The URL can be used to link to this page

Home My WebLink AboutAPPLICATIONS - 16-00595 - BYU-I Smith Building Server ExpansionCITY O F REXBURG Ow America's Family Community Building Safety Department Submit By Email City of Rexburg 35 North 1St East Rexburg, Idaho 83440 COMMERCIAL/MULTI-FAMILY APPLICATION CHECKLIST The following items should be completed before you submit your building permit application. *Reasonable accommodations will be made upon request. Complete the Following: ❑ 3 sets of site plans (see Site Plan Checklist on page 2) ❑ 3 sets of building plans (see box below) - stamped by a licensed professional ❑ Electrical panel layout and calculations included with building plans. ❑ Exterior Lighting Plan including photometric layout. ❑ Digital Plans (PDF Format - can be submitted by USB, CD, or Dropbox) ❑ Structural Calculations (see box below) - stamped by a licensed Engineer ❑ Energy Compliance Report: Asper the 2012 IE CC, a COM Check is required (available online at www.energycodes.gov) ❑ Permit Policies Acknowledgment signed. (see page 3) ❑ Building Permit Application signed by a registered General Contractor. (see page 4) ❑ Exemptions from State Registration (see page 5) ❑ Affidavit of Legal Interest signed. (see page 6) ❑ Property Line form signed by builder. (see page 7) ❑ Mechanical Permit Application signed by a registered Mechanical Contractor. (see page 8) ❑ Electrical Permit Application signed by a registered Electrical Contractor. (see page 9) ❑ Plumbing Permit Application signed by a registered Plumbing Contractor. (see page 10) ❑ Fire Alarm Permit Application (if applicable) signed by a registered professional. (see page 11) ❑ Fire Sprinkler Permit Application (if applicable) signed by a registered professional. (see page 12) ❑ Subcontractor list filled out (see page 13) ❑ Commercial Projects: Completed Business Use Summary. (see page 14) 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. Wind Load - 90 MPH Frost Depth - 36" Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016 CITY OF Building Safety Department v c T �,T �� Submit By Emaii City of Rexburg jam, �1� 35 North 1St East o , Ame"tas F° ly Comm""m' Rexburg, Idaho 83440 SITE PLAN CHECKLIST O 1 Site plan must be drawn to scale, be legible and also be submitted electronically if possible. O 2. Adjoining streets labeled. 0 3. Right-of-way location and width, curb to curb widths and sidewalk location. 0 4. Building location, sq footage and dimensions, with distance to property lines and distances between buildings. 0 5. Show existing and proposed easements. 0 6. Existing utilities (waterlines, sanitary sewer lines, manholes, storm drains). 0 7. Proposed utilities including tie in location to existing services and new easements. 0 8. Proposed storm drain and sanitary sewer elevations (for pipe inverts at manholes and catch basins). 0 9. Storm drainage plan for parking lot and roof areas, with calculations. 0 10. Fire hydrants and fire suppression lines (including tie to City lines). 0 Sprinkled 0 Not Sprinkled 0 11. Indicate Fire apparatus access. 0 12. Parking (including parking lot, drainage arrows, dimension of lot, distance between rows, and total numbers). 0 13. Landscaping (type and total area, including dimensions). 0 14. Trash facilities. 13 15. North Arrow Included 0 16. Proposed street improvements (curb, gutter, sidewalk, pavement, etc.) 0 17. Legal description of proposed building site included. 0 18. Percent of lot covered by building or paving calculated. O 19. Show 10% snow storage area. 0 20. Distance of entrances from street corner indicated. 0 21. Current Vicinity Map. (81/2 x 11") at 1" = 300' scale, showing location of the property. 0 22. Lighting Plan SITE PLANS MUST BE COMPLETE AND SUBMITTED FOR REVIEW BEFORE THE PROJECT WILL BE PLACED ON THE PLANNING & ZONING AGENDA. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016 CITY OF REXBURG OW America's Family Community Building Safety Department Submit By Email City of Rexburg 35 North 1St East Rexburg, Idaho 83440 Permit Policies Acknowledgement 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. a 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 1 ais Official may remove the red tag. If the red tag is removed by anyone but a City Official, citations will be 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 will be issued and the occupants will be evicted. I • ials Calling in 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. /y 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 n als put up, the inspector may require the sheetrock be removed in order to perform the electrical rough in inspection.) Any approval for Certificate of Occupancies and Building Permits is only verified through the Permit Technician. If an inspector says something like "You're good to go", understand that you still need to receive all relevant documentation from the Permit Technician before you are truly good to go. 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. als It is your responsibility to relay this information on to anyone who this would be applicable to for your project. All sub -contractors will be held to this standard with no exceptions. o The above policies will be enforced to all, regardless if you pass this information onto them or not Ini als Applicant's Name (print): vat H- �� Signature: �,C• (/T/� Date: 23 20/(0 r Inspections must be called in before 8 AM on the day the inspection is requested. Insp n requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 3722341 Revised March, 2016 CITY OF REXBURG CW America's Family Community Submit By Email BUILDING APPLICATION Commercial/Multi-family Residence Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Digital Plans Included: ❑ CD ❑ USB ❑ Dropbox ❑ Not Included Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition Deposit Amount: ❑ $1000 New Const. ❑ $250 Addition ❑ $100 Other Deposit Included with Application: ❑ Yes ❑ No 1. Property Owner Name: IBM - Im"o Address: 6170 -QX ' ftS10Yt O&LrAMW City: /��?C.Bdtelr State: jD Zip Code: g3 Y& Phone & Type: 2108 %1& Zl../a 31kffice ❑ Mobile Email: tAAft -MV'r(e) B Yy/ &ZV Under Idaho Building Code, a contractor must do the work for a Commercial Building. 2. Applicant Name: OYU — ID4/!0 Role: JOwner, Tenant, Contractor, etc.) O&W,% GeWA Address: 1/20 7H &YS/CAt T City: BMQIr State: _/ Zip Code. ?3YZ,_Q Phone & Type: 208 Y% ZGb 3 D<OfficeOMobile Email: Wit 'X TSR Yd/.Eat! Contact/Rep. Name: At.te-k Phone: -W8 VI& we3 Email: W BYy/• �y 3. General Contractor Name: .8Yy " IP*H0 Registration #: 10 A _ Exp.: Address: Y?0 Sa' VM f3/YSuK- City: R"404- State: /n Zip Code: X3&1&0 Phone &Type: 218 "&X&633 Wffice ❑Mobile Email: EbtJ Contact/Rep. Name: JJa yy Rea Phone:208 M 2613 Email: )eeZat7bCU ,6Y0. 6;u General Contractor Authorized Signature: Date: 4. Project Description Address:,SA'?"# AtgAw6- • 278 S. /rr E -OR- Lot #: _ Block #: _ Subdivision: Type of work: Check one: ❑ New ConstructionRemodel* ❑Addition* Check all that apply: ❑Framing X Mechanical )qPlumbing Electrical NOTE: Any sub -contractors involved will need to submit their own signed applications. Description of work: E-c'P/FNA THE sot✓'M R44t 4!10% 'Weow/C,t , ozetlwe-ft, P41911"ISIN(� *Total cost of project - materials and labor: $'✓ (used to calculate permit fees) # Of Buildings: / Building is Units t.3 sq. ft Building 2: Units sq. ft Building 3: Units sq. ft. Additional Buildings: Utility, Misc, Private Garage: sq. ft. Storage: sq. ft APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury,) 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 mein hearings before the Planning and Zoning Commission orthe 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 forinspections 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 Permit void if not started within 180 days. Permit void if workstops for 180 days. Applicant's Name (print): � b 4 44 Signatur a, Date: Z 241(0 Inspections must be called in before 8 AM on the day the inspection is requested. Insption requests called in after SAM will be scheduled for the next baseness day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016 F� 7 CITY OF Building Safety Department REXBURG Submit By Emaii City of Rexburg Ow 35 North 1St East "•,,� Americals Family Community Rexburg, Idaho 83440 EXEMPTIONS FROM STATE REGISTRATION As of January 1, 2006, the City of Rexburg can no longer sell permits without having a copy of your State registration number or your exemption from the State registration. Please send a copy of your state registration or fill out this form showing your exemption and send it with your license renewal or your next permit application. (This list is a summarization of Idaho Code Title 54 Chapter 5205, for full definitions of these exemptions please see the State's website at www.iboUdaho.goyIcon thtm) ❑ Currently State licensed pursuant to Title 54 Idaho Code, Chapters: 3- Architects, 10 Electrical Contractors/Journeyman, 12 Engineers/Surveyors, 19 Public Works Contractors (exempt from fee only registration required), 26 Plumbing/Plumbers, 45 Public Works Construction Management Licensing Act (exempt from fee only registration required), or 50 Installation of heating, ventilation and air conditioning systems ❑ Employee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit charitable activity with no wages or salary ❑ Employee of a US Government agency (State, City, County, or other municipality) ❑ Public Utility doing construction, maintenance, or development to its own business ❑ Involved with gas, oil or mineral operations ❑ Supplier doing no installation or fabricating ❑ Contracting a project or projects with a total cost less than $2000 ❑ Operation of a farm or ranch or construction of agriculture buildings exempt from Idaho Building Code ❑ Any type of water district operations ❑ Work in rural districts for fire prevention purposes ❑ Owner who performs work on own property or contracts with a registered contractor to do work as long as the Xproperty is not for resale within 12 months Owner or lessee of commercial property performing maintenance, repair, alteration or construction on that property ❑ Real estate licensee/property manager acting within Idaho Code ❑ Engaging in the logging industry ❑ Renter working on the property where they live with the property owners approval ❑ Construction of a building used for industrial chemical processing per Idaho Code ❑ Construction of a modular building (defined by Idaho Code) to be moved out of state I hereby certify that the above information is true and correct to the best of my knowledge. 23 uo/(e Signa re Dat• ,�b.D Q. Print Name Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 3722341 Revised 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: Tuesday, August 23, 2016 Subscribed and swom to before me the day and year first above written. E N. 0 T,4,,� (P�A US L I C, *. 0yx .... .. ' 4�' * -ICX 7//J OF I'D Notary Public Residing at: Akbe� My commission expires: -A-uA , a-7, i oQB�Up� v c CITY OF REXBURG CW Amencds Fami[ community Building Safety Department Submit By Email City of Rexburg 35 North 1St East Rexburg, Idaho 83440 Property Lines Each site plan that is submitted to the City of Rexburg for the Building Permit process requires that property lines are shown accurately. It is the Developer's responsibility to correctly identify on the site plan the location of these lines in reference to the public right-of-way, other adjoining property lines, the street, other structures and all utility lines. The Developer should find property pins that are still available at the lot in question. If these pins do not exist or have become unrecognizable then