HomeMy WebLinkAboutAPPLICATION - 18-00509 - Insomnia Cookies - RemodelktV,X 8V4 ,
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REXBURG
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:
❑ 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
❑ Permit 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
❑ Plumbing Permit Application signed by a licensed Plumbing Contractor
❑ Fire Alarm Permit Application (if applicable) signed by a registered professional
❑ Fire Sprinkler Permit Application (if applicable) signed by a registered professional
❑ Subcontractor list filled out
❑ Affidavit of Legal Interest signed by owner
❑ Notifications Distribution List
❑ Business Use Summary Completed
Subdivisions: If you plan to build in a subdivision please check the Rexburg Development Code for
any requirements such as property setbacks, architecture board approval, etc.
This information is available at httD : /i-exl)ui-ti.or,-,/i)ayes/(Ieveloiiiiietit-code.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016
osgExarvR� Building Sae
.� c. I 'r v o F gft3' Department
� BUILDING PERMIT FORM 210 City of Rexburg
°°;'Z°'° 35 North 1St East
Anterica3 Family con,mirnity Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Mechanical
I to' OIi tcc Oso:
Permit Number:
Mechanical Fees Paid ❑
1. 111 ,p""rt'y O�
Name
Address: A)- LJ �4 City: Aeyj�,J� State: Zip Code:
Phone: Email:
E..Ul1`t'EiCLC>1'
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: State License #: Exp.: _
Address: City: State: Zip Code:
Phone:
Contact/Rep. Name:
Phone:
Email:
Email:
Mechanical 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-RexbuT, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please cheep with the Perinit Technician by calling (208) 372-2341.
3.
i) tic: iDUOt!
Address: 1t 1,/ ,2,7 eog' FJ, -1q 0
Description of work:
❑ llrojcct CosL: $
Cost f (fie'' p z j'e v:
Calculation 10r i :imef'tion fee:
If project cost is between $0 to $10,000 then:
(Cost of project * 291o) + $60
If project cost is between $10,001 to $100,000 then:
((Cost of project - $10,000) * 191b) + $260
If project cost is greater than $100,001 then:
((Cost of project - $100,000) * t/a%) + $1160
An additional plan review fee is required which is 10% of the calculated inspection 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 withal[ 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
oQ"k.xe�R Building Safe Department
.a crTv of g ty p
Cit of Rexburg
� ���.Gr BUILDING PERMIT FORM 402 Y g
� Updated 03/2018 35 North 1St East
r
Americas Family Community Rexburg, Idaho 83440
BUILDING APPLICATION
Fire Sprinkler
['or OI(icti. Use
Permit Number:
Fire Sprinkler Fees Paid 01
1 Propel tv i t ,elle
r
Name: �j
Address: 10."", 1 �,l. 5 � City: State: —� Zip Code: _ 3
Phone: Email:
?. ContrIctor
Business:
Address:
Phone:
Contact/Rep. Name:
State License #:
City: State:
Email:
Phone: Email:
Exp.:
- Zip Code:
Contractor Authorized Signature: Date:
A copy ofyour state registration1license is required to be on file. If this is the first titre you have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure if your license is on file, please check with the permit Technician by calling (208) 372-2341.
�.J. i'� a;ect DescrijItioci
Address:
Description of work:
Number of Heads:
❑ Fire sprinkler System host: $
• Fees for remodels are charge by cost:
INITIAL IAL C.OS
CIIAI2,HI BY C.OST
Up to $10, 000 =
2%+$60
Up to $100, 000 =
1%+260
Above $100,000 =
.5%+1,160
0 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 ee
• 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.
f
Applicant's Name (print): / �' 'rl �S �t S 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
o�µFX°UR(" Building Safety Department
.� CITv OF g J Y
Cit of Rexburg
REXBURG BUILDING PERMIT FORM 2 �► � Y
Updated 03/2018 35 North 1St East
America# FromilyCommunity Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Electrical
For0s'lis Il!;c
Permit Number:
. propel-f"v Ov,'m2l
a
Name{ r;cf� n>>Pd� tLG
Address: City:
Phone:
Electrical Fees Paid ❑
t' State: Zip Code: G"
Email:
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business:
Address:
Phone:
Contact/Rep. Name:
State License #:
City:
Email:
Phone:
Exp.: _
State: Zip Code:
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.
J, iii{1)1.1.1.
Address: 1 / r'iY°i 'i, Y3' -1q0
Description of work: Z'���hl<�
P. oie
wit o `, I r>i«vt:l
l i;'n ) - inspe°c� ion r'c>e:
If project cost is between $0 to $10,000 then:
(Cost of project* 2916) + $60
If project cost is between $10,001 to $100,000 then:
((Cost of project - $10,000) *191o) + $260
if project cost is greater than $100,001 then:
((Cost of project - $100, 000) * % %) + $1160
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 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): .1�1(1 j4e / 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 T Y O F Building Safety Department
is
01
City of Rexburg
4 REXBURG
0, 35 North 1St East
America' FamilyConnnunity Rexburg, Idaho 83440
DISTRIBUTION LIST
Please provide the names and emails of anyone who should be getting automated updates for this project:
Review Notes
1
Name: Email:.nla f��c_�/r'S
i � i 1 1
Name: € l l`if's Email: i : it- St 15&I''l41'i C'cck7rS . 0.117
Name:
Name:
Name:
Inspection Tickets
Name:
Name:
Name:
Name:
Name
Email:
Email:
Email:
Email:
Email:
Email:
Email:
Email:
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016
OF StFXBUR,
C IT Y OF Building Safety Department
o
y
P.EXBURG City of Rexburg
°
35 North 1St East
AanericasEaandlyCommunity Rexburg, Idaho 83440
Affidavit of Legal Interest
State of Idaho
CountX of Madison
Name
Jf :/✓4�vC';l I t{ �q 1
City
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
Address
State
A. That I am the record owner of the property described on the attached, and I grant my permission to:
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 thisday of 20
20 L
./
Signature
Subscribed and sworn to before me the day and year first above written.
Notary Public of Idaho
Residing at:
My commission expires:
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit'rechnician - (208) 372.2341 Revised 10, 2016