Forms
❑ Permit Policies Acknowledgment signed
❑ Building Permit Application signed by a registered General Contractor
❑ Mechanical Permit Application signed by a registered Mechanical Contractor
❑ Electrical Permit Application signed by a licensed Electrical Contractor
❑ Plumbing Permit Application signed by a licensed Plumbing Contractor
❑ Fire Alarm Permit Application (if applicable) signed by a registered professional
❑ Fire Sprinkler Permit Application (if applicable) signed by a registered professional
❑ Subcontractor list filled out
G Affidavit of Legal Interest signed by owner
❑ Notifications Distribution List
❑ Business Use Summary Completed
Subdivisions: If you plan to build in a subdivision please check the Rexburg Development Code for
any requirements such as property setbacks, architecture board approval, etc.
This information is available at h_tt p•//rexburg org/pages/d velopment-code.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016
C I T Y O F
REXBURG
tw
America's Family fbmmunity
PERMIT POLICIES ACKNOWLEDGMENT
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
The City of Rexburg Building Safety Department is determined to provide excellent customer service. In an effort to help you
understand the City of Rexburg Permit Policies, listed below are several policies which you are required to know prior to
proceeding with your project.
Any construction within the City of Rexburg which requires a permit shall not begin until an approved permit is
obtained. If you do not have a Pink Building Permit signed by the Building Inspector, then you do not have an
approved permit.
FDG o Building without the pink building permit signed by the Building Inspector will result in double fees to be
assessed and the project to be red tagged. If your project is red tagged, halting all construction, only a City
Initials Official may remove the red tag. If the red tag is removed by anyone but a City Official, citations may be
issued.
No building may be occupied without receiving a signed Certificate of Occupancy.
FDG o If a building is occupied without receiving a signed Certificate of Occupancy, citations may be issued and the
occupants may be evicted.
Initials
Scheduling inspections is the responsibility of the applicant and their contractor. Inspections need to be called
into the hotline and not to the inspector. Inspections called in later than 8 AM will be scheduled for the following
business day.
o If an inspection is not done, the inspector may require any measures to be taken to allow him to correctly
FDG perform the inspection. (Example: If the electrical rough in inspection is not done and the sheetrock has been
Initials put up, the inspector may require the sheetrock to be removed in order to perform the electrical rough in
inspection.)
Construction on any project can begin ONLY when you have received a Pink Building Permit from the Building
Department. Occupancy of any structure can begin ONLY when you have received an official Certificate of
Occupancy from the Building Department. These documents must be signed by the appropriate authorities from
the City of Rexburg. Any approvals can be verified by calling (208) 372-2341.
FDG o Even if you hear from an inspector that'you're good to go, ultimately if you do not have a Building Permit or
Certificate of Occupancy, the above policies will be enforced.
Initials
It is your responsibility to inform anyone on your project of the above policies. All sub -contractors will be held
to this standard with no exceptions.
FDG o The above policies will be enforced to all, regardless if this information is passed on to them or not.
Initials
Applicant's Name (print): F. David Gay Signature: -- Date: 05/10/2017
Inspections must be called in before 8 AM on the day the Inspection Is requested. Inspection requests called in after 8 AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexb"rg.org Permit Technician -(208)372.2341 Revised 10/2016
CITY OF
REXBURG
CV
Ameriais Family Community
BUILDING PERMIT FORM 201
updatm 10/2a16
BUILDING APPLICATION
Commercial Remodel
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Application Fee: ❑ $100
1. Property Owner
Name: BYU-Idaho
Address: 470 South Physical Plant Way City: Rexburg State: ID Zip Code: 83460
Phone: (208) 496-2510 Email: clarkw byui edu
2. Applicant
Name: BYU-Idaho Role: (Owner, Tenant, Contractor, etc.) Owner/Contractor
Address: 470 South Physical Plant Way City: Rexburg State: ID Zip Code: 83460
Phone: (208) 496-2667 Email: gaayf(@.bvui.edu
Contact/Rep. Name: David Gay
3. General Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building,
Name: BYU-Idaho Registration #: n/a Exp.:
Address: 470 South Physical Plant Way City: Rexburq State: ID Zip Code: 83460
Phone: (208) 469-2667 Email: aavf(a)bvui edu
Contact/Rep. Name: John Reed PhoneQ0 51 Em reedjoDbyui edu
General Contractor Authorized Signature: Date: 05/10/2017
Acopy ofyourstate regis[ration/license is requi dto eonfile, Ifthis istheffrsttimeyouhave done work inthe City ofRexburg,please provide
a photo copy ofyour license. Ifyou are unsure ifyour cense is on file, please check with the Permit Technician by calling (208) 372-2341.
4. Project Description
Address: Gordon B. Hinckley Building - 488 South 2nd East, Rexburg, ID 83460
Description of Work: Hinckley 307. 309 & 310 Remodel
Project Description:
• Total cost of project - materials and labor: $ 51,300.00
• Check all that apply:
® Mechanical: Cost $ 950.00 ® Electrical: Cost $ 7,228.00 ❑ Plumbing: Cost $
® Fire Alarm: Cost $ 200.00 ® Fire Sprinkler: Cost $ 4,240.00
Note: Any contractors involved will need to fill out their respective application.
