Loading...
HomeMy WebLinkAboutAPPLICATION - 19-00156 - 433 Airport Rd - Barney Self Storage Plus - Bldg 7aQ aexauR� CITY OF REXBURG 0& America's Family Community Building Safety Department COMMERCIAL APPLICATION CHECKLIST City of Rexburg 35 North 1St 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 2015 IECC, a COMCheck 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 ❑ Permit Policies Acknowledgment signed Seismic Design Category - D (unless soil evaluation confirms category C) Ground Snow - 50 lbs. 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 httl2:llrexbuEg.org/pages./development-code. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician -208 ( ) 372.2341 Revised 10/2016 CITY O F REXBURG Americas Family Community Community Development Department City of Rexburg 35 North 1St East SITE PLAN CHECKLIST Rexburg, Idaho 83440 ❑ 1. Legal Description of proposed building site 1:12. North Arrow ❑ 3. Drawn to scale ❑ 4. Lot Dimensions ❑ 5. 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 ❑ 10. 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.) ❑ 17. Parking (Lot dimensions, distance between rows, loading areas if required) ❑ 18. 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 ❑ 20. 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 CITY O F REXBURG nv America's Family Community PERMIT POLICIES ACKNOWLEDGMENT Building Safety Department City of Rexburg 35 North 1St East Rexburg. Idaho B3440 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 i 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 iais 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. 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 itiai 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 I01tials not be completed. Extenuating circumstances will need to be approved by the Building Department. o 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 in is Occupancy will be issued without these plans, extenuating circumstances will need to be approved by the Building Department. OCCUPYING A FINISHED BUILDING. No building may be 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 i lal be required to vacate. ealsMAKING 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 i information is passed on to them or not. Applicant's Name (print): Signature: N Date: pS I Inspections must be called in before 8Mon the day th spection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 ww.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016 CITY OF REXBURG nv Americds Family Community PROPERTY LINES Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 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. Signature Prin ed Name er Date Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016 oQaeXa N U O CITY OF REXBURG CW America's Family Community BUILDING PERMIT FORM 200 Updated 03/2017 BUILDING APPLICATION New Commercial Building Building Safety Department City of Rexburg 3S North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Zoning: Application Fee: ❑ $1000/Building 1. Property Owner Name: U2 It ` _-� %J `,lam Address: 0 0 /6 c 3'� / City: /?e -,f -,f b L, r S State��a U Zip Co de: 03 7 7 U Phone: o/ 66'7 //31 Email: /Yi rL n 5 e 1— /92 .5e ?4'_ 57`o r S� p 4 . J� 2. Applicant Name: r ✓l 2 I Role: Owner, Tenant, Contractor, etc.) " Address: �0 �5 i'r o ity: e k ( ' State: Zip Code: U Phone: G % �i4 S Email: bA >WL- Contact/Rep. Name: 1 3. General Contractor Under Idaho Building Code, a re istered co>�trar�tor must do the work for a Commercial Building. Name: 6) �'` 9 UI Registration #: Exp.: Address:City: State: Zip Code: _ Phone: Email: _ Contact/Rep. Name: Phone: Email: General Contractor Authorized Signature: Date: A copy of your state registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 4. Project Description f� • Address: 413 3 n P ' 1 -OR-/, Lot #: Block #: Subdivision: • Project Name:$Q /f S'ilo(1QS @,P/NS Q 4 i IG r'h5' e Construction Type:..!! • Occupancy Type: `�-2 • Square footage: -?.600 • Total cost of project -materials and labor: $ • Check all disciplines that apply: ❑ Mechanical: Cost $ ❑ Electrical: Cost $ ❑ Plumbing: Cost $_ ❑ Fire Alarm: Cost $ ❑ Fire Sprinkler: Cost $_ Note: Any contractors involved will need to fill out their respective