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Home My WebLink AboutAPPLICATION - 17-00309 - 525 S Center St - BYUI - Austin Bldg RemodelOa gEXBURC �o CITY OF 'o XB m ^ T ,- Submit By Email ., l�jljS lJ ltlj (14 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: 17-06101 Permit Type: ❑ New J6 Remodel ❑ Addition DepositAmount: ❑ $1000 New Const. O $250 Additionx$100 Other Deposit Included with Application: J0 Yes ❑ No 1. Property Owner Name: BYU-Idaho Address: 525s. Center St. City: Rexburg State: ID Zip Code: 63440 Phone& Type: 208-496-1000 0Office ❑Mobile Email: Under Idaho Building Code, a contractor must do the work for a Commercial Building. 2. Applicant Name: Big -D Construction corp. Role: (Owner, Tenant, Contractor, etc.) contractor Address: 1788 West 200 North City; Lindon State: UT Zip Code: 84042 Phone & Type: 801-673-5953 ❑ Office 0 Mobile Email: andrew.wolford@big-d.com Contact/Rep. Name: Andrew Wolford Phone: 801-673-5953 Email: andrew.wolford@big-d.com 3. General Contractor Name: Big-DConstruction Corp. Registration#: fIC.£ Exp.: Iz—Z$•Zvl7 Address: 1788 West 200 North City: Lindon State: DT Zip Code: 84042 Phone & Type: 801-769-7300 p Office [3 Mobile Email: andrew.wolford@big-d.com Contact/Rep. Name: Andrew Wolford PI 801-673-5953 Email: andrew.wolford@big-d.com jl�General Contractor Authorized Signatures Date: 6-2-2017 4. Project Description Address: 525S. Center St. OR- Lot #: _ Block th _ Subdivision: Type of work: Check one: E3 New Construction 0 Remodel* ❑Addition* Check all that apply: 0 Framing 0 Mechanical 0 Plumbing O Electrical NOTE: Any sub -contractors Involved will need to submit their own signed applications. Description of work: Remodel classroom building, and upgrade mechanical, electrical, and fire sprinkler systems. *Total cost of project - materials and labor: $ 4,662,00 (used to calculate permit fees) If Of Buildings: 1 Building 1: _Units 63,300 sq. ft Building 2: _Units sq. ft. Building 3: _Units sq. ft. Additional Buildings: Utility, Misc, Private Garage: sq. It Storage: sq. ft APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, Ihereby 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. 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 permiton 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): Andrew Wolford Signature: Date: 6-2-2017 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.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 C IT Y OF REXBURG cW America's Family Community Submit By Email Permit Policies Acknowledgement Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 The City of Rexburg Building Safety Department is determined to provide excellent customer service. In an effort to help you understand the City of Rexburg Permit Policies, listed below are several policies which you are required to know prior to proceeding with your project Any construction within the City of Rexburg which requires a permit shall not begin until an approved permit is obtained. If you do not have a pink building permit signed by the Building Inspector, then you do not have an approved permit. 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. 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. o If an inspection is not done, the inspector may require any measures to be taken to allow him to correctly perform the inspection. (Example: If the electrical rough in inspection is not done and the sheetrock has been Initials put up, the inspector may require the sheetrock be removed in order to perform the electrical rough in inspection.) Any approval for Certificate of Occupancies and Building Permits is only verified through the Permit Technician. If an inspector says something like "You're good to go", understand that you still need to receive all relevant documentation from the Permit Technician before you are truly good to go. o Even if you hear from an inspector that'you're good to go', ultimately if you do not have a Building Permit or Certificate of Occupancy, the above policies will be enforced. 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. The above policies will be enforced to all, regardless if you pass this information on to them or not. I tirtf aK Applicant's Name (print): Andrew Wolford Signature: Date: 6-2-2017 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 Perm it Technician -(208)372.2341 Revised March, 2016 W CITY OF REXBURG ry drnerirui Fnnily Community BUILDING PERMIT FORM 21� u,d.na 10/2016 BUILDING APPLICATION Commercial Mechanical Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Mechanical Fees Paid ❑ L Property Owner Name: BYU-Idaho Address: 525 5; Centpr city: Rexburg State: Idaho Zip Code: 83460 Phone: _20.8 496 1411 Email: 2. Mechanical Contractor Under Idaho ButldingCode, a re�Istered contractor must do the work for a Commercial Building. Business: _I_eWIS C;OrpOrailon StateLicenseit: HVC-C-4440 Exp.:_ 5-31-19 Address: X�55136 W Hunziker Rd City: Chubbuck State: Idaho Zip Code: 83202 Phone: Li7�•238. 