Loading...
HomeMy WebLinkAboutAPPLICATION - 16-00627-00631 - Sawtelle Apts[6-00CD4-G31 aQ,E a°4p CITY OF Building Safety Department Or o n 7yvB7 ll7n /'1l�l7 Submit By Email City of Rexburg cy,35 North 1St East Americas Family Cammanity 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: V-"3 sets of site plans (see Site Plan Checklist on page 2) V"3 sets of building plans (see box below) - stamped by a licensed professional e Electrical panel layout and calculations included with building plans. m"'Exterior Lighting Plan including photometric layout. p'�Digital Plans (PDF Format - can be submitted by USB, CD, or Dropbox) Structural Calculations (see box below) - stamped by a licensed Engineer VEnergy Compliance Report: As per the 2012 IECC, a COMCheck is required (available online atwww.energycodes gov) M/ Permit Policies Acknowledgment signed. (see page 3) Z Building Permit Application signed by a registered General Contractor. (see page 4) d Exemptions from State Registration (see page 5) Q( Affidavit of Legal Interest signed. (see page 6) Id /Property Line form signed by builder. (see page 7) Mr Mechanical Permit Application signed by a registered Mechanical Contractor. (see page 8) fad Electrical Permit Application signed by a registered Electrical Contractor. (see page 9) ti� Plumbing Permit Application signed by a registered Plumbing Contractor. (see page 10) s/ Fire Alarm Permit Application (if applicable) signed by a registered professional. (see page 11) M/ Fire Sprinkler Permit Application (if applicable) signed by a registered professional. (see page 12) ei Subcontractor list filled out. (see page 13) M/ Commercial Projects: Completed Business Use Summary. (see page 14) Inspection 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" w rexhura.aro Permit Technician -(208)372.2341 Revised March, 2016 oQ p¢zaUy� C I TY OF Building Safety Department c oG Submil By Email City of Rexburg REXBUR c,,, 35 North 1st East Amerlc4 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 *o Will the business be doing any structural/or remodeling changes to the building? Dyes Po Any changes to the electrical? MYes ❑ No Any changes to the plumbing? pYes ❑No Any changes to the mechanical system? ,4Yes ❑ No Is the business type changing? ❑Yes, it will change to N0 Is this business changing ownership? Dyes XNo Is the business registered with the City of Rexburg?❑Yes, License #: No *If Nq, please apply for a business license with the Customer Service Dept. Will the business have food preparations? Dyes 10 No Will there be any cooking of foods? ❑Yes KNo Will there be any deep fat frying? ❑Yes ,2No Will you have food disposal on site? ❑YesKNo Will there be sumps or floor drains in the facility? ❑Yes N No Will the business have any chemicals on site? Dyes JXNo 002;-3,51 .3o�t� ° 6 I -ZA Q. Appl' ant Signa ure Phone bate I certify that the information that I have provided above is to the best of my knowledge accurate and true. Inspection Hot) ine-(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY OF REXBURG America's Family Community Building Safety Department Submit By Email City of Rexburg 35 North 1st East Rexburg, Idaho 83440 SITE PLAN CHECKLIST M--11 Site plan must be drawn to scale, be legible and also be submitted electronically if possible. M L. Adjoining streets labeled. tt-'�3. Right-of-way location and width, curb to curb widths and sidewalk location. W�4. Building location, sq footage and dimensions, with distance to property lines and distances between buildings. M--5. Show existing and proposed easements. M-'�& Existing utilities (waterlines, sanitary sewer lines, manholes, storm drains). Or' 7. Proposed utilities including tie in location to existing services and new easements. 12"8. Proposed storm drain and sanitary sewer elevations (for pipe inverts at manholes and catch_ basins)._ d 9. Storm drainage plan for parking lot and roof areas, with calculations. ff�1'0. Fire hydrants and fire suppression lines (including tie to City lines). G!"Sprinkled 13 Not Sprinkled M'111. Indicate Fire apparatus access. E3 12. Parking (including parking lot, drainage arrows, dimension of lot, distance between rows, and total numbers). 19" 13. Landscaping (type and total area, including dimensions). Er'14. Trash facilities. M0 '15. W116. M'117. North Arrow Included Proposed street improvements (curb, gutter, sidewalk, pavement, etc.) Legal description of proposed building site included. 