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Home My WebLink AboutAPPLICATIONS - 17-00799 - 485 N 2nd E #105 - The Hickory - Commercial Tenant Remodel0 '1 CITY OF REXBURG Lli+ Amerea's family Community BUILDING PERMIT FORM 202 updaW 1912016 BUILDING APPLICATION Commercial Tenant Improvement Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: /7-00719 Application Fee: ❑ $100 1. Property Owripp Name: AZ, Address:_City:_% ComState:ZipCode: Phone: 464 — ;36,C>=Z (l— 70O Email: r b 6,11 4f M t.166!.�Q 2. Applicant � -rte ,�� Name: /9M:! S '�%.�IS/a Role: Owner, Tenant, Contractor, etc.) �G tJfiA) Address: 3l �� .u, ?,ra �. City: State: Z-�_ Zip Code: 53'7,4c<6 Phone: 7_ o $1 — 3 -?9 - T'9 f j Email: Contact/Rep. Name: 3. General Contractor Under I o BuAA�E7� ode, a registered contractor must do the work for a Commercial B i ing. �e Name: (Exp.:s:. State: Zip Code: Email: ul �G/iLtGL' . (�/`J Contact/Rep. Name: �R 9M 1761MQ/ Phone: 3 fl - mail: 5 til E7 General Contractor Authorized Signatures \7�� Date: P -a ri` F7 A copy ofyourstate registration/license is required to be on file. If this is the first time you have done work in the CityofRexburg, 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 rr Address: y4,� Aj, Description of Work: r -Ala v t u Project Description: • Total cost of project - materials and labor: $ D t7 -o • Check all that apply: ❑ Mechanical: Cost $ 7DD1�� df� ❑ Electrical: Cost $ 49 dr) !") , oa ❑ Plumbing: Cost $ i60Z> r no ❑ Fire Alarm: Cost $ ❑ Fire Sprinkler: Cost $ Note: Any contractors involved will need to fill out their respective application. • Change of Occupancy? 13 No EYV es: New occupancy: Building Permit fees 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 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 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 he given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City 0 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 oZz�__Date: permit or approval was based. Permit void if not started within 180 days. Permitvoid if workstops for 180 days. Applicant's Name (print): 1) Gi D n/ D.t1 Signature: /Z 2711 Inspections must he called In before 8 AM on the day the Inspection is requested. Inspection re sts called in after 8 AM will be scheduled for the next business day. Inspection Hotline- (208) 372.2344 www.rexburg.org Permit Technician - (2 08) 3 72.2 341 1 F;O p6EB[rp�ly CITY OF REXBURG u M America's Famiiy Community BUILDING PERMIT FORM 210 uva.xa zo/zazs 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 ❑ 1. Property Owner e,0,4f/,;V5 spry, J(p0 e0, ;14 5 2D0 Name: 7 Ams �dLi rSTD J J %LGSCit p�� Address: 31 <P v City: e 2 State: 'rF,-> Zip Code: S'3z1 o Phone: i ;l 2. Mechanical Contractor Under Ida Building Code, a registered contractor must do the work for a Commercial Building. Business: e S ttate L'en e l35 / Exp.: %-2,0-1 Address: L(J CO A0 City: State: M Zip Code: Phone: C _ C Email: Contact/Rep. Name: lZeld Pho - maiL•V�lLPClF¢ 11 t Mechanical Contractor Authorized Signature: (:1� Dater A copy ofyourstate registration/license is required to be on file. If this is the first tirp you h ve 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: Z4115 A) , ` A) Description of work: ✓ Uo iJ/ i� /reg r 4h+;=4J=> &f6w )7— a'Project Cost: $ ' ZW 6 , oo • 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=.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 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 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 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 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 workstops for 180 days. Applicanfs Name (print): -;4 /. 4i to n/S 1 � Signature: O tai/ �— Date: Inspections must be called in before BAM 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.rexbmg.org Permit Technician - (208) 372.2341 CITY OF REXB V RG BUILDING PERMIT FORM22 0 CW updatttl 10/2016 Amental Family Community BUILDING APPLICATION Commercial Electrical Building Safety Department City of Rexburg 35 North 15Y East Rexburg, Idaho 83440 For Office Use Permit Number: Electrical Fees Paid ❑ 1. Property Owner 7 Name: '24w&GL Address: !31/, ,r) 2 r� �F City: fi�State: _X -1P Zip Code: Phone: 2O5-3md —S9// Email:— 2. Electrical Contractor Under Idaho Buildin de, a r gistered contractor must do the work for a Commercial Building. 