0 Email: Kenyan Icorp.com Contact/Rep. Name: Kenyan Lewis Pho;;t 8.238.1202 Email: kPnyan Innrn rnm Mechanical Contractor Authorized Sign re: Date:_�'30 •L-1 A copy ofyour state registration/license is equired to n file. If this is the first timeyou have done work in the City of Rexburg, please provide a photocopy ofyaur license. If you are un re if your cense is on fie, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Austin Building BYU-1 Rexburg Description of work: n(�f RNP MgChanirnl 13 ProjectCost: $ 918.000.00 B Feesfor commercial projects are charged by cost o First $10,000 = 246 + $60. From $10,000 to $100,000 =196 + $260. Above $100,000 =.595 +$1,160. t e. Work costing $15,000 will be charged $260 for the first $10,000 and 196 of the remaining $5,000 = $260 + $50 = $310 total fee B There will also be a plan review fee totaling 10966 of the abovefee. APPLICANTS 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 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 tithe 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 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 180 days. Permit void if work stops for 180 days. Applicant's Name (print): �it'x� o.,� L. :> Signature: Date: Inspections must be called In before 0 AM on the day the Inspection Is requested. Inspection requests called in alter 0 AM will be scheduled for the next business day. Inspection Hotline -(200)372.2344 www.rexburg.org Permit Technician (208)372.2311 CITY OF RMURG Ameriofs Pmrufy Community BUILDING PERMIT FORMZ 1 O UpNUL to/]Ota BUILDING APPLICATION Commercial Mechanical Building Safety Department City of Rexburg 35 North SM East Rexburg, Idaho 83440 For Office Use Permit Number: Mechanical Fees Paid 0 1. Property Owner Name: BYU-Idaho 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: Bingham Mechanical, Inc. State License #: HVC-C-2701 Exp.: 9/30/17 Address: 4400 S Yellowstone Hwy City: Idaho Falls State: ID Zip Code: 83402 Phone: 208-522-4484 Email: jasonolson@binghammechanical.com Contact/Rep. Name: Jason Olson p ne. 8-.522-4484 Email: tasonolson@binghammechanical.c Mechanical Contractor Authorize dS(gnatu Date: 5/30117 A copy ofyourstate registrationgicenre it required to onflle.lfthiststhejlrst tlmeyou have done work in the CityofRexburg, please provide a photo copy ofyour license. lfyou are unsure if your license is on file, please check with the permit Technician by calling (108) 372.2341. 3. Project Description Address: BYU-1 Austin Bldg Description of work: HVAC Improvements/Remodel - .43ICC *,k aa�oa �c (3 Project Cost: $ 249,000.00 e Feer for commercial projects are charged by cosh o Flrst$10,000=2%+S60. From $10,000to$100.000=1%+5260.Above$100,000=.5%+51,160. Le.Workcoshng $15,000 will be charged$260 for the flmt$10,000 and 1% of the remaining $5,000 = $260+ $50 = S310 total fee e There will also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury. therebycertify 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 tothe subject matter of this application and hereby authorized representatives of the City to enterupon the above-mentioned property for inspections purposes. NOTE: Thebuilding ofIcial may revoke a permit on approval issued under the provisions ofthe 2%2 International Code In cases of any false statement or misrepresentation of fact in the application or onthe 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): Jason Olson Signatur 7--r—_ Date: 5130117 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 Hotiine- (208) 3721344 www.rcaburgmg Permit Technician - (2081372.2341 r CITY O P e RMURG cyr Mrerkai FaniNy Community BUILDING PERMIT FORM230 upd,rce 10/rola 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 0 1. Property Owner Name: BYU-Idaho Address: City: State: Zip Code: _ Phone: Email: 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work far a Commercial Building. Business: Bingham Mechanical, Inc. State License #: PLB-C-10702 Exp.: 9/30117 Address: 4400 S Yellowstone Hwy City: Idaho Falls State: ID Zip Code: 83402 Phone: 208-522-4484matt: lasonoison@binghammechanical.com Contact/Rep. Name: Jason Olson n8-522-4484 Email: lasonolson@binghammechanical.c Plumbing Contractor Authorized Signature. l Date; 5/30117 A copy ofyaur state registration/license is requ/red t eon e.Ifthis Isthefirst timeyou have done work in the City o% Rexburg, please provide a photo copyofyoorlicense.Ifyouareunsureifyot license ison/11e,pleisecheckwiththePermitTechnicianbycalling(208)372-2341. 