HomeMy WebLinkAboutAPPLICATION - 16-00332 - 49 E Maint St - RemodelCITY OF
REXBURG
ty
Ameriw5 Family Community
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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)
❑ Permit Policies Acknowledgment signed. (seepage 3)
❑ Building Permit Application signed by a registered General Contractor. (seepage 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. (seepage 14)
Seismic Design Category - D
(unless soil evaluation confirms category C)
Ground Snow - 50 lbs. per sq. it
Roof Snow Load - 35 lbs. per sq. it
Wind Load - 90 MPH
Frost Depth - 36"
Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
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CITY OF
REXBURG
Americas Fnmily 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.
❑ 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.
Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
Americas 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
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.
o If a building is occupied without receiving a signed Certificate of Occupancy, citations will be issued and the
occupants will be evicted.
In tia
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
Is 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.
Inl lois
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.
11❑/A`_\/1 o The above policies will be enforced to all, regardless4pasthismation onto them or not
Initial' " S
Applicant's Name (print):" gna Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in erB AM will he scheduled for the next business day.
Inspecdan Hotline -(208)372.2344 www.rexburg.org Permit Techmdan - (208) 372.2341 Revised March, 2016
CITY OF
REXBURG
cy�
Americzi 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 ❑ Dr box ❑ Not Included
Permit Number: Ib -00331 Permit Type: ❑New7Remodel ❑Addition
Deposit Amount: ❑ $1000 New Const ❑ $250 Addition ❑ $100 Other Deposit Included with Application: ❑ Yes ❑ No
1. Proper Owner
Name:
Address: Itsoy City: State:Zip Code: $.a4_21D_
Phone&Type: — ❑Office Mobile Email: Y
ddvnet-
Under Idaho Building Code, a contractor most do the work for a Commercial Building.
2. Applicant
Name: Role: Role: (Owner, Tenant, Contractor, etc.)
Address: City: State: Zip Code:
Phone &Type: ❑ Office ClMobile Email:
Contact/Rep. Name: Phone: Email:
3. Genera
Name: fir' ( �1 rUG�6r is do #: 4f7^ �/_ V10 Exp.: ��
Address: �, City• _ Stat : Zip Code:
Phone & Type: ❑tOf£ce q&obile Email: o )G
Contact/Rep. Name: Al�Phone: mail:
General Contractor Authorized Signature: Date:
4. Project
Address: al D4e cription
� Mi}/N 9T. -OR- of #: _ Block #: _Subdivision:
Type of work:
Check one: ❑ New Construction Kemodel* ❑ Addition*
Check all that apply: ❑ Framing ❑ Mechanical ❑ Plumbing ❑ Electrical
NOTE: Any sub -contractors Involved will need to submit their awn signed applications.
Description of work:
*Total cost of project - materials and labor: $ 50i 000 (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 ofperjury,I hereby certify that l have read this application and state that the information herein
Is correct and 1 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 inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012
International Code in rases ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoidifnot
started within 180 days. Permitvoid ifworkstops for 180 days.
Applicants Name (print):
Date: -q -3L �p
Inspections must be called in before 8 AM on the day the inspection is requested. lnstlon req6eatz called in after 8 AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org it Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
N,
Americas Fami(y Community
EXEMPTIONS FROM STATE REGISTRATION
Building Safety Department
City of Rexburg
35 North 15t 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,
12 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
U 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 projector 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 o/f a-Mclular building (defined by Idaho Code) to be moved out of state
the above information is true and correct to the best of my knowledge.
Date
Print Name
Inspection Hotline -(208)372.2344 www.re%burg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
Ob
America's Family community
Affidavit of Legal Interest
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
State of Idaho
County
ou�ntyofMadison
�ry,knI/
I Lazp
Name Address
/ aAA
City
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, strip to B)
State
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 0
Subscribed and sworn to before me the day and year first above written.
Notary Public of daho
••�
NOTARY 0. - —
i
_
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Residing at: ZX-b[ATI�IQ�{��— 1 dJ
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My commission expires:
s �q "E O DP�����\\``
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Inspection Hotline -(208)372.2344
w .rexhurg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
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 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.
Signature
Printed Name
Date
Inspection Hotline -(208)372.2344 w .rex6urg.org Permit Technician -(208)372.2341 Revised March, 2016
C I TY OF
RMURG
Amencui Family Community
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: 0 New 0 Remodel []Addition 0 Basement Finish
Fees Paid: 0 Yes ONO
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. Mechanical Contractor
Name: - Registration#: _Exp.: _
Address: City: State: Zip Code:
Phone & Type: 0 Office ❑ Mobile Email:-
Contact/Rep.
mail:-Contact/Rep. Name: Phone: Email:
Mechanical Contractor Authorized Signature: _ Date:
3. Project Description
Address: -OR- Lot #: —Block It: _ 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 $10,0014100,000 = ((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
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpedury, l hereby certify that l have read this application and state that the information herein
is correct and I swear that any information which may hereafterbe given by mein hearings before the Planning and Zoning Commission or the City Council for the Cityof 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 of the 2012
International Code in rases ofany 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 100 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 VA be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
oFeexauQC
CITY OF
REXBURG
,t
Ameruak 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: 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/subcontractors involved will need to submit their own signed applications.
