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Home My WebLink AboutAPPLICATION - 16-00266 - 1360 S 12 W - Motel 6n�pFXaURC , CITY OF REXBURG ter Amerim's Family Community Permit Policies Acknowledgement Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 The City of Rexburg Building Safety Department is determined to provide excellent customer service. In an effort to help you understand the City of Rexburg Permit Policies, listed below are several policies which you are required to know prior to proceeding with your project. Any construction within the City of Rexburg which requires a permit shall not begin until an approved permit is obtained. If you do not have a pink building permit signed by the Building Inspector, then you do not have an approved permit. o Building without the pink building permit signed by the Building Inspector will result in double fees to be assessed and the project to be red tagged. If your project is red tagged, halting all construction, only a City nitial: 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. () •� /J o If a building is occupied without receiving a signed Certificate of Occupancy, citations will be issued and the occupants will be evicted. Initials Calling in inspections is the responsibility of the applicant and their contractor. Inspections need to be called into the hotline and not to the inspector. Inspections called in later than 8 AM will be scheduled for the following business day. r , n 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. nZ� o Even if you hear from an inspector that'you're good to go', ultimately if you do not have a Building Permit or Certificate of Occupancy, the above policies will be enforced. Initials It is your responsibility to relay this information on to anyone who this would be applicable to for your project. All sub -contractors will be held to this standard with no exceptions. o The above policies will be enforced to all, regardless if you pass this information on to them or not In Bials la o Applicant's Name (print):zosuta/pfr(/�«r Signature: t Date: 10, Inspections must be called in before 8 AM on the day the inspection is requested. Inspecdon requests called in after 8 AM YAH be scheduled for the next business day. Inspection Hatline-(208)372.2344 v .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY OF REXBURG CW- Amerimi Family Commonly, BUILDING APPLICATION Commercial/Multi-family Residence Building Safety Department City of Rexburg 35 North 1St East Rexburg. Idaho 83440 For Office Use Digital Plans Included: ❑ CD ❑ USB ❑ Dropbox ❑ Not included Permit Number: Permit Type: ❑ New []Remodel ❑ Addition Deposit Amount: ❑ $1000 New Const ❑ $250 Addition ❑ $100 Other Deposit Included with Application: ❑ Yes ❑ No 1. Property Owner Name: `� It� c I&4L-bw Address: 1172- in -m Lila n °ue- City:`\r:owns State:'T�f Zip Code: 834Nb Phone&Type:!ZW,n 'JSS(c ❑ Office 1p -Mobile Email: davidlotcal w 45 s(<t M5f(7 co— Under Idaho Building Code, a contractor must do the work for a Commercial Building. 2. Applicant Name: 15'�a Rol. (Owner, enant, Contractor, etc.) Address: City: State: Zip Code: Phone & Type: ❑ Office ❑ Mobile Email: Contact/Rep. Name: Phone: Email: 3. General Contractor _- / Name: BIL°ELOV PrtoPcnn€s LI -c, Registration #: RCE -41;191 Exp.: 5ZZ Address: 503,Ea 34 N. City: eiR1e State: V> Zip Code: 834 i 3 Phone&Type: lot -SS*1-`1tSS ❑OfficeRMobile Email: �erem �lnb,;eluw�rhs�-ro,� Contact/Rep. Name: Phone: Email: General Contractor Authorized Signature: Date: 4. Project Description Address: -OR- Lot #: _ Block #: _ Subdivision: Type of work: Check one: f _New Construction ❑ Remodel* ❑ Addition* Check all that apply: )� Framing ❑ Mechanical ❑ Plumbing ❑ Electrical NOTE: Any sub -contractors involved will need to submit thelrown signed applicad Description of work:_ FOk"Lg4,Zx t�j-td(°„Tpr�.t� ate *Total cost of project - materials and labor: $ (used to calcu ate 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. It. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have read this application and sort, that he information herein Is correct and I swear that any information which may hereafter he 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 Intemational Code! n cases ofany false statement or misrepresentation offact in the application or on the plans on which the permit or approval was based. Permit void ifnot started within 180 days. Permit void ifworkstops for 180 days. Applicant's Name (print):Aat` Is R1 Signature: Lwl! Date:q-ljr--�6 Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM VA 6e scheduled for the neat business day. Inspection Rotline-(208)372.2344 wwmrexhurg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY OF REXBURG CW Americal Family Community Affidavit of Legal Interest Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 State of Idaho County of Madison ( / Name Address 9 G 4 0 / YOU City State 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. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any claim or liability resulting from any dispute as to the statements contained herein or as to the ownership of the property which is the subject of the application. Dated this day of Signature 20 Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 CITY OF REXBURG 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, seethe front counter at the Community Development Department. I have read and understand the above requirements. z6z�ZZes�� Signature —a &(`IA 61, t., IULI_) Printed Name yyz�--/6 Date Inspection Hotline—(208)372.2344 w vrexhurg.org Permit Technician—(208)372.2341 Revised March, 2016 C I TY OF REXBURG rw America's Family Community BUILDING APPLICATION Mechanical Building Safety Department City of Rexburg 35 North 1st East Rexburm Idaho 93440 For Office Use Permit Number: Permit Type: D New D Remodel D Addition D Basement Finish Fees Paid: ❑ Yes D No 1. Property owner �j Name: V 1 Vyo, O l iT L o ttJ � II Address: _JJ 72 AHI Ito d City: rKEAtvb State:_ ( Zip Code: Phone &Type: ?A % 7 & S(o D Office PCMobile Email: (feo f �,U la,p MSW , Cowes 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? D Yes (Skip to #3 and complete the Homeowner's Exemption page) D No: I am a contractor working for the homeowner {W No: This property is a Multi -family Residence or Commercial Property. NOTE: Any contractors/sub-contractom involved will need to submit their own signed applications. 2. Mechanical Contractor Name: Registration #: Exp.: Address: City: State: Zip Code: Phone & Type: D Office D Mobile Email: Contact/Rep. Name: ---Phone:— Email: Mechanical Contractor Authorized Signature: _ . _ . Date:___ 3. Project Description Address: OR- Lot #: —Block #: _ Subdivision: Check one: D Single-family Residence D Multi -family Residence D Commercial Check one: D New Construction* D Remodel D Addition D Basement Finish Description of work: New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $ D Up to $10,000 = (total cost of system x .02) + $60 D $10,0014100,000 = ((total cost of system -10,000) x.01) + $260 D Over $100,001= ((total cost of system -100,000) x.005) + $1,160 New Single -Family Residential Work: Sq. Ft D Up to 1,500 Sq. Ft = $130 D 1,501-2,500 Sq. Ft = $195 D 2,501-3,500 Sq. Ft = $260 D 3,501-4,500 Sq. Ft = $325 D Over 4,500 Sq. Ft = $325+(65 x # ofadditional 1,000 Sq. Ft. (or portion thereof)) $ New Multi -Family Residential: D Duplex= $260 D Three or more units = $((130 x# of buildings)+(65 x # of units))$_ New work on any other residence and Detached Shops:_ 165 + (l0 x # of HVAC fixtures)) Miscellaneous: D Gas Pressure = $65 ❑ Furnace or A/C = $65 O Water Heater = $65 D Requested Inspection =$65 D Gas Line = $65 D Fireplace/Solid Fuel Burning Unit= $65 []Technical Service = $65/hour D Plan Check =10% of Contracted Amount APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify than have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. 1 agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representadves 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 ofthe 2012 International Code in cases ofany false statement or misrepresentadon of fact in the application or on the plans on which the permit or approval was based. Permitvoldifnot started within 180 days. Permit void ifworkstops 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 wiIf be scheduled for the next business day. Inspection Hotline -(208)372.2344 www.rexburg.org PermitTechnician-(208)372.2341 Revised March, 2016 OQ pE%BUgC CITY OF 9K REXBURG tti America's Family community BUILDING APPLICATION Electrical Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition []Basement Finish Fees Paid: ❑ Yes ❑ No 1. Property Owner Name: Address: City: State: Zip Code: Phone & Type: _ ❑ Office 13 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) 0 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. Electrical Contractor Name: Registration #: Exp.: Address: City: State: Zip Code: Phone & Type: 0 Office[] Mobile Email: Contact/Rep. Name: Phone: Email: Electrical Contractor Authorized Signature: _ _ Date: 3. Project Description Address: -OR- Lot #: _ Block #: _ Subdivision: Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial Check one: ❑ New Construction* ❑ Remodel ❑ Addition 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 ❑ $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 0 1,501-2,500 Sq. Ft = $195 ❑ 2,501-3,500 Sq. Ft = $260 ❑ 3,501-4,500 Sq. Ft = $325 0 Over 4,500 Sq. Ft = $325+(65 x # ofadditional 1,000 Sq. Ft (or portion thereof)) $ New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more units = $((130 x # of buildings)+(65 x # of units))$ New work on any other residence and Detached Shops: = $(65 + (lox # of branch circuits)) Miscellaneous: 0 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 2OOHP ❑ Irrigation Machine= $65 for center pivot+ $10 per tower of drive motor $ El Technical Service= $65/hour ❑ Temporary Amusement= $65 + $10 per ride, concession, or generator $ ❑ Plan Check =10% of Contracted Amoun ❑ Tenr3orary Construction Services ONLY= 65 f200 amp or less. One location for less than 1 year.1 aurarreuT•c crrueTnoc r _ --•••••••••••W••.••-•-- .I .c,penany or perjury, t nereoy cenity, mat l have read this application and smte that the information herein is correct and 1 swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter ofthis application and hereby authorized representatives 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 of the 2012 International Code in rases of any false statement or misrepresentation offact in the application or on the plans on which the permit or approval was based. Permit void ifnot started within 180 days. Permit void ifwarkstops for 180 days. Applicants 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 nett business day. Inspection Hotline -(208)372.2344 www.rexburg.org PermltTechnician-(208)372.2341 Revised March, 2016 CITY OF RMURG AmMcai 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: n New n Remodel n Addition n Basement Finish Fees Paid: n Yes n No 1. Property Owner Name: Address: City: State: Zip Code: Phone & Type: _ ❑ Office n 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? n Yes (Skip to #3 and complete the Homeowner's Exemption page) E3 No: I am a contractor working for the homeowner 13 No: This property is a Multi -family Residence or Commercial Property, NOTE: Any contractors/sub-mmmaor, involved will need m submit their own signed applications. 2. Plumbing Contractor Name: Registration #: _ _ Exp.: Address: --_ City: State:Zip Code: Phone & Type: _ n Office n 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: n Single-family Residence n Multi -family Residence n Commercial Check one: n New Construction* n Remodel n Addition n Basement Finish Description of work: New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $ EI Up to $10,000 = (total cost of system x.02) + $60 n $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260 El Over $100,001= ((total cost of system -100,000) x.005) + $1,160 New Single -Family Residential Work: Sq. Ft n Up to 1,500 Sq. Ft = $130 n 1,501-2,500 Sq. Ft = $195 n 2,501-3,500 Sq. Ft = $260 EE = $325 ❑ Over 4,500 Sq. Ft = $325+(65 x # ofadditional 1,000 Sq. Ft. (or portion thereof)) $ New Multi -Family Residential: n Duplex= $260 n Three or more units= $((130 x # of buildts))$_ n Gray Water Systems = $130 n Lawn Sprinklers/Backflow device= $65 n Multipurpose Festic Water Supply System = $65 or $4 per sprinkler head whichever is greater) New work on any other residence and Detached Shops: : 65 for sewer and water stub connections Miscellaneous: n Sewer Line = $65 n Water Line = $65 n Sewer and Water Line= $65 ❑Requested inspection = $65 []Sewer Turnaround (septic to city) = $65 n Hydronic Heating= $65 + ($10 x # of manifolds/zones) n Technical Service= $65/hour []Plan Check =10% of Contracted Amount Ano, •-••••�••.•..••.9.,+,uRc, ccn„rtwrluN ANU AUTHORIZATION: Under penalty ofpedury, 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 me In hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter ofthis application and hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions ofthe 2012 International Code in cases ofany fake statement or misrepresentation offact in the application or on the plans on which the permit orapproval was based. Permit void ifnot smrted 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.rexburg.org Permit Technician -206 ( ) 372.2341 Revised March, 2016 QQaUeC .