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Home My WebLink AboutAPPLICATION - 17-00312 - 525 S Center St - BYUI - Hart Building - RemodelC IT Y OF REXBURG Americas Family community Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 COMMERCIAL TENANT IMPROVEMENT APPLICATION CHECKLIST The following items should be completed before you submit your building permit application. *Reasonable accommodations will be made upon request. Submit the Following Documents: ❑ 3 sets of building plans - stamped by a licensed professional. Include the following as applicable ❑ Foundation Plan, Floor Joist Layout, Floor Plan, Roof Layout, Truss Details, Sectional Views, Front, Back, and Side Elevations, Mechanical Layout Stair Details, and any details required to illustrate special construction. ❑ Electrical panel layout and calculations included with building plans. ❑ Exterior Lighting Plan including photometric layout. ❑ Structural Calculations (if applicable) - stamped by a licensed Engineer ❑ Digital Plans (PDF Format- can be submitted by USB, CD, or Dropbox) ❑ **Copies of any Contractors' State License if not on file already. Complete the Following Forms ❑ Permit Policies Acknowledgment signed ❑ Building Permit Application signed by a registered General Contractor ❑ Mechanical Permit Application signed by a registered Mechanical Contractor ❑ Electrical Permit Application signed by a licensed Electrical Contractor ❑ Plumbing Permit Application signed by a licensed Plumbing Contractor ❑ Fire Alarm Permit Application (if applicable) signed by a registered professional ❑ Fire Sprinkler Permit Application (if applicable) signed by a registered professional ❑ Subcontractor list filled out ❑ Affidavit of Legal Interest signed by owner ❑ Notifications Distribution List ❑ Business Use Summary Completed Subdivisions: If you plan to build in a subdivision please check the Rexburg Development Code for any requirements such as property setbacks, architecture board approval, etc. This information is available at http://rexburg.org/pages/development-code. Inspection Hotline -(208)372.2344 w .rexhurg.org Permit Technician -(208)372.2341 Revised 10/2016 CITY OF REXBURG tnt America's Family Community PERMIT POLICIES ACKNOWLEDGMENT Building Safety Department City of Rexburg 35 North 151 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 may 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 may be issued and the occupants may be evicted. Initials Scheduling 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. 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 to be removed in order to perform the electrical rough in inspection.) Construction on any project can begin ONLY when you have received a Pink Building Permit from the Building Department. Occupancy of any structure can begin ONLY when you have received an official Certificate of Occupancy from the Building Department. These documents must be signed by the appropriate authorities from the City of Rexburg. Any approvals can be verified by calling (208) 372-2341. - (t 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. nl[Id15 It is your responsibility to inform anyone on your project of the above policies. All sub -contractors will be held to this standard with no exceptions. o The above policies will be enforced to all, regardless if this information is passed on to thein or not. Initials Applicant's Name (print): M Ic [.J2;imm,/ Signature: Date: 6 6Ol % 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. I nspealon Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016 CITY OF j:XBURG' BUILDING PERMIT FORM 2 �2 Ow UpdrtN 10/2016 Americas Family Community BUILDING APPLICATION Commercial Tenant Improvement Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: Application Fee: ❑ $100 1. Property Owner Name: BHN 1 Address: City: State: Zip Code: Phone: Email: 2. Applicant Name: E41GNdr8L '(..J SMMwU Role: (Owner, Tenant, Contractor, etc.)0"t-It c,T Address: iSC PRCa IF -.c— AUe City: SALT Lffy& c\'r'( State: N T' Zip Code:. %4 1404-- P G Phone: F(01 4 LO l 2So Email: i�it �ttn%Aa1 B FF%c-ya. c40AA Contact/Rep. Name: 3. General Contractor Under Idaho Building Code, a registered contractor must do the work far a Commercial Building. Name: !%NLS LDA5D\A.�-�IIA� Registration#: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: General Contractor Authorized Signature: Date: A copy ofyourstate registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 4. Project Description Address: kA A 2T ��\LO\l?C� *1 Description of Work: jEAAPlA1T R -E -11.t ieD Project Description: • Total cost of project - materials and labor: $ 400, • Check all that apply: ❑ Mechanical: Cost $ ❑ Electrical: Cost $ ❑ Plumbing: Cost $ ❑ Fire Alarm: Cost $ ❑ Fire Sprinkler: Cost $ Note: Any contractors involved will need to fill out their respective application. • Change of Occupancy? l9<No ❑ Yes: New occupancy: Building Permitfees for commercial construction are charged based on square footage and the City's estimated valuation. The application fee applies toward the fee total. For details on Now fees are calculated, contact the Building Department. There will also be a plan reviewfee totaling 10%ofthe building permitfee. 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 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 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 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 ifwork stops for 180 days. 1 - / Applicant's Name (print): I�ILLY1hY �(BLNUA/.tNl Signature: Date: b/i 7 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 - (2 08) 372.2344 www.rexburg.org Permit Technician - (208) 3 72.2 341 CITY OF REXBURG tn� America's Pamfly Community Building Safety Department BUILDING PERMIT FORM 210 City of Rexburg 35 North 15t East BUILDING APPLICATION Commercial Mechanical Rexburg, Idaho 83440 For Office Use Permit Number: Mechanical Fees Paid ❑ 1. Property Owner Name: Address: City: State: Zip Code: Phone: Email: 2. Mechanical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Mechanical Contractor Authorized Signature: Date: A copy ofyour state registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: ❑ Project Cost: $ • Fees for commercial projects are charged by cost: 0 First$10,000 = 2% + $60. From $10,000 to$100,000=1%+$260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 total fee • There will also be a plan review fee totaling 10916 of the above fee. 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 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 of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void Root started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): Signature: Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 3 72.2 341 0.8xBUe ugae c�9� CITY OF ° REXBURG BUILDING PERMIT FORM 4 cW updatM 10/2016 Amanras Family Community BUILDING APPLICATION Commercial Electrical Building Safety Department City of Rexburg 35 North 15t East Rexburg, Idaho 83440 For Office Use Permit Number: Electrical Fees Paid ❑ 1. Property Owner Name: Address: City: State: Zip Code: Phone: Email: 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Electrical Contractor Authorized Signature: Date: A copy ofyour state registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: ❑ Project Cost: $ • Fees for commercial projects are charged by cost: 0 First $10,000 = 2% + $60. From $10,000 to $100,000 = 1 % + $260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 total • There will also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l hereby certify that l have read this application and state that the information herein N 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 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 Codein cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoidifrum started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): Signature: Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 CITY OF REXBURG tU+ Amenra's Family Community BUILDING PERMIT FORM 230 undated 10/2016 BUILDING APPLICATION Commercial Plumbing Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: Plumbing Fees Paid ❑ 1. Property Owner Name: Address: City: State: Zip Code: Phone: Email: 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work fora Commercial Building. Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Plumbing Contractor Authorized Signature: Date: - A copy ofyour state registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: ❑ Project Cost: $ • Feesfor commercial projects are charged by cost: 0 First$10,000 = 2% + $60. From $10,000 to$100,000=1%+$260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 +$50 = $310 total,feee • There will also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have read this application and state thatthe 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 of this application and hereby authorized representatives of the Cityto enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions ofthe 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): Signature: Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.urg Permit Technician - (2 08) 3 72.2 341 CITY OF REG BUILDING PERMIT FORM 4 01 Update rolxots America's Family Community BUILDING APPLICATION Fire Alarm Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: Fire Alarm Fees Paid ❑ 1. Property Owner Name: Address: City: State: Zip Code: Phone: Email: 2. Contractor Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Contractor Authorized