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Home My WebLink AboutAPPLICATIONS - 19-00354 - BYUI Hart Auxilary Building - RemodelCITY OF _ Building Safety Department Jai 5 REXBURG City of Rexburg 01 35 North 15Y East America's Family Community xpq 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 upon request. Submit the Following Documents: ❑ 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 ❑ 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 ❑ 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 htto: //rexbur- org/pages./development code. Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician -208 ( ) 372.2341 Revised 10/2016 Building Safety Department City of Rexburg 35 North 1St East 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. 1 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 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 Inoccupants may be evicted. itials 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 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. 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. 0 E The above policies will be enforced to all, regardless if this information is passed on to them or not. Applicant's Name (print): �� W O Signature. Date: p 'I "10\ 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 �y r� C II T'�(Yj OF RE� BURG Americas Family Community BUILDING PERMIT FORM 2 01 Updated 10/2016 BUILDING APPLICATION Commercial Remodel Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 For Office lJse Permit Number: Application Fee: ❑ $100 1. Property Owner Name: Brigham Young University - Idaho Address: 525 South Center Street City: Rexburg State: ID Zip Code: 83460 Phone: 208 496 2664 Email: iohnsonaabyui edu 2, r\pplicant Name: Big -D Construction Corp Role: (Owner, Tenant, Contractor, etc.) CM / GC Address: 343 East 4th North Suite 112 City: Rexburg State: ID Zip Code: 83440 Phone: 208.709.9761 Email: andrew wolfordnbia-d com Contact/Rep. Name: Andrew Wolford 3. General Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Name: Big -D Construction Corp Registration #: RCE -4751 Exp.:12/28/2019 City: Rexbur Address: 343 East 4th North Suite 112 Zip g State: ID Zip Code: 83440 Phone: 208.709.9761 Email: and rew.wolford(a)big-d com Contact/Rep. Name: Andrew Wolford Phone: 208.709.9761 Email: and rew.wolford(acr�big-d com General Contractor Authorized Signature: Date: 10-01-2019 A copy ofyour state registration/license is required to be onfile. 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. 4. Project Description Address: 311 S. 1st W. , Rexburg, ID 83440 Description of Work: Remodel of Hart Bldg Aux. Gym and misc other spaces. Project Description: • Total cost of project - materials and labor: $ $3,981,718 • Check all that apply: ❑ Mechanical: Cost $$174,201 ❑ Electrical: Cost $ $351,413 ❑ Plumbing: Cost $ $151,200 ❑ Fire Alarm: Cost $ $15,000 ❑ Fire Sprinkler: Cost $ $118,420 Note: Any contractors involved will need to fill out their respective application. • Change of Occupancy? I@ No ❑ 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 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): Andrew Wolford Signature: ---� Date: 10-01-2019 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 �> CITY OF _ Building Safety Department REXBURG BUILDING PERMIT FORM 210 City of Rexburg 7"'1012". 35 North 1St East Americ48 Fainly Community Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Mechanical !,or Office Use Permit Number: Mechanical Fees Paid ❑ 1. Property Owner Name: _ Brigham Young University - Idaho Address: 525 South Center Street City: Rexburg State: ID Zip Code: 83460 Phone: 208.496.2664 Email: iohnsonana byui edu 2. Mechanical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: Lewis Corporation HVC-C-4440 State License #: Address: 15136 W Hunziker Road City: Pocatello Code: 83202 Phone: kenyan@lcorp,com Email: Contact Rep. Name: Kenyan Lewis 208.238.1202 Email: kenyan@Lcorp.com 1 Exp.: 5/31/2022 State: Idaho Zip Phone: Mechanical Contractor Authorized Signature: Date: 9'30-19 A copy of your state registration/license is requir d to�ffl�isthe first time you have done work in the City of Rexburg, please provid( a photo copyy of your license. Ifyou are unsure r icense is on file, please check with the Permit Technician by calling (208) 372-234 3. Project !)escriptlon Address: 311 S. 1st W. , Rexburg, ID 83440 Description of work: Remodel of Hart Bldg Aux. Gym and misc other spaces. C4 Project Cost: $ 174,201.00 Fees for commercial projects are charged by cost: o First $10,000 = 290 + $60. From $10,000 to $100,000 =1 45 + $260, Above $100, 000 = .595 +$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 There will also be a plan review fee totaling 1096 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 Net 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): Kenyan Lewis Signature: p Date: 9-30-19 Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests caped in after 8 AM Inspection Hotline - (208) 372.2344 will be scheduled for the next business day. wcvw.rexburg org Permit Technician - (208) 372.2341 OF µEXB tr CITY OF Building Safety Department ° REY.