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Home My WebLink AboutAPPLICATION - 18-00424 - 940 N 2nd E - Christensen Body ShopOE pEXnURC C I TY OF REXBURG N+ Amerim's Family Community BUILDING PERMIT FORM200 edam 5/2017 BUILDING APPLICATION New Commercial Building Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: I bh c12 t/ Zoning: Application Fee: ❑ $1000/Building 1. Property Owner Name: V4, 0 (' asrn,.rnL Address: City: State: Zip Code: Phone: O(X_iz7 o` g WEmail: 2. Applicant Name: Role: (Owner, Tenant, Contractor, etc.) Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: 3. General Contractor Under Idaho Building Code, a registered contractor must do the work for �a Commercial Building. Name: Registration #: 4ii , - Oaal) Exp.:I IQ I j q / /A Address: City: i State: Zip Code: Phone: I % ail: d ? VI CCZYI Contact/Rep. Name: Phone: 'mail: _.--- General Contractor Authorized Signature: _ y� y Date: "Ille Ila A copy ofyour state registration/license is required to be on file. If this is the first tinge 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 Name: • Construction Type: _ • Occupancy Type: • Square footage: • Total cost of project - materials and labor: $ • Check all disciplines that apply: ❑ Mechanical: Cost $ ❑ Electrical: Cost $ ❑ Plumbing: Cost $ Cl Fire Alarm: Cost $ ❑ Fire Sprinkler: Cost $ Note: Any contractors involved will need to fill out their respective application. • # of Water Meters: • Water Meter Size(s): • # of Parking Stalls: • # of Dumpsters: • Estimated Dumpster Delivery • # of Dumpster Pickups/week Date: _ /_ /_ 1 2 3 4 5 • Other Comments (if any): _ Building Permitfees 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 reviewfee totaling 10% of the building permitfee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l 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 ofthe 2012 International Code In cases of any false statementormisrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvofdifnot started within 180 days. Permit void if work stops for 180 days. p Applicant's Name (print): 1� i�{gQ� Signature:Date: / p 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 wwwrexburg.org Permit Technician - (208) 372.2341 c l'I'Y of RE) BURG CW Armerica's Family Community BUILDING PERMIT FORM 200 Updated 10/3016 BUILDING APPLICATION Commercial Addition Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use , 1 Permit Number: _ �U`� o Zoning: Light Indeamal Application Fee: ❑ $1000/Building 1. Property Owner Name: Jeff Chrlstensen Address: 225 N FREMONT ST City: Sugar City State: Idaho Zip Code: 83448 Phone: 208-390.2960 Email: leffcbshop@cableones.net 2. Applicant Name: South Fork Design LLC Role: (Owner, Tenant, Contractor, etc.) Contractor Address: 1066 N Yellowstone Hwy City: Rexburg State: Idaho Zip Code: 83440 Phone: 208-351-5784 Email: blake@southforkengineering.com Contact/Rep. Name: Blake walker, or Ray McDougal 3. General Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Name: South Fork Design Group LLC Registration #: RCE -21235 Exp.: 4/17/2019 Address: 1066 N Yellowstone Hwy City. Rexburg State: Idaho Zip Code: 83440 Phone: 208-240.0994 Email: Ray@southforkengineering.com Contact/Rep. Name: Blake walker, or Ray McDougal Phone: 208.351-5784 Email: blake@soufhforkengineedng.com �7 General Contractor Authorized Signature: G rArsz 2-42 Date: %�•261i2 A copy ofyour state registratiou/license is tequired,61A on file. /f thi rst tin you have done work in the City ofRexburg, 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: RPR6N40E1741D0 Project Description: • Square footage of addition: 17,918 • Total cost of project - materials and labor: $1,447,836 • Check all that apply: ❑ Mechanical: Cost $ 75.000 ❑ Electrical: Cost $127,298 ❑ Plumbing: Cost $15,600 ❑ Fire Alarm: Cost $ in electrical ❑ Fire Sprinkler: Cost $86,608 Note: Any contractors involved will need to rill out their respective application. • Change of Occupancy? ❑ No ❑ Yes: New occupancy: NA • Other Comments (if any): Building Permitfees 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 reviewfee totaling 1096 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 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 to 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): Ray McDougal Signature: Date: Inspections must be called in before 8 AM on the day the Inspection is requested. inspection requests called n after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexborg.org Permit Technician - (208) 372.2341 C I TY OF REXBURG OR, Anieric4 Family Community ,) t) Building Safety Department COMMERCIAL APPLICATION CHECKLIST City of Rexburg 35 North lst East Rexburg, Idaho 83440 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 drawn to scale (see Site Plan Checklist) ❑ 3 sets of building plans (see box below to right) - 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 (see box below) -stamped by a licensed Engineer ❑ Energy Compliance Report: As per the 2012 IECC, a CCIMCheck is required (available online at www.energycodes.