HomeMy WebLinkAboutAPPLICATIONS - 19-00178 - BYUI - Benson 190 Building Remodel - Temp. Ceramics Lab.� FgF.YU 4'.pC
IT l' OF Building Safety Department
REXBURG City of Rexburg
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Ameriai's1- ,unilyCommunity 35 North 1St East
Rexburg, Idaho 83440
COMMERCIAL REMODEL/TENANT IMPROVEMENT APPLICATION CHECKLIST
The following items should be completed before you submit your building permit application.
*Reasonable accommodations will be made pon request.
Submit the Following Documents:
MY" 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
El 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
Li Building Permit Application signed by a registered General Contractor
2( 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
2Fire Alarm Permit Application (if applicable) signed by a registered professional
❑ Fire Sprinkler Permit Application (if applicable) signed by a registered professional
E( Subcontractor list filled out
0 Affidavit of Legal Interest signed by owner
ci 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://rexbtjrg.org/pages./development-code.
Inspection Hotline - (208) 372.2344 www.rexbur .or
8 B Permit Technician - (208) 372.2341 Revised 10/2016
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REXBURG City of Rexburg
-------- ---`y' --- ---- -- 77 35 North 1St East
Americas Pandy Communih
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.
CA 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 to If the red
g• tag is removed by anyone but a City Official, citations maybe
issued.
No building may be occupied without receiving a signed Certificate of Occupancy.
CA 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
CA 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.
CA 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.
CA 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): Chad Alldredqe
Signature: A* Date: 04/08/2019
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
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C I T v o f Building Safety Department
REXBURG BUILDING PERMIT FORM 201 City of Rexburg
- CW ---- --------- uPaaced,o,zn,e 35 North 1st
America's Finnily Conumnity East
Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Remodel
For Office Use 1
Permit Number: �� " oc 1
Application Fee: ❑ $100
1. Property Owner
Name: BYU-Idaho
Address: 470Quth Phvsical Plant Way City: Rexburg State: ID Zip Code: 83460
Phone: _(208) 496-2510 Email: clarkwna bvui edi
2. Applicant
Name: BYU-Idaho Role: (Owner, Tenant, Contractor, etc.) Owner/Contractor
Address: 470 So Ith Phy i al Plant Aiay City: Rexburg State: ID Zip Code: 83460
Phone: (208) 496-2659 Email: _alldredgecabyui edu
Contact/Rep. Name: Chad Alldredge
3. General Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Name: BYU-Idaho Registration #: n/a
Address: 470 South Physical Plant Way Ci Rexbur_ Exp.:
Phone: (208) 469-2530 �' g State: ID Zip Code: 83460
Email: -edwardsQ0bvui d I
Contact/Rep. Name: John Reed Phone:(208) 496-2513Emai1: reedioCa)byui edu
General Contractor Authorized Signature: �d^
A copy ofyour state registration/license is re red a be on file. If this is th"ef, r 1,eou 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: University Operations Building =470 South Physical Plant Way, Rexburg, ID 83460
Description of Work:. Benson Temporary Ceramics Lab
Project Description:
• Total cost of project -materials and labor: $ a 5bd. Op
• Check all that apply:
® Mechanical: Cost $ 040.00 ® Electrical: Cost $ 000 pu ® Plumbing: Cost $ %2T6dO ao
Fire Alarm: Cost $ o0 0 8 Fire Sprinkler: Cost $
Note: Any contractors involved will need to fill out their respective application.
• Change of Occupancy? ® No ® Yes: New occupancy:
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 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): Chad Alldredge Signature:Date:
p 04/08/2019
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
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Building Safety Department
REXBURG
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BUILDING PERMIT FORM 210
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City of Rexburg
Americas Fainily Con vnunity
35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Mechanical
For Office Use
Permit Number:
Mechanical Fees Paid ❑
1. Property Ovner
Name: BYU-Idaho
Address: 525 South Center
City: Rexburq Id
Phone: l&pg'- q% - g5/g5/(.Nate:
St
Zip Code: 83460
Email: ctc,,r I) P,
2. Mechanical Contractor
Under Idaho Building Code, a registered contractor must do the workfor a Commercial Building.
