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Home My WebLink AboutAPPLICATIONS - 17-00158 - 52 College Ave - Tenant ImprovementCITY OF J�EXBJMG BUILDING PERMIT FORM - America's Family Community BUILDING APPLICATION Commercial Tenant Improvement 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: Chart Z/ s -t_ Address: MNIII//GI/ff-c *yt, City: —�L✓Aoy State:. Zi 83 T-- P Code: q��2-- Phone: �'�� .4/S Email: 2. Applican Name: V Role: (Owner, Tenant, Contractor, etc.) T!w'LLL 4I` Address: ✓ K City:—OtMState: Zip Code: W 51elJ Phone: 74ar- Email: d/CJr.XYV1L/ %inert �Iwl Contact/Rep. Name: i 3. General Contractor Underldaho Building Code, a registered contractor mustdo the workfora Commercial Building. Name: Registration #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: General Contractor Authorized Signature: Date: A copy ofyour state registration license is required to be on Elie. If this is the first lime you have done work in the City of Rexburg, please provide a photo copy ofyour license if you are unsure Ifyour license Is on file, please check with the Permit Technician by calling (208) 372.2341. 4. Project Description Address: $Z CO/k Description of Work: S ',n .1„ lir we.,, >lS � AE41 01?f Project Description: � • Total cost of project- materials and labor: $ • Check all that apply: ❑ Mechanical: Cost $ OS Electrical: Cast $ 1049 V? Plumbing: Cost $4/d00 ❑ Fire Alarm: Cost $ ❑ Fire Sprinkler: Cost $ Note: Any contractors Involved will need to fill out their respective application. • Change of Occupancy? ❑ No KYes:New occupancy: Building Permitfeesfor commercial construction are charged based on square footage and the City's estimated valuation The application fee applies toward Ute fee total For details on how fees are calculated, contact the Building Department There will also be a plan review fee totaling 1096 of the building permitfea APPLICANPS SIGNAIURZ CERTIFiCAT10N ANDAUTHORIZATION: Under penalty ofperjury, I hereby mtt rythat I have read this application and state that the information herein Iscorred and I 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 complywith all City regulationsand State laws relating to the subject manerofthis 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 underthe provisions oftbe 2012 International Code in cases ofany false statement or misrepresentation offact In the applicationor on the plans on which the perm@ or approval wasbascd. Permitwid if not started within 180 days. PermltvoldUwork stops for 180 days. Applicant's Name (print): UUSS vl W&JS&40dA Signature: 0 � Zo 17 gn , Date; � s Inspections mus[ be called In before 8 AM onthe daythe inspection is requested.lnspeclbn requests called in after 8 A will be scheduled for the next bgshresB ON. Inspection Hotfne- (208) 372.2344 www.rexburgnrg Pernft Technician, (208) 372.2341 CITY OF REXBURG BUILDING PERMIT FORM220 C, UUmme rormts Amerimi Family Community BUILDING APPLICATION Commercial Electrical Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: Electrical Fees Paid ❑ 1. Property Owner _ Name: C I &rein 0-t (T,/ifl y gg �� Address: 17 1 (llr7' lk4j- YI- City: i'�" State: XV Zip Code: 89010 Phone: 26f - 9 S) - 'S6// 8 Email: 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work fora Commercial Building. Business: Y11 em k An [(/p ri o /en(„� ( t1 C State License #: IC -17 7yog— Exp.: J a� 3 / - / 7 Address: g(e pAN24,41 City: 5l0.CK�si" State:�ZipCode: F,/ -Y Phone: 4L Email: elvc. 1-0'- Contact/Rep. Name: 1T( %40'/1 a unai &Oyt r' y Phone: &Ii 'Z7,f 625 Email: Electrical Contractor Authorized Signature: �t�t"'f Date: - A copy of your state registration/license is required to be on file. If this Is the first dme 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 (200) 372.2341. 3. Project Description Address: uC. Description of work: AMlCl1Ca/ Aja.✓ &Xe%.