2. Electrical Contractor _
Name: '[P�M�``C� _ Registration #: _ Exp.:
Address: City: State: Zip Cade: _
Phone & Type: 0 Office 0 Mobile Email:
Contact/Rep. Name: 1 .Ppi IIf le _Phone:J6q—%0J Email:
Electrical Contractor Authorized Signature: Date:
3.Project Dewi tion
Address: E nAAW GT. -OR- Lot #: _ Block #: _ Subdivision: _
Check one: 0 Single-family Residence 0 Multi -family Residence 0 Commercial
Check one: 0 New Construction* 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
[]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:[] Small Works (work costing less than $200 with no change in service connections)=$10(needs no inspection.
0 Central Heating/Cooling Systems= $65 0 Spas, Hot Tubs, and Swimming Pools= $65 0 Requested Inspection= $65
[]Pumps - Water, Irrigation, Sewage (per motor) = 0 $65 up to 25HP 0 $95 26- 200HP 0 $130 over 200HP
0 Irrigation Machine= $65 for center pivot + $30 per tower of drive motor $ 0 Technical Service= $65/hour
0 Temporary Amusement= $65 + $10 per ride, concession, or generator $ 0 Plan Check =10% of Contracted Amoun
❑ Temporary Construction Services ONLY= 65 200 am or less. One location for less than 1 ear.
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 mein hearings before the Planning and 'ng Commission or the City Council for the CityofRexburg
shall be truthful and correct. l agree to comply with all City regulations and State laws relating to the subject ma rof his application and hereby authorized representatives ofthe
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may r oke Perini napproval issued under the provisions ofthe 2012
International Code in cases ofany NIse statement or misrepresentation of fact in the application oron a permitorappmvalwasbased. Permitvoidifnot
RO
startedwithinldays.permit void ifwork sinday
us for IRO s. -.I _
Applicants Name (print):
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
oQaexatrQo
yy �9 CITY OF
REXBURG
Ameriat's Family Gommunity
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:
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-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: ❑ 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: ❑ 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 s rinkler head whichever is realer
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 + ($30 x # of manifolds/zones)
❑ Technical Service = $65/hour ❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpedury, t hereby certify that l have read this application and state that the information herein
is correct and 1 swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the Cityof Rexburg
shall be truthful and correct. 1 agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives ofthe
City to enter upon the above-mendoned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions ofthe 2012
International Code In rases ofany false statement or misrepresentation offact in the application or on the plans on which the permit orapproval was based. Permitvoidifnot
started within 180 days. Permit void ifwork stops for 160 days.
Applicant's Name (print): Signature: Date
Inspections most 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.
Imperil on Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016
CITY OF
REXBURG
America's Family Community
BUILDING APPLICATION
Fire Alarm
Building Safety Department
City of Rexburg
35 North 15C East
Rexburg, Idaho 83440
For Office Use
Permit Number:
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 # Expiration:
2. Location of Work to be Done
Street Address: City:
State: Zip Code:
Business Name:
Contact/Rep. Name: Phone:
11 Office ❑ 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: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein
correct and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall
he 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 pennit on approval issued under the provisions ofthe 2012
International Cade in cases of any fake statement ormisrepresentation 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 8 AM on the day the inspection is requested. Inspection requests called in after 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
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C I TY OF
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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: 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 # _ Expiration: _
2. Location of Work to be Done
Street Address: City:_ _State:_ Zip Code:
Business Name:
Contact/Rep. Name: _ Phone: ❑ Office Cl 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
❑ New Construction = $1 per sprinkler head ($2,000 max) # of heads:
❑ Existing Inspection Base = $65
❑ Plan Review = 30% 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 state 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 City Council for the City of Rexburg shall
be truthful and correct. I agree to comply with all City reguladam 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 petmiton approval issued under the provisions ofthe 2012
International Code in rases ofany fake statement or misrepresentation affect in the application or on the plans on which the permit or approval was based. Permit void if not
started within 180 days. Permit void ifwork stops for 180 days.
Applicant's Name (print):
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.rexhurg.org Permit Technician -(208)372.2341 Revised March, 2016
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America' Family Community
Excavation & Earthwork:
Concrete:
Masonry:
Roofing: _
Insulation:
Drywall: L7 -
Painting:
Floor Coverings:
Plumbing:
Heating: _
Electrical:
Roof Trusses:
Floor/Ceiling Joists: _
Siding/Exterior Trim:
Other:
Subcontractor List
Special Construction
(Manufacturer or Supplier)
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
Inspection Hotline -(208)372.2344 w .rexburgxrg Permit Technician -(208)372.2341 Revised March, 2016
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REXBURG
Amerlcas Family Community
BUSINESS USE SUMMARY
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
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? n Yes ❑ No
Will the business be doing any structural/or remodeling changes to the building? ❑ Yes ❑ No
Any changes to the electrical? o Yes n No
Any changes to the plumbing?
❑ Yes
❑ No
Any changes to the mechanical system?
❑ Yes
n No
Is the business type changing? o Yes, it will change to
o No
Is this business changing ownership?
❑ Yes
❑ No
Is the business registered with the City of Rexburg? o Yes, License #:
n No
*If No, please apply for a business license with the Customer Service Dept.
Will the business have food preparations?
n Yes
❑ No
Will there be any cooking of foods?
❑ Yes
n No
Will there be any deep fat frying?
❑ Yes
o No
Will you have food disposal on site?
❑ Yes
o No
Will there be sumps or floor drains in the facility?
❑ Yes
o No
Will the business have any chemicals on site?
❑ Yes
o 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