� ♦d CITY OF REXBURG America's Family Community BUILDING APPLICATION Fire Alarm Building Safety Department City of Rexburg 35 North ixt East Rexburg, Idaho 83440 For Office Use Permit Number: _ Permitapproved: OYes ONo Fees Paid: O 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: O Office O Cell Phone Email: Dates for work to be done: From to 3. New Construction Contracted Amount: $_ _ Calculated Fee (See Below): $ O Up to $10,000 = (total cost of system x.02) + $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 4. Miscellaneous O Plan Review =10% of Contracted Amount ❑ Re -Inspection = $65 APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, l 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 mein hearings before the Planning and Zoning Commission or the City Cc until for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State laws relat ngto 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 rases ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoidifnot starred 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 SAM will be scheduled for the next business day. Inspection Hotline -(208)372.2344 www.rexburgorg Permit Technician -(208)372.2341 Revised March, 2016 CITY OF Building Safety Department REXBURG City of Rexburg � 35 North 1St East Americas Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Fire Sprinkler For Office Use Permit Number: _ Permitapproved: ❑Yes ❑No Fees Paid: ❑ Yes ❑ No 1. Applicant Business Name: Office Address: City: State: ___ Zip Code: Office Phone: Contact Person: Cell Phone: Contractor's Authorized Signature: Date: License/Registration # Expiration: 2. Location of Work to be Done Street Address: City: _State: Zip Code: Business Name: Contact/Rep. Name: Phone: ❑ Office ❑ 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 =10% of Contracted Amount ❑ Re -Inspection = $65 APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, t 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 regulations and State laws relating to the subject matter ofthis application and hereby authorlmd 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 Intemadonal Code in rases afany 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. Permit void ffwork 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 inafter 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 CW AmenwS Family Community Subcontractor List Excavation & Earthwork: 'z �z-- Concrete: Masonry: 'rte l�vd✓'u ( �� Roofing: L 6- // 1 Insulation: lrYp ,}pv-W I, e Drywall: Painting: Floor Coverings: L G -LL Plumbing: -7-e— /� r/2v7k (ti ec✓ Heating: l I I Electrical: IL tt << Special Construction (Manufacturer or Suppli Roof Trusses: Floor/Ceiling Joists: Siding/Exterior Trim: Other: L L Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Inspecdon Hotline -(208)372.2344 v .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 "`xnUR° C I TY OF Building Safety Department FF !7 o REXBURG City of Rexburg 35 North 1st East Amerlcak Family Commmoi v 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? n Yes Po 1I Will the business be doing any structural/or remodeling changes to the building? 1:1 Yes No Any changes to the electrical? ❑ Yes 0o Any changes to the plumbing? n Yes No Any changes to the mechanical system? ❑ Yes I�N0 Is the business type changing? o Yes, it will change to q No Is this business changing ownership? ❑ Yes qNo Is the business registered with the City of Rexburg? ❑ Yes, License #: 00 ` a *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? n Yes y No Will there be any cooking of foods? ❑ Yes �No Will there be any deep fat frying? n Yes �PLNo Will you have food disposal on site? ❑ Yes kvNo Will there be sumps or floor drains in the facility? n Yes No Will the business have any chemicals on site? n Yes 4rN o / .k U Applicants SignatuoK Phone Date I certify that the information that I have provided above is to the best of my knowledge accurate and true. I nspection Hot] me - (20 8) 3 72.2344 www.rexmrg.mg Permit Technician -(208)372.2341 Revised March, 2016 Report generated: 'w Madison County Parcel Report 4/15/2016 10:12:54 AM Parcel Number: RPRXBCA0359180 Primary Owner: BIGELOW DAVID Secondary Owner: BIGELOW PENNIE P Site Address: Mailing Address: 507 N 4000 E RIGBY Acreage: 2.479 GIS Square Feet: 110,229 GIS Acres: 2.531 Total Value: $148,740 Year Inspected: 2014 Last Year Taxes: $207.76 Current Taxes: Legal Description: REXBURG CITY ACREAGE TAX -1447 35 -06N -39E SE4SE4 Deed Number: 386043 385798 386046 385769 ID 83442 Category TCA 21 1010 Description Acreage Commercial Lot or Acreage 2.479 Total Value: This map is a user generated static output from an Internet mapping site and is for reference only. Data layers that appear on this map may or may not be accurate, current, or otherwise reliable. Value $148,740 $148,740 0 \N, MOWS M C) 0 0 0 P11 OD cam Mr ;u 0 m