HomeMy WebLinkAboutALL DOCS - 12-00507 - BYUI Romney 269 & 272 - Classroom Remodel,l
CITY OF
REXBURG
c\, *--*---*-
Ame ricab Fa nily C,om mu ni ty
35 N 1"E,, REXBURG.ID 83440
248-372-2326
PARCEL NUMBER:\7e will provide this for you)SUBDTVISION:UNIT# BLOCK# LOT#on the information - must be
FIow many are located on this property?
Did you recently purchase this propertyl @ Ves(If yes,list previous ownefs name)
Is this a lot split?@ vE5 lpl.ase bi-r,gcopy of new legal description of property)
PROPOSED USE:
(i.e-, Single Family Residence, Multi Family,nts, Remodel, Garage, Commercial, Addition, Etc.) _ CIRCLE ONE
,T::.t"a-1):rt""t"1"9)L:y.*P;:_P"1TlT91Ti-oY AND AUTHORIZATTON: under penarty orperjury, r hereby certiry that rh:XX1f;,**y".1#"*:;1f*;r;::3;ij";^11T::::1f1l :y:f ":i li 1"io,_"uo^,uhrch -"y r,",."r*. u" $ill.,ilr"iHH;J;.Ji?1j...i,r.PlanningandZoningcommissio-northecityc-ouncitrorthecityorR"lil"e;"iib:iffi"ffi:'#:;.i,*.%ffiffitrfffiil:#J;f.T::::::',"**,
fi:T,Tjf|#fi';1i'"TflT:"*r:"1":*.:3:i:1""ji.:r*":;:':-::i:iF:.:3:^":F,po1 ,h".upr.r-"ntioned propertv ror inspections purpo*s. NOrE:
vith a.[ City regulations md State laws relatins
The buildingofficialmavrevoke apamiton approvalissued undL the provisionsorthitot i;,;ffio.lrffil#,"i,Ji"ffff3#;'ff'l:*.H*,:.n,n the application or on the els on whth the panit or approval was based. Pennit r.oic if not started within 1g0 days. per*it
"ora if work stops for 1g0 days.
in the appliJation o, o, h" 'r;r;;;;il"5:;;; "::.:::;,.:':I^::"':']" "i-T:,1Y: ll'"""o9nar ('de '".cass oranv ralse stat€ment or mis*presentation or factrs on whLh the pernit or approval was 6ased. Pennit r.oid if not started within 1g0 days. per*it
"ora if work stops for 1g0 davs.
JLJLl / lzSignature
Do you
of Owner/
CONTACT PHONE #
PROPERTYADDRESS: hfrr{ A Oamnr, A ildtnAt -?nwt ---
PHONE #: Home (
OWNERMAILINGADDRESS, S2S q. Unfw crry: Le:rb4nl SrATE: tD ztp:6b{6o,lnwAtr Lrrqnt € huui.edq FAx
-
(Applicant if other than owne! a statement auth orrzing^ppli.^rr, a "* ".
-"g.nt
for owner -ori "..o-pany this application)
APPLICANTINFORMATION: ADDRESS
STATE: Z,IP--- EMAIL
PHONE #: Home ( )
CoNTRACToR 7y t,- lda.tte -
MAILING ADDRESS T TW Vonbun^ sTATtr ,n "ro ^*7. rznnrr uuo"a6) ct]I/_kxbu3-_sTLTtr lD zw_aeylo_pHoNE: cer# Qh\ 6ot- ougg_w"ra* ?ryt v4b- ? bh^ I^**
EMAII IDAHO REGISTRATION # & EXP. DATE
prefer to be
Building Sofety Depqrtmenl
-! ityg Rexburg
Phone: 208.372.2326
Fox:208.359.3022
Aflidavit of Legal fnrerest
State of Idaho
Counw of Madison
I,
Na-e Address
City
Subscribed and swom to before
Signature
me the day and year first above written.
State
A.
Being fust duly swom upon oath, depose and say:
(If Applicant is also Owner of Recotd, skip to B)
Dated this day of
That I am the record owner of the property described on the attached, and I grant mypermission to: --
Name Address
to submit the accompanFng application pertaining to that property.