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 ❑ Site Plan Checklist in Permit Policies Acknowledgment signed Seismic Design Category - D (unless soil evaluation confirms category C) Ground Snow - 50 Its. per sq. ft. Roof Snow Load - 35 lbs. per sq. ft. Wind Load - 90 MPH Frost Depth - 36" ❑ Property Line form 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 http: //rexburg.org/pages/development-code. Inspection Hotline -(208)372.2344 www.rexbLirg.org Permit Technician -(208)372.2341 Revised 10/2016 OQ pC%BbgC o CITY OF Building Safety Department City of Rexburg REXBURG CW 35 North 151 East '•„ America's Family Communily Rexburg, Idaho 83440 SITE PLAN CHECKLIST ❑ 1 Site plan must be drawn to scale, be legible and also be submitted electronically if possible. ❑ 2. Adjoining streets labeled. ❑ 3. Right-of-way location and width, curb to curb widths and sidewalk location. ❑ 4. Building location, sq footage and dimensions, with distance to property lines and distances between buildings. ❑ S. Show existing and proposed easements. ❑ 6. Existing utilities (waterlines, sanitary sewer lines, manholes, storm drains). ❑ 7. Proposed utilities including tie in location to existing services and new easements. ❑ 8. Proposed storm drain and sanitary sewer elevations (for pipe inverts at manholes and catch basins). ❑ 9. Storm drainage plan for parking lot and roof areas, with calculations. ❑ 10. Fire hydrants and fire suppression lines (including tie to City lines). ❑ Sprinkled ❑ Not Sprinkled ❑ 11. Indicate Fire apparatus access. ❑ 12. Parking (including parking lot, drainage arrows, dimension of lot, distance between rows, and total numbers). ❑ 13. Landscaping (type and total area, including dimensions). ❑ 14. Trash facilities. ❑ 15. North Arrow Included ❑ 16. Proposed street improvements (curb, gutter, sidewalk, pavement, etc.) ❑ 17. Legal description of proposed building site included. ❑ 18. Percent of lot covered by building or paving calculated. ❑ 19. Show 10% snow storage area. ❑ 20. Distance of entrances from street corner indicated. ❑ 21. Current Vicinity Map. (8 th x 11") at 1" = 300' scale, showing location of the property. ❑ 22. Lighting Plan 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.rexturg.oig Pennit Technician -(208)372.2341 Revised 10/2016 C I TY OF REXBURG rw -- Amcric6 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. 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 i^mals Official may remove the red tag. If the red tag is removed by anyone but a City Official, citations maybe 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. Initials 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 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. 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. o The above policies will be enforced to all, regardless if this information is passed on to them or not. is s Applicant's Name (print): Ray McDougalSignature: Date: 7/26/18 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.mxburg.org Permit Technician -(208)372.2341 Revised 10/2016 (te µf X BURV CI T Y O F Building Safety Department . 1tT� r,G r�URG City of Rexburg ew 35 North lst East America's Family 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. Signa Ray McDougal Printed Name 7/26/18 Date Inspection Hodlne-(208)372.2344 www.rexburg,org Permit Technic Ian -(208)372.2341 Revised 10/2016 C I TY OF REXBURG tly America's Family Community '1 r BUILDING PERMIT FORM 21� updnm so/2016/2016 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 Name: Jeff Christensen Address: 226NFREMONTST City: Sugar City State: Idaho Zip Code: 83448 Phone: 206-390-2960 Email: jeffcbshop@a bleone.net 2. Mechanical Contractor Under Idaho Building Code, a registered contractor must do the workfor a Com ercial Buil/ding. q Business: Mountain River Mechanical Inc. State License #: e' G ' uS;i`tap,: 1 ¢ G I Address: 70 o 3 G —city: State: Zip Code: Phone: ZU.�7etrr— —711 Email: ?'7 <5' //oTi�tFrG<<o Contact/Rep. Name: 112 C T,-, !i / P onelEmail: 7 Mechanical Contractor Authorized Signature: e--' e_ �__�— Date:/' -2 G 'lam A copy ofyour state registration/license is required to be on file. If this is the first 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: RPR6N40E174190 Description of work: Mechanical work per engineered plans ❑ Project Cost: $ 75,000 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, l 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 tivthful 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): l Signature: �/, iii. 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 DocuSign Envelope to: 6481A1DE-562A-4BBB-A3B7-7--IOF645B19 Ox {EXBURO �y !