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Home My WebLink AboutAPPLICATION - 19-00401 - Pizza Hut - Tenant RemodelOQ pEXDURC a5 CITY OF Building Safety Department ° REXBURG City of Rexburg "° 35 North 1St East '• „..' America's Family Community 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. 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 Official may remove the red tag. If the red tag is removed by anyone but a City Official, citations may be issued. No building may be occupied without receiving a signed Certificate of Occupancy. o If a building is occupied without receiving a signed Certificate of Occupancy, citations may be issued and the occupants may be evicted. l i 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 perform the inspection. (Example: if the electrical rough in inspection is not done and the sheetrock has been t; 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. 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. It 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. o The above policies will be enforced to all, regardless if this information is passed on to them or not ni is s Applicant's Name (print): !r Signature: Date; 9 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 oearxeugc C I T Y O F iWX—B VR America's Family Community BUILDING PERMIT FORM 202 Updated 1012016 BUILDING APPLICATION Commercial Tenant Improvement Building Safety Department City of Rexburg 35 North 1St East Rexbura, Idaho 83440 For Office Use Permit Number: Application Fee: ❑ $100 1. Property wrier i Name: C 0.T Address: Yll S. arid WfS4 City: r State:_ Zip Code: 43�t4b Phone: IcA5 - Ril - U0 i Email: 2. Applicant Name: Role: (Owner, Tenant, Contractor, etc.) Address: « 6 $ City: _e4co;e>t3d State: Zip Code: 1 Phone: Email: rn.�'(�gt+►�•�.r��n�,� .rh ` Contact/Rep. Name: Rachael &q 3. General Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Name: 778b Registration #: Exp.: Address: City: State: Zip Code: Phone: Email: Contact/Rep. Name: Phone: Email: General 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, 4. Project Description Address: a • Mm Q] Description of Work: Project Description: • Total cost of project - materials and labor: $ • Check all that apply: ❑ Mechanical: Cost $ 46), wo ❑ Electrical: Cost $ &, OOU ❑ Plumbing: Cost $ 35, 000 ❑ Fire Alarm: Cost $ -1` 500 ❑ Fire Sprinkler: Cost $ 10f 000 Note: Any contractors involved willfila lr respective application. • Change of Occupancy? ❑ No 13s: 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 1096 of the building permittee. 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): 2�&Ml d0f�!Signature: Date: / Inspections must be called in before 8 AM on the day the inspection is requested. Inspection r ests a led i 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 PERMIT FORM 210 Updated 10/2016 BUILDING APPLICATION Commercial Mechanical Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Mechanical Fees Paid ❑ 1. Property Owner Name: Address: City: State; Zip Code: Phone: Email: 2. Mechanical 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: Mechanical Contractor Authorized Signature: Date: A copy ofyour state registrationflicense 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: $ • Fees for commercial projects are charged by cost: 0 First $10,000 = 2% + $60. From $10,000 to $10o 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 = S310 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 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 - (208) 372.2341 CITY jOTF�� REISB V G r� America's Family community BUILDING PERMIT FORM ZZO Updated 10/2016 BUILDING APPLICATION Commercial Electrical Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Electrical Fees Paid ❑ 1. Property Owner �� Name: Address: City: State: Zip Code: Phone: Email: 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 ofyour state registration/license is required to be on file, /f this is the first timeyou have done work in the City of Rexburg, please provide a photo copy ofyour license. lfyou 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: $ • 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 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. 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 04 pEXB VRC CITY OF 7 REXBURG •, , Americ6 Farnify Carnmanity BUILDING PERMIT FORM 2 3 0 Upd.wd 10(2016 BUILDING APPLICATION Commercial Plumbing Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office Use Permit Number: Plumbing Fees Paid ❑ 1. Property Owner TQ^ 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 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 iyour license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: Description of work: ❑ Project Cost: $ • 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 =,5910 +$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 10916 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 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 OS µEXBURC U G CITY OF R.EXBURG America's Family Community BUILDING PERMIT FORM %01 Updamd 10/2016 BUILDING APPLICATION Fire Alarm Building Safety Department City of Rexburg 35 North lst East Rexburg, Idaho 83440 For Office Use Permit Number: Fire Alarm Fees Paid ❑ 1. Property Owner TWD 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 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: ❑ Fire Alarm System Cost: $ • Fees forFre 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, I hereby certify that I have read this application and state that the information herein 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 Permit Technician - (208) 372.2341 C I TY O F REXBURG America's Family Community BUILDING PERMIT FORM4OZ Updated le/2016 BUILDING APPLICATION Fire Sprinkler Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 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 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: 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 =.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 10916 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 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 - (208) 372.2341 i= URc, C I TY o f Building Safety Department '; 0 0 REXBURG City of Rexburg 35 North 1St East ,, Americai Family Community Rexburg, Idaho 83440 a 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 - (206) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 Revised 10/2016 OQ gEXB URC, `y rQ CI TY OF REXBURG Ob- .. ,.' AmericdsFamily 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: ��-1► (5.nopay-- Name: Name: Name: Name: Inspection Tickets Name: Name: Name: Name: Name: Email: i7i1GhAG�. GoOP��ytl /1Q110M1�.( Email: )(OA rte lg ,1IAeAif-d16416 ' L11r1. C -CM 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 OF REXBURG CW Americas 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? Is the business registered with the City of Rexburg? ❑ Yes, License #: *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? 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? �—Aep hone Date 6 Yes ❑ No ❑ Yes [4No ❑ Yes M"N* o ❑ Yes O No 8es ❑ No IN ❑ Yes /,No Zo Xi Yes []No Vyes ❑ No k(Yes ❑ No 1 Yes 13 No O&es ❑ No iYes ❑ No 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 CITY Of Building Safety Department RMURG City of Rexburg -C%* 35 North Ist East A—k- opmma-ay Rexburg, Idaho 83440 Affidavit of Legal Interest State of Idaho County of Madison "L( 5 S'i6 Lt- C'- ov>+ Name Address city Being first duly sworn upon oath, depose and say: (if Applicant is also Owner of Record. skip to H) state A. That I am the record owner of the property described on the attached, and I grant my permission to r Wjec 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. Datedthis day of 20 T Signature Id Subscribed and sworn to before me the d6y and year first above written. K Virta NobtyPublic of IdAho Notary Public Residing at. jas kT) State of Idaho Commission -No. 69527 My commission expires: l.Aacc V --N 3, -.:2, ImmImcdox Hodkoe - (200) 372.I344 WWWxft4WrJJArK Pwmit Tachmkim - (208) 3712341 Rtvis*d 10.2916