B' I agtee to indemni$', defend and hold Rexburg City and its employees harmless from anyclaim or liability resulting ftom any dispute as io the statemenrs contained herin or as to theownership of the properry which is the subject of the application.
20
Residing at:
Notary Public of Idaho
My commission expires:
Building Sofety Depqrtmenl
Properly lines
Each site plan that is submitted to the City of Rexburg for the Building Permit process requires that propercy lines
are shown accurately. It is the Developer,s responsibility to correctly identi!, on the site plan the location of these
lioes 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,legai
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 countef at the Community
D evelopment Department.
I have read and understand the above requiremeots.
Signature Date
Pdnted Name
Business Applicqtion CITY OF
35 North ld Eosf
Rexburg, lD 8U40
Please take the time to answer all quations so thatu'e canfurlher assist yoa and your facility Thank you.
Yes
Yes
No t/
No rz
Yes No____!z_
Yes No__l<_
Yes No b-
Yes No y'
Yes No t/
Yesg' No
Yes y' No
Yes l,/ No
Yes o.z No
Yes /ZNo
No L.'/Yes
Yes Noy'
WJ#4-
What type of business will be performed CIAS< fhM
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 any maintenance or mechanical work in the building?
Will there be sumps or floor drains in the facility?
Will the business require more parking?
Will the business have any chemicals on site ?
Is this business occupying an existing building?
will the business be doing any structuravor remodeling changes to the building?
Any changes to the electical?
Any changes to the plumbing?
Is this business planned to be the same with different ownership?
Will there be a change of occupancy?
I Certify that The information that I have provided above is to the besr of my knowledge accurate and true,
Building Sofety Deporlmenl
City of Rexburgwww.rexburg.org
CITY OF
ITEXBI.'RG
C\r __*_-__--^"
Anrcri.a\ Fatnily An mu,,i,ttD8U40
PROPERTY ADDRESS
35N I'tE
SUBDTVISION
PHASE
Phone: 208.372.2326
Fox:208.i59.3022
Permit#
LOT B
Requircd!!!Plumbing
Plumbingcontractor's N^ . (rala) ftrbu<h brsiness N^ , ff(0- (/aho
rr'a'r"' 525 $n(k Cz^l<, crty St"t Jdaho-np_331L o
cellphone 1;og 3la- 2</bS hrsiness phone rAil _f.?L:_?gq p
Fax(Jot) a?L - L4zt B^^t l""b*Ae@Aru. .e^
(COMMERCIAL/IND_USTRIAL) Total cost of plumbing system (contractedAmount) g_lhlJbj t(nckdes tbe cost of mateials iytakd ,rcardlzst of the partl supp$iag ;t. lnt pu titniruio tbis inrpction flpe thalt @p! to oo1 ood-oi jtn*ng installationsnot gecifcal$ nentioaed ebeuher on tbirfotrz).
(total cost of system x 0.02) + 60 = $
( (total cost of system - 10,000) x 0.01) + g260 = g
( (total cost of system - 100.000) x 0.005) + g1,160 = g
D Up to $10p00
n Between $10p01- $100,000
tr Over 91001001
RESIDBNTIAL
I'{ew: Single Family Dwelling, including aII buildings with lcidng being consttucted on each propetqr. (*Based on liuing space,see definition below)
tr Up to 1,500 sq ft - 9130
tr 2,501. to 3,500 sq ft - 9260
n Over 4,500 sq ft 9325 plus 965 for each additional
1.000 sq. ft. orportion thereoO).