� CITY OF REXBURG '•,,•• o c America's Family Community BUILDING PERMIT FORM 220 opdatmin/zws BUILDING APPLICATION Commercial Electrical Building Safety Department City of Rexburg 35 North 151 East Rexburg, Idaho 83440 For Office Use Permit Number: Electrical Fees Paid ❑ 1. Property Owner Name: Jeff Christensen Address: 225 N FREMONT ST City; Sugar City State; Idaho Zip Code: 63448 Phone: 208-390-2960 Email: jeffcbshop@cableone.net 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: Nelson Electric State License #: ELE-38127 Exp.: 11/30/2018 Address: 3896E 600 N Cit},; Rigby State: Idaho Zip Code: 83442 Phone: 208-754.9389 Email: greg@nelson-electricllc.com Contact/Rep. Name: Gfeg Phone:208-390-3424 Email: greg@nelson-electricllc.com Doe Sig ed by: Electrical Contractor Authorized Signature: 4"4 MJ,W/t,Date:7/26/2018 2:22 A copy ofyour state registration/license is requir 6dhgS4jI {f4Chjs is the first time you 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: RPR6N40E17419O Description of work: Instal electrical per engineered plans ❑ Project Cost: $ TBD • Fees for commercial projects are charged by cost,- 0 ost:0 First $10,000=2%+$60. From $10,000to$100,000=1%+$260.Above $100,000=.5%+$1,160, i.e. Work costing $15,000 will be charged $260 for the ff rst $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 ofpedury, l 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 ofthe 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 Hoot started within 180 days. Permit void if work stops for 180 days. Applicant's Name (print): c x Signature: Dater G 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 36 PM C I TY OF Building Safety Department ., REX-B BUILDING PERMIT FORM Z 3 O City of Rexburg nv np°""101201 35 North 1St East America's Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Plumbing For Office Use Permit Number: _ _ Plumbing Fees Paid ❑ L Property Owner Name: Jeff Christensen Address: 225 N FREMONT ST City: Sugar City State: Idaho Zip Code: 83448 Phone: 208-390-2960 Entail: jeNobshop@mbleone.net 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: Rexburg Plumbing and Heating State License #: PLG -C-13439 Exp.: 10/31/2020 _ Address: 766 N Yellowstone Hwy City: Rexburg State: Idaho Zip Code: 83440 Phone: 208-351-8770 Email: rexburgph@gmajl.wm _ Contact/Rep. Name: Nephi Allen Phone: 208-351-8770 Email: rexbur @gmail.mm Plumbing Contractor Authorized Signature; Date: Acopy ofyourstate registration/Gcelsei.srequired to eonFle.lfthisisthe eyou havedoneworkin the City of Rexburg, please ptovide a photocopy ofyour license. Ifyou are unsure ifyour license is oft file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: RPR6N40E174190 Description of work: Install plumbing per engineered plan ❑ Project Cost: $ 15,600 • 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 I % 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 or 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): Ray McDougal Signature:Date Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called 1n after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburgerg Permit Technician - (2 08) 372.2341 [C6 DocuSign Envelope ID: 6481A1DE-562A-48BB-A3B7-7 1OF645B19 e4 yExSUgC CITY OF Building Safety DepartmentUI REXBURG BLDING PERMIT FORM 4� 1 City of Rexburg _CW_Unanmia/2016 35 North 1St East 0 America's Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Fire Alarm For Office Use Permit Number: Fire Alarm Fees Paid D 1. Property Owner Name: Jeff Christensen Address: 225 N FREMONT ST City: Sugar City State: Idaho Zip Code: 83448 Phone: 208.390.2960 Email: leffcbshop@cableone.net 2. Contractor Business: Nelson Electric State License #: ELE-38127 Exp.: 1113012018 Address: 3896 E 600 N City: Rigby State: Idaho Zip Code: 83442 Phone: 208-754-9389 Email: greg@nelson-electricllc.com Contact/Rep. Name: Greg Nelson Phone: 208-390-3424 Email: greg@nelson-electricllc.com DocuSigned by: Contractor Authorized Signature: GVt,A misbyu Date: 7/26/2018 2:22:36 PM A copy ofyour state registration/licen smgfbm4*te4W...on file. If this is the first 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: RPR6N40E174190 Description of work: Install Fre alarms per engineered plans ❑ Fire Alarm System Cost: $ TBD • Fees for fire alarm systems are charge by cost: 0 First$10,000=2%+$60. From $10,000to$100,000=1%+$260.Above $100,000=.545+$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 thatthe infurmationherein 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 Iagree 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 ofthe 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. Permltvoidifnot started within 180 days. Permit void if work stops for 180 days. )T Applicant's Name (print): Ray McDougal 