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Home My WebLink AboutAPPLICATION - 18-00315 - Approx. 1000 N Yellowstone Hwy - The Grove at Thomson Farms - 30 Unit BldgO� µEX B (IRC CITY OF Building Safety Department REXBURG City of Rexburg America' Family Community 35 North 1St East Rexburg, Idaho 83440 MULTI -FAMILY RESIDENTIAL 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 site plans (see Site Plan Checklist on page 2) ❑ 3 sets of building plans (see box below) - stamped by a licensed professional ❑ 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. ❑ StructuralCalculations (see box below) -stamped by a licensed Engineer ❑ Energy Compliance Report: As per the 2015 IECC, a COMCheck is required (available online at www.energ codes gov) ❑ 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: Seismic Design Category - D (unless soil evaluation confirms category C) Ground Snow - So lbs. per sq. fL Roof Snow Load - 35lbs. per sq. ft. Wind Load - 90 MPH Frost Depth - 36" ❑ 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 ❑ Permit Policies Acknowledgment signed. ❑ Affidavit of Legal Interest signed ❑ Property Line form signed ❑ 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 ® Notification Distribution List filled out ❑ Commercial Projects: Completed Business Use Summary 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 httn://rexburg.ora/pa gees/development-code. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016 OF gEXB V,pG v� e� C I TY o f Community Development Department REXBURG City of Rexburg America' Family -Ow- America' 35 North 1St East %NEO E Rexburg, Idaho 83440 SITE PLAN CHECKLIST ❑ 1. Legal Description of proposed building site 1:12. North Arrow ❑ 3. Drawn to scale ❑ 4. Lot Dimensions 135. Building locations, and dimensions with distance to property lines and distances between buildings ❑ 6. Distance of entrances from street corners dimensioned ❑ 7. Show 10% snow storage area ❑ 8. Drainage Plan (with arrows) ❑ 9. Fencing/Screening 1310. Landscaping/Buffering ❑ 11. Lighting Plan (if needed) ❑ 12. Existing and proposed easements ❑ 13. Existing utilities (waterlines, sanitary sewer lines, manholes, storm drains) ❑ 14. Existing right-of-way location and width, curb to curb widths ❑ 15. Existing streets labeled ❑ 16. Proposed street improvements (curb, gutter, sidewalk, pavement, etc.) 1317. Parking (Lot dimensions, distance between rows, loading areas if required) 1318. Sidewalks - both along rights-of-way and internal (existing and proposed) ❑ 19. Fire hydrants and fire suppression lines (including tie to City lines) o Sprinkled o Not Sprinkled 1320. Fire apparatus access ❑ 21. Proposed utilities including tie in location to existing services and new easements ❑ 22. Proposed storm drain and sanitary sewer elevations (for pipe inverts at manholes and catch basins) ❑ 23. Trash facilities (dumpsters for right-hand truck) 0 1 Dumpster per 20 doors (non -dormitory) 0 1 Dumpster per 50 beds (dormitory) ❑ 24. Numbers needed: o Building square footage o Percent of lot covered by building o Paving Area o Drainage Plan Calculations o Parking space numbers (tenant & visitor, handicap, private) SITE PLANS MUST BE COMPLETE AND SUBMITTED FOR REVIEW BEFORE THE PROJECT WILL BE PLACED ON THE PLANNING & ZONING AGENDA. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician -208 ( ) 359.3020 Revised 3/2018 OF RtYBURC -° C I TY OF Building Safety Department REXBURG City of Rexburg '• ,,w America' Family Community PERMIT POLICIES ACKNOWLEDGMENT 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 o APPROVAL OF CONSTRUCTION. 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 initials 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) 372-2167. 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. 0 SCHEDULING INSPECTIONS. 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 Initials following business day. 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 put up, the inspector may require the sheetrock to be removed in order to perform the electrical rough in inspection.) o STAIRWAYS REQUIRED. On jobsites for multi-level buildings the contractor must provide temporary stairs so that workers and inspectors can safely access upper levels of the building. If these stairs are not provided, inspections may Initials not be completed. Extenuating circumstances will need to be approved by the Building Department. DIGITAL AS -BUILT PLANS. A Certificate of Occupancy will not be issued without digital copies of the As -Built Plans. It is the Applicant's responsibility to turn in digital copies of the As -Built Plans when the project is completed. No Certificate of initials Occupancy will be issued without these plans, extenuating circumstances will need to be approved by the Building Department. o OCCUPYING A FINISHED BUILDING. No building maybe occupied without receiving a signed Certificate of Occupancy. If a building is occupied without receiving a signed Certificate of Occupancy, citations may be issued and the occupants may Initials be required to vacate. o MAKING KNOWN POLICIES. 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. The above policies will be enforced to all, regardless if this Initials information is passed on to them or not. 