401/ ZOO Business:CState License #: C ' 29 Exp.: Addres : Ua City: K r State: Zip Code: j Phone �� Ci //,, Email. t.JGT G%r/7� �/rCo�+ Contact/Rep. Name: 4 S PhonB:r oy %'fi73 - Y'✓<¢/1/ Email: C TiC J �Nx <o Electrical Contractor Authorized Signature:Datea 2Z Sl Z A copy ofyour state registration/license is required to be onFle. If thi 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 file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: 4.1,Q, -5 t7 i Description of work: 54 %/i e A/'`— Ir�-Pioject Cost: $ /_ lJ�r e • Feesforcommercialprojects are charged bycost: 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 1 % of the remaining $5,000 = $260 + $50 = 5310 total fee • There will also be a plan reviewfee totaling 10%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 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 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): �iY//h7n/ S o J Signature: Date: _ZIHI 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 - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 CITY OF RMURG CW - America's Family Community BUILDING PERMIT FORM 23 upeaca ra/zots 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: -0742e 5;�k7®�.-J Address: City: State: :�r--> Zip Code: c Phone: Email: ��A3!517 .w3 - 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: t 'NUMA1 J+4 -a State License #: L - 1// yG Exp.: Address: X01 Mgli'I �Jyn r4= City: State::�kf) ZipCode: 6C3 !2-0 Phone: lac- 6 Z- 'hlam_ Email: ud6 $2/NMhi" ??i (RD -R:ua,?, Contact/Rep. Name: ::G 4r� '12L SIEPhone: 20q^ Izy - 0111 / Email: barn &-14,ld* 4 Plumbing Contractor Authorized Signature: C /«l Date: _(2- 2T 17 A copy ofyour state registration/license is required to be on file' If this 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: U;�N, ��d✓�DL%s<��`� Description of work: 'L �• ❑ Project Cost: $ 940 F oo • 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 1 % of the remaining $5,000 = $260 + $50 = $310 toffee • There will also be a plan reviewfee totaling 10% 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 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:1� 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 nv Amerka5 Family Community BUILDING PERMIT FORM4 01 10/201611 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 for fire 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 becharged $260forthefirst$10,000and 1%ofthe remaining $5,000=$260+$50=$3$ t (O 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 l 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 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. 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 HAM will be scheduled for the next business day. Inspection Hotline - (288) 372.2344 www.rexburgorg Permit Technician - (288) 372.2341 CITY OF REXBURG r� America's Furdy Community BUILDING PERMIT FORM 402 npdaW 10/2016 BUILDING APPLICATION Fire Sprinkler Building Safety Department City of Rexburg 35 North 15L 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 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: Number of Heads: ❑ Fire Sprinkler System Cost: $ • Feesforffrealarm systems are charge bycost. 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 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certifythat l have read this application and state that he 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 betruthful and correct I agree m 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 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): Signature: 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,tOYBegc,v CITY OF REXBURG CW Amerioa' FamllyCommunity Excavation & Earthwork: Concrete: Masonry: Roofing: N /f Insulation: Drywall: Painting: 4PO4G Floor Coverings: -411 Plumbing: Heating: N A Electrical: Roof Trusses: Floor/Ceiling Joists: _ Siding/Exterior Trim: Other: SUBCONTRACTOR LIST t . 1/.. ch Special Construction (Manufacturer or Supplier) Building Safety Department City of Rexburg 35 North list East Rexburg, Idaho 83440 Inspection Hotline -(208)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised 10/2016 CITY OF RMURG OW America's Family Community Affidavit of Legal Interest State of Idaho County of Madison 1, ir�n,j�, W4 Name city Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 I � u W . 