# -,4s &d� A.uu2n1d� l it qQ Project Cost: $ 1,60 . • Fees for commercial projects are charged by cost o Ffrst$10,000=295+$60. From$10,000to$100,000=1%+$260.Above$100,000=.595+$1,160. i.e. Workcosting $15,000 will be charged $260 for the first$10,000 and 196 of the remaining $5,000 = $260 +$50 =S310 total fee • There will also be a plan review fee totaling 1096 of the shave fee APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and state that the information herein is rorrect 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 Cityofaexburg shallbe truthful and correct. I agree to comply with all City regulationsand State laws relating to the subject matterofthis application and hereby authorized representatives ofthe City to enter upon the above-mentioned property for inspectionspurposes. NOTE: The building official may revoke a permit on approval issued underthe provisions ofthe 2012 International Code incases crony, false ftatemem or misrepresentation offaft in the application or on the plans on which the permit or approval was based. Permftvold ifnot startedwfthin 180days. Permit void 0work stops for 180 days. f Applicants Name (print): (AS6 /,I.VJC'wal-t Signature: t Date: ,7o_W7 Inspections must be called in before 8 A on the daythe Inspection is requertedAnspection requests called in after 6 A will be scheduled for the nextbusinessday. Inspection Hotline -(208) 372.2344 www rmtburg.org Permit Technician- (208) 372.2341 C I Ty OF RMtMG BUILDING PERMIT FORM230 c, upm.m 10Mrs Amerkds Family Community BUILDING APPLICATION Commercial Plumbing Building Safety Department City of Rexburg 35 North let East Rexburg Idaho 83440 For Office Use Permit Number: Plumbing Fees Paid ❑ 1.Praper/ty� caner � Name: 1�%LrPn�'Z G• Address: I Gdii6 . J. /� —City: LReKbdr5 State: Zip Code: VW49 Phone: 'Z4'-• WI?- Email:-� 2. Plumbing Contractor Under Idaho Buing de, a registered contractor must do the work for a Commercial Building. Business: ISA j i l UM 6rWj' f M . State License #: O I6 3g5 Exp.: 1 `31 — ?D lq Address: /09 q t:h1l S,t. F.O. ba 503 City: 11}5k*11 Stat • TD Zip Code: 8',? d Phone:—24v- 6';7-- 7373 Email: •!l ?Lima6 VAW 16-- Contact/Rep. Name: Tr Zt4�- PI121 ?t P �ne:Email: f i Plumbing Contractor Authorized Signature: �`" r' ��' Date: 3 `3a I A copy ofyour state registrationflicense is required to be on file. If this is the))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 De r' tion Address: �D��GC� I It ' '" � Description of work: pl %Ib %r U*Itr l' 57"A- 17 Project Cost: $ q000. 00 Fees for commercial projects are charged by cost - 0 Ffrst$10,000=296+$60. From $10,000 to $100,000 = 196 + $260. Above $100,000 =.596 +$1,160. i.e. Work costing $15,000 will be charged $260for the first$10,000 and 196 ofthe remaining $5,000 = $260 +$50 = 9310 total fee There will also be a plan review fee talining 1096 of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under pe unity ofperjury,I hereby certdy that 1 haw read this application and Am 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 ofilexburg shall be truthful and correct. I agree to comply with all City regulations and Seem laws relating to the subject matter ofthis 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 ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permdwld ifnot started within 180 days. Permit void Hwork stops for 180 days. Applicant'sName (print):_gnature: a Date: '3U`�// Inspections mum be called in before 8 A on the day the inspection is requested Inspection requests called in after 6 AM will be scheduled for the next business day. Inspection Hotline -(206) 372.2344 www raxburg.org Permit Technician- (208) 372.2341 C I TY OF Building Safety Department u REXBURG City of Rexburg cw 35 North 1st East America's Famhy Community Rexburg, Idaho 83440 PERMIT POLICIES ACKNOWLEDGMENT 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. o Building without the pink building permit signed by the Building Inspector will result in double fees to be T✓ 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 maybe issued. No building may be occupied without receiving a signed Certificate of Occupancy. o If a building is occupied without receiving a signed Certificate of Occupancy, citations maybe issued and the