3. Project Description Address: BYU-1 Austin Bldg Description of work: Plumbing Impovement/Remodei 0 Project Cost: $ 72.200.00 e Fees for commercial projects are charged by cost o First$10,000 = 2% + $60. From $10,000 to$100,000=1%+$260. Above $100,000=.5%+51,160. Le. Work costing $15,000 will be charged $260 for the first $10,000 and 196 of the remaining $5,000 = $160 + $50 = $310 total IS e There will also be a plan review fee totaling 10% of the above fee. APPLICANTS SIGNATURE. CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, Ihereby 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 orthe 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 Nis application and herebyauthorized representatives of the City to enter upon theabove-mentioned property for Inspections purposes. NOTE: The bulldingoainal may revoke a permit on approval issued under the provisions ofthe 2012 International Cade in cases of any false statement or misrepresentation of fan In the application or on the plans on which the permit or approval was based. Permitvoldifnot startedvnNlnlgOdays.Permitvoid ifwork stops for 180 days. ll i1 Applicant's Name (print): Date: 5/30/17 Inspections must be called in before SAM on the day the inspection is requested. Inspection requests called in after a AN will be scheduled for the next business day. Inspection Hotline -(208) 372.2344 www.rexburgurg Permit Technician -(208) 372.2341 nT� r�CITY nTo F Building Safety Department 1�leL� I7 V RG BUILDING PERMIT FORM Z 2 City of Rexburg C%W° °°°° 35 North 1°t East Amenca"s Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Electrical For Office Use Permit Number: Electrical Fees Paid ❑ 1. Property Owner Name: BVU-idaho Address: 525 S. Center St. City: Rexburg State: to Zip Code: 83460 Phone: Email: 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: Mountain west Electric. Inc. State License #: ELE-C-3802 Exp„ 12131117 Address: 586 west Highway 26 x1 City: Blackfoot State: ID Zip Code: 83221 Phone: 208-684-5463 Email: dbrown0nanwestelec.com Contact/Rep. Name: Dan Beck Phone: 208681.8460 Email: dbeck@minweslelec.com Electrical Contractor Authorized Signature: �///r Date: 612J17 A copy ofyour state registration/license is required to be on file. If this is thef rst timeyou have done work In the city of Rexburg, please provide a photocopy 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: 525 S. Center St., Rexburg Description of work: Electrical Remodel ❑ Project Cost: $ 287.700 • Fees forcommercial projects are charged by cost o First$10,000=2%+$60.From $10,000to$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 = $7�ttl fe It There will also be a plan review fee totaling 10% of the above fee. APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, l 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 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 afthe 2012 International Code in cases of any false statementor misrepresentation of fact in the application oron the plans on which the permleor approval was based. Permitmidifnot started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): Chad Fields Signature: Date: 612117 Inspections must be called in before 8 AM on the day the Inspection is requested. Inspection requests called in alter a AM will be scheduled for the next business day. Inspection Hotline - (288) 372.2344 www.rexburg.org Permit Technician -(208) 372.2341 (0 CITY OF RMURG (ue--- -- Areerfrai F.Of Onon.niry BUILDING PERMIT FOReM 901 BUILDING APPLICATION Fire Alarin Building Safety Department City of Rexburg 35 North tat East Rexburg, Idaho 83440 For Office Use Permit Number: Fire Alarm Fees Paid 0 1. Property Owner Name: avuadeho Address: 5255. Center St. City: Rexburg State: to Zip Code: 03460 Phone: Email: 2. Contractor Business: Nelson Fire systems State License #: 1r1 n • CC) ScILA Exp.: Address: 1481 South Malm Street City: Sail Lake City State: UT Zip Code: 84115 Phone: 801.46"300 Email: Contact/Rep. Name: Marisa Taylor��ii Phone: 801.468-8300 Email: medsa®nelson8m re.to Contractor Authorized Signature; ,J ! �41'LL%,ad len Date:\ D% Acopy afyourstateregistration/licenseisrquire file.If this isthefirsttimeyouhave done work In the City ofRexburg, please provide a photocopy ofyour license. Ifyou are unsure tfyour license is on file, please check with the Permit Technician by calling (208) 372.2341. 