Business: BYU Idaho
Address: 525 S Center
State License #: 006115
City:
Exp.: 10/31/21
Phone: 208-496-2570
_Rexburg State: ID
Zip Code: 83460
Contact/Rep. Name: Sam Merrick
Email:-merricks@byui edu
Phone: 208-496-2570
Email: merrickS@byui.edu
Mechanical Contractor Authorized Signature: 04/09/201
py fyregistration/license9 Date:
A co 0 our state 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: 505 South Center Street
Description of work: Add to the existin forced airs stem new heat and glaze exhaust hood
❑ Project Cost: $ 30000
• 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 10910 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. 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): -r%*{) ,1�%Z , �� Signature: (*AIA(e Date: 04/08/2019
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.rexbtirg.org
Permit Technician- (208) 372.2341
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C IT ti' OF Building Safety Department
`
RE -G BUILDING PERMIT FORM 2 2 0 City of Rexburg
,• - -- - N, --- - _ Updated 101"M
35 North 1St East
America's Farnily Cormmunity
Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Electrical
For Office Use
Permit Number:
Electrical Fees Paid ❑
1. Property Owner
Name: id`lU-Idako
Address: !Da S S l,g+ &4SA,*,r- S# City: gE*geac�, State: 10 Zip Code: 834(00
Phone: _ q% _ PUG Email �larkw @� b�t�l: ea
v
2. Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building,
Business: 19W ItAxWi State License #: ELF_— 1- 10510 Exp.:'!a
I JZ01J
Address: 525S yr _Z�
City: _��"g� State: _ iiiZip Code:,0—
. g
Phone: .269-Na((o-g5g0 Email: -r-�e¢,g p, b J- z
Contact/Rep. Name: $TElP� P (tl Phone 7610 25y0 Email: -p � � _
r
Electrical Contractor Authorized Signature: Date:L
A copy ofyour state registration/license is required to be o9file. If this is the first time you have done work in the City of Rexbur , 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.
.. Project Description
Address: 505 South Center Street
Description of work: Add 225 Amp panel kiln overhead & convenience outlets VAV and fan power
eproject Cost: $ J l , 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, 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: 6WtqDate• 04/04/2017
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
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CITY OF
Building Safety Department
' REXBURG
—"- OW ---
Updated 10/2016
City of Rexburg
America's Family Community
35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Commercial Plumbing
For Office Use
Permit Number:
Plumbing Fees Paid ❑
1. Property Owner
Name: BYU-Idaho
Address: 525S uthCenter
Phone:
City: Rexburg State:
Idaho Zip Code: 83460 _
_208-496-2590
Email: forbushcftyui edu
2. Plumbing Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building,
Business: BYU-Idaho
State License #• 008429
12 201
Exp.: - 9
Address: 525 South Center City: _Rexburg State: Idaho Zip Code: 83460
Phone: 208-496-2590 Email: _forbushc@byui.edu
Contact/Rep. Name: Craig Forbush Phone: 208313-2465 Email: forbushc@byui.edu _
Plumbing Contractor Authorized Signature: CMl9 7Dtbujh
g / Date: 4-9-19
A co _
py o fyour state re istration 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: 505 South Center Street
Description of work: Add 3 sinks and a sediment trap for clay, compressed air lines. VAV box lines
❑ Project Cost: $12,000
• 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 =.s% +$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 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): _ Craig Forbush Signature: 0*4 -ff'bhl fisc
d Date: 4-9-19
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
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CITY O F
REXBIJRG
America's Family Coinrramil}
For Office Use
Permit Number:
BUILDING PERMIT FORM 401
Updated 10/2016
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Fire Alarm
1. Property Owner
Name:(940—IpArVto
Address: _525 ,FN-TGW— City:
Phone: .20T- -.2151a
2. Contractor
Fire Alarm Fees Paid ❑
�EX8�1124 State: 11> Zip Code: 83N%O
Email: -ACI �h,,,,
Business: BYU - IDAr"t2i State License #: ELE-1- /0510 Ex
Address: 52� S C.IEN�(L p.: �� 31 � � /4
City: R-�x&Q-Xcg State: 10 Zip Code: 93yb0
Phone: A -C aV N410 - 25y0 Email: 1?0%e.Q S 10 u
Contact/Rep. Name: �'- 1EVF, ppA�
_Phone: 208' Nit 10-ZSKo Email: _er-&7 ,p„ S ui, toiK
Contractor Authorized Signature: Z_
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 Ci of R xburg, 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: BYUI Benson building - 505 South Center Street, Rexburg, Idaho 83460
Description of work: Add a horn strobe and smoke detector, ma be extend a couple heads
er-ire Alarm System Cost: $ / Sa e
• 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 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 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): 47,M140I� *F Signature: � i� Date: 04/03/2017
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will bescheduled for the next business day.
Inspection Hotline- (208) 372.2344 www.rexburg.org
Permit Technician - (208) 372.2341
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°
f REXBURG BUILDING PERMIT FORM 4,02 City of Rexburg
Q Updated 10/2016
America's Family Community
35 North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Fire Sprinkler
For Office Use
Permit Number:
Fire Sprinkler Fees Paid ❑
1. Property Owner
Name:
Address: City: State: Zip Code:
Phone: Email:
2. Contractor
Business: State License #:
Exp.:
Address: City: State: Zip Code:
Phone:
Email:
Contact/Rep. Name: Phone: Email:
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:
Description of work:
Number of Heads: --
❑ Fire Sprinkler 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 =.5910 +$1,160. i.e. Work costing
$15,000 will he charged $260 for the first $10,000 and 1% of the remaining $5,000 = $260 + $50 =S310
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 1 have read this application and state that the information herein
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):
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
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C I T Y o f Building Safety Department
REXBURG City of Rexburg
- - CW ---- ---- - 35 North 1St East
Americas Family Community
Rexburg, Idaho 83440
SUBCONTRACTOR LIST
Excavation & Earthwork: BYU-Idaho Carpentry Services
Concrete: N/A
Masonry: N/A
Roofing: N/A
Insulation: N/A
Drywall: _BYU-Idaho Carpentry Services
Painting: BYU-Idaho Auxiliary Maintenance Services
Floor Coverings: N/A
Plumbing: BYU-Idaho Mechanical Operations
Heating: BYU-Idaho HVAC Services
Electrical: BYU-Idaho Electrical Services
Special Construction
(Manufacturer or Supplier)
Roof Trusses: N/A
Floor/Ceiling Joists: N/A
Siding/Exterior Trim: N/A
Other: BYU-Idaho University Security & Safety; Byron Gilbert
Inspection Hotline - (208) 372.2344 www.rexbui-g.org Permit Technician -(208) ) 372.2341 Revised 10/2016
AFFIDAVIT OF LEGAL INTEREST
State of Idaho
) ss.
County of Madison
The undersigned, being first duly sworn, deposes and says:
A. that he is the authorized representative of Brigham Young University — Idaho (the
"University") for the purpose of submitting the attached application (the "Application")
including the making of this Affidavit;
B. that the University is the record owner of the property described in the Application; and,
C. that the University agrees 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 in this Affidavit or as to the ownership of the Property which is the subject of
the Application.
Dated: Monday, April 8, 2019
Subscribed and sworn to before me the day and year tirst above written.
JENNIFER C. LEAVITT
NOTARY PUBLIC - STATE OF IDAHO
COMMISSION NUMBER 20170318
MY COMMISSION EXPIRES 8-18-2023
N ryPubr
Residing at:��,� ( I
My commission expires: fj
-l11 RF.XU1"RP
C t T Y OF Building Safety Department
J REX.BURG City of Rexburg
----------------
(W -------- ------
Ameri35 North 1St East
rn's Family ComntuniN
Rexburg, Idaho 83440
DISTRIBUTION LIST
Please provide the names and emails of anyone who should be getting automated updates for this project.-
Review
roject:
Review Notes
Name: Andy Johnson Email: johnsona@byui.edu
Name: e -Builder Email: KRK_Design_Study.A_-_Inbox@docs.e-builder.net
Name: Chad Alldredge Email: alldredgec@byui.edu
Name:
Name:
Inspection Tickets
Name: John Reed
Name: e -Builder
Name:
Name:
Name:
Inspection Hotline- (208) 372.2344 www.rexburg.org
Email:
Email:
Email: reedjo@byui.edu
Email: KRK_Design_Study.A_-_Inbox@docs.e-builder.net
Email:
Email:
Email:
permit Technician - (208) 372.2341 Revised 10/2016
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C IT Y OF Building Safety Department
RBXBURG City of Rexburg
----- ----------- `il 35 North 1St East
AnzericnFiar�l's 1•ity Corn nn<nity
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?
m Yes
❑ No
Will the business be doing any structural/or remodeling changes to the building?
® Yes
❑ No
Any changes to the electrical?
m Yes
❑ No
Any changes to the plumbing?
® Yes
❑ No
Any changes to the mechanical system?
m Yes
❑ No
Is the business type changing? ❑ Yes, it will change to
® No
Is this business changing ownership?
❑ Yes
® No
Is the business registered with the City of Rexburg? m Yes, License #:
❑ No
*If No, please apply for a business license with the Customer Service Dept.
Will the business have food preparations?
0 Yes
p No
Will there be any cooking of foods?
❑ Yes
m No
Will there be any deep fat frying?
❑ Yes
m No
Will you have food disposal on site?
❑ Yes
® No
Will there be sumps or floor drains in the facility?
❑ Yes
m No
Will the business have any chemicals on site?
❑ Yes
m No
(tea (208) 496-2659 04/08/2019
Applicants Signature Phone 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 -20872.2341
( ) 3Revised March, 2016