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) 372.2344 www.rexburg.org Permit Technician — (208) 372.2341 Revised 10/2016 OE pEX B URC U� o� CITY OF Building Safety Department ° REXBURG City of Rexburg "" 35 North 1St East '•,,Ameriw'sFamily 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. / June 27, 2018 Signature Date Cory Ferguson Printed Name Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016 `e gk\Ot:k, C IT Y OF Building Safety Department REXBURG City of Rexburg 35 North Is' East Amtrita's Fnn:ily Ccmvnufrity Rexburg, Idaho 83440 Affidavit of Legal Interest State of Utah County of Utah I, RS17 Rexburq Preferred LLC 160 W Canyon Crest Dr. Suite 3 Name Address Alpine Utah 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: Joel Bringhurst, Urban Design Group; and -GolyFerowson, 0 11 PhDs Ar .hit ..ts 4 7 WPst 11950 South, #201, Draper, UT 84020 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 3rd day of July 20 18 RS 17 Rcxburg Preferred LLC by its Manager RS 17 Rexburg Manager LLC e - Paul rin Tan ger Subscribed and sworn to before me the day and year first above written. MARJORY TAYLOR oe Notary Public State of Utah _ My Commission Expires on: 1 R ,: January 15, 2019 Notary Public Comm. Number: 680822 Residing at: �I ;J (_A -V, -r_ My commission expires: Q (5;1 (01 Inspection llotlioe - (208) 372.2344 www.rerburg.org Permit Technician - (208) 372.2341 Revised 10, 2016 O� p,EXBU�pC -,� C I TY O F Building Safety Department REXBURG BUILDING PERMIT FORM 300 City of Rexburg • "il n°da d'°'2°'6 35 North 1St East America's Family Community Rexburg, Idaho 83440 BUILDING APPLICATION New Multi family Residence For Office Use Permit Number: Zoning Application Fee: O $1000/Building 1. Property Owner Name: RS17 Rexburg Preferred LLC Address: 160 W Canyon Crest Dr. Suite 3 City: Alpine State: Utah Zip Code: 84004 Phone: 385-429-4280 Email: 1mulftstillwatermail corn 2. Applicant Name: RS17 Rexburg Preferred LLC Role: (Owner, Tenant, Contractor, etc.) Owner Address: 160 W Canyon Crest Dr. Suite 3 City: Alpine State: Utah Zip Code: 84004 Phone: 385-429-428n Email: _paulOstillwatermail com Contact/Rep. Name: Paul Brin hurst 3. General Contractor Under Idaho Building Code, a registered contractor must do the work for a Multi family Residence. Name: Registration #:Ex Address: p•: Phone: CIS'' State: Email: Zip Code: Contact/Rep. Name: Phone: Email: General Contractor Authorized Signature: Date: A copy of your 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. 4. Project Description Address: -OR- Lot #: _ Block #: _ Subdivision: Project Description: • # of Buildings: # of Units: • # of Water Meters: Water Meter Size(s): • # of Parking Stalls: • Estimated Cost: $ • Proposed Use: ❑ Dormitory Housing 0 Non -Dormitory Housing • Construction Type (i.e. VA, VB, etc.): VB Building Permit fees for multi family residences are charged based on square footage and the City's estimated valuation. The application fee applies towards the total fee. 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. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 have read this application and state that the informatio 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 Rn herein exburg 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 permit on approval issued under the provisions of the s of t 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 tf 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 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 OF µEX B URC , % CITY OF Building Safety Department ° REXB BUILDING PERMITdFORM 310 City of Rexburg America's Family Community 35 North 1St East Rexburg, Idaho 83440 BUILDING APPLICATION New MFR Mechanical For Office Use Permit Number: Mechanical Fee Paid ❑ 1. Property Owner Name: RS17 Rexburg Preferred LLC Address: 160 W Canyon Crest Dr. Suite 3 Alpine p 84004 City: p State: Utah Zi Code: Phone: 385-429-4280 Email: Paul@stillwatermail.com 2. Mechanical Contractor Under Idaho Building Code, a registered contractor must do the work for a Multi family Residence. Business: State License #: Address: Exp.: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Mechanical Contractor Authorized Signature: Date: A copy of your 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: -OR- Lot #: _ Block #: _ Subdivision: Description of work: ❑ New MFR Construction: # of Buildings: # of Units: • Fees for new construction are charged by number of buildings and number of units. (130 x # of buildings) + (65 x # of units) = total fee (130 x 2 buildings) + (65 x 10 total units) = $260 (buildings) + $650 (units) _ $910 of I fgg ❑ Number of Fireplaces: • Note that fireplaces are not included in unit counts and will be charged $65 per inspection as shown below. o ❑ Built-in $130 ❑ Free-standing $65 • 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 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. 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 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 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 gEX B (IRC U, o� C I TY OF Building Safety Department REXBURG BUILDING PERMIT FORM 5i� City of Rexburg ��►► t� Updated 10/2016 America's Family Community 35 North 1St East Rexburg, Idaho 83440 BUILDING APPLICATION New MFR Electrical For Office Use Permit Number: Electrical Fee Paid ❑ 1. Property Owner Name: RS17 Rexburg Preferred LLC Address: 160 W Canyon Crest Dr. Suite 3 City: Alpine State: Utah Zip Code: 84004 Phone: 385-429-4280 Email: _paul@stillwatermail.com 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work for a Multi family Residence, Business: State License #: Address: Exp.: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Electrical 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: -OR- Lot #: _ Block #: _ Subdivision: Description of work: ❑ New MFR Construction: # of Buildings: # of Units: • Fees for new construction are charged by number of buildings and number of units. Buildings and Units Total Fee (130x # of buildings) + (65x # of units) = total fee (130 x 2 buildings) + (65x 10 total units) =.F260 (buildings) + $650 (units) = $910 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, 1 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 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 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 America's Family Community BUILDING PERMIT FORM 3 3 0 Updated 10/2016 BUILDING APPLICATION New MFR Plumbing Building Safety Department City of Rexburg 35 North 1st East Rexburg. iflahn R144n For Office Use Permit Number: Plumbing Fee Paid ❑ 1. Property Owner Name: RS17 Rexburg Preferred LLC Address: 160 W Canyon Crest Dr. Suite 3 City: Alpine State: Utah Zip Code: 84004 Phone: 385-429-4280 Email: Paul@stillwatermail.com 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work for a Multi family Residence. 