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Home My WebLink AboutAPPLICATIONS 2 - 18-00278 - 1480 N 2nd E, Suite 100 - Go Wireless - Tenant FinishC O F Building Safety Department vA7 'S REXBURG BUILDING PERMIT FORM 2 02 City of Rexburg ,7 Updated 10/2016 35 North 1St East America's family Community Rexburg, Idaho 83440 For Office Use Permit Number: t� 00 �- 1. Property Owner . Name: Address:.. Phone: BUILDING APPLICATION Commercial Tenant Improvement Application Fee:,!$ $100 �� I State:_ Zip Code: Email: - 2. Applicant /I ��,�,,,, Name: �� (:; �;;1��, ILC`hERole: (Owner, Tenant, Contractor, etc.) i Address: i t) GC r1 a tea. -I City: C"At la. State: ZI Code: Phone: 0 �Z Email:— P Contact/Rep. Name: 3. General Contractor Under Idaho Building Code, a registered contractor, must do the work for a Commercial Building. Name: iall�ti`�IQN �� /�I ISfiri (�r��r1 u� o'ti c �l — - l eglstration #: � �% % Exp.: ?1 Address: u M 2 p �� ll�_ �=-Ciry: -�{i'- State: .t�a-� Zi Code: Phone: '1 - Qi � Z Email: L,iaukj':�'L C-s-/Vlcti Contact/Rep. Name: _ter Phone: Email: General Contractor Authorized Signature: _.4 copy fy 9 q Date: A co 0 our state re istratiml license is re wren -t8 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. Address: (� Description of Work: S Project Description: r I • Total cost of project - materials and labor: $ pQ , e v • Check all that apply: ❑ Mechanical: Cost $ (ob ❑ Electrical: Cost $ 6U 6 Plumbing: Cost $ 3 st c cc. ❑ Fire Alarm: Cost ❑ Fire Sprinkler: Cost $p-4'_ Note: Any contractors involved will need to fill out their respective application. • Change of Occupancy? ❑ No ❑ Yes: ew occu _a`n : 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 permit fee. atives herein is correct and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application aRexburg nd hereby authorized representor the City Council for the City of Rexburg 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 t the s of t he 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): AeN B Signature Date: Inspections must be called in before 8 AM on the day the inspection is requested. Ins n 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 �FRtxsaRc CITY O F Building Safety Department ro REXBURG BUILDING PERMIT FORM 210 City of Rexburg 7 Ohl Updated 10/2015 35 North 1St East America's Family Community eo Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Mechanical For Office List. Permit Number: Mechanical Fees Paid ❑ 1. Property Owner Name: l-9— Address: l q9t, tJ State: _Zip Code: Phone: Email: 2. Mechanical Contractor Under Idah Building Codl, a registered contr¢Ftor ust do the work for a Commercial Building. Business: �1�5 ��<cmc_- State LExp.:Address: C a 1 City: State: Zi Code: Phone: Lc e 'S - -7 �C p - -• Email' Contact/Rep. Name: Phone: Email: Mechanical Contractor Authorized Signature: Date: A copy ofyour state registration/license is required to be on file. If this i e fast 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 Descrj tion Address: I Description of work: VC( L ❑ Project Cost: $ Lf C, • Fees for commercial projects are charged by cost: 0 First $10,000 = 2% + $60. From $10,000 to $100,000 =1 % + $260. Above $100,000 = .5% +$1,160. i.e. Work costing $15,000 will be charged $260 for the frst$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 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 ahove-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): /%n -&a /a it`P 5 Q i1 Signature: k 'moi — Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 4fxBE%? C I TY OF Building Safety Department U� REXBURGBUILDING PERMIT FORM 2 00 City of Rexburg OW -____ Updated 3012016 _ Americn's Family Cnmmuntity 35 North 1St East Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Plumbing Permit Number: Plumbing Fees Paid ❑ 1. t t vtwt �y vvvtiw Name. Address: G City: Vn State Zip Code: Phone: Email: Under Idaho Building Code, a registered contractpr must do the work for a Commercial Building. Business: vn.A--X� L lv✓ '4 C �S-' - State License #: _ 1'2,11 Exp.: Address: r' State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Plumbing Contractor Authorized Signature: Date: A copy ofyour state registration/license is required to be on file. If this is the first 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. Address: Description of work: • 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% +$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 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): ` 4"V Signature: Date: U ��- 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 `FRe.xst gc CITY O F Building Safety Department 7 REXBURG BUILDING PERMIT FORM 220 City of Rexburg --°Pda`�d'°,2°tb 35 North 1St East - ---- Americas Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Electrical Permit Number: Electrical Fees Paid ❑ 1. Property Owner Name:_ (2V&A1ie, Sko,.p- Address: Cita,: - LState: TO Zip Code: Phone: Email: 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work for a commercial Building. Business �' �l 5N �� 1 tl' —State License #:C,' Exp.: Address: Ci 2.kJu� 7 ty: Staters Zip Code: Phone: aa�s — ? 31 `� Email: o3 is Contact/Rep. Name: Phone: 5'c Ac Email: Electrical Contractor Authorized Signature: % %1j� Date: A copy ofyour state registration/license is required to b 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: 20 �! t G �t 2 0,!5 eq p lei" ❑ Project Gast: $ 9900117), • 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% +$1,160. i.e. Work costing $15,000 will be charged $260 for the first$10,000 and 1 % of the remaining $5,000 = $260 + $50 = $310 total fee • There will also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and state that the information herein 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. 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 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 www.rexburg.org Permit Technician - (208) 372,2341