Iiew: Muhi-Family Dwelling (Conttactots OnIy)
tr Duplex Apartment $260
tr Three or more multi-family units: $130_per building plus $65 per unit: ($130 x # of buildings) + ($65 x # of units)DExistingResidence,andDetache9,S-h"t.$65feeplus$10pera"onding
sq. ft. of the building ($65 + ($10 x # of fixtures))
D Gtay lZater Systems: 9130
D Lawn Sprinklets/Bacldlow Device: g65
tr Modulat, Manufactuted ot Mobile Flomes: $65 for sewer and water stub connectionstr Multipurpose Fite Spdnldet and Domestic Water Supply System: g65 fee or $4 per sprinkler head, whicheveris greater
Sewet & Watet
tr $38 Sevzer Line a$38 Water Line n$65 Sewer & rJTater- if inspected at rhe same timeu $65 Sewer tumaround under house (change from septic to ciry)
MISCELLANEOUS
tr Plan Checlc $65 per hout
ft Technical Service: $65 per hout
tr Gas Line: $65
D Water Heater Replacement: $65
tr Requested Inspection: $65
! Hydronic Ffeating: $65 + ($10 x # of manifolds/zones)
(t0qqL,.q
of Licensed Contractor License numbet & Exp. date
11 1,501 to 2,500 sq ft - 9195
D 3,501 to 4,500 sq ft - 9325
1,000 sq ft. or portion thereof ($3ZS + (g65 x # of additional
*Living Space - space within a dwelling unit intended for human habitation which may reasonably be utilizgd for sleeping, eating, cooking,bathing, *?li"*'recteation,;rnd saniation purposes. An unfinished basement is considered part of the living space.
Date
35N. 1sE.,Rexbwg,rd83440 Buil g Sofety Deportmenl
Phone - (208)359-3020 / Hotline - (208)372-2344 / Fax - (208)359-30 zz Citv of Rexburg
CITY OF
REXBURG
c\' '''-.-.*'-- -
A uetiu\ Fami ly Cnmmuni ty
Permit#SUBDIVISION
PI{ASE LOT BLOC
PROPERTY ADDRESS
Reqaircd!!!ELECTRIC,M
Electd.cal Contractor's Name Business N"-.-9Y J' ( dal,L"
Cell Phone (1 ,2/ j- ct6o{.5-BusinessPhone 1 1 7 ? O - a"s-?a
e^^n fAtLL< {<,1,/U/- sZ/Fax (
1,501 to 2,500 sq ft - 9195
3,501 to 4,500 sq ft - 9325
or portion thereof ($3ZS + ($65 x # of additional
(CoMMERCIAL/INDUSTRIAL) Total cost of electrical system (contractedAmount) g_I-|fi?(ncludcstltecostofmateiakyaalted.nsalleyoJtheparywpptlingit.Thefeutisteduidertbisin'tpctionQpeilallapplttoanltanda//eluticalin$allationt
not spcifua$ nentioned elseuhen on thfuforn).
tr Up to $10p00^ _ (total cost of system x 0.02) + 60 = $D Between $10,001 - $100,000 ( (total cost of system - 10.b00) x 0.01) + g260 = g
D over 9100,fi) ( (totar cost of system - 10e00'0) x o.obs) + g1,160 = g
Small Vorks (Contractors oNL!: $10 fee for work.rot .*..Jing $200 in'.ort and not involving a change inseryice connections. Does NOT require inspection.
RESIDENTIAL
New: Single Family Dwelling, including aII buildings with wiring being consttucted on each ptapetty. (*Based on liuittg space,see definition below)
n Up to 1,500 sq ft - gi30 !n 2,501. to 3,500 sq ft - 9260 trtr Over 4,500 sq ft 9325 plus 965 for each additional 1,000 sq ft.1.000 sq. ft. orportion thereoO).
New: Muhi-Family Dwelli ng (Contractots OnIy)
tr Duplex Apartment $260
E Three ot more multi-family units: $130 per building plus $65_per unir ($1 30 x # of buildings) + ($65 x # of units)UExistingResidence,Modulat,Manu}actutedoii4obil.Ao..,,""gp.,
branch circuit, up to the maximum of the-co-rresp"i93g sq. ft. of the building ($65 + ($10 x # btanch circuits))tr central Heating/cooling systems: $65 $7hen NoT pa; of new resideotii'lir rryac p.r-it -itr, ,ro "aditionalWidng
Spas, Hot Tub^s, and Swimming pools: $65 fee for each ttiF to inspecrPumps-Wate4 htigatio4 Sewage (each motor)
D $65 up o 25HP ng95 - 26 to 200Hp n$130 over 200 Hp
MISCELLANEOUS
D Tempotary Constuction Services oNLY: 200 ampor less, one location (for a period not to exceed 1 year) - g65
D Temporary Arnusement: $65 fee plus $10 per ride, concession or generator
D higation Machine: $65 for center pivot plus $10 per tower of drive moror
tr Technical Service: 965 per hour
D Plan Check $65 perhour
tr Requested Inspection: $65
*Living Space - space within a dwelling unit intended for human habitation which may reasonably be utrlizgd for sleeping, eating, cooking,bathing, washing, rccrt}ryYd "^nfudyt.po.".. An unfinished basement is .onsidered part of the living space.
