HomeMy WebLinkAboutAPPLICATIONS - 18-00285 - 2300 University Blvd - Madison High School Stadium - New ConstructionpF R�Bt'RC
v� a� CITY o F Building Safety Department
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REXBURG City of Rexburg
T America's Fam ly Community 35 North 1St East
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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.
G
jS ature
Printed Name
71171Zo t8
Date
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician -208
( ) 372.2341 Revised 10/2016
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iG CITY O F
�s� s REXBuRG
Americas Family Community
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
PERMIT POLICIES ACKNOWLEDGMENT
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
BAM 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
Initials Official may remove the red tag. If the red tag is removed by anyone but a City Official, citations may be
issued.
No building may be occupied without receiving a signed Certificate of Occupancy.
E
o If a building is occupied without receiving a signed Certificate of Occupancy, citations may be issued and the
Inoccupants may be evicted.
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
gqM 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.
BAM o Even if you hear from an inspector that 'you're good to go', ultimately if you do not have a Building Permit or
Certificate of Occupancy, the above policies will be enforced.
Initials
It is your responsibility to inform anyone on your project of the above policies. All sub -contractors will be held
to this standard with no exceptions.
BAM o The above policies will be enforced to all, regardless if this information is passed on to them or not.
Initials
Applicant's Name (print): Brent McFarland Signature: L ' ) Date: _711 7/2()l A
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 30/2016
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1E�yRG BUILDING PERMIT FORM 200 City of Rexburg
CWUpdated5/2017 35 North 1St East
America's Family Cmnmtmity
Rexburg, Idaho 83440
BUILDING APPLICATION
New Commercial Building
For Office Use
Permit Number: Zoning:
Application Fee: 0 $1000/Building
1. Property Owner
Name: Madison School District #321
Address: 60 West Main St. City: Rexburg State: ID
Phone: _208-2,59,23(g) Email: busby0msd321 com Zip Code: 83440
2. Applicant
Name: JRW & Associates PLLC Role: (Owner, Tenant, Contractor, etc.) Architect
Address: 1152 Bond Ave City: Rexburg
Phone: 208-359-2309 State: _ID Zip Code: _83440
Contact/Rep. Name: Brent McFarland Email: bmcfarlandCa)jrwa com
3. General Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Name: Headwaters Construction Company Registration #:
Address: Exp.:
City:Phone: Email: State: Zip Code:
Contact/Rep. Name: _Logan Bing�grp Phone:
Email: Ihinghamr7a hPad watPr;rr r•nm
General Contractor Authorized Signature:
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.
4. Project Description
• Address: 2300 University Blvd -OR- Lot #: — Block #: _ Subdivision:
• Project Name: MHS Stadium • Construction Type: • Occupancy T
• Square footage: _21,905sf, 968sf, 4 050sf . p y fie'
> Total cost of -materials and labor: $TBD
• Check all disciplines that apply: R Mechanical: Cost $ TBD W Electrical: Cost $ TBD
M Plumbing: Cost $TBD M Fire Alarm: Cost $
_TBD�__ 00 Fire Sprinkler: Cost $ TBD
Note: Any contractors involved will need to fill out their respective application.
• # of Water Meters: 3 • Water Meter Size(s): 1) 2-1/2" # of Parking Stalls: 471
• # of Dumpsters: • Estimated Dumpster Delivery # of Dumpster Pickups/week
• Other Comments (if any): Date: _/ / 1 2 3 4 5
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.
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 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): Brent McFarland Signature:
DateJUIV 1T 2018
Inspections must be called in before 8 AM on the day the inspection is requested. Inspect on requests called in after 8 AM will he scheduled for the next business day.
Inspection Hotline - (208) 372.2344
www.rexburg.org __-- --
('Ir, vac
6 CITY OF
° REXBURG
America's Fumii4y Community
For Office Use
Permit Number:
BUILDING PERMIT FORM 21�
Updated 10/2016
BUILDING APPLICATION
Commercial Mechanical
1. Property Owner
Name: Madison School Distri t #321
Address: 60 West Main St. City:
Phone: 208-359-3300
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
Mechanical Fees Paid ❑
_Rexburg State: ID Zip Code: 83440
Email: busbyj@a msd321.com
2. Mechanical Contractor TBD
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: StT
Address:
Phone:
Contact/Rep. Name:
ate Icense #:
City: State:
Email:
Phone: Email:
_ Exp. _
Zip Code:
Mechanical Contractor Authorized Signature:
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: _
❑ Project Cost: $
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 first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $ 10 total fe
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):
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 parn,cr ToA6..:..:.... .o ..... ...... .....
