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Home My WebLink AboutAPPLICATION - 19-00723 - Mountain America Credit Union Office Call CenterInspection 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 COMMERCIAL 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 site plans drawn to scale (see Site Plan Checklist) ⧠ 3 sets of building plans (see box below to right) – 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 (see box below) – stamped by a licensed Engineer ⧠ Energy Compliance Report: As per the 2015 IECC, a COMCheck is required (available online at www.energycodes.gov) ⧠ 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 ⧠ Site Plan Checklist ⧠ Permit Policies Acknowledgment signed ⧠ Property Line form 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 http://rexburg.org/pages/development-code. Seismic Design Category – D (unless soil evaluation confirms category C) Ground Snow – 50 lbs. per sq. ft. Roof Snow Load – 35 lbs. per sq. ft. Wind Load – 90 MPH Frost Depth – 36” Inspection Hotline – (208) 372.2344 www.rexburg.org Permit Technician – (208) 359.3020 Revised 3/2018 Community Development Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 SITE PLAN CHECKLIST ⧠ 1. Legal Description of proposed building site ⧠ 2. North Arrow ⧠ 3. Drawn to scale ⧠ 4. Lot Dimensions ⧠ 5. Building locations, and dimensions with distance to property lines and distances between buildings ⧠ 6. Distance of entrances from street corners dimensioned ⧠ 7. Show 10% snow storage area ⧠ 8. Drainage Plan (with arrows) ⧠ 9. Fencing/Screening ⧠ 10. Landscaping/Buffering ⧠ 11. Lighting Plan (if needed) ⧠ 12. Existing and proposed easements ⧠ 13. Existing utilities (waterlines, sanitary sewer lines, manholes, storm drains) ⧠ 14. Existing right-of-way location and width, curb to curb widths ⧠ 15. Existing streets labeled ⧠ 16. Proposed street improvements (curb, gutter, sidewalk, pavement, etc.) ⧠ 17. Parking (Lot dimensions, distance between rows, loading areas if required) ⧠ 18. Sidewalks – both along rights-of-way and internal (existing and proposed) ⧠ 19. Fire hydrants and fire suppression lines (including tie to City lines) o Sprinkled o Not Sprinkled ⧠ 20. Fire apparatus access ⧠ 21. Proposed utilities including tie in location to existing services and new easements ⧠ 22. Proposed storm drain and sanitary sewer elevations (for pipe inverts at manholes and catch basins) ⧠ 23. Trash facilities (dumpsters for right-hand truck) o 1 Dumpster per 20 doors (non-dormitory) o 1 Dumpster per 50 beds (dormitory) ⧠ 24. Numbers needed: o Building square footage o Percent of lot covered by building o Paving Area o Drainage Plan Calculations o Parking space numbers (tenant & visitor, handicap, private) SITE PLANS MUST BE COMPLETE AND SUBMITTED FOR REVIEW BEFORE THE PROJECT WILL BE PLACED ON THE PLANNING & ZONING AGENDA. 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 Initials Initials Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Initials Initials Initials Initials 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. o APPROVAL OF CONSTRUCTION. 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) 372-2167. 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. o SCHEDULING INSPECTIONS. 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. 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 put up, the inspector may require the sheetrock to be removed in order to perform the electrical rough in inspection.) o STAIRWAYS REQUIRED. On jobsites for multi-level buildings the contractor must provide temporary stairs so that workers and inspectors can safely access upper levels of the building. If these stairs are not provided, inspections may not be completed. Extenuating circumstances will need to be approved by the Building Department. o DIGITAL AS-BUILT PLANS. A Certificate of Occupancy will not be issued without digital copies of the As-Built Plans. It is the Applicant’s responsibility to turn in digital copies of the As-Built Plans when the project is completed. No Certificate of Occupancy will be issued without these plans, extenuating circumstances will need to be approved by the Building Department. o OCCUPYING A FINISHED BUILDING. No building may be occupied without receiving a signed Certificate of Occupancy. If a building is occupied without receiving a signed Certificate of Occupancy, citations may be issued and the occupants may be required to vacate. o MAKING KNOWN POLICIES. 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. The above policies will be enforced to all, regardless if this information is passed on to them or not. Applicant’s Name (print): ___________________________________ Signature: _____________________________________________ Date: ______________ 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 PROPERTY LINES Each site plan that is submitted to the City of Rexburg for the Building Permit process requires that property lines are shown accurately. It is the Developer’s responsibility to correctly identify on the site plan the location of these lines in reference to the public right-of-way, other adjoining property lines, the street, other structures and all utility lines. The Developer should find property pins that are still available at the lot in question. If these pins do not exist or have become unrecognizable then a new survey should be performed. Accurate property line information is a must for a timely review. In addition to finding existing property pins, legal descriptions should be checked. The best way to identify property line location is with a land survey. The City of Rexburg has aerial photos and a parcel line layer