application. • # of Water Meters: 0 • Water Meter Size(s): O . # of Parking Stalls: • # of Dumpsters: G . Estimated Dumpster Delivery • # of Dumpster Pickups/week Date: / / / 1 3 4 5 • Other Comments (if any): e / C C 4 � 'c- -_LT_ %9 f �` 66 f 7 Ind i 11 � E f2 111"J 5, P, r1.1 Building Permit fees for commercial construction are charged based on square footage and the City's estimated valuation. The application fee applies toward the fee total. For details on how fees are calculated, contact the Building Department. There will also be a plan review fee totaling 10% of the building permit fee. APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. -c K,\, Q /Applicant's Name (print): j2- Signature: / ate: Inspections must be called in before 8 AM on the day the ins on is requested. Inspection requests called in after 8 AM wilt c c eduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 ��OF gEXB U$C G CITY o F Building Safety Department r REXBy1tG BUILDING PERMIT FORM 210 City of Rexburg °pd °3i2019 35 North 1St East America's Family Community Rexburg, Idaho 83440 COMMERCIAL MECHANICAL BUILDING APPLICATION i ❑ New Construction ❑ Addition ❑ Remodel ❑ Tenant Improvement ❑ Accessory Str ture > 200 sq, ft. For Office Use Permit Number: Mechanical Fees Paid ❑ Property Owner Name: Address: Phone: City: 2. Mechanical Contractor Under Idaho Building Code, a registered contractor must Business: Address: Phone: Contact/Rep. Name: City: Phone: Zip Code: Email: worke a Commercial Building. Lic se #: Exp.: State: _ Zip Code: Email: Mechanical Contractor Authorized Signature: ti Date: A copy ofyour state registration/license is required t e on file. I his is the first time you have done work in the City of Rexburg, please provide a photo copy ofyour license. Ifyou are unsure ifyour li nse is file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: _ ❑ Project Cost: $ Cost o roject: Calculation for inspection fee: $0 to $10,000 then: (Cost of project * 2%) + $60 0,000 to $100,000 then: ((Cost of project - $10,000) * 1%) + $260 eater than $100,000 then: ((Costofproject - $100,000) * �%) + $1160 An a yitional plan review fee is required which is 10% of the calculated inspection fee APPLICANT'S SIGNATURE, CERTIFICAT N 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; inform ion 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 agre o 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 -men oned 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 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. Per it void if work stops for 180 days. Z //—/ Applicant's Name (print): , Signature: Date: r 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.rexburg.org Permit Technician — (208) 372.2341 CITY OF REXBURG America's Family Community BUILDING PERMIT FORM Z 2 Updated (13/2019 Building Safety Department City of Rexburg 3S North 1St East COMMERCIAL ELECTRICAL BUILDING APPLICATION Rexburg, Idaho ❑ New Construction 171 Addition C1 Remodel El Tenant Improvement 13ccesswy St ruc re > 200 sq. ft For Office Use Permit Number: i U P�ectrtral�Fees Paid ❑ 1. Property Owner Name: Address: Phone: City: 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do Business: c Address: City: Phone: jj��'' Contact/Rep. Name: Phorl�e:.) Email: C Code: f Commerc' 1 Building. #: V Exp.: C8tate: _ Zip Code: Email: F` Electrical Contractor Authorized Signature: � Date: A copy ofyour state registration/license is required to be on file. l his is the first ti e you have done work in the City of Rexburg, please provide a photo copy ofyour license. lfyou are unsure ifyour license isy file, pleaseFieck with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: ❑ Project Cost: $ C t f proj ct: Calculation for inspection fee: $0 A $10,000 = (Cost of project * 2%) + $60 0,000 0-A00,000 = ((Cost of project - $10,000) * 1 %) $$260 G ea er an $1 0,000 = ((Cost of project - $100,000) *'fa%) + $1160 0 N�nere will also be a plan review fee totaling 10% of the above fee. APP ICANT GN TURE, C TIFICATiON AND AUTHORIZATION: Under penalty of perjury, i hereby certify that i have read this application and state that the information herein is c rrect an 1 ar t t y 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 sha be tru Ful and cor ct. 