2"� 2D Address TD'd,k) State A. That I am the record owner of the property described on the attached, and I grant my permission to: e' 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 20 1-7 r Signature Subscribed and sworn to before me the day and year first above written. oUo —•-- ,.AUBUN F Residingat: w. ThMD My commission expires: 2-141 I -al Inspection Hotline -(20B)372.2344 wmv.rexburg.org Permit Technician -(208)372.2341 Revised 10, 2016 C I TY OF REXBURG tw Americas Family Community DISTRIBUTION LIST Building Safety Department City of Rexburg 35 North 151 East Rexburg, Idaho 83440 Please provide the names and emails of anyone who should begetting automated updates for this project: Review Notes � Name: /c "i / H 6f— Name: :Zln �2 Name: Ql _roM Name: Inspection Tickets Name: Name: Name: Name: Name: Email: Email: Email: Email: Email: Email: A671d461 G�/iY1�/ 4drJ U >. iJs(i Email: 4til$� f Email: u Email: Email: Inspedion Hotline -(208)372.2344 w .rexlmrg.org Permit Technician -(208)372.2341 Revised 10/2016 C I TY OF REXBURG Citi 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 the business registered with the City of Rexburg? Ves, License #: 3o 9 f D No *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? MX -es o No Is this business occupying an existing building? da"Yes D No Will there be any deep fat frying? s D No Will the business be doing any structural/or remodeling changes to the building?0-1 es o No Will you have food disposal on site? V4es D No Any changes to the electrical? es D No Will there be sumps or floor drains in the facility? aY es o No Any changes to the plumbing? W es D No Any changes to the mechanical sysem? es D No Is the business type changing? 04/es, it will change to%�9a(� P?P r✓ �L�� o No Is this business changing ownership? o Yes 041-0 Is the business registered with the City of Rexburg? Ves, License #: 3o 9 f D No *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? MX -es o No // �---- V4V)k1'7 r Applic n S' nature Phone Date I certify that the information that I have provided above is to the best of my knowledge accurate and true. Inspection Hotline -(200) 372.2344 w .rextmrg.org Permit Technician- (208) 372.2341 Revised March, 2016 Will there be any cooking of foods? es D No Will there be any deep fat frying? s D No Will you have food disposal on site? V4es D No Will there be sumps or floor drains in the facility? aY es o No Will the business have any chemicals on site? D Yes // �---- V4V)k1'7 r Applic n S' nature Phone Date I certify that the information that I have provided above is to the best of my knowledge accurate and true. Inspection Hotline -(200) 372.2344 w .rextmrg.org Permit Technician- (208) 372.2341 Revised March, 2016 r) Y pESBVAC CITY OF REXBURG r CW America'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: P/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 P-lermit 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 jVIPlumbing 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 VAffidavit of Legal Interest signed by owner g/Notifications Distribution List � tsusiness 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 hnp://rexburg.org/pages/development-code. Inspection Hotline -(206)372.2344 w .rexburg.org Permit Technician -(208)372.2341 Revised 10/2016 ♦„n en+o CITY OF RMURG CW Amerkan Family Community PERMIT POLICIES ACKNOWLEDGMENT 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 7 1 assessed and the project to be red tagged. If your project is red tagged, halting all construction, only a City this 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. Inhials 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 Ilan inspection is not done, the inspector may require any measures to be taken to allow him to correctly 7 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. IIo 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. Initiak 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. Initi/ak(( The above policies will be enforced to all, regardless if this information is passed on to them or not. Applicant's Name (print): Signature: Inspections must be called in before 8 AM on the day the inspection is requested. Inspe, Inspection Hotline -(208)372.2344 w .rexburg.org Date:Z% % 7 is next business day. Revised 10/2016