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Home My WebLink AboutAPPLICATIONS - 17-00627 - 426 S 2nd E - Student Health Center - RemodelCITY OF REXBURG ty Amerimi Family Community Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 COMMERCIAL REMODEL/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: m 3 sets of building plans - stamped by a licensed professional. Include the following as applicable ❑ Foundation Plan, Floor Joist Layout, Floor Plan, RoojLayout 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 O 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/122ggg/development-code. Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016 c IT Y Or REXBURG 0& Aruerica's Frunily (brnmunily PERMIT POLICIES ACKNOWLEDGMENT Building Safety Department City of Rexburg 35 North 1st East Rexburg. Idaho 83440 The Cityof 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 itlals 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. mtials 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 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 itials 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. 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. teals 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. nilials Applicant's Name (print): dedd A. Walker Signature: R �:8 ate: 08/28/2017 Inspections in ust 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 10/2016 CITY OF REXBURG cy Americas Family Community BUILDINGPERMITFORM 2�1 uomma,oizszs BUILDING APPLICATION Commercial Remodel 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: BYU-Idaho Address: 470 South Physical Plant Way City: Rexburg State: Idaho Zip Code: 83460 Phone: (208) 496-2663 Email: _walkerie by Ii- -d I 2. Applicant Name: BYU-Idaho Role: (Owner, Tenant, Contractor, etc.) Owner/Contractor Address: 470 South Physical Plant Wad City: Rexburq State: Idaho Zip Code: 83460 Phone: (208) 496-2663 Email: walker ieabyui edu Contact/Rep. Name: _Jedd A. Walker 3. General Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Name: BYU-Idaho Registration #: NA Exp.: Address: 470 South Physical Plant Wav City: _Rexburg State: Idaho Zip Code: _83460 Phone: (208) 496-2513 Email: reedio0byui edu Contact/Rep. Name: John Reed Phone(208) 496-251 Email- reedjo(5), ui edu General Contractor Authorized Signature: - 0 Date: 08/28/2017 A copy ofyour state registration/license is req Ube on file. /f this is the first time you have done work in the City of Rexburg, please provide a photocopy ofyour license. lfyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 4. Project Description Address: Student Health Center - 426 South 2nd East, Rexburg, Idhao 83460 Description of Work: SHC 2nd Floor Additional Offices - Reconstruct reception area & cons two additional offices Project Description: • Total cost of project - materials and labor: $_18,300 • Check all that apply: ® Mechanical: Cost $ 5,320 ® Electrical: Cost $ 11,931 ® Plumbing: Cost $ 1,020 ® Fire Alarm: Cost $ 1,000 ® Fire Sprinkler: Cost $ 3.998 Note: Any contractors involved will need to fill out their respective application. • Change of Occupancy? ® No Q Yes: New occupancy: Building Permit fees far 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 how fees are calculated, contact the Building Department. There will also be a plan review fee totaling 10% of the building permitfee. APPLICANT'S 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 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 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 provisionsofthe 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 180 days. Permit void ifwork stops for 180 days. Applicant's Name (print): Jedd A. Walker Signature:CLQ' a ///I te; 08/28/2017 Inspections must be called In before 8 AM on the day the inspection is requested. Inspectio r jests called In after 8 AM will be scheduled for the next business day. Inspection Hotline - (2013) 372.2344 www.mxburg.org Permit Technician - (208) 372.2341 C I TY OF REXBURG tiv Amental Family Community Building Safety Department BUILDING PERMIT FORM210 City of Rexburg °" 1'"012°" 35 North 1st East BUILDING APPLICATION Commercial Mechanical Rexburg, Idaho 83440 For Office Use Permit Number: Mechanical Fees Paid ❑ 1. Property Owner Name: BYU-Idaho Address: 470 South Phvsical Plant Wav city: Rexburg state: Idaho zip code: 83460 Phone: (208) 496-2663 Email: walkeriea vui.edu 2. Mechanical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: BYU-Idaho - Sam Merrick State License #: 006115 Exp,; 10/31/2018 Address: 470 South Physical Plant Way city: Rexburg State: Idaho zip code: 83460 Phone: (208) 496-2570 Email: merricksnabvuj edu Contact/Rep. Name: Sam Merrick Phone: 496-2570 Email: merricksAhivui.edu Mechanical Contractor Authorized Signature Date:08/28/2QJ A copy ofyour state registration/license is require tobean-le.Iftl'is theffrst timeyou have done work in the City of Rexburg, please provide a photocopy ofyour license. Ifyou are unsure ifyour license is on please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Student Health Center - 426 South 2nd East, Rexburg, Idhao 83460 Description of work: SHC 2nd Floor Additional Offices - Reconstruct reception area & cons two additional offices ❑ Project Cost: $ 5,320 e Feesfor commercial projects are charged by cost: o First $10,000 = 296 + $60. From $10,000 to $100,000 =1Yo + $260. Above $100,000 = .545 +$1,160. i.e. Work costing $15,000 will be