• Change of Occupancy? ® No ❑ Yes: New occupancy:
Building Permitfeesfor commercial construction are charged based on square footage and the City's estimated valuation. The
application fee applies toward the fee total. For details on howfees are calculated, contact the Building Department. There will also be a
plan review fee totaling 10% of the building permitfee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l have read this application and state that the information herein
Is correct and 1 swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall be truthful and correct. 1 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 official may revoke a permit on approval Issued under the provisions ofthe 2012
International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoldifnot
started within 180 days. Permit void if work stops for 180 days,
Applicant's Name (print): F. David Gay Signature: Date: 05/10/2017
Inspections must be called In before 8 AM on the day the inspection is requested. Inspection requests called in after 8 QM will 8 M will bhe next business day.
Inspection Hotline -(208)372.2344 www.rexburgorg II Permit Technician -(208)372.2341
CITY OF
REXBURG
tly
America Family Community
BUILDING PERMIT FORM 21�
updated 10/2016
BUILDING APPLICATION
Commercial Mechanical
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number: Mechanical Fees Paid ❑
1. Property Owner
Name: BYU-Idaho
Address: 470 South Physical Plant Way city: Rexburg State: ID zip Code: 83460
Phone: (208) 496-2510 Email: clarkw(d)byui edu
2. Mechanical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: BYU-Idaho HVAC Services State License #: Exp.:
Address: 470 South Physical Plant Way city: Rexburg State: ID Zip Code: 83460
Phone: Email:
Contact/Rep. Name: Sam Merrick Phone:(208) 469-2.57 Email: merrlcks Gn-byul.edu
Mechanical Contractor Authorized Signature: "'fie Date: 05/10/2017
A copy ofyour state registration/license is required to be on file. his is the first time you have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: Gordon B. Hinckley Building - 488 South 2nd East, Rexburg, ID 83460
Description of work: Hinckley 307, 309 & 310 Remodel
❑ Project Cost: $ 950.00
• Fees for commercial projects are charged by cost:
0 First $10,000=2%+$60.From $10,000to$100,000=146+$260.Above $100,000=.546+$1,160. i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 146 of the remaining $5,000 = $260 + $50 = $310 taial f
• There will also be a plan review fee totaling 10% of the above fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that l 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 ofthe
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 ofthe 2012
International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): F. David Gay Signature: Date: 05/10/2017
Inspections must be called in before a AM on the day the inspection Is requested. Inspection requests called in after 8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Techniclan - (208) 372.2341
C I TY OF
REXBURG
Ameriwn Family Community
BUILDING PERMIT FORM 220
Upda6 10/2016
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Electrical
For Office Use
Permit Number: Electrical Fees Paid ❑
1. Property Owner
Name: BYU-Idaho
Address: 470 South Physical Plant Way City: Rexburg state: ID Zip Code: 83460
Phone: (208) 496 2510 Email: clarkw @byui.edu
2. Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: BYU-Idaho Electrical Services State License #: Exp.:
Address: 470 South Physical Plant Way city: Rexburg State: ID Zip Code: 83460
Phone: Email:
Contact/Rep. Name: Steve Price Phone: 208 4 9-2540 Email: prices(c)byui.edu
Electrical Contractor Authorized Signature: Date: 05/10/2017
A copy ofyour state registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: Gordon B. Hinckley Building - 488 South 2nd East, Rexburg, ID 83460
Description of work: Hinckley 307 & 309. & 310 Remodel
❑ Project Cost: $ 7,228.00
• Fees for commercial projects are charged by cost:
o First $10,000=2%+$60.From $10,000 to $100,000 = 1% + $260. Above $100,000 = .5% +$1,160. i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = S310 total fe
• There will also be a plan review fee totaling 10% of the above fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have read this application and state that the information herein
Is correct and 1 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 ofthe
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 ofthe 2012
International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoid ifnot
started within 180 days. Permit void If work stops for 180 days.
Applicant's Name (print): F. David Gay Signature: Date: 05/10/2017
Inspections must be called In before 8 AM on the day the Inspection is requested. Inspection requests called in after 8 AM will a scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341
CITY OF
REXBURG
Amerfmi Family Community
BUILDING PERMIT FORM 402
BUILDING APPLICATION
Fire Sprinkler
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number: Fire Sprinkler Fees Paid ❑
1. Property Owner
Name: BYU-Idaho
Address: 470 South Physical Plant Way city: Rexburg State: ID Zip code: 83460
Phone: (208) 496-2510 Email: clarkw(a'.byui.edu
2. Contractor
Easiness: BYU-Idaho University Security & Safety state License #: Exp.:
Address: 102 E Viking Dr; room 150E City; State: Zip Code:
Phone: Email:
Contact/Rep. Name: Thomas Moore P o e:(208)496-3058 Email: mooret@byui.edu
Contractor Authorized Signature: 4 �'� Date: 05/10/2017
A copy ofyourstate registration/license is required to be on file. If thi Y e rst time you have done work in the city of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372.2341.