4- zr.( 2
of Liceised Contractor License number & exp. date /4#-"
Building Sofety Depqrtment
City of Rexburg
Rexburg, lD83440 www.rexourg.org Fox:208.359.3022
CITY OF
REXBURG
Ame rica\ Family Com mu rt ity
o\x/NERS NAME 7Y l, - ldr r ,^
PROPERTYADDRESS r)-*ir*r
SUBDTWSION
- ---._--
PHASE
Requircd!!!Mechanical
Mechanical Contractor's N^ . *rm ltleffioL g'siness Name o\v-ldaho
Address_ Cit,state_7,tp-
CellPhone (2t1 Zet-Coya Ur.rsinessphone (Zq) ,.qe- 2SZa
Fax (
(CoMMERCIAL/IND_USTRIAL) Total cost of plumbing sysrem (conrractedAmount) ilLtf1t.bS(tcladet tlte cost of materiab instalbd ngardhs of the parE supptling ;t. ittt 7t, tirninoder this intpction W ,t "a Epi"'.iirffi)tinstallatiou not specifuallt mentioned eketyber on tbisfom).
tr Up to $10p00 (total cost of system x 0.02) + 60 = $D Between $10,001 - $100,000 ( (total cost of iystem _ 10.b00) x 0.01) + g260 = g. over 9100,&)r ( (total cost of system - t0eo0b) x o.obs) + $t,tad = $RESIDENTIAL
New: Single Family Dwelling, including aII buildings with wfuing being consttucted on each ptoperqr. (*Based on ftwrzg space,see defraitioa below)
tr Up to 1,500 sq ft - 9130
o 2,501 to 3,500 sq ft - 9260! Over 4,500 sq ft 9325 plus 965 fot each additional 1,000 sq
D 1,501. to 2,500 sq ft - 9195
D 3,501 to 4,500 sq ft - 9325
ft. or portion thereof
($325 + (965 x
New: Muki-Family Dwelling (Co ntractors OnIy)
tr Duplex Apartrnent 9260
tr Three or more multi-family units: $130 pet building plus g65 per unir ($130 x # of buildings) + ($65 x # of unit$n Existing Residence, Modulat, Manufactured ot Mobile Homes and Detachea snopi$oiE ptr, $to po**HVAC equipment being installed up to the maximum of tlle corresponding ,q. ft. of the rolairrg'
($65 + ($10 x # of fixhxes))
MISCELLANBOUS
tr Plan Check 965 perhour
tr Technical Service: $65 pet hour
tr Gas Line: $65
D Watet Fleatet Replacement: $65
D Requested Inspection: $65
tr Fiteplace/Solid Fuel Buning Appliance: g65 per inspectionxliving Space - space within a dwelling unit intended for human habitation which may reasonably be uritirgcl for sleeping, eating, cooking,ba$ing, washing, recteation, and sanitation purposes. An unfinished basement is considered part of the Iiving space.**Examples of lrvAC Equipment-futnace replacement, solar, water heater, etc.
t'0obr3''t .te-31- l,z
nrre of Licensed Contractor Liceose number & Exp. date Date
Building Sofety Deportmenl
City of Rexburg35 N. 1" E., Rexburg, Id 83440
Phone - (208)359-3020 / Hotline - (208)37 2-2344 / F ax * (208)3 59 -3022 BEXg\8e
Ameriu\ Fami, Commmity
LOCATION OF WORKTO BE DONE:
Street Address Where Work Will Be Done:
Business Name Where Work Will Be Done:
Dates forwork to Be Done:
Contact Person:
To
Phone Number: ( )Cell#( )
Requited!!!FIRE SPRINI(LER
Fire Sprinkler Contractor's Name:
Business Name
b"D
Address City State-Zip
Cell Phone (Business Phone (
Fax( )Imt,, gwF.yfidme b5
I aP Wat 4+o. onc gprtnltlc-
\ n^bt't ?* Ll' 1*-'N>.fu )
(COMMERCIAL/INDUSTRIAL) Total cost of fire sprinkler system (Contracted Amount)
$_1a0:_
(ncludu the cost of materials installed regardless 0f tbe palxJ suppfiing it. Thertes listed under this inspectioTt Weshall appfr to an1 and allfre alarz installations not sperifcalQ mentioned elsewbere on thisforru).