charged$260for theffrst$10,000 and 1% of the remaining $5,000=$260+$50=ra totalf10 fpg e There will also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofper)ury, 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 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 offact 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): Jedd A. Walker Signature: .1441_ Date: 08/28/2017 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.rexburgurg Permit Technician - (208) 372.2341 oe pexeoec, CITY OF REXB V 1\V BUILDING PERMIT FORM 220 .t CWuna.ma to/ems AmeNrds ramily Community BUILDING APPLICATION Commercial Electrical Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Electrical Fees Paid ❑ 1. Property Owner Name: BYU-Idaho Address: 470 South Phvsical Plant Wav city: Rexburg state: Idaho Zip Code: 83460 Phone: (208) 496-2663 Email: walkerietftvui.edu 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work for a commercial Building. Business: BYU-Idaho -Steve Price State license #: ELE-1-10510 Exp.: Address: 470 South Phvsical Plant Way city: Rexburq State: Idaho Zip Code: 83460 _ Phone: (208) 496-2540 Email: prices aobvui.edu Contact/Rep. Name: Steve Price hone: 49 - 540 Email: prices(o)bVui.edu Electrical Contractor Authorized Signature: Date: 08/25/2017 A copy ofyour state registration license is required to Le 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: Student Health Center - 426 South 2nd East, Rexburg, Idhao 83460 Description of work: SHC 2nd Floor Additional Offices - Reconstruct reception area & cons two additional offices ❑Project Cost:$ 11,931 • Feesfor commercial projects are charged by cost- o 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 146 of the remaining $5,000 = $260 +$50 = $310 total reo • 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 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 Iagree 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): Jedd A. Walker Signature: a 6� Date: 08/28/2017 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.urg Permit Technician - (208) 372.2341 CITY OF REXBURG OW America's Family Community BUILDING PERMIT FORM 230 uemra m/zms 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: BYU-Idaho Address: 470 South Phvsical Plant Wav city: Rexburg State: Idaho zip code: 83460 Phone: (208) 496-2663 Email: walkedena bvui.edu 2. Plumbing contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: BYU-Idaho -Craig Forbush State License #: PLB-J-12382 Exp.: 6/30/2019 Address: 470 South Physical Plant Way city: Rexburg state: Idaho zipcode: 83460 Phone: (208) 496-2590 Email: forbushcja bvui edu Contact/Rep. Name: Craiq Forbush Phone: 496-2590 Email: forbushc(ailbvui.edu Plumbing Contractor Authorized Signature: Date: 08/28/2017 A copy ofyour state registration/license is require to be on (this is the first tun you have done work in the City of8exburg, 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: Student Health Center - 426 South 2nd East, Rexburg, Idhao 83460 Description of work: SHC 2nd Floor Additional Offices - Reconstruct reception area & cons two additional offices ❑ Project Cost: $ 1,020 • Feesfor commercial projects are charged by cost: o First $10,000 = 2916 + $60. From $10,000 to$100,000=1%+$260. Above $100,000=.535+$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 13o of the remaining $5,000 = $260 + $50 = 5310 tQtal fee • There will also be a plan review fee totaling 1036 of the above fee. APPLICANT'S 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 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 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 ofany false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoidifnot started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): Jedd A. Walker Signature: Q ate:08/28/2017 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 of cxooRc ,y �o CITY OF BUILDING PERMIT FORM 4 01 uvaare zo/zwc tm Amerf a' 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: BYU-Idaho Address: 470 South Physical Plant Way City: Rexburg State: Idaho Zip Code: 83460 Phone: (209) 496-2663 Email: walkerieta'�bvui edu 2. Contractor Business: BYU-Idaho - Thomas Moore State License #: Exp.: Address: 470 South Physical Plant Way City: Rexburg State: Idaho Zip Code: 83460 Phone: (208)496-3058 Email: moorQj&yui edu Contact/Rep. Name: Thomas Moore Phone: 496-3058 Email: mooret byu1 edu Contractor Authorized Signature: Date: 08/28/2017 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 photocopy ofyour license. Ifyou are unsure iyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Student Health Center - 426 South 2nd East, Rexburg, Idhao 83460 Description of work: SHC 2nd Floor Additional Offices - Reconstruct reception area & qQns. two additional offices. ❑ Fire Alarm System Cost: $ 1.000 • Feesforfire alarm systems are charge by cost: o First $10,000 = 246 + $60. From $10,000 to $100,000 =14'0 + $260. Above $100,000 =.5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first $10,000 and 146 of the remaining $5,000 = $260 + $50 = $310 totall f g • 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 l have read this application and state that the information herein correct and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall 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 ifnot started within 180 days. Permit void If work stops for 180 days. Applicant's Name (print): Jedd A. Walker Signature: �(iG• :�GL_Date: 