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11GXBURG BUILDING PERMIT FORM 220 City of Rexburg
cy, Updated l0/2016 35 North
Americu'sFami}�Cummunily 1st East
Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Electrical
For Office Use
Permit Number:
1. Property Owner
Name: Madison Schnool District #321
Address: 60 West Main St. city;
Phone: 208-359-3300
Electrical Fees Paid ❑
_Rexburg State: ID Zip Code: 83440
Email: busbyj@msd321.com
2. Electrical Contractor TBD
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: State License #:
Address: Exp.:
Phone: City: State: Zip Code:
Email•
Contact/Rep. Name: Phone:
Email:
Electrical Contractor Authorized Signature:
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:
❑ Project Cost: $
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 casting
$15,000 will be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $ 10 tit 1 f
There will also be a plan review fee totaling 10% of the above fee.
APPLICANrs 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):
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 -- - -
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1EXBy RG— BUILDING PERMITdFORM 2 3 City of Rexburg
Ow
America's Family (-on nn unity 35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Plumbing
For Office Use
Permit Number:
Plumbing Fees Paid ❑
1. Property Owner
Name: —Madison &hQol District# 21
Address: 60 West Main St. City: Rexburg State: ID
Phone: 208-359-3300 Zip Code: 83440
busb
Email: yjC)msd321.com
2. Plumbing Contractor TBD
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: State License #:
Address: Exp.:
Phone:
City: State: Zip Code:
Email:
Contact/Rep. Name: Phone:
Email:
Plumbing Contractor Authorized Signature:
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:
❑ Project Cost: $ _
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 = $ 10 �t 1 f�
ee totaling 10% of the above fee.
There will also be a plan review f
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. 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
N
ww.rexburg.org Permit Ta hni�i— - rvnoi — —
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REXBLJRG BUILDING PERMIT FORM 4,� 1 City of Rexburg
• ----- -- C�w Updated 10/2016
Ar»ericU's filmify c;t»»» guy 35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Fire Alarm
For Office Use
Permit Number:
Fire Alarm Fees Paid ❑
1. Property Owner
Name: Madison School District #321
Address: 60 West Main St. City: Rexburg state: ID
Phone: 208-359-3300 busbyj@Msd3�F-1.com Code: 83440
Email: YJ@msd321.com
2. Contractor TBD
Business:
Address:
Phone:
Contact/Rep. Name:
State License #:
City:
Email:
Phone:
Exp.
State: Zip Code:
Email:
Contractor Authorized Signature:
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. If you are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Description of work:
❑ Fire Alarm System Cost: $
• Fees for fire alarm systems are charge 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 totalrep
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
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:
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 - f20u1 zv') 99A 1
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�i CITY OF
U.� REXBURG
Atnerica' Firmly Community
For Office Use
Permit Number:
BUILDING PERMIT FORM 4,02
Updated l0/2016
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Fire Sprinkler
1. Property Owner
Name: Sch )nl Di_trirt I MP1
Address: 60 West Main St. City:
Phone: 208-359-3300
2. Contractor TBD
Business:
Address:
Phone:
Contact/Rep. Name:
Fire Sprinkler Fees Paid ❑
Rexburg State: ID Zip Code: 83440
Email: busbyj9msd321.Com
State License #:
City: State:
Email:
Phone: Email:
Exp.
. Zip Code:
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
Description of work:
Number of Heads:
❑ Fire Sprinkler 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 be charged $260 for the first $10,000 and 1 % of the remaining $5,000 = $260 + $50 = $11Q total fe
There will also be a plan review fee totaling 10% of the above fee.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l 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 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
Inspection Hotline - (208) 372.2344 www.rexburg.org will be scheduled for the next business day.
- _ Permit Technician - Onal aW) 71en
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iG CITY OF
REXBURG
America's Family Community
SUBCONTRACTOR LIST
Excavation & Earthwork: Edstrom's Construction
Concrete: TBD
Masonry: TBD
Roofing: TBD
Insulation: TBD
Drywall: TBD
Painting: TBD
Floor Coverings: TBD
Plumbing: TBD
Heating:
Electrical: TBD
Special Construction
(Manufacturer or Supplier)
Roof Trusses: TBD
Floor/Ceiling Joists: TBD
Siding/Exterior Trim: TBD
Other:
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
Inspection Hotline - (208) 372.2344 www.rexburg.org g B Permit Technician - (208) 372.2341 Revised 10/2016
Q� VtF.X B trRG.
