HomeMy WebLinkAboutAPPLICATION - 19-00145 - 859 S Yellowstone - Suite 3201 - Henry's Fork Plaza - Commercial Office BuildingOF gEx8v
�p CITY OF
RExBuRG Building Safety Department
Ow ____ City of Rexburg
1"7. America's 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
Initi s Certificate of Occupancy from the Building Department. These documents must be signed
by theauth
from the City of Rexburg. Any approvals can be verified by calling (208) 372-2167. Even if you heart omriataninspect rles 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.
o 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
correctly perform the inspection. (Example: If the electrical rough in inspection is not done
following business day. If an inspection is not done, the inspector may require any measures to be taken to allow him to
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
J 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.
�C o OCCUPYING A FINISHED BUILDING. No building maybe occupied without receiving a signed Certificate of Occupancy. If a
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
nitials information is passed on to them or not.
Applicant's Name (print): !„JGtJ / Signature:.31d 1�"4g;f
Date: /1$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 10/2016
OF 8E�U1pC
v� CITY OF Building Safety Department
° REXBURG BUILDING PERMIT FORM City of Rexburg
ey, Updated 03/2017 Famil
'' America35 North 1St East
's j+Community '�•ML�
Rexburg, Idaho 83440
BUILDING APPLICATION
New Commercial Building
For Office Use
Permit Number: Zoning:
Application Fee: ❑ $1000/BuildinLy
1. Propert ( Owner
Name: (, kdQ �r6fie �EmIfJAP_S LLC /�
Address: -59 S N ELLs,j3sb J = l+y,.! d 3c., City:
Phone: +JS 3 ( g� State: Zip Code: _UL/L/e'
Email:
2. Applica
Name:Aa: rj�EJF_�j Rolf: (Owner, Tenant, Contractor, etc.) 60.Ji RdeTpR.
Address: 1 a l E >}SANr J, Ec1 City: F x . ,2 �.
State: Y +
Phone: c�0 'i O ( � 31 a Email: l bS State:
- � -_) Zip Code: fs3yi/C'-
Contact Re Name: 2� 5 L Cable ,o.J0 - fJe-_
3. General Contractor
Under Idaho Building Code, a rfgistered contractor must do the work for a Commercial Building.
Name:`afEJEn1S�o`SSi Co/ �A2i �T��'+=;v"> n !_,)A -)b9 •� Registration #: Kt Exp.:
Address: la.� iDL� A An) i �i E ,) l� City: per:_ X ri 4:2 G T
Phone: _,� a n l o tj 7 3 I� State: _141 Zip Code: $3 v 140
Email:_ i �i�'SC.t�/NLlt I e C /Lc k
Contact/Rep. Name: +` Phone: I'a t —
Email:
General Contractor Authorized Signature: CPO
Date: 3Z) 7 A `1
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 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 Descriptigqn `S �( L/ Q L& 0-3 f'o,J c 1- ,o d 1t, b3-1 j-1
• Address:m :u2ypLx z4 -OR- Lot #: _ Block #: — Subdivision: ,-�+
r
iI'��K I
• Project Name: E� �FF� C �'ICL.ra � ,�, t,,� .� • Construction Type: YP t94At 0 Occupancy Type:
• Square footage: Hoo • Total cost of project -materials and labor: 066 I;eL`,C c
o�1�E1,L O.tSz�
• Check all disciplines that apply: ❑ Mechanical: Cost $ n%.4 ❑ Electrical: Cost $ NA
❑ Plumbing: Cost $ ti: 171 FireAlarm:Cost$ /1;.10 Fire Sprinkler: Cost $ M-1
Note: Any contractors involved will need to fill out their respectivepplication.