that can be checked, but they are only a tool and are not guaranteed for accuracy. If you want to request a copy of your lot, see the front counter at the Community Development Department. I have read and understand the above requirements. ______________________________________________________________ __________________ Signature Date ______________________________________________________________ Printed Name 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 Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 BUILDING APPLICATION New Commercial Building For Office Use Permit Number: ____________________ Zoning: ________________________________ Application Fee: ⧠ $1000/Building 1. Property Owner Name: ___________________________________________________________ Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: _________________ Phone: _____________________________________________ Email: _____________________________________________________________ 2. Applicant Name: __________________________________________________________ Role: (Owner, Tenant, Contractor, etc.) _______________________________ Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: _________________ Phone: _____________________________________________ Email: _____________________________________________________________ Contact/Rep. Name: _________________________________ 3. General Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building. Name: _____________________________________________________________ Registration #: _________________________ Exp.: _______________________ Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: _________________ Phone: _____________________________________________ Email: _____________________________________________________________ Contact/Rep. Name: ______________________________________ Phone: _________________ Email: ______________________________________________ General Contractor Authorized Signature: ____________________________________________________________________ Date: __________________ A copy of your 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 of your license. If you are unsure if your license is on file, please check with the Permit Technician by calling (208) 372-2341. 4. Project Description Address: ___________________________________ -OR-Lot #: _____ Block #: _____ Subdivision: _________________________________ Project Name: _____________________________________________•Construction Type: _______•Occupancy Type: ________ •Total cost of project - materials and labor: $_________________Square footage: ___________________ Check all disciplines that apply: ⧠ Mechanical: Cost $____________⧠ Electrical: Cost $___________ ⧠ Plumbing: Cost $___________ ⧠ Fire Alarm: Cost $___________ ⧠ Fire Sprinkler: Cost $____________ Note: Any contractors involved will need to fill out their respective application. # of Water Meters: _________Water Meter Size(s): _________# of Parking Stalls: ______________ # of Dumpsters:_________Estimated Dumpster Delivery Date: _____ /______ /______ # of Dumpster Pickups/week 1 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 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: ___________ BUILDING PERMIT FORM Updated 03/2017 200 Mountain America Credit Union 9800 South Monroe Street Sandy UT 84070 801-325-6449 nshepherd@macu.com Babcock Design Architect 52 Exchange Place Salt Lake City UT 84111 801-531-1144 Larry Oldham larry@babcockdesign.com TBD 2nd East Street Main Street MACU Rexburg Call Center IIB B 17,516 3,200,0000 TBD 1 3"91 1 TBD TBD TBD TBD TBDTBD 2 Larry Oldham 11/25/19 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 Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 BUILDING APPLICATION 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 of your 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 of your license. If you are unsure if your 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 $10,00 to $100,000 then:((Cost of project - $10,000) * 1%) + $260 reater than $100,000 then:((Cost of project - $100,000) * ½%) + $1160 An additional plan review fee is required which is 10% of the calculated inspection fee lication 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. (print): ___________________________________ Signature: _____________________________________________ Date: _______________ BUILDING PERMIT FORM Updated /201 210 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 Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 BUILDING APPLICATION 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 of your 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 of your license. If you are unsure if your 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) * ½%) + $1160 There will also be a plan review fee totaling 10% of the above fee. lication 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. ___________________________________ Signature: _____________________________________________ Date: _______________ BUILDING PERMIT FORM Updated /2019 220 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 Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 BUILDING APPLICATION 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 of your 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 of your license. If you are unsure if your 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) * ½%) + $1160 An additional plan review fee is required which is 10% of the calculated inspection fee lication 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. _______________ BUILDING PERMIT FORM Updated /2019 230 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 Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 COMMERCIAL FIRE ALARM BUILDING APPLICATION For Office Use Permit Number: ____________________ Fire Alarm 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 of your 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 of your license. If you are unsure if your 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) * 0.5%) + $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. .lication 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. Name (print): ___________________________________ Signature: _____________________________________________ Date: _______________ BUILDING PERMIT FORM Updated /2019 401 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 Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 COMMERCIAL FIRE SPRINKLER BUILDING APPLICATION 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 of your 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 of your license. If you are unsure if your 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 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) * 0.5% + $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. lication 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. ): ___________________________________ Signature: _____________________________________________ Date: _______________ BUILDING PERMIT FORM Updated /2019 402 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 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 Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 Affidavit of Legal Interest State of Idaho County of Madison I, _____________________________________________________, ___________________________________________________________________ Name Address _______________________________________________________, ___________________________________________________________________ City State Being first duly sworn upon oath, depose and say: (If Applicant is also Owner of Record, skip to B) A.That I am the record owner of the property described on the attached, and I grant my permission to:__________________________ ______________________________ 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 liabilityresulting from any dispute as to the statements contained herein or as to the ownership of the propertywhich is the subject of the application. Dated this ___________________________ day of ____________________________, 20_________ ____________________________________________________________________ Signature Subscribed and sworn to before me the day and year first above written. _______________________________________________________________________________ Notary Public of Idaho Residing at: ________________________________________________________ My commission expires: __________________________________________ Larry Oldham - Babcock Design- 52 Exhange Place SLC UT 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 DISTRIBUTION LIST Please provide the names and emails of anyone who should be getting automated updates for this project: Review Notes Name: __________________________________________________ Email: _____________________________________________________ Name: __________________________________________________ Email: _____________________________________________________ Name: __________________________________________________ Email: _____________________________________________________ Name: __________________________________________________ Email: _____________________________________________________ Name: __________________________________________________ Email: _____________________________________________________ Inspection Tickets Name: __________________________________________________ Email: _____________________________________________________ Name: __________________________________________________ Email: _____________________________________________________ Name: __________________________________________________ Email: _____________________________________________________ Name: __________________________________________________ Email: _____________________________________________________ Name: __________________________________________________ Email: _____________________________________________________ Larry Oldham - Architect larry@babcockdesign.com Nathan Shepherd - Owner Rep nshepherd@macu.com Contractor TBD Larry Oldham - Architect larry@babcockdesign.com Nathan Shepherd - Owner Rep nshepherd@macu.com Inspection Hotline – (208) 372.2344 www.rexburg.org Permit Technician – (208) 372.2341 Revised March, 2016 Building Safety Department City of Rexburg 35 North 1st East 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? ⧠ Yes ⧠ No Will the business be doing any structural/or remodeling changes to the building? ⧠ Yes ⧠ No Any changes to the electrical? ⧠ Yes ⧠ No Any changes to the plumbing? ⧠ Yes ⧠ No Any changes to the mechanical system? ⧠ 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? ⧠ Yes, License #: __________________________________ ⧠ No *If No, please apply for a business license with the Customer Service Dept. Will the business have food preparations? ⧠ Yes ⧠ No Will there be any cooking of foods? ⧠ Yes ⧠ No Will there be any deep fat frying? ⧠ Yes ⧠ No Will you have food disposal on site? ⧠ Yes ⧠ No Will there be sumps or floor drains in the facility? ⧠ Yes ⧠ No Will the business have any chemicals on site? ⧠ Yes ⧠ No ___________________________________________ _________________________________ ____________________ Applicants Signature Phone Date I certify that the information that I have provided above is to the best of my knowledge accurate and true. (toilet rooms) 11/25/19801-531-1144