9 18. Percent of lot covered by building or paving calculated. WI -9. Show 10% snow storage area. 0"�20. Distance of entrances from street corner indicated. 11 21. Current Vicinity Map. (81/2 x 11") at 1" = 300' scale, showing location of the property. 1111�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 x .rezburg.org Permit Technician -(208)372.2341 Revised March, 2016 C I TY OF REXBURG Americas Family Community Submit By Email 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. n� o Building without the pink building permit signed by the Building Inspector will result in double fees to be assessed and the project to be red tagged. If your project is red tagged, halting all construction, only a City Initials Official may remove the red tag. If the red tag is removed by anyone but a City Official, citations will be issued. No building may be occupied without receiving a signed Certificate of Occupancy. A� o If a building is occupied without receiving a signed Certificate of Occupancy, citations will be issued and the '7 occupants will be evicted. InOials 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. 3V 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. Inklalt 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. It o The above policies will be enforced to all, regardless if you pass this info motion onto them or not Initlals / Applicant's Name (print): A Signature: ate: Inspections must be called in before 8 AM on the day the inspection is requested. ins ecdonreq stscalled nage AM will be scheduled for the next business day. Inspection Hotline -(208)372.2344 www,rexburg.org Per Technicia -(20 )372.2341 Revised March, 2016 CITY OF REXBURG civ America's Family Community Building Safety Department Submit ey Email City of Rexburg 35 North ls' East Rexburg, Idaho 83440 BUILDING APPLICATION Commercial/Multi-family Residence For Office Use Digital Plans Included: ❑ CD Cl USB ❑ Dropbox ❑ Not Included Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition Deposit Amount: ❑ $1000 New Const. ❑ $250 Addition O $100 Other Deposit Included with Application: ❑ Yes ❑ No 1. Propelr- Owner Name: L,(_F-S- Address: P6 Ammo 4z9 City: State: :T-1 Zip Code: 4 440 Phone & Type: Z/5S--2ti/-7,D4A1❑Office eMobile Email: _hynnPffFu`L. Cn Under Idaho Building Code, a contractor must do the work for a Commercial Building. 2. Applicant Name: at --o ry poi- a r" Role: (Owner, Tenant, Contractor, etc.) (,1 kyhn l— Address:_ pb Rm, L/29 City: P-Lybuva State::Fi> Zip Code: '935b,M Phone & Type: zoo. �;/ . �O fs�❑ Office C✓JMobile Email: fir: a fix. T e rr Contact/Rep. Name: Phone: Email: 3. General Contractor Name: De/[p/nf>rn0-n4- R gistration #: Exp.: lZ • 3I • /!o Address: AD FkaY City: State: Zip Code: 1-34-fD Phone &Type:2,07. 3c3/- ao41y- ❑ Office o le Email Contact/Rep. Name: • tz Phone: ail: tarI4 q General Contractor Authorized Signature; - Date: / J 4. Project Description Address: /� Ar / �i✓. -OR t #: _Block #: _Subdivision: Type of work: -- Check one: 10 !! ewConstruction ❑Remodel* ❑Addition* Check all that apply: Framing eMechanical 121"Plumbing CJ Electrical NOTE: Any suh-contractors involved will need to submit their own siped app ications. Description of work: Aald/- Lnmrn/Z.,nt774 hoieSi ria w-n/0A- *Total cost of project - materials and labor: $ (used to ca culate pe4 mit fees) # Of Buildings: Building 1: Units PZsq. ft. Building 2: -J'9 -Units 2 & sq. ft. Building 3: Units sq. ft. Additional Buildings: VFG 9 .-64-- Utility, Misc, Private Garage: a sq. It Storage: 2/a 1,Q sq. ft. 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 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 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 an approval Issued under the provisions of the 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. PermRvoidifnot started within 180 days. Permit void ifwork stops for 180 days. Applicant's Name (print)_ Signature: Date: Inspections must be called in before a AM on the day the inspection is requested. Insp 'onre estscalled in after AM will be scheduled for the next business day. Inspection Hotline -(208)372.2344 www.rexburg.org mit Technician -(220 372.2341 Revised March, 2016 CITY OF REXBURG OW Amerlras Family Community