• # of Water Meters: l • Water Meter Size() Hs : 3 . :v
# of Parking Stalls:
• # of Dumpsters: +li.� ,
Estimated Date: DIL,,l 1 2 3 4 5ump ter Delivery . # of Dumpster Pickups/week
• Other Comments (if any): j
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 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.
jh
Applicant's Name (print): g fk-r � 16� 6,0/j
Signature: ��� `� Date: s.
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
oFgBxeURC
c> TY OF Building Safety Department
1ExBuRG City of Rexburg
Ameri-d Family Community 3S North 1St East
Rexburg, Idaho 83440
Affidavit of Legal Interest
State of Idaho
County of Madison
Name
Address
City
State
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
A. That
it That I am the record owner of the property described on the attached, and I grant my permission to:
i!1��
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 J7 day of / "—l'--'/ 20 / 6?�
Signature
Subscribed and sworn to before me the day and year first above written.
H
S WADENUMBER 854413 PUBLICF IDAHO
Inspection Hotline - (208) 372.2344
Public of Idaho
Residing at:
My commission expires: 7 Zi 20 ?i
www.rexburg.org Permit Technician - (208) 372.2341 Revised 10, 2016
aQ µExe ups
CITY o F Building Safety Department
REXBU'RG City of Rexburg
,•' America' Family Community 35 North 1St East
Rexburg, Idaho 83440
Affidavit of Legal Interest
State of Idaho
CountyofMadison
0 A) S-t�
Name Address
City
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
State
A. That I am the record owner of the property described on the attached, and I grant my permission to:
Name ��� - Sa +moi �4.. 'ID a &/W
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 1� i day of IAafc, Z0- I!�
Signature
Subscribed and sworn to before me the day and year first above written.
a
WADENUMBER 65446 PUBLICF IDAHO
Inspection Hotline - (208) 372.2344
01
Public of Idaho
Residing at: /U (Rr,/ //7
My commission expires:
www.rexburg.org Permit Technician - (208) 372.2341 Revised 10, 2016
OQ pEXBURC
o1 CITY o F Building Safety Department
REx.BuRG City of Rexburg
America' Family community 35 North 1st East
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.
----& I
Signature
ick/t --4�*ts
Printed Name
Inspection Hotline - (208) 372.2344 www.rexhurg.org
Date
Permit Technician - (208) 372.2341 Revised 10/2016
oQ aexspR�
u� 7 CITY OF Building Safety Department
REXBuRG City of Rexburg
America's FaCmiillyCommuniiy 35 North 1St East
Rexburg, Idaho 83440
SUBCONTRACTOR LIST
Excavation & Earthwork:
><3
�f/4 JFK (..,j
Concrete:
,11� o 0 y
r 0 f L, A E N E
Masonry:
L
,4YF)eI
o ►ul
Roofing:
TEFF &d L!J
Insulation:
&\ L
Drywall:rQP,cF-
RiZETO.aJ
Painting:
re-AJi 5
5 9 A R P
Floor Coverings: WAQ E 447-1.AJA.�
Plu b'
R E
P
tic -T) O ,J
m mg.
J Q I,
L .—A, 0 nJ(e
Heating:
�f_ X 43JQ�
Electrical:
�F 6,464
Roof Trusses:
Floor/Ceiling Joists:
Siding/Exterior Trim
Other:
Special Construction
(Manufacturer or Supplier)
lV \
Lo, -,
AeOEE 4)EELS I�J,LOE_RS
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341
Revised 10/2016
oQQexaaRc
C I TY o f Building Safety Department
0
REXBURG City of Rexburg
AmericasFamily Community 35 North 1St East
Rexburg, Idaho 83440
DISTRIBUTION LIST
Please provide the names and emails of anyone who should be getting automated updates for this project.
Review Notes f
Name:.. det/4 d C'LS
Name:
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Name:
Inspection Tickets (�
Name: I�� Qt -- +Ccln
Name:
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Email: .i b 5 t JCAStP rnt ,i -
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Email: ih5kutn3 6V Crblf,
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Email:
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341
Revised 10/2016