08/28/2017 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 °a EE%e pBC, °�. •, 4 CITY OF °G BUILDING PERMIT FORMQ QZ undam 10/ams Amerim's Family Community BUILDING APPLICATION Fire Sprinkler Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: Fire Sprinkler Fees Paid El 1. Property Owner Name: BYU-Idaho Address: 470 South Physical Plant Way City: Rexburg State: Idaho Zip Code: 83460 Phone: (208) 496-2663 Email: walkerienabyui.edu 2. Contractor Business: 3-D Fire Protection State License #: Exp.: Address: 6312 South Burggraf Way City, Idaho Falls State:ldaho Zip Code: 83402 Phone: (208) 525-8377 Email:lamar@3dfire.com Contact/Rep. Name: Lamar Hayward Phone: (208) 525-8377 Email:lamar@3dfire.com Contractor Authorized Signature: Date: 08/28/2017 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 photocopy ofyour license. Ifyou are unsure ifyour license is on/i/e, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Student Health Center - 426 South 2nd East, Rexburg, Idhao 83460 Description of work: SHC 2nd Floor Additional Offices - Reconstruct reception area & cons two additional offices Number of Heads:9 ❑ Fire Sprinkler System Cost: $ 3,998 • Feesforffre alarm systems are charge by cost: o First $10,000 = 2% + $60. From $10,000 to $100,000 = 1% + $260. Above $100,000=.595+$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 f • There will also be a plan review fee totaling 1095 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 I swear that any Information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall he truthful and correct I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives ofthe City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a 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): Jedd A. Walker Signature: `��gate: 08/28/2017 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.rexburgorg Permit Technician - (208) 372.2341 R;o 4cleuaprs CITY OF REXBURG America's Fam Community SUBCONTRACTOR LIST Excavation & Earthwork: N/A Concrete: N/A Masonry: N/A Roofing: N/A Insulation: BYU-Idaho -Carpentry Services Drywall: BYU-Idaho - Carpentry Services Painting: BYU-Idaho - Auxiliary Maintenance Services Floor Coverings: BYU-Idaho - Maintenance Services Plumbing: BYU-Idaho - Mechanical Operations Services Heating: BYU-Idaho - Electrical: Services Electrical Services Special Construction (Manufacturer or Supplier) Roof Trusses: N/A Floor/Ceiling Joists: N/A Siding/Exterior Trim: N/A Building Safety Department City of Rexburg 35 North 15t East Rexburg, Idaho 83440 Other: Fire Alarm - BYU-Idaho - University Security & Safety; Fire Sprinklers - 3-D Fire Protection Inspectlon Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016 ptiXa q CITY OF REXBURG America's Family Community DISTRIBUTION LIST Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Please provide the names and emails of anyone who should begetting automated updates for this project.- Review roject: Review Notes Name: David Gay Name: e -Builder Name: Name: Name: Inspection Tickets Name: John Reed Name: e -Builder Name: Name: Name: Email: 9ayf@byui.edu Email: SHC 2nd Floor Additional Offices.A - Inbox docs.e-builder.net Email: Email: Email: Email: reedjo@byui.edu Email: SHC-2nd—Floor—Additional—Offices.A---lnbox@docs.e-builder.net Email: Email: Email: Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016 FjoQ }pxeup� o CITY OF REXBURG cil America's Family Community BUSINESS USE SUMMARY Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 The following questions will help speed the review process along. Please take the time to answer all of them. Is this business occupying an existing building? ® Yes O No Will the business be doing any structural/or remodeling changes to the building? ® Yes ❑ No Any changes to the electrical? m Yes ❑ No Any changes to the plumbing? ® Yes ❑ No Any changes to the mechanical system? ® Yes 17 No Is the business type changing? ❑ Yes, it will change to ®No Is this business changing ownership? p Yes ONO Is the business registered with the City of Rexburg? m Yes, License #: O No *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? U Yes 0 No Will there be any cooking of foods? ❑ Yes ®No Will there be any deep fat frying? O Yes ®No Will you have food disposal on site? O Yes ® No Will there be sumps or floor drains in the facility? O Yes ®No Will the business have any chemicals on site? O Yes ®No Signature 18) 496-2663 08/28/2017 Phone Date I certify that the information that I have provided above is to the best of my knowledge accurate and true. Inspection Hotline -(208)372.2344 w .rexhurg.org Permit Technician -(208)372.2341 Revised March, 2016 AFFIDAVIT OF LEGAL INTEREST State of Idaho ) ss. County of Madison The undersigned, being first duly sworn, deposes and says: A. that he is the authorized representative of Brigham Young University — Idaho (the "University") for the purpose of submitting the attached application (the "Application') including the making of this Affidavit; B. that the University is the record owner of the property described in the Application; and, C. that the University agrees 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 in this Affidavit or as to the ownership of the Property which is the subject of the Application. Dated: Tuesday, Aug. 29, 2017 Subscribed and sworn to before me the day and year 2e N. H okay oc .... o NOTARY'; k PUBLIC OF I na Notary Public l Residing at: 0 ONIJAV My commission expires: g