3. Project Description Address: 525 S. Center St., Rexburg Description of work: Fire Alarm -Level 2 a3 O Fire Alarm System Cost $ 35.000 • Feesforfirealarm systems are charge bycost.- o First $10,,000=1%+$60. From $10,000 to $100,000 = 1% + $260. Above $100,000=.5%+51,160. Le. Work costing $15,000 will be charged $260 for the first $10,000 and I% of the remaining $5,000 = $260 + $50 = $310 total fee • There will also be a plan review fee totaling 10% of the above fee. APPLICANTS 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 he given by me In hearings before the Planningand Zoning Commission or the City council for the City of Rexburg shall he truthful and correct. 1 agree to comply with ail City regulations and State taws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentlaned property for Inspections purposes. NOTE: The building official may revoke a permit on approval Issued under the provisions of the 2012 1 tematiunal Code in cases of any false statement or misrepresentation or fact lit the application or on the plans an which the permit or approval was based. Permit void if not started within 180 days. Permit void If work stops for 100 days. Applicant's Name (print): Wygk Signature: Y/�.��(,} ! Date: Inspections must be called In before 8 AM on the day the inspection Is requested. Inspection requests called In after a AM will be scheduled for the neat business day. Inspection Umline- (288) 372.2344 www.rexbureorg Permlt Technician - (208) 372.2341 OE 0.E%9 UqC CITY OF REXBURG AmerW Family Community Submit By Email BUILDING APPLICATION Fire Sprinkler Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: Permit approved: ❑ Yes ❑ No Fees Paid: ❑ Yes ❑ No 1. Applicant Business Name: Office Address: City: Rexburg State: ID Zip Code: 83440 Office Phone: Contact Person: Cell Phone: 801-673-5953 Contractor's Authorized Signature: Date: 6-2-2017 License/Registration # Expiration: 2. Location of Work to be Done Street Address: City: State: Zip Code: Business Name: Contact/Rep. Name: Andrew Wolford Phone: 801-673-5953 ❑Office❑Cell Phone Email: andrew.wolford@big-d.com 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 = $65 APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein correct and 1 swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives ofthe City to enter upon the above.mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void lfwork stops for 180 days. Applicant's Name (print): Andrew Wolford Signature: Date: 6-2-2017 Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 C I TY OF REXBURG Ob Amerlca3 Family Community Excavation & Earthwork: Concrete: 7F-st> Masonry: -r&p Roofing: 'T= Insulation: TgLL Drywall: TT&V Painting:-T-C31Z_ Floor Coverings: Building Safety Department Submit By Email City of Rexburg 35 North 1St East Rexburg, Idaho 83440 Subcontractor List Plumbing: / /,c%h&4A7 /!%ECNh1lCdlf — Heating: ZSWI$ C Electrical: t?1Pi1^MAJ iW4rr f` Fer7A1 L Roof Trusses: N/A Floor/Ceiling Joists: Siding/Exterior Trim: Other: ,,v /A Al /4 Special Construction (Manufacturer or Supplier) Inspection Hotline -(208)372.2344 ..rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 O a 0 O z E W2 z ra m F r LU FM Q H LL O O Q O T O � 3 3 j07 « N L L O OI Wy O W @ > W L N Q =Z <6 O¢ O U 4] W o @ d li Q N m CCSLu _ C G U O } X J O z 4H @ O @ � a 0 1.0 @ W c H U t Z O - . _" p _ ________..... __ --------- Bureau ofUccif a itinarucehses _."_.erre Your registration _."erre_., __ ------- Bureau of accupational licenses Department of Self Governing Agencies must be shown on Department of Self Governing Agencies The person named has mel the requirememsforregistretion and is The person named has met the requirements for registration and le entitled under the laws and rule. of the State of Idaho to operate as air) demand. entitled under the laws and ndes of the State of Idaho to operate as sin) REGISTERED ENTITY CONTRACTOR REGISTERED ENTITY CONTRACTOR BIG D CONSTRUCTION CORP carry this copy BIG D CONSTRUCTION CORP JACK LIVINGOOD, ET AL JACK LIVINGOOD, ET AL 404 W 400 S 404 W 400 S SALT LAKE CITY UT 84101 SALT LAKE CITY UT 84101 display this copy - /.", c -V, Tana Cory RCE -4761 12/2812017 Tana Cory RCE4761 12128/2017 Chief, B.O.L. Number Expires