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HomeMy WebLinkAboutAPPLICATION - 17-00289 - Cedars Bldg B - Biomat BuildoutCITY OF REXBURG OW Amerrrtu's 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 �, F� �� Include the following as applicable -- See Sk2.Q.t � '� C%_ �r ❑ Foundation Plan, Floor Joist Layout, Floor Plan, Roof Layout, Truss Details, Sectional Views, Front, Back, acid Side Elevations, Mechanical Layout, Stair Details, and any details required to illustrate special construction. ❑ Electrical panel layout anti calculations included with building ,plans. ❑ Exterior Lighting Plan including photometric layout. ❑ Structural Calculations (if applicable) -stamped by a licensed Engineer X 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 littp:J/l�exbtu.g.org/pages/development-code. Inspection Hadiae - (208) 372.2344 %vxv%v.rexburg.arg Permit Technician - (246) 372.2341 Revised 10/2016 CITY Cr F REXBURG A,nerienk Family canumoeify BUILDING PERMIT FORM ord5red IC/2016 BUILDING APPLICATION Coinmercial Tenantlrnprovement Building Safety Department City of Rexburg 35 North 11t East Rexburg, Idaho 83440 Fiji- Office Use Permit Number: Application Fee: $100 1. Property Owner Name: RICHT %- Wei , H - MMIJOn C op -P. Address: 1 LLL) W L'ST Z Plat S'oUT H City:. RE)X f3 UR State: Zip Cade:. Lla _ Phone: tog 35b G1 �k2 Email: iS WAh brte? bt2LtP MKk;vt q Cr�Y tnnn 2. Applicant Name: (3I L!_ A(, r -A L- Role: (Owner, Tenant, Contractor, etc.) A Pop 1 Tccr Address: 10 � C W APE L 'D C, City: LAFAU E 71F State: LA Zip Code:�© 4)6 Phone: Email: gANT f� ACKA L ARC FIlTECTS • r -,OM Contact/Rep. Name: P,DA W l t'. H A MDGLA 3. General Contractor --r lj p Under Idaho Building Code, a registered contractor i'nust do the work for a Cominei-cial Building. Name: Registration H. FXp.: Address: City: State: Zip Code: Phone: Entail: Contact/Rep. Name: Phone: Email: General Contractor Authorized Signature; Date: A copy ofyour state registration/license is required to be on file. If this is the first tin€e 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. 4, Project Description Address: 155 wf'ST 2"°15nuTH , sui T E Blob, REl 5L)RC'I, IT]Ac t b 93111,16 Description of Work: A WEW TNT ERIpg TFNi N' ti ul L_DOUT Project Description: • Total cost of project - materials and labor: $ Z r r 6j?D alto ft ('-P)P) • Check all that apply: ❑ Mechanical: Cost $ Tb L ❑ Electrical: Cost $j,�. ❑ Plumbing: Cost $ljo ❑ Fire Alarm: Cost $._ rLD_a ❑ Fire Sprinkler: Cost $ TZ D Note: Any contractors involved will need to fill out their respective application. • Change of Occupancy? 0 No rl Yes: New occupancy: hL�21 a E SS Building Perrnitfees for coininercial construction are charged based oil square footage and the City's estiruated voluotion. The application fee applies toward the fee total, For details on how fees are calculated, contact the Building Department There will also he a plan review fee totaling 10% of the building pennit fee. APPLICANT'S SIGNA'T'URE, 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 betruthful and correct. I agree to comply with all City regulations and State latus 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 revolve a permit on approval issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation offact in the application or on the plans on which the permit or approval was based. Permit void if not started within 160 days. Permit void if work stops for 180 days. Applicant's Name (print): //.L CkA L- Signature: 4 C �f'1UN 1 Date: 05 � j7 Inspections must be called in before SAM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline -(208) 372.2344 %vww.rexburg.org Permit Technician -(208) 372.2341 CITY o F Building Safety Department „y REXBURCity of Rexburg v G 35 North 1s, East 0 AmericasFamifyCommunity Rexburg, Idaho 83440 BUSINESS USE SUMMARY The following questions will help speed the review process along. Please take the time to answer all of thein. Is this business occupying an existing building? []Yes ?XNo Will the business be doing any structural/or remodeling changes to the building? ❑ Yes jKNo Any changes to the electrical? ❑ Yes A No Any changes to the plumbing? ❑ Yes V No Any changes to the mechanical system? ❑ Yes N No Is the business type changing? ❑ Yes, it will change to :fO, No Is this business changing ownership? ❑ Yes ^No Is the business registered with the City of Rexburg? ❑ Yes, License #: l No *If No, please apply for a business license with the Customer Service Dept, Will the business have food preparations? ❑ Yes No Will there be any cooking of foods? ❑ Yes VNo Will there be any deep fat frying? ❑ Yes V No Will you have food disposal on site? ❑ Yes t No Will there be