n Up to $10,000 (total cost of system x 0.02) + 60 = $
tr Between $10'001 - $100,000 ( (total cost of system - 10.000) x 0.01) + g260 = g
tr Over $100'001 ( (total cost of system - 100.000) x 0.005) + g1,160 - g
MISCELI-ANEOUS
tr Existing Inspection Base: $60
n Re- Inspection: 965 per trip
! New construction $1per sprinkler head ($21000 maximum)number head
of Licensed Contractor License number & exp. date Date
Building Sofety Deportmenl
35 N. 1s E., Rexburg, Id 83440 City of Rexburg
LOCATION OF WORKTO BE DONE:
Street Address \fhere Work Will Be Done:
Business Name Where Sfork Will Be Done:
Dates for Work to Be Done:To
Contact Person:
Phone Number:(_)
Requircd!!!FIRE' URM
Fire Alarm Contractor's Name
Business Name
Address City tate-Zip
f
Cell Phone () Business Phone (
Fax( )\...........................-
(COMMERCIAL/ INDUSTRIAL) T otat of fire alarrn system (Contracted Amount)
$
(ncludu tlte cost of materiah installed of the parE suPPbing it Tbefeu listed under this inspection rypesball app! to arly and allfre alarm i s not specifcalfi mentioned elsewhere on tbisform).
tr Up to $10,000
tr Between $10.001-
(totai cost of system x 0.02) + 60 = $
( (total cost of system - 10,000) x 0.01) + 9260 = g
( (total cost of system - 100.000) x 0.005) + 91,160 - gtr Over $100,001
MISCELI-ANEOUS
! Plan Revie{per Flour: 965 per hour
n Re-tion: $65 per trip
of Licensed Contractor License number & exp. date Date
10
SUBCONTRACTOR LIST
Excavation & Earthwork:
Concrete:
Masonrv: -
Insulation:
D,y*,n b\0 -lleha
Paindns: BYU - t/4h,)
Floor
couenngr, B\ lJ - | 4.ahu>
m"-ui"g' BYU" [la,h.o
Heatins: BtfU -ldt'lto
Etrm.*' bY) - ld4l'ao
Special Construction
(Manufacturer or Supplier)
RoofT
Floor/CeilingJoists:
Siding/Exterior Tri
Other:
EXEMPTIONS F'ROM STATE, RE,GISTRATION
-l':rl"Y"ry 1,3oo le*j-.registration number or.your exemption fiom the st^t. i.grrtt" -fill out this form showing your exemption and send it with your license renewal or your next permir application.
(Ihis list is a summarizalon of Idaho Code Title 54 Chapter 5205, for full definitions of these exemptions pleasesee the State's website at vzww.ibol.idaho.gov/cont.htm)
n currendy state licensed pursuant to Title 54 Idaho code, chapters:
f Architects,
1 0 Electrical Contractors/Joumeyman,
1 2 Engineers /Surveyors,
19 Public W"$: Contractors (exempt from fee only registration required),
26 Plumbing/Plumbers,
45 Public Works Construction Managemcnt Licensing Act (exempt from fee only registration required), or50 Installation of heating, ventilation and air conditioning systems
tr Employee or volunteer of a licensed contractor or part ol an educational curriculum or nonprofi.t charitableactivity with no wages or salary
tr Employee of a-US Government agency (State, City, County, or other municipality)
n Public Utility doing construction, maintenance, or development to its own bLin.r,
tr Involved with gas, oil or mineral operations
tr Supplier doing no installation or fabdcating
D contracting a project or projects with a total cost less than $2000D Operation of a fzrm ot ranch or construction of agnculture buildings exempt fiom Idaho Building Codetr Any type of water district operations
n !7ork in rural districts for fire prevention purposes
tr Owner who performs work on own Property or contracts with a registered contractor to do work as long asthe property is not for resale vdthin 12 months
D Owner ot lessee of commercial properry performing maintenance, repair, alteration or construction on that
Propefiy
n ReaI estate licensee/propefty manager acting vdthin Idaho code
tr E"g"gug in the logging industry
n Renter working_on the property where they live with the property ov/ners approvalD Construction of,a building used for industrial chemical processing per Idaho^Code
tr Construction of a modular building (defined by Idaho Code) to be moved out of state
I hereby certify that the above information is true and correct to the best of my knowledge.