a new survey should be performed. Accurate property line information is a must for a timely review. In addition to finding existing property pins, legal descriptions should be checked. The best way to identify property line location is with a land survey. The City of Rexburg has aerial photos and a parcel line layer that can be checked, but they are only a tool and are not guaranteed for accuracy. If you want to request a copy of your lot, see the front counter at the Community Development Department. I have read and understand the above requirements. a. ign�4 e Printed Name 23 ?-o/4,- Da Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016 CITY OF REXBURG CW Amerwa Family Community Submit By Email BUILDING APPLICATION Mechanical Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish Fees Paid: ❑ Yes []No 1. Property Owner Name: BY0 - Ax4tf o Address: qJQ .Spur# I. ysAcft A4J� City: &X80A& State: /o Zip Code: P3Y &O Phone & Type: 7-05 W4 2&63 )(Office ❑ Mobile Email: cv#dAeXJF (5 $Yd/. 6ey Under Idaho Building Code, a homeowner is allowed to do work on their own home. Are you a homeowner doing work on your own home? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page) ❑ No: I am a contractor working for the homeowner o: This property is a Multi -family Residence or Commercial Property. NOTE: Any contractors/sub-contractors involved will need to submit thei own signed applications. 2. Mechanical Contractor Name: LWO - 1,04HO Registration #: D06 /l S Exp.: --b, 3Yzhsr Address: 'i70 -SoO M Al Y.SeCW. AfOl City: J ?- C?l6us & State: AS Zip Code: k3Nrad Phone & Type: 205 Y94P Z-670 'Office ❑ Mobile Email: MERRIC:i :-r<5 8Yu/. Ept/ Contact/Rep. Name: 55- M /I e -w l- Phone:? -0+8 '!5(Q 2670 Email: SYU?• 67OU Mechanical Contractor Authorized Signature: Date: 9-Z V-14 3. Project Description Address: SA /s7/ &11a01jw Z16 $ %sr E -OR- Lot #: _ Block #: _ Subdivision: Check one: ❑ Single-family Residence ❑ Multi -family Residence Xcommercial Check one: ❑ New Construction* Remodel ❑ Addition ❑ Basement Finish Description of work: ?--% G£ ?WE CWI -WrX, /mcpEtr ?ko- ewwwy ~ eaoeLAI( . New Commercial Work: Contracted amount: $ 302 -A672 -14e Calculated Fee (See Below): $ Z, 69 -Z. 9(P ❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,000 = ((total cost of system -10,000) x.01) + $260 Over $100,001 = ((total cost of system -100,000) x.005) + $1,160 New Single -Family Residential Work: Sq. Ft ❑ Up to 1,500 Sq. Ft. = $130 ❑ 1,501-2,500 Sq. Ft = $195 ❑ 2,501-3,500 Sq. Ft = $260 ❑ 3,501-4,500 Sq. Ft = $325 ❑ Over 4,500 Sq. Ft = $325+(65 x # of additional 1,000 Sq. Ft (or portion thereof)) $ New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more units= $((130 x# of buildings)+(65 x # of units))$_ New work on any other residence and Detached Shops: = $(65 + (10 x # of HVAC fixtures)) $ Miscellaneous: ❑ Gas Pressure= $65 ❑ Furnace or A/C = $65 ❑ Water Heater = $65 ❑ Requested Inspection = $65 ❑ Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Service= $65/hour ❑ Plan Check =10% of Contracted Amount 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 mein hearings before the Planning and Zoning Commission or the City Council forthe Cityof 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 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. Permitvoid if not started within 180 days. Permit void if work stops for 180 days. ��J f Applicant's Name (print):�W*1 /e- Signature: trmests _ Date: �'Z `� 16 Inspections must be called in before 8 AM on the day the inspection is requested. Inspecticalled in after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016 o4aexauQ� �7 o t•��hIC ♦��1 CITY OF -RE"- V RG Submit By Email civ Ameriaa's Family Community BUILDING APPLICATION Electrical Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Permit Type: ❑ New ❑ Remodel D Addition ❑ Basement Finish Fees Paid: ❑ Yes ❑ No 1. Property Owner Name: 5YU — lvaH O Address: q7O Pyr vat uHvs WA Y City: AWS UAL& State: ID Zip Code: 88y(a0 Phone & Type: Z'3E Me 2-M43 Office ❑ Mobile Email: �./Ai�'�T� p,BYU/. env Under Idaho Building Code, a hom owner is allowed to do work on their own home. Are you a homeowner doing work on your own home? ❑Yes (Skip to #3 and complete the Homeowner's Exemption page) ❑ No: I am a contractor working for the homeowner)fito: This property is a Multi -family Residence or Commercial Property. NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications. 