HomeMy WebLinkAboutAPPLICATIONS - 16-00504 - Tenant Finish - Dentist OfficeCITY OF
REXBURG
America's Family Community
Building Safety Department
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:
s see 1 )
❑ 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.
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cu ahons see ox e - neer
nce epor : s per t e IECC, a COMCheck' required [available online
at=w, ww,t�yeades.gov)
❑ Permit Policies Acknowledgment signed. (seepage 3)
❑ Building Permit Application signed by a registered General Contractor. (seepage 4)
.6—Affidavit of Legallntara�r�;a„P.t r�oo,,,Ror;�_
y er. see page 7)
❑ Mechanical Permit Application signed by a registered Mechanical Contractor. (seepage 8)
❑ Electrical Permit Application signed by a registered Electrical Contractor. (seepage 9)
❑ Plumbing Permit Application signed by a registered Plumbing Contractor. (seepage 10)
signed by a registered professional. (see page 11)
17—F iu r(ifapplicable) signed by a registered professional. (see page 12)
❑ Subcontractor list filled out. (seepage 13)
❑ Commercial Projects: Completed Business Use Summary. (seepage 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 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
cy,
America's rwmily 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 youarerequired. 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
"'tlals 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.
Inkials
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
;nitlals 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 (print):
Signature:
Date:
Inspections mus[ 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
REXBURG
Amerfcai 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 ❑ Dropboa ❑ 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 Ownery 11 ��q
Name: �+"S' 11` G4,opleed
Address: City: P C �� State: TV Zip Code: -9.3yVO
Phone & Type: gqOElOffice obile Email:iJW t�Suf
Under Idaho Building Code, a contractor must do the work for a Commercial Building.
2. Applicants J //'
Name: �l/1 ", / CIV "e Role: (J�wnbr, Tenant, Contractor c
Address: - %� City: (� S ate: Zip Code: ,-
Phone&Type: '-` ��' ❑Office obile Email: �V w !`�tu�J�rC?�C�gy�tt+r .( � .�,
Contact/Rep. Name: Phone: Email: J
3. General Contractor y,, C
Name: IVl�, �1�� Registration #: Fc G ` J 5 b 9 Exp.: ! Z ;FI
Address: n _ City: State: Zip Code:
Phone & Type:% ❑ Office ❑ Mobile Email:�—
Contact/Rep. Name: Phone: Email:
;General Contractor Authorized Signature: Date:
Address: " • l^ Lot#: Block#: Subdivision:
Type of work:
Check one: ❑ New Con uction�Re del* ❑ Addition*
Check all that apply: F ming Mechanical ❑ umbing efflectrical
NOTE: An sub -contractors involved will nee to bmitt vow•"+ eda elicca ons.
Description of work: 1 ow
*Total cost of project - materialsand bo (used to calculate permit fees) # Of Buildings:
Building 1: _Units 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, l hereby certify that l have read this application and state that the information herein
is correct and l 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. 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 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. Permitvmcl if not
started within 180 days. Permit void ifwork stops for 180 days.
M)6
Applicant's Name (print): `"ems4" �,•'�. Signature. Date: ✓�^�
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection req ed in after 8 AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Perm' chnician-(208)372.2341 Revised March, 2016
CITY OF
REXBURG
cW
Amerk4 Family Community
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
PermitNumber: Permit Type: 0 New 0 Remodel ❑ Addition 0 Basement Finish
Fees Paid: ❑ Yes ONO
1. Property Owner
Name:
Address: City: State: Zip Code:
Phone & Type: 0 Office Cl 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: 1 am a contractor working for the homeowner 0 No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-rontraams involved will need to submit their own signed applications.