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 on file. if this is the first time you have done work in the City of Rexburg, please provide a photo copy ofyour license. /fyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: -OR- Lot #: _ Block #: _ Subdivision: Description of work: ❑ New MFR Construction: # of Buildings: # of Units: • Fees for new construction are charged by number of buildings and number of units. Buildings and Units Total Fee (130x # of buildings) + (65x # of units) =total fee (130 x 2 buildings) + (65 x 10 total units) = $260 (buildings) + $650 (units) = $910 total fee • There will also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AnTHnalzATinni• n.,.ie. --- . .. ... -_- - --•- r_•• .7 FwJ � y, , un —y Germy that i nave reaa tens 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 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 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 C I TY OF REXBURG Q - America's Family Community BUILDING PERMIT FORMqol Updated 10/2016 Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 BUILDING APPLICATION Fire Alarm For Office Use INITIAL COST CHARGE BY COST Permit Number: C) Up to $10,000 = 2%+$60 Fire Alarm Fees Paid ❑ 1. Property Owner Above $100,000 = .5%+1,160 i a Name: RS17 Rexburg Preferred LLC Address: 160 W Canyon Crest Dr. Suite 3 City: Alpine State: Utah Zip Code: 84004 Phone: 385-429-4280 _ Email: paul(Wstillwatermail.com 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. lfyou 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 remodels are charge by cost: will ur cuutyeu ozou for the first $"I0,00 and 1 % of the remaining $5,000 = $260 + $50 = $310 total -fee • There will also be a plan review fee totaling 109/16 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 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 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 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 - (206) 372.2341 INITIAL COST CHARGE BY COST C) Up to $10,000 = 2%+$60 Up to $100,000 = 1%+260 Above $100,000 = .5%+1,160 i a will ur cuutyeu ozou for the first $"I0,00 and 1 % of the remaining $5,000 = $260 + $50 = $310 total -fee • There will also be a plan review fee totaling 109/16 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 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 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 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 - (206) 372.2341 CITY O F REXBURG C% — - America's Family Community BUILDING PERMIT FORMad— Building Updated 10/2016 Safety Department City of Rexburg 35 North 15Y East Rexburg, Idaho 83440 BUILDING APPLICATION Fire Sprinkler For Office Use INITIAL COST Permit Number: Fire Sprinkler Fees Paid ❑ 1. Property Owner Name: RS17 Rexburg Preferred LLC up to $100,000 = Address: _ 160'W Canyon Crest Dr. Suite 3 City: Alpine State: Utah Zip Code: 84004 Phone: 385-429-4280 _ Email: paulaa stillwatermail.com 2. Contractor Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Contractor Authorized Signature: A copy ofyour state registration/license is required to be on Date: 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: $ • Fees for remodels are charge by cost: • �_ _ �___� ai�,wv wtii ve cnargea atou for the first $10,000 and 1% of the remaining $5,000=$260+ $s0= $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 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. 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 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 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 INITIAL COST CHARGE BY COST up to $10,000 = 2%+$60 up to $100,000 = 1%+260 Above $100,000 = .5%+1,160 • �_ _ �___� ai�,wv wtii ve cnargea atou for the first $10,000 and 1% of the remaining $5,000=$260+ $s0= $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 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. 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 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 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 pEXB V* U� a5 CITY OF Building Safety Department " 1t.GY.,BuRG City of Rexburg ""3S North 1st East f o Americas Family Community Rexburg, Idaho 83440 SUBCONTRACTOR LIST 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 Hotline- (208) 372.2344 www.rexburg.org Permit Technician- (208) 372.2341 Revised 10/2016 4 REXB URC �� fp CITY O F REXBURG 1117— Amerimd 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 Notes Name: Cory Ferguson Name: Paul Bringhurst Name: Jared Ford Name: Name: Inspection Tickets Name: Name: Name: Name: Name: Email: coryouldplus.com Email: paul@stillwatermail.com Email: jford@ensignutah.com Email: Email: Email: Email: Email: Email: Email: Inspection Hotline- (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016