Building Safety Department Submit By Email City of Rexburg 35 North 1st East 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.ibo1.idaho.gov/cont.htm) ❑ Currently State licensed pursuant to Title 54 Idaho Code, Chapters: a Architects, 1Q Electrical Contractors/journeyman, 12 Engineers/Surveyors, 12 Public Works Contractors (exempt from fee only registration required), 2¢ Plumbing/Plumbers, 4Q Public Works Construction Management Licensing Act (exempt from fee only registration required), or SQ 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 �f 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 It modular building (defined by Idaho Code) to be moved out of state hereby cetify that the above information is true and correct to the best of my knowledge. 14 4711. Zo II DaYe Print Name Inspection Hotline -(208)372.2344 v .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY OF REXBURG AmerlcB's Family Community Building Safety Department Submit By Emall City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Affidavit of Legal Interest State of Idaho County of Madison yI, 'ki _ASI -- Name Address City Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) APA4o State A. That 1 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 b -T+ day of Subscribed and sworn to before me the day 20 1 G first above written. Notary Public of Idaho Residing at: My commission expires: AN01 A. �;��•,, Inspection Hotline—(208)372.2344 w .rexburg.org Permit Technician—(208)372.2341 Revised March, 2016 CITY OF REXBURG Amerlroi Family 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. oSign ure D t &W4 ( L', I Printed Name Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY O P Building Safety Department " RMURG Submit Hy Email City of Rexburg °"35 North ldt East Amerkdi Fundy Community Rexburg, Idaho 83440 BUILDING APPLICATION Mechanical w i >�T as: ��„,a ,'i:4•,� � + i��' ajrtc= 4 rEr - Y I i� x, .+A�Z"4K.Cu� z• , m.� s�,t-+tt�t a-.��"� �' l.0 x m' 1 I. Property Owner Name:F W,01,4 W1.0sh"AP17' UA Address:_ 82. A&e w a City:_ llY�ur� State: Phone&T e:�&. _3r/.7jda,LF � Zip Code: 5Q,4�L� Type: ❑ Office eMoblle Email: _- L_arl 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) 13 No: 1 am a contractor working for the homeowner C6No: This property is a Multi -family Residence or Commercial Property. NOTE: Any contractors/sub-ourc aacoms involved wlli need to submit theirown signed applications. 2. Mechanical Conn•act tar Name:�r-e ���-f-jha /n� Registration 0: DI��LD Ex I--30-2(j(g Address: Za1 a n t-JD� City �_ p Stater Zip Code: �h 1 Phone&Type:?._p4•lp7��/.![ / Office❑Mobile Email: Contact/Rep. Name: AL 115 as ('rune Phone:2a2_ 2sc / .� Peia•� >� /Email• n,c, r��,lno ?E b 11 1911. 4SRTtA k1A?.: e$ ' tltLE`.rt— v Date:�(0 3. Project Description Address:` - +OR- Lot #: _ Block #: — Subdivision; Check one: �❑ Single-family Residence 13 Multi -family Residence ❑ Commercial Check one: © New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish Descri tion of work: rrarncutf NewCorijpierclalWork>Contrattedamouht:$ Calculated Fee `(See Below)o$ _ ❑ Up to 10,000 (total costof system x 02) +$60' ❑ $10,001-$100,000 = ((total cost of system -10,000) xt01) ❑ Over $100,OD1= ((total cost of system -100,000) x .005) + $1,160 New Single -Family Residential Wm•k: Sq. Ft - r ❑ 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 # ofadditional 1,000 Sq. Ft (or portion thereof)) $ NewMulti;FamilyReside ntlal.ElDuplex=$2fi0 Three -or more units =$C(130a#ofbulldlggs)+(65x:#.ofunits))$z$bD New work on any other residence and Detached Shops: Miscellaneous. ❑Gas.Pressure=$fi5 ❑FurnaceorA/C=$65❑WaterHgater=$65 ❑Requestedfnspectton :$65: : OGas Line=$65 ,•q Fireplace/SolfdFuelBurnlzlpUt4it,$¢5t':�lTechnical.SergtGe $65/hour A Plan.C)Teck=l0%QfOontractedAmount APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: under penalty of perjury, I hereby certify that l have read this applintio and rtatethnnhe mformuknn herein is mrreccand i swearthat any Infosmabo t which may herealterbe given by me in hearings before the Planning and Zoning Commission orthe City Council for the Cityuf Rexburg shalibe truthful and eorrea. 