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Home My WebLink AboutAPPLICATION - 19-00371 - 480 W 2nd N - Veterans Memorial Building - RemodelOF BEX B L',pC Cl Ty " F Building Safety Department c REXBURG BUILDING PERMIT FORM 2 1 City of Rexburg OW Updated 05/2019 35 North 1St ' America's F'omiJ}' Community East tU Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Remodel/Tenant Finish For Office Use Permit Number: Application Fee: ❑ $100 1. Property Owner Name: _ re—AK150n1 Gou►UTV Address: q!al Sfi12 t- (�-x�l Phone: (aUg3) _ n7 pa City: - 1 State: I P Zip Code: Email: 2. Applicant Name: ?—w /�ssa� ,ate Role: (Owner, Tenant, Contractor, etc.) 1i✓�, Address: i i5 7 I�7o„ta �tl Phone: (at�a� 35R - ,7 �� City: - � : State: CDP.Ao Zip Code: 62WO Contact/Rep. Name: 2:1a,.( wla�prn Email: �wl.� (nt (c�4ri AJ0. 6AA-- 3. General Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Name: U-4 S ('oN.�r Lk, t-7 p 1 Re istration #: Address: �, ht oa—Tu 3 -4 Q0 !_ r Exp.: Phone: Cangl 7x4.8 6 8 y Clty. __ ttt lZ y State: i.O,at 1) Zip Code: - TA 442_ Contact/Rep. Name: a512�� S „} Email: 1 g c �'�S , ne•} Phone: Email: General Contractor Authorized Signature: 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. 4. Project Description Address: Description of Work: L3Ag-f+ ,vL kl -j_-H1aA �ITbP � r� T Project Description: • Total cost of project - materials and labor: • Check all that apply: Mechanical: Cost $ V1 Electrical: Cost $ ,l Plumbing: Cost $ ❑ Fire Alarm: Cost $ ❑ Fire Sprinkler: Cost $ Note: Any contractors involved will need to fill out their respective application. • Change of Occupancy?,P1No ❑ Yes: New occupancy: 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. Applicant's Name (print): Ic>./ ►J AWl Signatu Date: �_19 1q 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 Tnrhni�f�., _ r�no� ovo o.., OF 1tEX B URC CITY o FCr Building Safety Department RE)MURG BUILDING PERMIT FORM 210 City of Rexburg CV ___ Updated 03/2019 America35 North 1St East 's Family Cornmunity Rexburg, Idaho 83440 COMMERCIAL MECHANICAL BUILDING APPLICATION ❑ New Construction ❑ Addition 0 Remodel For Office Use Permit Number: ❑ Tenant Improvement ❑ Accessory Structure > 200 sq. ft Mechanical Fees Paid ❑ 1. Property Owner Name: N,41_>1561L/ CoLtl4j t Address: MAI A./ S gyr Phone: _ a08i �i 5"9 - iDo�00 CIS'' i> Gur�� State: - I (� D Zip Code: �3 `f Email: 2. Mechanical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: State License #: Address: Exp.: Phone: City: State: Zip Code: Email: Contact/Rep. Name: Phone: Email: Mechanical Contractor Authorized Signature: 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, pleaseprovide 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: ❑ Project Cost: $ Cost of project: Calculation for inspection fee: $0 to $10, 000 then: (Cost of project * 2%) + $60 $10,000 t0$10 0, 000 then: ((Cost of project - $10, 000) * 1 a/o) _+$260 Greater than $100,000 then: ((Cost ofproject - $100,000) * 3i%) + $1160 An additional plan review fee is required which is 10% of the calculated inspection 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): Signature: Date: Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM wil Inspection Hotline — (208) 372.2344 l be scheduled for the next business day. www.rexburg.org D_-;-_-_!__ -_ __ - OF VSxBURC U� -y CITY OF Building Safety Department REXBURG BUILDING PERMIT FORM 220 City of Rexburg ctv Updated 03/2 Americas Family Commtauty 35 North 1St East Rexburg, Idaho 83440 COMMERCIAL ELECTRICAL BUILDING APPLICATION ❑ New Construction ❑ Addition 15(Remodel ❑ Tenant Improvement ❑ Accessory Structure > 200 sq.ft For Office Use Permit Number: Electrical Fees Paid ❑ 1. Property Owner Name: MAPISaA/ C �/ �� Address: 1'j?� Iti/ `i1` City: - InBX BU l2G Phone: _ �� State: 1[�AVo Zip Code: 3� Email: 2. Electrical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: State License #: Address: Exp.: Phone: City: State: Zip Code: Email: Contact/Rep. Name: Phone: Email: Electrical Contractor Authorized Signature: 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: ❑ Project Cost: $ Cost of project: Calculation for inspection fee: $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 - $100, 000) * j) + $1160 There will also be a plan review fee totaling 10% of the above fee. APPLICANT'S SIGNATURE, CERTIFICATION 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. 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.��, ^� .. Permir Tort....,...... ., .. of ytti.X a URC c' TY o F Building Safety Department REXBURG BUILDING PERMIT FORM 23 City of Rexburg Cly __Updated 03/2019 3 5 North 1st ' America's family Community East Rexburg, Idaho 83440 COMMERCIAL PLUMBING BUILDING APPLICATION ❑ New Construction ❑ Addition Of Remodel ❑ Tenant Improvement ❑ Accessory Structure > 200 sq. ft For Office Use Permit Number: Plumbing Fees Paid ❑ 1. Property Owner Name: _Ink,91 Spit./ Address: l'?�4��69 S� Phone: ��OSppCity: X 'Lf17" State: _Zip Code Email: 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: State License #: Address: Exp.: Phone: City: State: Zip Code: Contact/Rep. Name: Phone: Email: Email: Plumbing Contractor Authorized Signature: 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: ❑ Project Cost: $ Cost of project: Calculation for inspection fee: (Cost of project*2%)+$60 EEEE ((Costo of project $10,000) *JY 1 0),$260 ) + $260 Greater than $100,000 = ((Cost ofproject - $100, 000) *z %) + $1160 An additional plan review fee is required which is 10% of the calculated inspection fee APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l 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 mein 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. 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 Techniria - MAI Zai ��n