-BURGBUILDING PERMIT FORM 23-01! City of Rexburg CW Updated le/2016 35 North 1St East � America's Family Community Rexburg, Idaho 83440 BUILDING APPLICATION Commercial Plumbing For Office Use Permit Number: Plumbing Fees Paid ❑ I. Property Owner Name: Brigham Young University - Idaho Address: 525 South Center Street City: Rexburg State: ID Zip Code: 83460 Phone: 208.496.2664 Email: iohnsonalitlyui edu 2. Plumbing Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Business: Bingham Mechanical, Inc. State License #: PLB-C-10702 9/30/2020 4400 S Yellowstone Exp.: Address: City: Idaho Falls State: ID Zip Code: 83404 Phone: 208-522-4484 Email: jasonolson@binghammechanical.com Contact/Rep. Name: Jason Olson P nn : 208-522-4484 asonolson bin hammechanical.cwm Email: 1 @ 9 Plumbing Contractor Authorized Signature: 09/30/19 A co 0 our state re istration license is required t be on file. If this is the first timeyou have done work in the City of Rexburg, please provide PY fy g / a photocopy ofyour license. Ifyou are unsure ifyou license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project Description Address: 311 S. 1st W. Rexbur ID 83440 Description of work: Remodel of Hart Bldg Aux. Gym and misc other spaces. ❑ Project Cost: $ 151,200.00 • 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, 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 he 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 Cade 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): v,4Yt D/ Signat Date: 9 3b 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'rechnician - ("LOB) 372.2341 CITY OF REXBURG "W America's Family Community BUILDING PERMIT FORM 4,02 Updated 10/2016 DUILUINty AYYLICATION Fire Sprinkler Building Safety Department City of Rexburg 35 North 1st East RPVII-111-fT TA,I, 4?AAf1 For Office Use Permit Number: Fire Sprinkler Fees Paid ❑ Iopor,_v t)�.Lner Name: Brigham Young University - Idaho Address: 525 South Center Street City: Rexburg State: ID Zip Code: 83460 Phone: 208.496.2664 Email: iohnsona(@byui.edu 2. Contrattar Business: 3-D Fire Protection State License #: FPSC-00812/31/2019 Address: 6312 S. Burggraf Way Ci Idaho Falls Idaho Exp.: Phone: 208-525-8377 �'' State: Zip Code: 83401 Email: kelly.bateman@3dfire.us Contact/Rep. Name: Kelly Bateman Phone: 208-525-8377 Email: kelly.bateman@3dfire.us Contractor Authorized Signature: /1 QL �az�_� Date: 9/30/19 A copy ofyour state registration/license is req red to be on file. !f 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: 311 S. 1st W. , Rexburg, ID 83440 Description of work: Remodel of Hart Bldg Aux. Gym and misc other spaces. Number of Heads: ❑ Fire sprillkier 5vs1e111 Co. -;r: $ $118,420 • Fees for fire alarm systems are charge by cost. o First $10,000 = 2% + $60. From $10,000 to $IOQ000 = 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 = $110 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 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. C�dDApplicant's Name (print): A, - i Signature: Date: InspInspections 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. ection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341 C I T Y O F REXBURG Ow Americas Faintly <.anlntunav BUILDING PERMIT FORM 22� Updated 10 2016 BUILDING APPLICATION Commercial Electrical Building Safety Department City of Rexburg 35 North 1St East Rexburg, Idaho 83440 i`or Office Use Permit Number: _ _ Electrical Fees Paid ❑ Name: Bri ham Younq University Idaho _ Address: 525 South Center Street City: --.---Rexburg State: ID Zip Code: 83460 Phone: 208.496.2664 Email: lohnsona@byui.edu Hectric1l Contract(11 Under Idaho Building Code, a registered contractor must do the work for a Commercial Building, Business: Mountain West Electric, Inc. State License #: ELE-C 3802 Ex 12/31119 Address: 586 W. Highway 26, #1 Ci Blackfoot � ID p 83221 city: _ State: Zip Code: Phone: 208-684 5463 Email: dbrown@mtnwestelec.com Contact/Rep. Name: Scot Wanstrom Phone: 208.684.5463 Email: swanstrom@mtnwestelec.com Electrical Contractor Authorized Signature: Date: 1011/19 A copy of your scute registrutionlhcense is required to be on file. If this is the first time you have clone work rn the Cay of Rexburg, please prn1,1(te a photo copy of your license. If you are unsure if your license is on file, please check with the permit Technician by calling (208)372-2341 . .. ,1.,.. .-.,..t. --1 Address: 311 S. 1st W. , Rexburg, ID 83440 Description of work: Remodel of Hart Bldg Aux. Gym and mise other spaces. ❑ Pt'(1jc c! C(jtit: $ 31-11,413.00 • 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 far 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 Rextturg shall be truthful and correct I agree to comply with all City regulations and State laws relating to the subject matter or this application and hereby authorized representatives of the City to enter upon the above-mentioned property for inspections purposes NOTF- The budding official may revoke a permit on approval issued under the provisions of the 2012 International Code in cases or any false statement or misrepresentation of fact in the application or on the pians on which the permit or approval was