1 agree to comply with all City regulations and Slate laws relating to the subject matter ofthis application and hereby authorized representatives ofthe City to ewer upon the above-mentioned property for inspections Purposes. NOTE: The building official may revoke a Permlton approval Issued under the provisions ofthe 2012 International code In cans ofany fake statement or misrepresentation of fact in the application oron the plans on which the permit or approval was based. Permit voidif not started within 180 days. Permit void ?(work stops four 18,0 days. Applicant's Name (print): �S ` ` C. ri ( r) Signature: Date: Inspections mug be called In before SAM on the day the Inspection is requested. Inspection requests called In alters AM "it be scheduled forth next business day. Inspection Hotline. (208) 372.2344 www.rexburg.org Permit Technician- 208 372.2341 t ) Revised March, 2016 4o4ugap4o� CITY OF Building Safety Department RMUR%City of Rexburg Submit By Email 35 North mgt East ° AmerfRasFamiyComngnrty Rexburg, Idaho 83440 BUILDING APPLICATION Electrical For Office Use Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish Fees Paid: ❑ Yes ❑ No 1. Property Owner Name: tgROAJ LERTNA»? Address: City: State: __ Zip Code: Phone & Type: ❑ Office ❑ Mobile Email: _ Under Idaho Building Code, a homeowner is allowed to do w rk 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: T is 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: %3yAA1 1-0i MAA/ Registration #: a52-119 Exp.: Address: 14/55 'XJD 5T City: Qgx9dR6 State:-r,D._ZipCode: 931/114) Phone &Type:(2OR)' 390-370Lo ❑OfficelYMobile Email: �uanlaishrPmCui CP MSA,Go>w Contact/Rep. Name: Phone: Email: Electrical Contractor Authorized Signature: Dater 3. Project Description Address: /q b N I ° r /A)EsT 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 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 for portion thereof)) $ New Multi -Family Residential: Duplex = $260 IA Three or more units= $((130 x # of buildings)+(65 x New work on any other residence an Detached S ops: _ (6 + (10 x # of branch circuits)) Miscellaneous: ❑ Small Works (work costing less than $200 with no change in service connections) =$10(needs no insp tion. ❑ 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 10Temporary Construction Services ONLY= 65 200 am or less. One location for less than 1ear• APPI.ICANT'SSIf.NAT1IRR rmaTlvmre•rmN n --------------------•----••••-••••-••�••���...,...,,•,,,,.,�.; onuer penanyor perjury, I neremycenttymat [have mad this application and state that the infbtmationherein 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. 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 offact in the application or on the plans on which the permit orapproval was based. Permit voldif nat started within 180 days, Permit void lfworkstops for 180 days,1. C Applicant's Name (print): f2-UAk) / 1,-1AriJSignature: .tom &.LGLva-t,Li'd)Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in atter 8 AM will he scheduled for the nexthusiness day. Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY OF REXBURG cw Amerlm's Family Community Submit By Email BUILDING APPLICATION Electrical Building Safety Department City of Rexburg 35 North 1sl East Rexburg, Idaho 83440 For Office Use Permit Number: _ Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish Fees Paid: ❑ Yes ❑ No 1. Property Owner Name: FiFSf (yp_sF lhu?c�-lMPri+ L-1 ` Address: PI) Pd>< City: PJkl2aLq State: Zip Code: 13440 Phone &Type:zog•3r=l -P 11 Office Mobile Email: hi-brt a 412, -un,f. [`nm 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: l am a contractor working for the homeowner 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: k - ' Registration #: Exp.: Address: G5 ./c �l S�- city: R-Pyhu_T_ State: Z,> Zip Code: '973-4 11D Phone& Type: Z04.303.2 D1,2?= Office❑Mobile Email: Contact/Rep. Name: i2 fn,in J yr c6mon Phone:2,OT..3 maiL-tr 2nl�iq Sh Nnartn. A Electrical Contractor Authorized Signature: J Date: 3. Project Des ription Address: / X .f/. /fit -OR- Lot #: _ Block #: _ Subdivision: Check one: ❑ S})'ngle-family Residence 111fAulti-family Residence []Commercial Check one: IRTIew Construction* ❑ Remodel ❑ Addition ❑ Basement Finish Description ofwork: k7AWrvr i 0 V-Ot 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 ❑ 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: O Duplex= $260 13'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 Amoun TemporarV Construction Services ONLY= 65 200 amp or less. One location