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 en r upon the ove-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012 Intern anal Code ;d,/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 in 1 days. Permit void if work stops for 180 days. Applicant's Name (print): fl :5"n'� Signature: ��--�'1 Date: -t ! �� IVB / Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM w,,}! lie scheduled for the next business day. Inspection Hotline — (208) 372.2344 www.rexburg.org v° Permit Technician — (208) 372.2341 o�4exsuRc U� r� CITY o f Building Safety Department »1EXy1MG BUILDING PERMIT FORM 230 City of Rexburg � Updated U3/2079 35 North 1St East America's Family Community Rexburg, Idaho 83440 COMMERCIAL PLUMBING BUILDING APPLICATION ❑ New Construction ❑ Addition ❑ Remodel ❑ Tenant Improvement ❑ Accessory Structure > 200 s . ft For Office Use Permit Number: Plumbi Fees Paid ❑ 1. Property Owner Name: Address: City: State: /pCode: Phone: Email: 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the Business: Address: Phone: Contact/Rep. Name: State Lic City: Email: Phone: Plumbing Contractor Authorized Signature: A copy ofyour state registration/license is required to be on�isn ffile, a photo copy ofyour license. Ifyou are unsure ifyour license Project Description Address: Description of work: ❑ Project Cost: $ a Comm al Building. #: Exp.: Zip Code: Email: tl-- Date: me you have done work in the City of Rexburg, please provide with the Permit Technician by calling (208) 372-2341. Clost of project: Calculation for inspection fee: $0 to 10,000= (Cost of project * 2%) + $60 $10,000 $100, 000 = ((Cost of project - $10,000) * 191o) + $260 Greater han $100,000 = ((Cost of project - $100, 000) * i/z%) + $1160 review fee is required which is 10% of the calculated inspection fee APPLICANT'S SIGNATURE, CERTIFICA N AND A HORIZATION: 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 informati whic ay 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 co pl ith 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 pr erty for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the p rovisions of the 2012 International Code in cases of any false tement 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 ' work stops for 180 days. li o� > _ L — Applicant's cants 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 Safety Department BUILDING PERMIT FORM401 City of Rexburg Updated 03/2019 35 North 1St East Rexburg, Idaho 83440 COMMERCIAL FIRE ALARM BUILDING APPLICATION ❑ New Construction ❑ Addition ❑ Remodel ❑ Tenant Improvement For Office Use Permit Number: 1. Property Owner Name: Address: Phone: 2. Contractor Business: Phone: Contact/Rep. Name: City: State: Email: State License #: City: sta Email: ��� Phone:/Email: Contractor Authorized Signature: I ) A copy of your state registration/license is required to be on file. f this is a photo copy ofyour license. Ifyou are unsure ifyour lignse is o file, ple 3. Project Description Address: Description of work: ❑ Fire Alarm System Cost: $ _ • Fees are Viged by 14 o Work i Fire Alarm Fees Zip Exp.: - Zip Code: Date: me you have done work in the City of Rexburg, please provide with the Permit Technician by calling (208) 372-2341. INITIA OST CHARGE BY COST $0 $10,000 = (Cost of project *2%) + $60 $ Wo to $100,000= ((Cost of project - $10,000) * Mo) + $260 Gr ater than $100,000 = ((Cost of project - $10,000) * 0.5%) + $1,160 15,U00 will be charged $260 for the first $10,000 and 1% of the remaining $5,000 =$260 + $50 =$310 total fee • There w}lf also be a plan review fee totaling 10% of the above fee .APPLICANT'S SIGNATUI;k, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein correct and I swear th 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 corm I agree to comply with all City regulations and State laws relating to the subj ect matter of this application and hereby authorized representatives of the City to enter upon the ove-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012 International C e 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 withi 80 days. Permit void if work stops for 180 days. � Applicant's Name (print): CJ fi� ' mature: Inspections must be called in before 8 AM on the day