2. Mechanical Contractor
Name: Registration #: Exp.:
Address: City: State: Zip Code:
Phone & Type: 0 Office 0 Mobile Email:
Contact/Rep. Name: Phone: Email:
Mechanical Contractor Authorized Signature:, Date:
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): $
0 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
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: El Gas Pressure = $65 0 Furnace or A/C = $65 0 Water Heater = $65 0 Requested Inspection .= $65
0 Gas Line = $65 Cl 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 hereby certify that 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. I 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 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):
Signature:
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 Marcb,2016
CITY OF
REXBURG
test
Amerim3 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 ❑ Addition ❑ Basement Finish.
Fees .Paid; .❑ Yes ❑ No
1. Property Owner
Name:
Address: City: State: Zip Code:
Phone & Type: ❑ 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? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page)
❑ No: I am a contractor working for the homeowner O No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-ronuactors involved will need to submit their own signed applications.
2. Electrical Contractor
Name: Registration #: Exp.:
Address: City: State: Zip Code:
Phone & Type: ❑ Office ❑ Mobile Email:
Contact/Rep. Name: Phone: Email:
!Electrical Contractor Authorized Signature: Date:
3. Project Description
Address: -OR- Lot #: _ Block #: _ Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
❑ Up to $10,000 = (total cost of systemx.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 branch circuits)) $
Miscellaneous: O Small Works (work costing less than $200 with no change in service connections)=$I (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 Amoun
❑ Temporary Construction Services ONLY = $65 200 amp or less. One location for less than 1 ear.
APPLICAN IS SIUNA'1'URE, CEK'1'IFICA'1'ION AND AUTHORIZATION: Under penalty ofpedury, I hereby certify that I 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 ofthis 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. Permitvoid 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 maker 8 AM will be scheduled forthe next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
RMURG
Amerka4 Family Community
BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
PermitNumber: Permit Type: ❑New.. ❑ Remodel ❑ Addition ❑ Basement Finish
FeesPaid: ❑ Yes ❑ No
1. Property Owner
Name:
Address: City: State: Zip Code:
Phone & Type: ❑ Office ❑ Mobile Email:
Under Idaho Building Cade, 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)
❑ No: I am a contractor working for the homeowner O 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: ❑ Office O Mobile Email:
Contact/Rep. Name: Phone: Email:
Plumbing Contractor Authorized Signature; Date:
3. Project Description Water Meter Quantity: Water Meter Size:
Address: -OR- Lot#: Block#: Subdivision:
Check one: D Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work:
New Commercial Work: 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
Cl 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 O 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
13 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 ofthis application and hereby authorized representatives of the
City to enter upon the above-mentioned property for inspecti ons purposes. NOTE: The building official may revoke a permit on approval issued underthe 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): Signature: Date
Inspections most 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
¢eXHpq
Fq� C0 CITY OF
REXBURG
n
rn
Amerieds Family Community
Excavation & Earthwork:
Concrete
Masonry
Roofing:
Insulatio
Drywall:
Painting:
Floor Co,
Plumbin;
Heating:
Electrica
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
Subcontractor List
66
Roof Trusses:
Floor/Ceiling Joists: _
Siding/Exterior Trim:
Other:
Special Construction
(Manufacturer or Supplier)
9&"-c.
`-e
Inspection Hotline -(208)372.2344 vrv✓w.rexburg.org Permit Technician -(208)372.2341
Revised March, 2016
CITY OF Building Safety Department
City of Rexburg
l G 35 North 1st East
Americas 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 o
Any changes to the electrical? prYes ❑ No
Any changes to the plumbing?:ess No
Any changes to the mechanical system? Yes ❑ No
Is the business type changing? o Yes, it will change to Tl ❑ No
Is this business changing ownership? ❑ Yes q o
Is the business registered with the City of Rexburg?YLrtJ es, License #: o No
*If No, please apply for a business license with the Customer Service Dept.
Will the business have food preparations?
❑ Yes
J`Noo
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? /111/4V5
❑ Yes
❑ Yes
❑ Ye
It Yes
❑ Yes
54
Roo
allo
C7No
L9'No
o� W3l
Applicants ' ature Phone
U X16
I certify that the information that I have provided above is to the best ofmy knowledge accurate and true.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016