3. Project Description
Address: Gordon B. Hinckley Building - 488 South 2nd East, Rexburg, ID 83460
Description of work: Adding two sprinkler heads & lowering existing sprinkler heads
Number of Heads:2
❑ Fire Sprinkler System Cost: $4,240.00
• Fees for fire alarm systems are charge by cost:
o First$10,000 =2% + $60. From $10,000 to $100,000 = 1% + $260. Above$100,000=.545+$1,160. i.e. Work costing
$15,000 will be charged $260 for the first $10,000 and 1% of the remaining $5,000 = $260 + $50 = $310 total fee
• There will also be a plan review fee totaling 10% of the above fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l have read this application and state that the information herein
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 ofthe 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 2012
International Code In cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permltvoidifnot
started within 180 days. Permit void if work stops for 180 days,
Applicant's Name (print): F. David Gay Signature: Date: 05/10/2017
Inspections must be called In before 8 AM on the day the inspection Is requested. Inspection requests called In after 8 AM will b scheduled for the next business day,
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341
Of ptiXB �/,pC
qs �a CITY OF
REXBURG
C
Amerimk Family Community
Excavation & Earthwork: N/A
Concrete: N/A
Masonry: N/A
Roofing:
Insulation: N/A
Drywall: BYU-Idaho Carpentry Services
SUBCONTRACTOR LIST
Painting: BYU-Idaho Auxiliary Maintenance Services
Floor Coverings: BYU-Idaho Auxiliary Maintenance Services
Plumbing: N/A
Heating: BYU-Idaho HVAC Services
Electrical: BYU-Idaho Electrical Services
Roof Trusses: N/A
Floor/Ceiling Joists: N/A
Siding/Exterior Trim: N/A
Other: BYU-Idaho University
Special Construction
(Manufacturer or Supplier)
& Safety; Thomas Moore
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
Inspection Hotline -(208)372.2344 w W.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016
` OF 0.E%BURC�i
CITY OF
REMURG
en
Amerirds Amity Community
DISTRIBUTION LIST
Building Safety Department
City of Rexburg
3S North 1st East
Rexburg, Idaho 83440
Please provide the names and emails of anyone who should begetting automated updates for this project.
Review Notes
Name: F. David Gay
Email:
9ayf@byui.edu
Name: e -Builder
Email:
HIN_307_309 Remodel.A - Inbox@docs.e-builder.net
Name:
Email:
Name:
Email:
Name:
Email:
Inspection Tickets
Name: John Reed
Email:
reedjo@byui.edu
Name: e -Builder
Email:
HIN_307 309 Remodel.A --Inbox@docs.e-builder.net
Name:
Email:
Name:
Email:
Name:
Email:
Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised 10/2016
C IT Y OF
REXBURG
tw
Aniericai Family C3ammunity
BUSINESS USE SUMMARY
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
The following questions will help speed the review process along. Please take the time to answer all of them.
Is this business occupying an existing building? ® Yes ❑ No
Will the business be doing any structural/or
remodeling changes to the building?
p Yes
❑ No
Any changes to the electrical?
m No
m Yes
❑ No
Any changes to the plumbing? []Yes ® No
Any changes to the mechanical system? ® Yes ❑ No
Is the business type changing? ❑ Yes, it will change to ONO
Is this business changing ownership? ❑ Yes p No
Is the business registered with the City of Rexburg? m Yes, License #: ❑ No
*If No, please apply for a business license with the Customer Service Dept.
Will the business have food preparations?
❑ Yes
m No
Will there be any cooking of foods?
p Yes
ONO
Will there be any deep fat frying?
❑ Yes
m No
Will you have food disposal on site?
❑ Yes
O No
Will there be sumps or floor drains in the facility?
❑ Yes
ONO
Will the business have any chemicals on site?
❑ Yes
p No
E (208) 496-2667 05/10/2017
Applicants Signature Phone Date
I certify that the information that I have provided above is to the best of my knowledge accurate and true,
Inspection Hotline -(208)372.2344 www.rexburg.org Per mit Technician -(208)372.2341 Reviscd March, 2016
AFFIDAVIT OF LEGAL INTEREST
State of Idaho )
) ss.
County of Madison )
The undersigned, being first duly sworn, deposes and says:
A. that he is the authorized representative of Brigham Young University — Idaho (the
"University") for the purpose of submitting the attached application (the "Application")
including the making of this Affidavit;
B. that the University is the record owner of the property described in the Application; and,
C. that the University agrees 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 in this Affidavit or as to the ownership of the Property which is the subject of
the Application.
Dated: Friday, May 10, 2017
Subscribed and sworn to before me the day and year first above written.
Notary Pub
Residing at. QJr
My commission expires: