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HomeMy WebLinkAboutAPPLICATION - 19-00359 - 871 Jet Stream Dr - The Rock Gym - New CommercialV.VXBL, CITr O F JRG REXBL America's Family Community BUILDING PERMIT FORM 200 Updated 03/2017 BUILDING APPLICATION New Commercial Building Building Safety Department City of Rexburg 35 North 1St East Rexburg Idaho 83440 For Office Use Permit Number: �C'66 -qJC q Zoning: t j Iti-_J7&&si0lC f Application Fee:�i$1000/Buildin 1. Property Owner Name: �-� (_ j -7!:> nJ Address: - 171 2 E' r2 { t ty: -1 L t t State: �_ Zip Code: Phone: Email: 2. Applicant Name: Role: (Owner, Tenant, Contractor, etc.) '- Address: O City: -5[ %�✓2 G State: In Zip Code: Phone:—'9©Q__ Email: Contact/Rep. Name11 :` 3. General Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Name: ^J Registration #: CWA-)E(L Exp.: Address: e City: 12, Li State: c ✓..� Zip Code: -� Phone: Email: _ Contact/Rep. Name: n! OU Phone: 2DV M9 Email:'N..aA SO.� i►W 2 301 � General Contractor Authorized Signature: Date: A copy of your state registration/license is required to be on file. If this is th 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 Q • Address: -OR- Lot #: 8 Block #: Z Subdivision: A 11 • Project Name:"�- i�t�t� �/M • Construction Type: ILA • Occupancy Type: ' -- • Square footage: 1 !2�_ T • Total cost of project - materials and labor: $ • Check all disciplines that apply: Mechanical: Cost $ M&__r FT -Electrical: Cost $ Plumbing: Cost $-� ❑ Fire Alarm: Cost $ El Fire Sprinkler: Cost $ " Note: Any contractors involved will need to fill out their respective application. • # of Water Meters: i . Water Meter Size(s): _�_ • # of Parking Stalls: • # of Dumpsters: i • Estimated Dumpster Delivery • # of Dumpster Pickups/week Date: =/ -14- / T- 0 2 3 4 5 • Other Comments (if any): 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 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 provisionsof 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):. CIAO QAJ Signature: Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection reques led 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 -— CV& — Ameriuu Family Community IWI)Ir BUILDING PERMIT FORM 21� Updated 03/2019 Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 COMMERCIAL MECHANICAL BUILDING APPLICATION ❑ New Construction ❑ Addition ❑ Remodel ❑ Tenant Improvement ❑ Accessory Structure > 200 sq. ft For Office Use Permit Number: 1. Property Owner Name: Address: Phone: City: Email: Mechanical Fees Paid ❑ State: Zip Code: 2. Mechanical Contractor Under Idaho Building Code, a registered contractor must do the work fora Commercial Building, Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Mechanical Contractor Authorized Signature: Date: A copy ofyourstate 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: _ ❑ Project Cost: $ Cost of project: Calculation for inspection fee: $0 to $10,000 then: (Cost of project * 2%) + $60 $10,000 to $100,000 then: ((Cost of project - $10,000) * 1916) + $260 Greater than $100,000 then: ((Cost of project - $100,000) * Y2 Yb) + $1160 An aaamonal plan review fee is required which is 10% of the calculated inspection fee nrrwt.nn t b WUNA I UKC, Lhi(TIMK:ATION AND AUTHORIZATION: Under penalty of perjury, 1 hereby certify that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by 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. Permitvoid 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 C I TY OF REXBURG O, America's Family Community TW BUILDING PERMIT FORM 2 2 Updated 03/2019 Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 COMMERCIAL ELECTRICAL BUILDING APPLICATION ❑ New Construction ❑ Addition ❑ Remodel ❑ Tenant Improvement ❑ Accessory Structure> 200 sq,ft For Office Use Permit Number: 1. Property Owner Name: Address: Phone: City: Email: State: Electrical Fees Paid ❑ Zip Code: 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Electrical Contractor Authorized Signature: Date: A copy ofyourstate 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: Description of work- _ ❑ Project Cost: $ Cost of project: Calculation for inspection fee: $0 to $10,000 = (Cost of project * 2%) + $60 $101000 to $100,000 = ((Cost of project - $10, 000) * 1 %) + $260 Greater than $100, 000 = ((Cost of project - $100, 000) * M %) + $1160 7'here 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 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): 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 - (2081 3722341 VLV,xaEUIR CITY OF _ Building Safety Department uQj RYMBURG BUILDING PERMIT FORM 230 City of Rexburg `► CW ___ Updated 35 North 1St East America's Family Community Rexburg, Idaho 83440 COMMERCIAL PLUMBING BUILDING APPLICATION ❑ New Construction ❑ Addition ❑ Remodel ❑ Tenant Improvement ❑ Accessory Structure>200sq.ft For Office Use Permit Number: Plumbing Fees Paid ❑ 1. Property Owner Name: Address: City: State: Zip Code: Phone: Email: 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: State License #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: Plumbing Contractor Authorized Signature: Date: A copy ofyourstate 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: Description of work: ❑ Project Cost: $ Cost of project: Calculation for inspection fee: $0 to $10,000 = (Cost of project * 2%) + $60 $10,000 to $100,000 = ((Cost ofproject - $10,000) * 1%) + $260 Greater than $100,000 = ((Cost of project - $100,000) * 46%) + $1160 An additional plan review fee is required which is 10% of the calculated inspection fee nrrwt.Hir i b MUNA I Uxn, LEWHFI ATION AND AUTHORIZATION: Under penalty of perjury, 1 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): Signature: Date: Inspections must be called in before 8 AM on the day the inspecti on 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 us, CITY OF REBURG 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 begetting automated updates for this project.- Review roject. Review Notes Name: � (044AJ Name: Name: Name: Name: Inspection Tickets Name: Name: Name: Name: Name: Email: ✓'cvG;k Email: Email: Email: Email: Email: Email: Email: Email: Email: Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016 C I TY O F REXBURG BUILDING America's Family Community Building Safety Department T FORMCity of Rexburg Updated 03/2019 401 35 North 1St East Rexburg, Idaho 83440 COMMERCIAL FIRE ALARM BUILDING APPLICATION ❑ New Construction ❑ Addition ❑ Remodel ❑ Tenant Improvement IFor Office Use Permit Number: 1. Property Owner Name: Address: Phone: I2. Contractor Business: Phone: Contact/Rep. Name: Fire Alarm Fees Paid ❑ City: State: Zip Code: _ Email: State License #: Exp.: City: State: Zip Code: Email: Phone: Email: Contractor Authorized Signature: Date: 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: Description of work: _ ❑ Fire Alarm System Cost: $ • Fees are charged by cost. INITIAL COST CHARGE BY COST $0 to $10,000 = (Cost of project * 2%) + $60 $10,000 to $100,000 = ((Cost of project - $10,000) * 1 %) + $260 Greater than $100,000 = ((Cost of project - $10,000) * 0.591o) + $1,160 0 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 herebv certifv that 1 have read this annlicatinn and ctara rh�r rho in&e ­:..,, t,e ;e correct ana i swear teat any mtormation 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): Signature: Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 C I TY OF NIA REXBURG I BUILDING PERMIT FORM Q.OZ Updated 03/2019 America's Family Community 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: 1. Property Owner Name: (Phone 2. Contractor Business: Address: Phone: Contact/Rep. Name: City: Email: State License #: Fire Sprinkler Fees Paid ❑ 1 State: Zip Code: City: State: Phone: Email: Email: Exp.: _ Zip Code: 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 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: Description of work: _ Number of Heads: I ❑ Fire Sprinkler System Cost: $ • Fees are charged by cost: INITIAL COST CHARGE BY COST $0 to $10,000 = (Cost of project * 2 %) + $60 $10,000 to $100,000 = ((Cost of project - $10,000) * 1 Yo) + $260 Greater than $100,000 = ((Cost of project - $10,000) * 0.5% + $1,160 o 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 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): 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 - (2081372.2 341 U07 C I TY oP / , Building Safety Department REX-BURG City of Rexburg OW 35 North 1St East Americas Family CommunRy Rexburg, Idaho 83440 SUBCONTRACTOR LIST Excavation & Earthwork: Concrete: Masonry: Roofing: Insulation: Drywall: Painting: Floor Coverings: Plumbing: Heating: Electrical: Special Construction (Manufacturer or Supplier) Roof Trusses- Floor/Ceiling Joists: Siding/Exterior Trim: Other: Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016