CITY o F Building Safety Department
REXBURG City of Rexburg
America's Family Community 35 North 1St East
Rexburg, Idaho 83440
DISTRIBUTION LIST
Please provide the names and emalls of anyone who should begetting automated updates for this project.
Review Notes
Name: Brent McFarland
Name: Ryan Maim
Name:
Name:
Name:
Inspection Tickets
Name: _Brent McFarland
Name: Ryan Maim
Name: Jordan Busby
Name: _ Loaan Bingham
Name:
Email: bmcfariand@irwa.com
Email: rmalm@'rwa.com
Email:
Email:
Email:
Email: bmcfarlandna cfarland(@irwa.com
Email: rmalmna irwa com
Email: _hi Ichy'amc&i21 cnm
Email: _ Ibingham0headwaterscc om
Email:
Inspection Hotline - (208) 372.2344 www.rexhurg.org Permit Technician - (208) 372.2341
Revised 10/2016
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1�xBuRG City of Rexburg
M
America' Famil},Community 35 North 1St East
Rexburg, Idaho 83440
BUSINESS USE SUMMARY
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?
Will the business be doing any structural/or remodeling changes to the building?
Any changes to the electrical?
Any changes to the plumbing?
Any changes to the mechanical system?
Is the business type changing? ❑ Yes, it will change to
Is this business changing ownership?
Is the business registered with the City of Rexburg? ❑ Yes, License #:
*If No, please apply for a business license with the Customer Service Dept.
Will the business have food preparations?
Will there be any cooking of foods?
Will there be any deep fat frying?
Will you have food disposal on site?
Will there be sumps or floor drains in the facility?
Will the business have any chemicals on site?
208-359-230 7/17/ 018
Appl�pants S' n4tur Phone Date
M Yes ❑ No
R Yes ❑ No
IX Yes ❑ No
M Yes [:]No
N Yes ❑ No
ISI No
❑ Yes N No
M No
I$ Yes ❑ No
(X Yes ❑ No
❑ Yes PQ No
❑ Yes M No
04 Yes ❑ No
❑ Yes R No
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 www.rexburg,org Permit Technician -208
( ) 372.2341 Revised March, 2016
,XXXBUgr,
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U' 5
,�nT
' XBURG City of Rexburg
`> 35 North
America's Family Conununity 1st East
Rexburg, Idaho 83440
BUILDING APPLICATION
New Commercial Building
For Office Use
Permit Number: Zoning:
Application Fee: ❑ $1000/Buildine
1. Property Owner
Name: Madison School District #321
Address: 60 West Main St. City Rexburg State: ID
Phone: 208-3,99-3300 Zip Code: 83440
Email: busbviCc�msd321 com
2. Applicant
Name: JRW & Associates PLLC Role: (Owner, Tenant, Contractor, etc.) Architect
Address: 1152 Bond Ave City: RexburgState: D
Phone: 208-359-2309 Zip Code: 83440
Contact/Rep. Name: Brent McFarland
Email: _bmcfarlandCa�jrwa com
3. General Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Name: Headwaters Construction Company
Address: West 9500 South
Registration #: RCE -2339 Exp.: 12-14-18
Phone: (208) 313-1058
City: Victor State: Idaho Zip Code: _ 83455
Contact/Rep. Name: _Lham o an Bin
9 g
Email: See below
Pho (208/) 313-1058Emai1: lhingham hPadwa1Prsrr
General Contractor Authorized Signature:
rnrn
A copy ofyour state registration/license is required to a on file. If'this is the first time you have done work in the City of Rexburg, pl0eas8e 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: _2300 University Blvd
-OR- Lot #: _ Block #: Subdivision:
• Project Name: MHS Stadium
_
• Construction Type: • Occupancy T
p y fie'
• Square footage: 21,905sf. 968sf, 4 050sf .
> Total cost of -materials and labor: $TBD
• Check all disciplines that apply: R
Mechanical: Cost $ TBD IN Electrical: Cost $ TBD
ig Plumbing: Cost $TBD 00
Fire Alarm: Cost $ -IBD M Fire Sprinkler: Cost $ TBD
Note: Any contractors involved will need
to fill out their respective application.
• # of Water Meters: _ 3
• # of Dumpsters:
. Water Meter Size(s): 2 1) 2-1/2: # of Parking Stalls: —All_
• Estimated Dumpster Delivery • # of Dumpster Pickups/week
• Other Comments (if any):
Date: _/ / 1 2 3 4 5
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.
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): Brent McFarland Signature: ?
�. DateJu_ ly 17, 2018
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will he scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org