sumps or floor drains in the facility? [:]Yes No Will the business have any chemicals on site? ❑ Yes `) 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 - (2013) 372.2344 %vxvLv.rexhurg.org Permit Teclen'acian - (208) 372.2341 Revised March, 2016 ,jL C[TY 4F Building Safety Department 4 RE���� City of Rexburg �,,, 35 North Is' East ,a o Anrericas&milyCommun4y Rexburg, Idaho 83440 DISTRIBUTION LIST Please provide the names and emails of anyone who should he getting automated updates foci this project; Review Notes Name: PAW1 GFIANDPLA Name: ILL ALLAU Name:_JEN L -j LA N DR -1 Name Name: Inspection Tickets Name: Name: Name: Name: Name: Email: IZAN l Q-AGkAL--ARc.m aE06` (-0M Email: INN 2 ACKAL AR -04 11-E&75 - CO M Email: q FN LYP k-KALARLH T L (-e) M Email: Email: Email: Email: Email: Email: Email: Inspection Hotline — (208) 372.2344 www.rexburg.org Permit Technician — (208) 372.2341 Revised 10/2016 CITY OF lea XBURG CW America's Family community PERMIT POLICIES ACKNOWLEDGMENT Building Safety Department City of Rexburg 3S 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 he f " 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. a If 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. o If an inspection is not done, the inspector may require any pleasures to be taken to allow him to correctly n f 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 slieetrock 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. 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 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 them or not. Initials Applicant's Nanie (print): kVU, ,A t. Signature: Date: Inspections must be called in before HAM 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 10/2016 <e�a Building Safety Department U_r CITY OF n� �City of Rexburg ltEXBURG BUILDING PERMIT FORM 1Q uPaa«ta12016 35 North 1St East OW America's ra»trtyi„»t»tr»iry Rexburg, Idaho $3440 For Office Use Permit Number: 1. Property Owvmer Name: Address: Phone: 2. Mechanical Contractor BUILDING APPLICATION Commercial Mechanical City: State Email: Mechanical Fees Paid Zip Code: Under Idaho Building Code, a registered contractor must do the work far a Commercial Building. Business: State License #: Exp.: Address: Phone: Contact/Rep. Name: Mechanical Contractor Authorized Signature: City: Email: Phone: State: Zip Code: Email: Date: — A catty ofyour state registrationflicense is required to be on file. If this is the first tirneyou have done work inn the City of Rexburg, pi a.s : 1"ir)I I'l a Photo copy ofyour license. Ifyou are unsure ifyour license is on file, Please check with the Pennit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: ❑ Project Cost: $ • Fees for commercial projects are charged by cost: o First $10,000 = 2% + $60, Froin $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 10% of the above fee. 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 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 vofd 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 AAI will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 wwtv.reaburg.org Pennit Technician - (208) 372.2341 For Office Use Permit Number C I T Y O F R EXBURG .America`s Family Cbrnmunily 1. Property Owner. Name: Address: Phone: BUILDING PERMIT FORM ZZ� np6te� to/201G BUILDING APPLICATION Commercial Electrical City: Email: Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Electrical Fees Paid ❑ State: Zip Code. 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 of your state registration/license is rewired to be on file. If this is tine first thne you have clone work in the City of P,exbtirg, please provide a photo copy ofyorr license. if yarn are wisla-e ifyour license is on file, please check tvrth 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- o First $10,000 = 2% + $60. Franc $101000 to $100,000 =1 % + $260. Above $100,000 =.5910 +$1,160, i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 16/6 of the remaining $5,000 = $260 + $50 = $310 total fee • There will also be a plan review fee totaling 10Y66 of the above fee. 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 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 lases 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 clay the inspection is requested. Inspection requests called in after HAM will be scheduled for the nextbusiness day. Inspection Hotline - (20B) 372.2344 www.rexhurg.org Permit Technician - (208) 37'1.2341 {�,g4�CaUQG' e CITY O F Building Safety Department U 'i City of Rexburg ���.