HomeMy WebLinkAboutAPPLICATIONS - 16-00572 - Grace Baptist - AdditionCITY OF
Building Safety Department
REXBURG City of Rexburg
c%V 35 North 1St East
Americas Family Community 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 IECC, a COMCheck is required (available online
atwww.ener codes.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"
Permit Technician -(208)372.2341 Revised March, 2016
F;o ggtceVq�rd CITY OF Building Safety Department
REXBURG City of Rexburg
tw 35 North 1st East
America's Family Community Rexburg, Idaho 83440
SITE PLAN CHECKLIST
❑ 1 Site plan must be drawn to scale, be legible and also be submitted electronically if possible.
❑ 2. Adjoining streets labeled.
❑ 3. Right-of-way location and width, curb to curb widths and sidewalk location.
❑ 4. Building location, sq footage and dimensions, with distance to property lines and distances
between buildings.
❑ S. Show existing and proposed easements.
❑ 6. Existing utilities (waterlines, sanitary sewer lines, manholes, storm drains).
❑ 7. Proposed utilities including tie in location to existing services and new easements.
❑ B. Proposed storm drain and sanitary sewer elevations (for pipe inverts at manholes and catch basins).
❑ 9. Storm drainage plan for parking lot and roof areas, with calculations.
❑ 10. Fire hydrants and fire suppression lines (including tie to City lines).
❑ Sprinkled ❑ Not Sprinkled
❑ 11. Indicate Fire apparatus access
❑ 12. Parking (including parking lot, drainage arrows, dimension of lot, distance between rows, and total
numbers).
❑ 13. Landscaping (type and total area, including dimensions).
❑ 14. Trash facilities.
❑ 15. North Arrow
❑ 16. Drawing to Scale, including a graphic scale (11 1h x 17" paper if possible).
❑ 17. Proposed street improvements (curb, gutter, sidewalk, pavement, etc.)
❑ 18. Legal description of proposed building site included.
❑ 19. Percent of lot covered by building or paving calculated.
❑ 20. Show 10% snow storage area.
❑ 21. Distance of entrances from street corner indicated.
❑ 22. Current Vicinity Map. (81/2 x 11") at 1" = 300' scale, showing location of the property.
❑ 23. Lighting Plan
SITE PLANS MUST BE COMPLETE AND SUBMITTED FOR REVIEW BEFORE THE PROJECT WILL BE PLACED ON
THE PLANNING & ZONING AGENDA.
Inspecdon Hotline -(208)372.2344 www.r Imrg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
Ob
America's Family Community
Permit Policies Acknowledgement
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.
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
Initlals 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.
Initials
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.
o If an inspection is not done, the inspector may require any measures to be taken to allow him to correctly
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 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.
Initials
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 on to them or not.
Initials
Applicant's Name
Signature:
Date:
Inspections must be caged in before 8 AM on the day the inspection is requested. Inspection requests called in after a AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 w vrexburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
OW
Amerimd Family Community
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. O $250 Addition O $100 Other Deposit Included with Application: ❑ Yes
❑ No
1. Pro per }yOwner 6/� f tt
9fA,ce
Name: {�tt�l+i5'i'" 'or-ii�
i��
Address: 7_Gz N 71W) V✓ CityJr,State: T -A Zip Code:
'p6A jwIr fQ0yq ) ✓st U o [Jofd
Phone &Type: bOffice[] Mobile Email: r
�
Under Idaho Building Code, a contractor must do the work for a Commercial Building.
2. Applicant
Name: 175r 1 COAC'(-t 0/) Role: (Owt}� r, T pant, Contractor, WM'T
etc.)
Address: SK( 4nQa acx -(_1 16 City: State: Zip Code:
Phone & Type: I ❑ Office ❑ Mobile Email:
Contact/Rep. Name: Phone: SA 1� Vmail: T5M A.L
�r
3. General Contractor a, _
Name: 5$WI [O/l�Sir�GY+l1t Registration#:__
Exp.:
23-3y 44,
Address: _ a Svlk 16 City: b'lr State: :EJ_ Zip Code:
Phone & Type: -ft -5-69 --z l i -IrI� !'(Mobile Email:
_Office
Contact/Rep. Name: _ XbA 'sVWMA Phone: Email:
mineral Contractor Authorized Signature; Date:
4. Project Descriptio
"A/
Address: 76 WO7 O -OR- Lot #: _ Block #: _ Subdivision:
Type of work:
Check one: ❑ New Construction ❑ Remodel* Addition*
Check all that apply: i Framing V Mechanical 0 Plumbing FrElectrical
NOTE: Any sub -contractors involyy��d 44n,eggdtosubmittheir am signed applications.
Description ofwork:�-{ IM'ftdh. 64- ji7'7 S l%T
*Total cost of project - materials and labor: $(used to calculate permit fees) # Of Buildings:
Building 1: Units sq. fL Building 2: _Units 11Z_7 sq. ft. Building 3: Units _
sq. ft
Additional Buildings:
Utility, Misc, Private Garage: sq. ft. Storage: _
sq, ft.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenalty ofperiary, I hereby certifythat l have read this application and state that the information herein
is correct and 1 swear that any Information which may hereafter be given bymein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall bs 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 ofany false statement or misrepresentation offact in the application or on the plans on which the permit or approval was based. Perankvoidifnot
started within 180 days. Permit void ifwork stops for 180 days.
4 Applicants Name (print): &,'I 66'r Signature: Date: gl4zt I �O
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after AM will be scheduled for the next business day.
Inspecdon Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
Americ6 Family Community
EXEMPTIONS FROM STATE REGISTRATION
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
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.ibol.idaho.gov/cont.htm)
❑ Currently State licensed pursuant to Title 54 Idaho Code, Chapters:
3 Architects,
34. 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
property 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.
Signature
Date
Print Name
Inspection Hotline -(208)372.2344 vrevr.rexhurg.org Permit Technician -(208)372.2341 Revised March, 2016
o4 gBXBURc
CITY OF
REXBURG
,I
Americus Family Community
State of Idaho
County of Madison
I,
Name
Affidavit of Legal Interest
Address
City State
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, sldp to B)
r�
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
A. That I am the record owner of the property described on the attached, and I grant my permission to:
Name
Address
to submit the accompanying application 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.
Dated this
day of
Signature
20
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing at:
My commission expires:
Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
nb
America's Family Community
Property Lines
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
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 Cityof
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.
Signa 4re
Printed Name
Date
Inspecdun Hotline -(208)372.2344 w .rsxburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
CW
America's family Community
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 151 East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: 0 New O: Remodel 0 Addition 0 Basement Finish
Fees Paid: 0 Yes ❑ No
1. Property Owner
Name:
Address: City: State: Zip Code: _
Phone & Type: 0 Office[] Mobile Email: _
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? 0 Yes (Skip to #3 and complete the Homeowner's Exemption page)
0 No: I am a contractor working for the homeowner 0 No: 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. Mechanical Contractor
Name: Registration #: Exp.:
Address: _ City: State: Zip Code:
Phone & Type: 0 Office D Mobile Email:
Contact/Rep. Name: Phone: Email:
Lechanical CclnrtrafcmrAuthorized Signature Date:
3. Project Description
Address: -OR- Lot #: _ Block #: _ Subdivision: _
Check one: 0 Single-family Residence 0 Multi -family Residence []Commercial
Check one: 0 New Construction* 0 Remodel 0 Addition 0 Basement Finish
Description of work: _
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
0 Up to $10,000 = (total cost of system x.02) + $60 0 $10,0014100,000 = ((total cost of system -10,000) x.01) + $260
0 Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. Ft
0 Up to 1,500 Sq. Ft. = $130 0 1,501-2,500 Sq. Ft = $195 0 2,501-3,500 Sq. Ft. = $260 0 3,501-4,500 Sq. Ft. = $325
0 Over 4,500 Sq. Ft = $325+(65 x # of additional 1,000 Sq. Ft. (or portion thereof)) $
New Multi -Family Residential: 0 Duplex= $260 0 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: 0 Gas Pressure = $65 0 Furnace or A/C = $65 0 Water Heater= $65 0 Requested Inspection= $65
0 Gas Line = $65 0 Fireplace/Solid Fuel Burning Unit= $65 0 Technical Service= $65/hour
0 Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I herebycertify 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 ofany false statement or misrepresentation affect in the application or on the plans on which the permit or approval was based. Permitvoidifnot
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print):
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 wwmnexburg.org Permit Technician -(208)372.2341 Revised March, 2016
oQpxxeoRo,
Fq ♦9 CITY OF
REXBURG
Americds Family Community
BUILDING APPLICATION
Electrical
Building Safety Department
City of Rexburg
35 North lot East
Rexburg, Idaho 83440
For Office: Use
Permit Number: Permit Type: 0 New 0 Remodel 0 Addition 0 Basement Finish
Fees Paid: 0 Yes 0 No
1. Property Owner
Name:
Address: City: State: Zip Code:
Phone &Type: 0 Office 0 Mobile Email: _
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? 0 Yes (Skip to #3 and complete the Homeowner's Exemption page)
0 No: I am a contractor working for the homeowner 0 No: 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: Registration #: _ Exp.:
Address: City: State: Zip Code: _
Phone & Type: C Office 0 Mobile Email:-
Contact/Rep.
mail:_Contact/Rep. Name: Phone: _ Email:
Blectrfcal Contractor
Authorized SignatureDate:
3. Project Description
Address: -OR- Lot #: _ Block #: _ Subdivision: _
Check one: 0 Single-family Residence 0 Multi -family Residence 0 Commercial
Check one: 0 New Construction* 0 Remodel 0 Addition 0 Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
11 Up to $10,000 = (total cost of system x.02) + $60 0 $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260
0 Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. Ft
0 Up to 1,500 Sq. Ft. = $130 0 1,501-2,500 Sq. Ft = $195 0 2,501-3,500 Sq. Ft. = $260 0 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: 0 Duplex= $260 0 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: 0 Small Works (work costing less than $200 with no change inservice .connections)=.$10(needs no inspection.
0 Central Heating/Cooling Systems= $65 0 Spas, Hot Tubs, and Swimming Pools= $65 0 Requested Inspection= $65
0 Pumps -Water, Irrigation, Sewage (per motor) = ❑ $65 up to 25HP 0 $95 26- 200HP 0 $130 over 2OOHP
0 Irrigation Machine = $65 for center pivot+ $10 per tower of drive motor $ El Technical Service = $65/hour
0 Temporary Amusement = $65 + $10 per ride, concession, or generator $ 0 Plan Check =10% of Contracted Amoun
0 TemporarV Construction Services ONLY = $65 200 amp or less. One location for less than 1 year.1
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjuM I hereby certify that l have read this application and scam 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 ofthis application and hereby authorized representatives of the
City m 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 Cade in rases ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoid ifnot
starred within 180 days. Permitvoid ifworkstops for 180 days.
Applicant's Name (print): Signature: Date
Inspections most be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 0 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
REXBURG
CW
America2 Family Community
BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: 0 New 0 Remodel 0 Addition OBasement Finish
Fees Paid: 0 Yes 0 No
1. Property Owner
Name:
Address: City: State: Zip Code:
Phone & Type: 0 Office 0 Mobile Email:
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? 0 Yes (Skip to #3 and complete the Homeowner's Exemption page)
0 No: I am a contractor working for the homeowner 0 No: 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: Registration #: __ Exp.:
Address: _ City: State: Zip Code:
Phone & Type: 0 Office 0 Mobile Email:
Contact/Rep. Name: Phone: Email:
Plumbin Contractor Authorized Signature, Date:
3. Project Description Water Meter Quantity: Water Meter Size:
Address: -OR- Lot #: _ Block #: _ Subdivision:
Check one: 0 Single-family Residence 0 Multi -family Residence 0 Commercial
Check one: 0 New Construction* 0 Remodel 0 Addition 0 Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
0 Up to $10,000 = (total cost of system x.02) + $60 0 $1010014100,000 = ((total cost of system -10,000) X.01) + $260
0 Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. Ft
0 Up to 1,500 Sq. Ft. = $130 0 1,501-2,500 Sq. Ft = $195 0 2,501-3,500 Sq. Ft = $260 0 3,501-4,500 Sq. Ft = $325
0 Over 4,500 Sq. Ft = $325+(65 x # of additional 1,000 Sq. Ft. (or portion thereof)) $
New Multi -Family Residential: 0 Duplex= $260 []Three or more units= $((130 x# of buildings)+(65 x # of units))$_
0 Gray Water Systems= $130 0 Lawn Sprinklers/Backflow device= $65 0 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: 0 Sewer Line = $65 Cl Water Line = $65 0 Sewer and Water Line= $65 ORequested inspection = $65
0 Sewer Turnaround (septic to city) = $65 0 Hydropic Heating= $65 + ($10 x # of manifolds/zones)
0 Technical Service = $65/hour 0 Plan Check =10% of Contracted Amount
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenalty ofperjury, I 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 bymein 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 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 penniton approval issued under the provisions ofthe 2012
International Cade in cases ofany false statement or misrepresentation offset in the application or on the plans on which the permit or approval was based. Permitvoidifnot
starudvrit1un 180 days. Permitvoid lfwork stops for 180 days.
Applicant's Name (print): 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 wwmrexburg.org Permit Teehniclan - (208) 372.2341 Revised March, 2016
0
CITY OF
REXBURG
nv
America's Family Community
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:
Office Address: City:
State: ----Zip Code:
Office Phone: Contact Person:
Cell Phone:
Contractor's Authorized Signature_
Date:
License/Registration # Expiration:
2. Location of Work to be Done
Street Address: City:
_State: Zip Code:
Business Name:
Contact/Rep. Name: --Phone:
❑ Office 13 Cell Phone
Email:
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
❑ Plan Review = 10% of Contracted Amount
❑ Re -Inspection = $65
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenalty ofperjury,I hereby certify that l have read this application and state thatthe information herein
correct and I swear that any information which may hereafter be given bymein 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 ofthis application and hereby authorlred 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. Permit voidif not
started within 180 days. Permit void Ifwork stops for 180 days.
Applicant's Name (print):
Signature:
Date:
Inspections most 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 Technician -(208)372.2341 Revised March, 2016
OC�apRC,
CITY OF
REXBURG
America's Family Community
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 ONO
Fees Paid:. 0 Yes 0 No — -
1. Applicant
Business Name:
Office Address: City: State: —Zip Code:
Office Phone: Contact Person: Cell Phone:
Contractor's Authorized Signature _ Date:
License/Registration # Expiration: _
2. Location of Work to be Done
Street Address: City: State: Zip Code:
Business Name:
Contact/Rep. Name: Phone: 0 Office 0 Cell Phone
Email:
Dates for work to be done: From to
3. New Construction Contracted Amount: $_ _ Calculated Fee (See Below): $
0 Up to $10,000 = (total cost of system x .02) + $60 0 $10,001-$100,000 = ((total cost of system -10,000) x.0 1) + $260
0 Over $100,001= ((total cost of system -100,000) x.00 5) + $1,160
4. Miscellaneous
0 New Construction = $1 per sprinkler head ($2,000 max) # of heads:
0 Existing Inspection Base = $65
0 Plan Review =10% of Contracted Amount
0 Re -Inspection = $65
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have read this application and state thatthe 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 ofthis application and hereby authorlmd 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 provlsions 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. Permitvoidif not
started within 180 days. Permit void ifwork stops for 180 days.
Applicant's Name (print):
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 nem business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
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Americans Family Community
Excavation & Earthwork:
Concrete:
Masonry:
Roofing:
Insulation:
Drywall:
Painting:
Subcontractor List
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Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
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Floor Coverings:
Plumbing:
Heating:
Electrical:
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Special Construction
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(Manufacturer or Supplier)
Roof Trusses: "� P 6Xpp 1(v55,S
Floor/Ceiling Joists: : c2 ILEO(.
Siding/Exterior Trim: 5®k (1 S i5f X` An
Other:
Inspecdon Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF Building Safety Department
o REr�URG, City of Rexburg
C 35 North 1St East
America's Family community 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? ❑ Yes ❑ No
Will the business be doing any structural/or remodeling changes to the building? ❑ Yes ❑ No
Any changes to the electrical? ❑ Yes ❑ No
Any changes to the plumbing?
[]Yes
❑ No
Any changes to the mechanical system?
❑ Yes
❑ No
Is the business type changing? o Yes, it will change to
❑ No
Is this business changing ownership?
❑ Yes
❑ No
Is the business registered with the City of Rexburg? o Yes, License #:
❑ No
*If No, please apply for a business license with the Customer Service Dept.
Will the business have food preparations?
❑ Yes
❑ No
Will there be any cooking of foods?
❑ Yes
❑ No
Will there be any deep fat frying?
❑ Yes
❑ No
Will you have food disposal on site?
❑ Yes
❑ No
Will there be sumps or floor drains in the facility?
❑ Yes
❑ No
Will the business have any chemicals on site?
❑ Yes
❑ No
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 Permit Technician -(208)372.2341 Revised March, 2016