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.rexburg.org Permit Technician - (208) 372.2341 OQ pYXBUgC u o C IT Y OF REXBURG America's Family Cornmunily BUILDING PERMIT FORM 4 02 UVdaW 10/2016 BUILDING APPLICATION Fire Sprinkler Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: Fire Sprinkler Fees Paid ❑ 1. Property Owner Name: Jeff Christensen Address: 225 N FREMONT ST City: Sugar City State: Idaho Zip Code: 83448 Phone: 208-390-2960 Email: jeffcbshop@cableone.net 2. Contractor Business: Pheonix Fire Protection State License #: FPFC-108 Exp.: 12/31/2018 Address: 4130 Airport Rd City: Nampa State: Idaho Zip Code: 83687 Phone: 208-468-9117 Email: lacci@pheonixfp.com Contact/Rep. Name: Teri Cruickshank Phone: 208468-9115 Email: teri@pheonixfp.00m 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: RPRISN40E174190 Description of work: Install fire supression per engineered plans Number of Heads: per plan ❑ Fire Sprinkler System Cost: $ 86,698 • 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$310 total feefee • 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 p roperty for Inspections pu rposes. NOTE: The build Ing official may revoke a permit o a approval issued under the provisions of the 20 12 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): Ray McDougal Signature: Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after SAM will be scheduled for the next business day. Inspection Hotline- (208) 372.2344 www.rexburgorg Permit Technician - (208) 372.2341 <1F p4XBUgU CITY O F Building Safety Department c o REXBURG City of Rexburg c'W 35 North 1st East America's Family Corrmnmiry Rexburg, Idaho 83440 SUBCONTRACTOR LIST Excavation & Earthwork: Kauer Construction Concrete: Subcontractor of Teton West Masonry: NA Roofing: Romero Roofing Insulation, Advanced Insulation Drywall: Nava Drywall and Finishing Fainting: Nava Drywall and Finishing Floor Coverings: Carpet Direct Plumbing: Rexburg Plumbing Heating: Mountain River Mechanical Electrical: Nelson Electric Special Construction (Manufacturer or Supplier) Roof Trusses: Snake River Truss Floor/Ceiling Joists: Boise Cascade Siding/Exterior Trim: Briggs Metal Other: Inspection Hotline -(208)372.2344 www,rexburg.org permit Technician -(208)372.2341 Revised 10/2016 De pEXBUq� C I T Y O F Building Safety Department AA � o„ 0 1t77 r. XBURG City of Rexburg G CW 35 North 1St East Americas Family Communlry Rexburg, Idaho 83440 Affidavit of Legal Interest State of Idaho County yQoffMadison I, Q.16 6,f -VT LJ / YYL� �C rl`�%?i Xet� �'L - — Name Address "f•n, , (k 9W/-/0City State Being first duly sworn upon oath, depose and say: (if Applicant is also Owner of Record, skip to B) A. Tha``t�'I am the record owner of the property described on the attached, and I grant my permission to: , k,X �r tb wo�r� L -G -C Name dd!{ ress 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. I Dated this _ (z_ day of 20J6 Subscribed and sworn to before me HOgT��i Q�•�pT/Wy • E Z jDU81?G � OF Inspection Hotline - (208) 372.2344 day and year first above written. Public of Idaho Residing at: _ ��ura / / My commission expires: C�(2 C/ r 2 U2 www.mxburg.org Permit Technician -(208)372.2341 Revised 10, 2016 oFatixa°"� C I T, Of Building Safety Department a o REXBURG City of Rexburg � 35 North 1St East •,,,F o ,.• Amen,' Fmullycanniun/ty 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? ❑ Yes ) A' No Will the business be doing any structural/or remodeling changes to the building? ❑ Yes [kNo Any changes to the electrical? ❑ Yes INNO Any changes to the plumbing? ❑ Yes j% No Any changes to the mechanical system? I] Yes CKNo Is the business type changing? o Yes, it will change to b -No Is this business changing ownership? ❑ Yes *lo Is the business registered with the City of Rexburg? V -Yes, License #; ❑ No *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? []Yes 91fo— Will there be any cooking of foods? ❑ Yes (gNo Will there be any deep fat frying? []Yes lK No Will you have food disposal on site? ❑ Yes t_No Will there be sumps or floor drains in the facility? Yes ❑ No Will the business have any chemicals on site? ONYs 13No e Ap ants Signature Phone Date I certify that the information that I have provided above is to the best of my knowledge accurate and true. Inspection Hot) lne-(208)372.2344 www.ivxborg.org permit Technic !an -(208)372.2341 Revised March, 2016 OF p4.XBUgC, � `o CITY OF ° REXBURG America's Family Community DISTRIBUTION LIST 1. 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: Blake Walker Name: Ray McDougal Name: Jeff Christensen Name: Name: Inspection Tickets Name: Name: Name: Name: Name: Email: blake@southforkengineering.com Email: ray@southforkengineering.com Email: jeffcbshop@cableone.net Email: Email: Email: Email: Email: Email: Email: Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised 10/2016