the' Zi.nequested. Inspection requests called in after 8 AM will Inspection Hotline – (208) 372.2344 www.rexburg.org 1 �9 3iness day. —1 iecnmuan–(208) 372.2341 CITY O F REXBURG America's Family Community BUILDING PERMIT FORM 4,02 Updated 03/2019 Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 COMMERCIAL FIRE SPRINKLER BUILDING APPLICATION ❑ New Construction ❑ Addition ❑ Remodel ❑ Tenant Improvement For Office Use Permit Number: �rerinkler Fees Paid ❑ 1. Property Owner Name: Address: City: SXtat. Zip Code: _ Phone: Email: 2. Contractor Business: State License Exp.: Address: City: State: Zip Code: _ Phone: Em ' Contact/Rep. Name: Phone: Email: Contractor Authorized Signature: Date: - A copy of your state registration/license is required to be on file. If is 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 o flle, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: F Description of work: Number of Heads: ❑ Fire Sprinkler System Cost: $ • Fees are charged qy�c t: ITIAL COST CHARGE BY COST $0 to $10,000 = (Cost of project * 2916) + $60 10,000 to $100,000 = ((Cost of project - $10,000) * 1 %) + $260 reater than $100,000 = ((Cost of project - $10,000) * 0.5% + $1,160 0 Wor Gostin $15,000 will be charged $260 for the frst$10,000 and 1% of the remaining $5,000 = $260 +$50 =$310 total Fee • There wi also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATU , CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein correct and I swear th 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 corre . 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 thea ove-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2012 International _/-mentioned 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 0 days. Permit void if work stops for 180 days. Applicant's Name (print): ,�26(- c.. Signature: te: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be sche ed for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 OF gEXSURC .� �7 CITY O F REXBURG '• America's Family Community SUBCONTRACTOR LIST Excavation & Earthwork: 'D Concrete: L at in w e O i Masonry: Building Safety Department City of Rexburg 3S North 1St East Rexburg, Idaho 83440 Roofing: �. Insulation: Drywall: Painting: Floor Coverings: Plumbing: Heating: Electrical: 19"2, Ci- �� n 2 ��-- e C i t1 C Roof Trusses: Floor/Ceiling Joists: _ Siding/Exterior Trim: /� Other: � J ► 13 t\' Special Construction (Manufacturer or Supplier) (`4 i 5 j0P(Z-5t-- L.)(nr )k� Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016 oQ gEXBUAC CITY OF REXBURG Ob '•<,, E p ,.' Americas Family Community Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho,'3440 Affidavit of Legal Interest State of Idaho County of Madison I, Name City 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 esc Name Address Address State d onAe attached, and I grant my permission to: to submit the accompanying applica 'o/pern' g to that property. B. I agree to indemnify, defe d anurg City and its employees harmless from any claim or liability resulting from any disp. e as oents contained herein or as to the ownership of the property which is the subject of the ppli Dated this Subscribe of 20 y' Signature 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 Technician - (208) 372.2341 Revised 10, 2016 CITY OF REXBURG 006 Americas 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 be getting automated updates for this project.- Review roject: Review Notes Name: Name:./�%����, Name: Name: Name Inspection Tickets Name: Name: Name: Name Name: Email: /�?�[l%k�e�{�t��5��5f�( �x��✓s<�s Email: Email: Email: Email: Email: Email: C t C t> �G " Email: Email: Email: Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016 CITY OF REXBURG CV America's Family Community BUSINESS USE SUMMARY Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 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? ❑ Yes tko []Yes PNo sj7Yes []No 119dded ❑ Yes �No ❑ Yes .moo �Io El�\Yes �No Is the business registered with the City of Rexburg?�es, License #: � ❑ No *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? ❑ Yes E/ 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? 5/ DDv •• •• • ❑ Yes o ❑ Yes '0o 13 Yes �lo ❑ Yes 0�o ❑ Yes �6o Date 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