for less than 1 ear. APPLICANT -S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby cern ty that lhaver ad thisappliwtionand 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 Zorn Commission or the City Council for the City of Rexburg shall be truthful and correct, l agree to comply with all City regulations and State laws relating to the subject matter ofthis pplication and hereby authorized representatives of the City to enter upon the above-mentioned property forin ctions purposes. NOTE: The building o . ayr okeaper 'tons proval issued under the provisions ofthe 2012 International Code in cases ofany false stat ent or m' represenmtionoffac[ in the applicati ron the sonwhicht a permit or approval was based. Permits ol If not startedwithn 180 days. Permitvol o stops to eO days. Applicant's Name (print): Signature: Date: ZO /(o Inspections mustbe wiled in before 8 AM on the day the Inspection is requested. Inspection requests w ed after 8 AM will be scheduled for the next business day. Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technicia (208)372.2341 Revised March, 2016 CITY OF RMlJ G Submil By Email �v Amerier i 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: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish Fees Paid: ❑ Yes ❑ No 1. Property Owner Name: Et'Nc;� b0 S-% Address: OD 43W fd-Zq City: Je-Afka!4 State: -fes Zip Code: 1:3 4.4,0 Phone&Type:ZbT, 3472/ 30 ❑ Office0'Mobile Email•-LIv/frunk .Cot 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 No: This property is a Multi -family Residence or Commercial Property. NOTE: Any contractors/subcontractors Involved will need to submit their own signed applications. 2. Plumbing Contractor 2t� (� Name: P_6c&y -4 0/umb; ynIaA.{y�_ Registration #: I.:l M Exp.: Address: -7/,& Llo�o _ Ll w_t� City•v State: _-.r�L Zip Code: S73 P -ID Phone &Type•— 1�1Office❑Mobile Em�J al: Contact/Rep. Name: I✓Fnti i i?-Il0_!o Pone:ZlJ• 390 •D/�z'E ' • - - Plumbing Contractor Authorized Signature: Date: 3. Project Description Water Meter Quantity: Water Meter Size: Address: Lt -//o .U': / 5=- (, -OR- Lot #: _ Block #: _ Subdivision: Check one: ❑ Single-family Residence t�Multi-family Residence ❑ Commercial Check one: Cd 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 ❑ 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 reater) 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, I hereby certify that I have read this application and state that the information herein is correct and l swear that any information which may hereafter be given by me in hearings before the Planning and Zoning C mission or the City Council for the City of Rexburg shall be truthful and correct. l agree to comply with all City regulations and State laws relating to the subject matter of this ap lication and hereby authorized representatives ofthe City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit n approval issued under the provisions of the 2012 International Code! noses of any fake statementormi representation of fact in the application or ont an nwhichthe ermito approval was based. Penni[v id if not started within 180 days. Permit voi k2tops ar 80 days. Applicant's Name (print): �j11 Signature: Date: Inspections must be called in before a AM on the day the inspection is requested. InspecKn requests milk in a r 8 AM will be scheduled for the next business day. Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician )372.2341 Revised March, 2016 CITY or Building Safety Department u burg REXBURG Submit By Email 5 Nortly of Re 1st tti 35 North 1�t East A acak4 rnmtly fnmmuray Rexburg, Idaho 83440 BUILDING APPLICATION Fire Alarm i�' � f, if%�Sd•, a i� Tr3 se' .std' t r -u'�•p �i 1? S 3`Clt 45 Y:f+s 1. Applicant Business Name: Iola- OfficeAddresstiylOiNo.l/drG( Sf City:j�,_state:�ZipCode:�'z4Z Office Phone: D Contact Person: Cell Phone: �Q rR.. "�k' es(i a t �' - . ^ C,',m S Date: q -`I -tu License/Registration k uo 34 Expiration: 4 -bb -l(a 2. Location of Work to be Done Street Address:_lq& f /2tw- Ci 7.�vt��r� t3: State: Zip Code: '6 Business Name: �Civ7�'s�- Wa_��- nuoSf-rnFr»<-- ,'s Contact/Rep. Name:-Bi-ari kj6 64,nj Phone: ZQ17----'w5J a944 ❑OfficeCTellPhone Email: br— Dates for work to be done: From /Q - 7--D I6 to D4- 7,Dlh 3. New Construction Contracted Amount: $ Calculated Fee (See Below): $ 0 Up to $10,000 = (total cost of system X.0 2) + $60 O $10,0014100,000 = ((total cost of system -10,000) x.01) + $260 O Over $100,001= ((total cost of system -100,000) x.005) + $1,160 n1 - s'I'€ie zys{`'f j cY tom' 'ir tk i'�'t" ras r^s�{4z.