�G BUILDING PERMIT FORMZ3� updated 1012016 35 North Ist East Amerimrt Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Plumbing For Office Use Permit Number: Plumbing Fees Paid 13 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 for a 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 ori file. If this is the first time you have done work in the City of Rexburg, please provide a photo copy ofyour license. Ifyoa are insure i`fyoar license is ora fife, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: D 11rok t Cost: $ • Fees for coinrnercial projects are charged by cost: o First $10, 000 = 2 % + $60. Frons $10,000 to $100,000 =1 916 + $260. Above $100,000 = .5916 +$1,160. i.e. Work costing $15,000 will be charged $260 for the f rst $10,000 and I of the rentoining $5,000 = $260 + $50 =.$310 total fee • There will also be a plan review fee totaling 1040 of the above fee. 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 I swear that any information which may hereafter be given by mein hearings before the Pianning 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 1130 clays. 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) 3721344 cvtnv,rexburg.org Permit Technician - (208) 372.2341 CITY OF 1 WXBURG ow 13UILDING PERMIT FORM 4� 1 Updated 1D/2016 Building Safety Department City of Rexburg 35 North 1st East '+, w00 Ameocns Fntrnly Commrma(y Rexburg, Idaho 83440 BUILDING APPLICATION Fire Alarm For Office Use Permit Number; Fine 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 ofyour state registratiori/license is required to be on file. If this is the first tune you have done work in the City of Rexburg, please provide a photo copy of your license. If you are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 37Z-2341. 3. Project Description Address: Description of work: ❑ Fire Alarm System Cost: $ • Fees for fire alorfn systems are charge by cost. o First $10,000 = 2% + $60. Froin $10,000 to $100,000 = 1 Vo r $260. Above $100,000 = .5g'a +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1 % of the r. einuirling $5,000 = $.260 + $50 = 9310 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 I have read this application and state that the information herein correct and I swear that any information whfelt may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Con icil 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 Cade 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 Nalne (print]: Signature: Date: inspections must he 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 CW AenLriral FhmifyCommunity BUILDING PERMIT FORM 02► Ura=tFa to/zore BUILDING APPLICATION Fire Sprinkler Building Safety Department City of Rexburg 35 North 15t East Rexburg, Idaho 83440 For Office Use Permit Number: fire Sprinkler Fees Paid ❑ 1. Property 0[AFler Name. Address: City: State: Zip Code: Phone: Email: 2. Contractor Business: State License it: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep, Name: Phone: Email: Contractor Authorized Signature: Date: A copy ofyour-state recdistration/license is required to be ora file. ff this is the first time you have done work in the Cityof Rexburg, please provide a photo copy ofyour license. ifyou are unsure ifyour license is on file, please check with tire Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: Number of Heads: ❑ Fire Sprinkler System Cast: $ a Fees for fire alarm systems are charge by cost: o First $10,000 = 240 +$60. From $10,040 to $100,000 =1 % + $260, Above $100,000 = .540 +$1,160, i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 1 % of the reinairting $5,000 = $260 + $50 = .3310 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 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 sliall 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 pians on which the permit or approval was based. Permit void if nat 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 a AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 wwxv.rexburg.org Permit Technician - (208) 372.2341 CITY o F Building Safety Department US sCity of Rexburg ® REXBURG 35 North 15k East nv Americas Family Community Rexburg, Idaho 83440 SUBCONTRACTOR DIST 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 i lotline - (2.08) 372.2344 www.rexburg.org Permit'rechnician - (208) 372.2341 Revised 10/201b SL BEf Building Safety Department o crQ CITY OF City of Rexburg 3S North 1st hast Anurica' Family Community Rexburg, Idaho 83440 State of Idaho County of Madison 1, Name 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 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 .20 Signature Subscribed and sworn to before me the day and year first above written. Notary Public of Idaho Residing at: My commission expires: Inspection Hotline -- (2116) 372.2344 %vw%v.rexburg.org Permit Teclinician - (208) 372.2341 Revised 10, Z016