2. Electrical Contractor Name: 45YU - ��a SIWS 1 A -K c Registration #: RE /- 10510 Exp.: Address: y70 Soup/ &YQ01t A.avr OV City: State: to Zip Code: ?31166 Phone & Type: 2A8 K?(o 2,15'40 bCOffice ❑ Mobile Email: PlueEs �BYy/ ED tJ Contact/Rep. Name: S'mye Phone: 2.48 2% 26ftmail: P"GeSUgYU/. ED U Electrical Contractor Authorized Signature: Date: 3. Project Descripgtion Address: S�+n►tn �/edN�lbr Z78 S. /.tr E. -OR- Lot #: _ Block #: _ Subdivision: Check one: ❑ Single-family Residence, ❑ Multi -family Residence 'Commercial Check one: ❑ New Construction* XRemodel ❑ Addition ❑ Basement Finish Description of work: PieoYiDF Mwe-A 7M RFCcWM& IAEA f V4,C #No Now /icor AlStC- New Commercial Work: Contracted amount: $ 3�4 &96. 37- Calculated Fee (See Below): $ 536.35 ❑ Up to $10,000 = (total cost of system x.02) + $60 $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260 ❑ Over $100,001= ((total cost of system -100,000) x.005) + $1,160 New Single -Family Residential Work: Sq. Ft ❑ Up to 1,500 Sq. Ft = $130 ❑ 1,501-2,500 Sq. Ft = $195 ❑ 2,501-3,500 Sq. Ft = $260 ❑ 3,501-4,500 Sq. Ft = $325 ❑ Over 4,500 Sq. Ft = $325+(65 x # of additional 1,000 Sq. Ft (or portion thereof)) $ New Multi -Family Residential: D Duplex= $260 D Three or more units= $((130 x# of buildings)+(65 x # of units))$ New work on any other residence and Detached Shops: _ (65 + (10 x # of branch circuits)) Miscellaneous: ❑ Small Works (work costing less than $200 with no change in service connections) =$10 (needs no inspection. []Central Heating/Cooling Systems= $65 ❑ Spas, Hot Tubs, and Swimming Pools= $65 ❑ Requested Inspection =$65 []Pumps - Water, Irrigation, Sewage (per motor) = ❑ $65 up to 25HP ❑ $95 26- 200HP ❑ $130 over 200HP ❑ Irrigation Machine = $65 for center pivot+ $10 per tower of drive motor $ ❑ Technical Service = $65/hour ❑ Temporary Amusement = $65 + $10 per ride, concession, or generator $ ❑ Plan Check =10% of Contracted Amount 10 Temporary Construction Services ONLY = $65 f200 amp or less. One location for less than 1 ear. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct 1 agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void ifwork stops for 180 days.. Applicant's Name (print): =tee �>P r /a ) (!e Signature: ��z Date:. Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016 o4a$xav4��' � o •��th�O CITY OF REXBURG CW America's Family Community Submit By Email BUILDING APPLICATION Plumbing Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Permit Type: ❑ New ❑ Remodel []Addition ❑ Basement Finish Fees Paid: ❑ Yes ❑ No 1. Property Owner Name: 6YU - /ogtto Address: 5/70 South i%JJ&gtk RANT WAY City: %ZeVJ(JX& State: �0 Zip Code: tffte0 Phone & Type: 249 Y94 ?4&J Office ❑ Mobile Email: JeedSM. Eou Under Idaho Building Code, a homeowner is allowed to do work on their own home. Are you a homeowner doing work on your own home? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page) ❑ No: I am a contractor working for the homeowner —' _o: This property is a Multi -family Residence or Commercial Property. NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications. 