based Perrot void if not started within 180 days Permit void if work stops for 180 (lays Applicant's Name (print): Bart Grover Signature: ,B --A I Date: 1011119 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 ttodme - (208) 372 2344 www rexbtirg.org Permit Technician - (208) 372 2341 C IT Y OF REXBURG Ow Anmruas }•anuli t,onimundy BUILDING PERMIT FORM 401 n,�iacM 10 2016 BUILDING APPLICATION Fire Alarm Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 I'or Office Use Permit Number: Fire Alarm Fees Paid ❑ Property Owner Name: Brigham Young University - Idaho Address: 525 South Center Street Ci Rexbur tY� _g__. State: ID __Zip Code:83460 Phone: 208.496.2664 Email: johnsona@byui.edu _ 2. Contractor Business: Mountain West Electric. Inc. State License #: ELE-C-3802 Exp.: 12/31/19 Address: 586 W. Highway 26, sit City: Blackfoot State: Io Zip Code: 83221 Phone: 208.684 5463 Email: dbrownemtnwestelec.com Contact/Rep. Name: Scot Wanstrom 463 Email: swanstromCo)mtnwestelec.corn J� Phone:208 684 5 _ Contractor Authorized Signature: __L / � Date: 1011/19 A copy ofyour state rcyistrcrtitrn/license n retlurred to he on file I/ this is the first time you have Clone work in the City of Rexhtirq, please provide a photo copy of your license:. If you are unsure if your license is on file please check with the Permit Technician lay caNuui (208) .372-2341 3. PrD)ect Description Address: 311 S. 1st W. Rexburg, ID 83440 Description of work: Remodel of Hart Bldg Aux. Gym and mise other spaces. ❑ I1rc Alarm `;y;tejn Cost, $ 15.000.00 + Fees for fire alarm systems are charge by cost: o First $10,000 = 2% + $60. From $10,000 to $100,000 = 1% + $260. Above $100,000 =.5% +$I,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 = $3I0 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 heanngs 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 budding 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 ifwork stops for 180 days Applicant's Name (print): Bart Grover Signature: _- Date: 1011119 Inspections must he 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 :y C I TY OF Building Safety Department REXBURG City of Rexburg "" - _ 35 North 1St East Americas Famdv Community Rexburg, Idaho 83440 SUBCONTRACTOR LIST Excavation & Earthwork: Jerome Bowen Construction Concrete: TBD Masonry: Daniel's Masonry Roofing: Smith Roofing Insulation: USI Cardalls Drywall: Advanced Drywall Painting: Ed's Painting Floor Coverings: Design Team Plumbing: Bingham Mechanical Heating: Lewis Corp Electrical: Mountain West Electric Special Construction (Manufacturer or Supplier) Roof Trusses: N/A Floor/Ceiling Joists: N/A Siding/Exterior Trim: N/A Other: N/A Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician -208 ( ) 372.2341 Revised 102016 � }axeur� C1 TY o f Building Safety Department REXBURG City Df Rexburg - "— 35 North 1s1 East America's Family Community Rexburg, Idaho 83440 Affidavit of Legal Interest State of Idaho County of Madison I, Andrew Johnson 311 South 1 st West (Hart Building) Name Address Rexburg City Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to ii) Idaho Stale A. That I am the record owner of the property described on the attached, ar.d I grant my permission to: 343 East 4th Norh Ste. 112 Big -D Construction Rexburg, ID 83440 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.. rt. Dated this 17 day of ZO �7 Signature Subscribed and sworn to before me the day and year first above written. Notary Public of Ida o r; Residing at: My commission expires: ltispection tlotl.ne - (208) 312.2344 www.rexbury.org Permit Technician- (2,18) 372.2341 Revised 10, 2016 CITY O f REXBURG Ow 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: Andrew Wolford Name: Kenny Rasmussen Name: Matt Blomquist Name: Tyler Ames Name: Inspection Tickets Name: Andrew Wolford Name: Kenny Rasmussen Name: _Matt Blomquist Name: Tyler Ames Name: Email: Andrew wolford0big-d com Email: _ krasmussen@biq-d.com Email: matt. blomguist biq-d com Email: _ tyler-ames@bia-d.com Email: Email: andrew-wolford(@bia-d.com Email: krasmussen biq-d com Email: matt blomguist biq-d com Email: tyler.amesga biq-d com Email: Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician -208 ( ) 372.2341 Revised 10/2016 4� gER6 t�RG �y fd CITY of REXBURG r 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? iYes ❑ No Will the business be doing any structural/or remodeling changes to the building? beyes ❑ No Any changes to the electrical? 91pYes ❑ No Any changes to the plumbing? toes ❑ No Any changes to the mechanical system? Aes ❑ No Is the business type changing? ❑ Yes, it will change to AO Is this business changing ownership? ❑ Yes A0 Is the business registered with the City of Rexburg? Yes, License #: ❑ No *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? ❑ Yes A Will there be any cooking of foods? ❑ Yes AO Will there be any deep fat frying? ❑ Yes FAINo Will you have food disposal on site? ❑ Yes A Will there be sumps or floor drains in the facility? ❑ Yes AO Will the business have any chemicals on site? Aes ❑ No D -- Applicants Signature 208-709-9761 Phone 10-01-2019 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