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Home My WebLink AboutAPPLICATIONS - 16-00554 - 433 Airport Rd - Barney Storage - Bldg 3CITY OF REXBURG Americas 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: ❑ 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 at www.energycodes.gov) Q� Permit Policies Acknowledgment signed. (see page 3) Building Permit Application signed by a registered General Contractor. (see page 4) 9Z_Exemptions from State Registration (see page 5) gf/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 -b0 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 CITY OF REXBURG cw America's Family Community SITE PLAN CHECKLIST Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 ❑ 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. ❑ 5. 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. ❑ 8. 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 (111/2 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. Cl 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. Inspection Hothne- (208) 372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY OF REXBURG America's Family Community Permit Policies Acknowledgement Building Safety Department City of Rexburg 35 North 1Bt 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. Building withoutthe 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 IZO 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. LeoIf a building is occupied without receiving a signed Certificate of Occupancy, citations will be issued and the occupants will be evicted. 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 land s 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. 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. oThe above policies will be enforced to all, regardless if you pass this information onto them or not. Applicant's Name (print): Signature; `� Signature: at 4;) business Y _ ` Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM eschechled for the ne:business day. Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY OF REXBURG America's 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 DepositAmount: ❑ $1000 New Const. ❑ $250 Addition ❑ $100 Other Deposit Included with Application: ❑ Yes ❑ NO 1. Property Owner Name: ?),211 R Address: y/ "3 3 119 �" LIi1 " �: d"P— c� kA State: — _ �� Zip Code:,g_3 Phone &Type:�� / SS%/ 3 ❑ Office O --Mobile Email: Under Idaho Building Code, a contractor must do the work for a Commercial Building. 2. Applict Name: W -;37. e C.o✓1 % Role: Owner, Tenant, Contractor, etc.) 414 " ec Address: He/O W J 't ri a`S 1- 6 C /,City: h r5 State; Zip Code: O Phone & Type: �Oa$a/y9 �❑OfficeQ01obile Email: j ahe 'f"OC')0Vet h0GGtly�'L.. Contact/Rep. Name: Phone: _Email: 3. General P Contractor Name: X Wl r Registration #: Exp.: Address: City: State: Zip Code: Phone & Type: ❑ Office ❑ Mobile Email: Contact/Rep. Name: Phone: Email: General Contractor Authorized Signature:' Date: 4. Project Description Address: 0 Ack -OR- Lot #: _ Block #: _ Subdivision: Type of work: Check one: 19�New Construction ❑ Remodel* ❑ Addition* Check all that apply: `Framing ❑ Mechanical ❑ Plumbing ❑ Electrical NOTE: Any sub -contractors involved will need to submit theirownsigned applications. lJt'll Description of work: C � 2 C '� P 1`2 V1 (n P S P c d! C.S2i�c. 'L *Total cost of project - materials and labor: $ (used to calculate permit fees) # Of Buildings: Building 1: —Units S000 sq. ft. Building 2: Units -Alt& sq. fL 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, 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 by mein hearings before the Planning and Zoning Commission or the City CoundI 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 permiton approval issued under the provisions of the 2012 International Code in cases ofany fake 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): //�' c` C n y Signature: Date: 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 0.EXX R CITY OF REXBURG nv America's Family Community Building Safety Department EXEMPTIONS FROM STATE REGISTRATION 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, 10 Electrical Contractors/Journeyman, 12 Engineers/Surveyors, 19 Public Works Contractors (exempt from fee only registration required), 2L Plumbing/Plumbers, 45 Public Works Construction Management Licensing Act (exempt from fee only registration required), or 5R 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 &(( ',-s Print Name Inspecfion HoBine-(208)3722344 ..rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 �4o aexevq�la CITY OF ° REXBURG mAmenook Family Community State of Idaho County of Madison 1. Name City Affidavit of Legal Interest Address State Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) 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. l 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 20 Signature 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 .rcxhurg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY OF REXBURG tw Americas 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 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. WINE Signature Printed Name 9- 9_ / Date Inspection Hotline -(208)372.2344 ..rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY OF REXBURG cn, Amerim5 Family Community BUILDING APPLICATION Mechanical Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Office Use Per it Number: Permit Type: ❑New ❑Remodel ❑Addition.