Signature
ltrnc Urse,n
Print Name
I2
Routing:
Dorcfr
12 00507
BYU-I Romney #269 & #272 - Classroom Remodel
LU0812012
@
Bret Stoddard (Please review by Friday, November 9)
Current Status
Please complete the following:
Dole NA
lE J Review Plans
il I Enter Notes for the applicant under Submittals
d I Update status in the Approvals tab
t I Return building plan to Amanda Saurey
NA
T
REV
T
*/
EI
Please indicate time spent in hrs/min reviewing the plans: '/#lt'
Notes:
Nfl
12 00s07
BYUI Romney #269 & #272 - Classroom Remodel
Donerz
/
Routing:
NA
I
Notes:
Quinton Owens (Please review by Friday, November 9)
Current Status
Please complete the following:
Done- NA
-'/ h
,W f Review Plans
./ rr
r L-r
/
{
F
! Enter Notes for the applicant under Submittals
I Update status in the Approvals tab
n Return building plan and this check list to Amanda Saurey
tt/09/t2
12 00507
BYUI Romney 269 & 272 - Classroom Remodel
r1t09t20r2
Routing:
Done NA
,W I Don Allen (Please review by Tuesday Nov 13)
AP REV
V ! Current Status
Please complete the following:
Done NA
.tr I Review Plans
-Jntr n Enter Notes for the applicant under Submittals
' I Update status in the Approvals tab
,! [ Return building plan to Amanda Saurey
Please indicate time spent in hrs/min reviewing the plans: 16,*; rJ
Notes:
dt2'&it
lnsrncrloN TIcKET
n BHg. O Phmb' I Mah. O Fia
j-F- t s.,. vInspction Reguest: Rcc'd BY Dale
Req. By
Project
Address
lnspection TYPe
Day ffime xeq. '3 - il- I '
lnspeclor's RePort 0 Res.I cottn.
NSPF,CIED mt"tS COXfOnM TO APPROVED DWGS nY nN flN/A
NHNAL
n DID Nor INSPECT
INSPECTOR'S ACTION
MAPPROVED.-T
nco.(FINAL)
ACTION REQUIRED:
U DISAPPROVED
f] NOTAPPLICABLE
Rec't Acdwkdgcd
tryhi. . Otic. CoPt
F.f rF.C0o3
'fblos .Job CopY Pil-Frcul@l
., Phone No. j I J-i* tw'-
:;)-dennir No. lL (L9)7 =
r,a1.--.t ,'
"
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fnspction Request no'a nYB# *': 44:?
;;; ;r d*', Phonerro' 3t-;ll6(c
:.:,, ^ ^.' n *,* ^, Zbt4-VlA'l< p er nir N o. \Z fttl
lnspction TYPe
Day /Time Req.
lnspector's RePort
INSPESTOR'S ACTION
rdrr*outo IDISAPPRoVED DFINAL-{r.o
(F,NAL) o N'TAPPLICABLE D DtD Nor NsPEcr
ACTION REQUIRED: N\F)E: '
lNSpffi trEMt-coNFoRM To APPRovED DwGs
Rec't Ackruwledged
ll,hat. - Ollicc CoPt
F.FrR.C03
tblor . Job CogY Pfi-lnorc5'l@r
I INsracrIsNrICKErO
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Incp*etion Req**st: Rcc'd BY
Req. By
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lnsp*ction TYPc
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d*pBnoveP ilDISAPPRSVIS
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ACTI0NREQUIRED:lr-tnEr*- * * --
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