Signature: Date: A copy ofyourstate registration/license is required to be on file. If this is the first time you have done. work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: ❑ Fire Alarm System Cost: $ • Fees forffre alarm systems are charge by cost: 0 First$10,000 = 2% + $60. From $10,000 to $100,000 = 1% + $260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 total ee • There will also be a plan review fee totaling 10% of the above fee. .APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and state that the information herein 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 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 permit on approval issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): Signature: Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 3 72.2 344 www.rexburg.org Permit Technician - (2 08) 372.2341 CITY OF RMURG tai Ameriwd Family Community BUILDING PERMIT FORM 4,02 Ureal a10/2016 BUILDING APPLICATION Fire Sprinkler Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: Fire Sprinkler Fees Paid ❑ 1. Property Owner Name: Address: City: State: Zip Code: Phone: Email: 2. Contractor Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Contractor Authorized Signature: Date: A copy ofyour state registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: Number of Heads: ❑ Fire Sprinkler System Cost: $ • Fees forge alarm systems are charge by cost: o First$10,000 = 2% + $60. From $10,000 to $100,000 = 196 + $260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1% of the remaining $5,000 = $260 + $50 = $310 total fee • There will also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and state that the information herein 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 withal] City regulations 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 permit on approval issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoidifnot started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): Signature: Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline - (2 08) 372.2344 www.rexburg.org Permit Technician - (2 08) 3 72.2 341 F4 4pE%BUgU'Q CITY OF REXBURG 135 AmsriwS Fammity Community Building Safety Department City of Rexburg North 1st East Rexburg, Idaho 83440 SUBCONTRACTOR LIST Excavation & Earthwork: Concrete: Masonry: Roofing: Insulation: Drywall: Painting: Floor Coverings: Plumbing: Heating: Electrical: Special Construction (Manufacturer or Supplier) Roof Trusses: Floor/Ceiling Joists: _ Siding/Exterior Trim: Other: Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016 CITY OF REXBURG CW - America's family Community Affidavit of Legal Interest State of Idaho County of Madison I, Name City Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) Address State Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 A. That I am the record owner of the property described on the attached, and 1 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 www.rexburg.org Permit Technician -(208)372.2341 Revised 10, 2016 C I T Y O F REXBURG America's Family Conammily DISTRIBUTION LIST Building Safety Department City of Rexburg 35 North Is' East Rexburg, Idaho 83440 Please provide the names and emails ofanyone who should begetting automated updates for this project: Review Notes Name: 25d1-0A05Gv1 Name: Ter r G LGrSrt� Name Inspection Tickets Name: Name: Name: Name: Name: Email:i�/�V1y�5OJ1L a 6Lkt . -G d L,- Email: i ctCSEV- I+ lotiu�+1 : cdLL Email: M (12 'now, Email: jowe G^ -v1 Email: Email: Email: Email: Email: Email: Inspection Hotline -(208)372.2344 www.rexburg.org Perm it Technician -(208)372.2341 Revised 10/2015 eae F,104 Mrd C IT Y OF REXBURG m America's Famfl Community BUSINESS USE SUMMARY Building Safety Department City of Rexburg 35 North ls' 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? Will the business be doing any structural/or remodeling changes to the building? Any changes to the electrical? Any changes to the plumbing? Any changes to the mechanical system? Is the business type changing? ❑ Yes, it will change to Is this business changing ownership? Is the business registered with the City of Rexburg? n Yes, License #: *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? Will there be any cooking of foods? Will there be any deep fat frying? Will you have food disposal on site? Will there be sumps or floor drains in the facility? Will the business have any chemicals on site? Applicants Signature Phone Date ;Zyes ❑ No Pies ❑ No ,aYes ❑ No e'Yes ❑ No ,Yes ❑3 No P,``c ❑ Yes. JKNo ❑ No ❑ Yes ❑ No n Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No I certify that the information that I have provided above is to the hest of my knowledge accurate and true. Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016