❑.Basement Finish Fees IN.., ' : ❑ Yes ❑ No 1. Property ner Name: Address: City: State: - Zip Code: Phone & Type: ❑ Office ❑ Mobile Email: Under Idaho Building e, a homeowner is allowed to do work on their own home. Are you a homeowner doi work on your own home? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page) ❑ No: I am a contractor worki for the homeowner O No: This property is a Multi -family Residence or Commercial Property. NOTE: Any contractors/sub-contractors lnvoly will need to submit their own signed applications. 2. Mechanical Contractor Name: Registration #: Exp.: Address: City: State: Zip Code: Phone & Type: Office o e Ema' : Contact/Rep. Name: Pho Email: Mechanical_ Contractor Authorized_shmaturei; Date: 3. Project Description Address: -OR- of #: _ B —Sub vision: Check one: D Single-family Residence ❑ Multi -family Re 'dence ❑ Comm rd Check one: ❑ New Construction* ❑ Remodel ❑ Additio ❑ Baseme Finish Description of work: New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $ ❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,001410 11100 = ((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. Cl Up to 1,500 Sq. Ft. = $130 ❑ 1,501-2,500 Sq. Ft. = $195 ❑ 2,501-3,500 Sq\.- 60 133,501-4,500 Sq. Ft. = $325 ElOver 4,500 Sq. Ft. = $325+(65 x # of additional 1,000 Sq. Ft (or portion there New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more units= $((130 x# o uildings)+(65 x # of units))$_ 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 = $6VIService=$65/hour nspection = $65 ❑ Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit= $65 ❑ T ❑ Plan Check =10% of Contracted Amount APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, l hereby certify that I have read this application 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 shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter ofthis application and her City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a psrmiton approval issm International Code in cases of any fake statement or misrepresentation of fact in the application or on the plans on which the permit or approv started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): Signature: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will b Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 2012 CITY OF RMURG test America's Family Cmnmunity 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 ONO 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 ❑ 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: ❑ Office O Mobile Email: Contact/Rep. Name: Phone: Email: Electrll ContractorAuthorizedSignatures 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 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 []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)=$10(needs no inspection. El Central Heating/Cooling Systems= $65 Cl 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 $ 13Plan Check =10% of Contracted Amoun ❑ Tem orar Construction Services ONLY= $65 200 amp or less. One location for less than 1 ear. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have read this application and state that he 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 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 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 CITY OF REXBURG Ow AmeMm's Family Community BUILDING APPLICATION Plumbing Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For 0 'ce Use PermitN her: Permit Type: O New ❑ Remodel C Addition ❑ Basement Finish Fees Paid: es O No 1. Property Owner Name: Address: City: State: Zip Code: Phone & Type: O Office O Mobile Email: Under Idaho Building Code, a omeowner is allowed to do work on their own home. Are you a homeowner doing wo on your own home? O Yes (Skip to #3 and complete the Homeowner's Exemption page) O No: I am a contractor working for a homeowner ?mgnapplications. is property is a Multi -family Residence or Commercial Property. NOTE: Any contractors/sub-contractors involved will n dmsubmitthei 2. Plumbing Contractor Name: Registr Exp.: Address: _ ity: State: Zip Code: Phone & Type: ❑ Of e O Mo ' Email: Contact/Rep. Name: he Email: lolumbin Contractor Authorized Si nature:' Date: 3. Project Description Water Meter Quantity: Water Meter Size: Address: -OR- Lot Block #: Subdivision: Check one: O Single-family Residence O Multi -family Reside ceO Commercial Check one: Cl New Construction* O Remodel O Addition Basement Finish Description of work: New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $ Cl Up to $10,000 = (total cost of system x.02) + $60 O $10,001-$100,0 =((total cost of system -10,000) x.01) + $260 O Over $100,001 = ((total costof system -100,000) x.005) New Single -Family Residential Work: Sq. Ft. O Up to 1,500 Sq. Ft. = $130 O 1,501-2,500 Sq. Ft. = $195 O 2,501-3,500 Sq. Ft. $260 1:13,501-4,500 Sq. Ft. = $325 O Over 4,500 Sq. Ft.