Chief, B.O.L. Number Expires 11/30/2010 BIG D CONSTRUCTION CORP JACK LIVINGOOD, ET AL 404 W 400 S SALT LAKE CITY UT 84101 Ilivergood 1 C I TY OF REXBURG OW Americas Family Community State of Idaho County of Madison 1, Name Building Safety Department Submit By Email City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Affidavit of Legal Interest Address 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 1 grant my permission to: Name Address to submit the accompanying application pertaining to that property. B. 1 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 rexhurg.org Permit Technician -(208)372.2341 Revised March, 2016 C I TY OF Building Safety Department REXBURG Submit By Email City of Rexburg Ob 35 North 1st East Amenw's Family Community Rexburg, Idaho 83440 Property Lines Each site plan that is submitted to the City of Rexburg for the Building Permit process requires that property lines are shown accurately. It is the Developer's responsibility to correctly identify on the site plan the location of these lines in reference to the public right-of-way, other adjoining property lines, the street, other structures and all utility lines. The Developer should find property pins that are still available at the lot in question. If these pins do not exist or have become unrecognizable then a new survey should be performed. Accurate property line information is a must for a timely review. In addition to finding existing property pins, legal descriptions should be checked. The best way to identify property line location is with a land survey. The City of Rexburg has aerial photos and a parcel line layer that can be checked, but they are only a tool and are not guaranteed for accuracy. If you want to request a copy of your lot, see the front counter at the Community Development Department. I have read and understand the above requirements. Signature/' Andrew Wolford Printed Name `- 2,Zor� Date Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016 0 C I TY Of 77EXB Tn (ti Submit By Email 1\P.L�1W71J\l7 Ameriml Rrmify Community BUILDING APPLICATION Fire Sprinkler Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: Permit approved: ❑ Yes ❑ No Fees Paid: ❑ Yes ❑ No 1. Applicant Business Name: �p�lai_ ✓� 4,1,�Fe�.gln. 6bc, 3-1) T:tRe Froiee}-U^ 83405 Office Address: Po Pr„< 50945 City: + G' 1 State: ID Zip Code: 99449 Office Phone: IDA • GA -5-A.-5-7-7 Contact Perso : _ M a �(l� Cell Phone: Hal -673=5953 Contractor's Authorized Signature: _ Date: 6-2-2017 License/Registration # t:j 000n Expiration: 2. Location of Work to be Done Street Address: City: State: Zip Code: Business Name: Contact/Rep. Name: Andrewwolford phone: 801.673.5953 fl Office []Cell Phone Email: andrew.wolford@big-d.com 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: 503 ❑Existing Inspection Base = $65 ❑Plan Review = 10% of Contracted Amount ❑Re -Inspection = $65 APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, l hereby certify that have read this application and state that the information herein correct and 1 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 matterofthis application and hereby authorised representatives ofthe City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions ofthe 2012 International Code in cases ofany false statement or misrepresentation of tact in the application or on the plans on whichthe permit or approval was based. Permit void if not started within 180 days. Permit void ifworkstups for 180 days. Applicants Name (print): 1-4 n1 ar l 4,4 Signature: Date: / Inspections must be caned in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 A will be scheduled for the next business day. Inspection Hotline -(208)372.2344 www.mxburg.org Permit Technician -(208)372.2341 Revised March. 2016 CITY OF Building Safety Department a o 1 EXB V G Submit ey Email City of Rexburg CW- 3S North 1st East AmenmS Family Commwiry Rexburg, Idaho 83440 Affidavit of Legal Interest State of Idaho County of Madison 1. SULbN Name Address Rexburg city Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) 6 DA4-4o State A. That 1 am the record owner of the property described on the attached, and I grant my permission to: 40h w asr 4m 501)rrt Name Address Sk1--T UT ge -lo l 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 17-t-" day of %'l.Ll . 20 1 -Snat e Subscribed and sworn to before me the day and year first above written. Residing at: My commission expires: J4 'JO j') Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised March, 2016