2. Plumbing Contractor Name: SYd- 1p*Hla - Registration #: P'J-J-123ffZ Exp.: Address: V-70 SwM BlItTle tf- f4+.Vr- M/201 City: Re"X8V9 State: Io. Zip Code: -F'?y40 Phone & Type: 208 Y140 7590 Office ❑ Mobile Email: rG46LSHcO AW1. Eay Contact/Rep. Name: CAAI& Phone: Z57CEmail: r0981JV(C P)gYiJ/. eU>U Plumbing Contractor Authorized Signature: Date: :c '� 3. Project Description Water Meter Quantity: Water Meter Size: Address:5Mrir/8✓icAW6-• L98 S /fr. E -OR- Lot #: _ lock #: _Subdivision: Check one: ❑ Single-family Residence ❑ Multi -family Residence ommercial Check one: ❑ New Construction* temodel ❑Addition Basement Finish Description of work: Pxdv'Jw 70 R4;CertR&VA40 H✓9G tWiAWROxr AMr> HaW Nor A-iSce New Commercial Work: Contracted amount: $ y 1549.0 Calculated Fee (See Below): $ 534.35 ❑ Up to $10,000 = (total cost of system x.02) + $60 $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260 ❑ Over $100,001 = ((total cost of system -100,000) x.005) + $1,160 New Single -Family Residential Work: Sq. Ft ❑ Up to 1,500 Sq. Ft = $130 ❑ 1,501-2,500 Sq. Ft = $195 ❑ 2,501-3,500 Sq. Ft = $260 ❑ 3,501-4,500 Sq. Ft = $325 ❑ Over 4,500 Sq. Ft = $325+(65 x # of additional 1,000 Sq. Ft (or portion thereof)) $ New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more units= $((130 x # of buildings)+(65 x # of units))$_ ❑ Gray Water Systems= $130 ❑ Lawn Sprinklers/Backflow device= $65 ❑ Multipurpose Fire Sprinkler & Domestic Water Supply System = $65 or $4 per sprinkler head (whichever is greater) New work on any other residence and Detached Shops: = $65 for sewer and water stub connections ❑ Miscellaneous: ❑ Sewer Line = $65 ❑ Water Line = $65 ❑ Sewer and Water Line = $65 ❑Requested inspection = $65 []Sewer Turnaround (septic to city) = $65 ❑ Hydronic Heating= $65 + ($10 x # of manifolds/zones) ❑ Technical Service= $65/hour ❑ Plan Check =10% of Contracted Amount APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l 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 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 of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on a plans on which re permit or approval was based. Permitvoid if not started within 180 days. Permit void if work stops for 18 days. Applicant's Name (print): C�%� Signature: Date: 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.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016 CITY OF RM VR CW Submit By Email BUILDING APPLICATION Fire Alarm Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: Permit approved: ❑ Yes ❑ No Fees Paid: ❑ Yes ❑ No 1. Applicant Business Name: Ccmr ot. SYs S, %t C. Office Address: 2/44 .SdWW 9M 44-M- City: Ste' Ufa C-137 State: UTAW Zip Code: gylob Office Phone: SQl 'Me 8Contact Person: .BRRfl 6tJiL&'Wray Cell Phone: 'i&4DL cZ-10 6*6 Contractor's Authorized Signature: Aa -4 (a L -- Date: 5 License/Registration # ELS - 5r- - 2irXoExpiration: /I& 2. Location of Work to be Done /D. Street Address: Z98 S. 6r E City: AZeXBdAG State: Zip Code: Business Name: 6Y11 - /PA.400 Contact/Rep. Name: tTEbo A. I%Ay� ex Phone: 2'8 5f'94 ?-&(^3 >gi Office ❑ Cell Phone Email:eXXJ Dates for work to be done: From to 3. New Construction Contracted Amount $ / Z 4 V' , 06 Calculated Fee (See Below): $ ❑ Up to $10,000 = (total cost of system x.02) + $60$10,001-$100,000 = ((total cost of system -10,000) x.01) + $260 ❑ Over $100,001= ((total cost of system -100,000) x.005) + $1,160 4. Miscellaneous ❑ Plan Review =10% of Contracted Amount ❑ Re -Inspection = $65 APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenaky ofperiury, I hereby certify that I 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 forthe 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 buildingofficial mayrevoke a permiton 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 orapproval was based. Permitvoidif not slatted within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): 4V.AQGtJ'ii +�e�,,;p_ Signature: 1.