= $325+(65 x # of additional 1,000 Sq. Ft. (or portion thereof)) $ New Multi -Family Residential: O Duplex= $260 O Three or more units= $((130 x# o uildings)+(65 x # of units))$_ O Gray Water Systems= $130 O Lawn Sprinklers/Backflow device= $65 O Multipurpos ire 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 connec ns Miscellaneous: O Sewer Line = $65 O Water Line = $65 O Sewer and Water Line= $65 ETUEquested inspection= $65 []Sewer Turnaround (septic to city) = $65 O Hydronic Heating= $65 + ($10 x # of manifolds/zone O Technical Service= $65/hour O Plan Check =10% of Contracted Amount APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpedury, l hereby certify that l have read this application and st is correctand 1 swearthat any information which may hereafterbe given by mein hearings before the Planning and Zoning Commission cribs City C shall be truthful and correct. I agree to comply with all City regulations and State laws relatingto the subject matter ofthis application and hereby ac City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued and International Code in rases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was started within 180 days. Permit void ifwork stops for 180 days. Applicant's Name (print): Signature Date: formation herein Cityof Rexburg 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 Inspection Hotline -(208)372.2344 www.rexburgarg Permit Technician -(208)372.2341 Revised Ma 2012 CITY OF REXBURG c1v America's Family Community BUILDING APPLICATION Fire Alarm Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 or Office Use Pe. itNumber: Permitapprovedi. ❑Yes ONO Fees adYes ❑Yes ❑No 1. Applicant Business Name: Office Address: City: State: Zip Code: Office Phone: Contact Person: Cell Phone: Contractor's Authorized Slgnatur_, Date: License/Registration # Expiration: 2. Location of Work to be Done N"�z Street Address: ty: State: Zip Code: Business Name: Contact/Rep. Name: ne: ❑ Office O Cell Phone Email: Dates for work to be done: From to 3. New Construction Contracted Amount: $ N,Ealculated Fee (See Below): $ ❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,00 -((total costof 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: Under penalty of perjury, I hereby certify that l have read this application and sta that the information herein correct and l swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the Cl Ty Co unci r 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 authorizedre esarntivesofthe City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued undertheprovis nsofthe2012 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. Pe itvoidifnot started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): Signature: Date: Inspections must be called in before SAM 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 Qwe n°RQCITY OF `'Jy BuildingSafetyDepartment Fy e� J o REXBURG City of Rexburg c 35 North 1st East America's Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Fire Sprinkler For 0 'ce Use Permit her: Permitapproved: ❑ Yes ONO 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 # N Expiration: 2. Location of Work to be Done Street Address: City State: Zip Code: Business Name: Contact/Rep. Name:ne: ❑ "Office O 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 ❑ $10,001-$1 000 = ((total cost of system -10,000) x.01) + $260 0 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 AUTHORIZATION: Under penalty mperjury, I hereby certify that l have read this application and to that the information herein correct and I swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the Cl Ty Cou Ifarth City of Our shall be truthful and correct. l agree to comply with all City regulations and State laws relating to the subject matter ofthis application and hereby authorize epresentatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The building offirial may revoke a permit on approval issued under the pro ions 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. rmitvoidifnot started within 180 days. Permit void if work stops for 180 days. Applicants 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 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 •;oQ avtevq��a CITY OF ° REXBURG CW- America's Family Community Excavation & Concrete: Masonry: Roofing: Insulation: Drywall: /L Painting: / c Floor Coverings: Plumbing: Heating: _ Electrical: 0 Roof Trusses: �' Floor/Ceiling Joists: Subcontractor List VT -C, -rd Cc Special Construction (Manufacturer or Supplier) Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Siding/Axterior Trim: I f V I ` j ,_ C 0theI'�+'e-e-1 9a"/%4%M LF r) Tee 1 s �oC -t't e u,%oP F-? Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 uo "�°As as CITY OF Building Safety Department REXBURG City of Rexburg CW— 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? Will the business be doing any structural/or remodeling changes to the building? []Yes 69e' Any changes to the electrical? (r- G h - Ln 5'e S Lt) I"[ be aJ;'f h � SePa fR �o Yes , Zo Q2� V✓l 0�, a La -I-< L— Any changes to the plumbing? des Ole Any changes to the mechanical system? ❑ Yes(!�?No Is the business type changing? ❑ Yes, it will change to "t Is this business changing ownership? []Yes 00 Is the business registered with the City of Rexburg s, License #:3 1� ❑ No *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? ❑ Yes Will there be any cooking of foods? ❑ Yes ,le 1:1/ Will there be any deep fat frying? Yes /% Will you have food disposal on site? ❑ Yes Will there be sumps or floor drains in the facility? ❑ Yes ,� Will the business have any chemicals on site? []Yes "zoS 0z/�/ K R -q-/�- Applicants Signature Phone Date [certify that the information that I have provided above is to the hest ofmy knowledge accurate and true. Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016