occupants may be evicted. InBfals 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 betaken to allow him to correctly perform the inspection. (Example: If the electrical rough in inspection is not done and the sheetrock has been �na 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. o Even if you hear from an inspector that 'you're good Logo', ultimately ifyou donot have aBuilding Permit or Certificate of Occupancy, the above policies will be enforced. mmol: 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. W o The above policies will be enforced to all, regardless if this information is passed onto them or not m0mis Applicants Name (print): V(r$}nn ✓.�i�alSWorj) Signature: � �,✓G�i�.nHi�t'1 Date: Inspections must he called Inbeore BAM on the daythe Inspection is requested.Inspection requests called in a8er8AM will be scheduled for the next business day. Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revisedl0/2016 E 0.EXbUgU g Safety Department op Buildin Safe De artment o REXBURG City of Rexburg 1�G � 35 North 1st East Amerfed Family Community Rexburg, Idaho 83440 Affidavit of Legal Interest State of Idaho County of Madison Name City Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) Address State A. That 1 am the record owner of the property described on the attached, and I grant my permission to: Jt') -46A Wd<2"' 36922E r32sN 14sh�rj rp F3YZCJ Name Address 1. 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 herein or as to the ownership of the property which is the subject of the application. Datedthis G ? i' day of 611? .20�r Signature Subscribed and sworn to before me the day and year first above written. NOTARY pUBLI� Z/ 'TE of 10�o\ Residing at:. X ura I I My commission expires: 2 ^2Z ^ 2] ImpMkm Hotline-(200)372.2344--Xb-gorg Nmk Technlclan-(208)372.2341 Reeked 10/2016 DE AESBUgC CITY OF ° REXBURG CW Amedra's Family Common ly SUBCONTRACTOR LIST Excavation & Earthwork Concrete: Masonry: Roofing: Insulation: Drywall: Painting. Building Safety Department City of Rexburg 35 North 151 East Rexburg, Idaho 83440 Floor Coverings: Plumbing Heating: Electrical: TttT41 IAal'L V� Zo S -Z76r - 6Z S.G Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists: _ Siding/Exterior Trim: Other: IBspKioeHo[Iiae-(208)372.2344 w .rexburg.org 1'ermB Te6oiclaB-(208)372.2341 Revised 10/2016 CITY OF Ii �P Building Safe Department T� EXBURG, City of Rexburg 1� n. 35 North 1st East Amerirui Family Community Rexburg, Idaho 83440 DISTRIBUTION LIST Please provide the names and emails of anyone who should begetting automated updates for this project. Review Notes Name: 4) US h4- 1A Name: Name: Name: Name: Inspection Tickets Name: Name: Name: Name: Name: Email: I1 wa-d5,iyelal Z I (� ria,% •C,i - Email: Email: Email: Email: Email: Email: Email: Email: Email: Inspection HoWne - (20B) 372.2344 w xexmurgArg Permit Twhnkian-(208)372.2341 Revind10/2015 lJ C I TY OF REXBURG nv — Mn,,wn's Family Cmnrnunity BUSINESS USE SUMMARY Building Safety Department City of Rexburg 35 North lst 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? P(Yes ❑ No Will the business be doing any structural/or remodeling changes to the building? ZYes ❑ No Any changes to the electrical? VYes ❑ No Any changes to the plumbing? X1 Yes ❑ No Any changes to the mechanical system? ❑ Yes ❑ No Is the business type changing? ®'Yes, it will change to RAc}Xvra n o< ❑ No Is this business changing ownership? Is the business registered with the City of Rexburg? O Yes, License #: *If No, please apply for a business license with the Customer Service Dept. 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 sumps or floor drains in the facility? Will the business have any chemicals on site? ❑ Yes p No No JKYes [-]No ,WYes ❑ No ❑Yes )K No ❑ Yes ❑ No ❑ Yes ❑ No 1®'Yes ❑ No T0l&� 2W -62-!5'k- 3-3G..�i� plicants Signature Phone Date I certify that the information that/ have provided above is to the best of my knowledge accurate and true. Inspect ion Hotline—(208)372.2344 w .rexburg.org N.ft Technician—(208)372.2341 Revised Mamb, 2016