� Date: Inspections must be called in before 8 AM on the day the inspection is requested Inspection requests called in after SAM will be scheduled for the next business day. Inspection Hotline— (208) 372.2344 www.rexburg.org Permit Technician — (208) 372.2341 Revised March, 2016 CITY OF REXBURG C. Mnedra's Fam,7y Comarwdry Submit By Email] BUILDING APPLICATION Fire Sprinkler Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: Permit approved: ❑ Yes []No Fees Paid: ❑ Yes ❑ No 1. Applicant Business Name: /}i:AX-41 Co 7XWZ- 6-11SfFM95. 104G Office Address: 21G(e SoyiW 700 & sT City .nfe,r 4*w-- C Y State:6_16W_Zip Code: 8'`l✓106 Office Phone: 80/ V84 873/ Contact Person: SP -40 Cell Phone: 1,' 74) CJ� Contractor's Authorized Signature: Date: Si Ds -114_ License/Registration # �[.-45' —�- "L�d>b',- Expiration: .3r: 2. Location of Work to be Done Street Address: LwaW Bf a Ayi(b . A76 S. ISr E. City: R0X&,VP-& State: /Q Zip Code: Oft'Y4a Business Name: SYy - fP*Ho Contact/Rep. Name: Drop A. Wir>r4k-d1A Phone: 208 Y94r =-443 ffice❑Cell Phone Email: 94A* CR,rEiJ 8Ye11.eVV Dates for work to be done: From to 3. New Construction Contracted Amount; $ Calculated Fee (See Below): $ ❑ Up to $10,000 = (total cost of system x .02) + $60 ❑ $10,0014100,000 = ((total cost of system -10,000) x.01) + $260 ❑ Over $100,001 = ((total cost of system -100,000) x.005) + $1,160 4. Miscellaneous ❑ New Construction = $1 per sprinkler head ($2,000 max) # of heads: ❑Existing Inspection Base = $65 ❑ Plan Review =10% of Contracted Amount ❑Re -Inspection = $65 APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHOR17ATION: Under penalty ofperjuM I hereby certify that I have mad 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. 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 of the 2012 International Code in cases ofany false statement or misrepresentation offact in the application or on the plans on which the permit orapproval was based. Permitvoidifnot started within 180 days. Permit void ff workstops for 180 days. Applicant's Name (print): L )_ Signature: a��r`z Date: 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.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016 U BBuilding Safety Department CITY OF n �,T m� Submit By Email City of Rexburg jam, �,,,�Jj� 35 North 1St East AmericasFamifyCommurtity Rexburg, Idaho 83440 Excavation & Earthwork: NIA Concrete: y Masonry: K/A Roofing: Insulation: Drywall: Painting: Subcontractor List H/4 14/A' NLA Q j' U -1 v*N o /f AIN7aw.""/C>c std ✓/ce-5 Floor Coverings: 8y1/ -/0'W-0 C40-'Eu7.i S'ex✓/c- Plumbing: 6 Y!! -IA4"0 /y% Heating: /3 Yv- Ic�tra ✓9� Electrical: 8v!/ -/vgrta �GTA`��iL �Scc,tv�c Special Construction %% (Manufacturer or Supplier) Roof Trusses: Y/14 Floor/Ceiling Joists: 'A4/4 Siding/Exterior Trim: N/A Other: F012o0 FIA -e SiJ,PP,beS.51W • 4zoxm Co,/rno L- S�S,,�_tw A/c Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised March, 2016 CITY O F REXBURG CW Americds Family community Building Safety Department Submit By Email City of Rexburg 35 North 1St East Rexburg, Idaho 83440 BUSINESS USE SUMMARY 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? XYes [:]No Will the business be doing any structural/or remodeling changes to the building? E] Yes 'RNo Any changes to the electrical? 'Ryes ❑ No Any changes to the plumbing? t2rVes ❑ No Any changes to the mechanical system?// Yes E] No Is the business type changing? ❑ Yes, it will change to '*`gNo Is this business changing ownership? ❑Yes tvo Is the business registered with the City of Rexb2?e 'withes, License #: ❑// No *If No, please apply for a business licthe Customer Service Dept. Will the business have food preparations? ❑Yes�No Will there be any cooking of foods? E] Yes ''No Will there be any deep fat frying? ❑Yes t�No Will you have food disposal on site? ❑Yes �Wo Will there be sumps or floor drains in the facility? Will the business have any chemicals on site? ❑Yes-1Vo tax ❑Yes'" No 2�8 y9� 2663232-0149 Appl' nts Signature Phone fiate 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 Permit Technician - (208) 372.2341 Revised March, 2016