`a, },ynkd"1f''9s.aa�es wSQ.°iAaracledAmoitnt: y ,.,� T`Tf, 1 `2z , APPLICANTSSICNATURE,CF.RTIFICATIONANO AUTHORIZATION: Under penaltyofperjury, I herebynrtifythat l have read this application and state that the lafonnation herein correct and I swear that any Information which my hereafter be given by., In haarings before the planning and Zouing Commksion or the City COundl for City of Rexburgshall be truthful and correct I agree to comply with all Cltyregulations and Rate laws relating to the subject matterafthis application and hereby authodsed representatives ofthe City to enterupon the above-mentionedproperty forhxpeulons purpnam NOTE: The build! ago Michel may revoke a permit on approval issued under the provisions of the 2012 International Code In uses ofany false statement ormtsrepresentation of fact In the application or on One plans on which the permit Or approval was based Permit raid If not started within 180 days. Permit void Ifworksto}e for 180 days. Applicant's Name (print): Signature: Date: Inspections must be called In before O AM on the day the Inspection is requested Inspection requestsalled in after 8 AM will be scheduled for the neat business day, Inspection HoUine-(200)372.2344 www.rexbu%org Parrott Technician -(2081372.2341 Revised March. 2016 $, CITY Of Building Safety Department > ;XBURG Submit ByEmall CityofRexburg cya 35 North 1s1 East Anaufmkrgmlly Cbmmunlry Rexburg, Idaho 83440 BUILDING APPLICATION Fire Sprinkler 6 xrd 1. Applicant Business Name:,Q�pv� r i`O OfOceAddress: _fn/i Mal/aYc/ Cd-, City:State: �—f _Zip Code;�b Office Phone: 2--6q. 232-. —3/ -yWontact Person: Cell Phone: &a r?tll}Sssi'sti�v��a�%? Date: License/Registration# FP�e.- 0 Expiration: lg 'Zl-ltn — t 2. Location of Work to be Done Street Address;. A- lit (y. —City: &av. r. Business Name:��4- flVa4{- hf �S�ra�o n -h t~G �� State: Zip Code: Contact/Rep. Name: )�zrnn LAf-Gtym Phone:. !!S[ 35/-:�3,94y4- ❑Office Cell Phone Dates for work to be done: From ID ZUI,{zto 12 2-0I6 3. New Construction Contracted Amount: $ Calculated Pee (See Below): $ 13Upto$10,000=(total cost of system x.02)+$60 0$10,001-$100,000=((totalcostof system -10,000)x.01)+$260 M Over $1170j0,001= ((total cost of system -100,000) x.005) + $1,160 011 wS�4o p� +sn�"iF D ax x r.1ia(5 cads tT-re"�.. au ry e stv r 'as'.wn't v' l,1 g c i x n APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpemlty ofperjury,l herebycertilythat] have read this application and state that the In(ormatlon herein corleceasd I swearthatanyinformanon which mayhereafterbe given by mein hemings before the Plamingand 7eningCommission or the City council for the Cltyof&xburg shag be truthful and correct I agree to comply with all City regu ltiOm and Scene laws relating to the Subject nutter ofthis application and herebyautharized represenlatins ofthe City to enter upon theabove.mendoned property for Inspections purposes. NOTE: The building Oft) may revoke a Penn It On approval issued under the provisions of the 1012 latero[bnei Code In osn ofany fab-stasement or mbrcprcsemmion offact In tis application or on the plans on which the permit or ppmval was based. Permitvoidifnot startedwitNn180 days. Permit void ifwork stops for 160 days. Applicants Name (print): Signature: Date: Inspeenom must be ailed In bar-ro SAM on the day the irepetdon Is requested. Inspection requests aged in after SAM Will be scheduled for the next business day. Inspection Hatllna-(208)372.2344 svwwrexburgorg PermitTechniciin-(208)372.2341 Revised March, 2016 CITY OF REXBURG Americas Family Community Excavation & Earthwork: Concrete: Masonry: Building Safety Department Submit By Email City of Rexburg 35 North lxt East Rexburg, Idaho 83440 Subcontractor List Roofing: AAA -N �oN ffLucTinl� Insulation: n.D%IAN Fo Drywall: Painting: `�mRV it�S Floor Coverings: _ Si6we-4- tr r r�2i e RS',I PIuinbing:y V- �i tY`ic-- t f �C-ITNL. Heating: �,UDco ±�-a'Tmz- I Ne - Electrical: ��occ t r--r=z ,c_ Special Construction (Manufacturer or Supplier) Roof Trusses: ( )AP Floor/Ceiling Joists: _ Siding/Exterior Trim: Other: Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016