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Home My WebLink AboutAPPLICATIONS - 06-00024 - Rexburg LDS Temple - New BuildingBuilding Safety Department oFa=xa�R� City of Rexburg j 19 E. Main ionellh®rexburg.org Phone: 208.359.3020 exf 326 , o Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 C I T Y O P REXBURG -- C Aruerica' Farnily Carrnnunity 1 � �� Iv . ^� � Office Hours�MOnday-Friday 8:00am-4:00pm Y �,I�C^ a I1 Commercial/Multi Family Pre -Construction Checklist 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 — 3611 The fallowing items should be completed be oreyou submityour building permit application. INCOMPLETE APPLICATIONS IPILL NOT BE ACCEPTED. Completion ofa Building Permit Application: You may print this application from our website Yvunv.rexburg.or or pick up a copy at the City Annex Building (address above). Commr�Aal Permits. (the following must be submitted with the Application) ❑ ofsite-plarrssrrd 3 sets of building plans stamped by a licensed professional ❑ dike- kAa&afldbuilding plans in PDF format must be submitted after plans have been approved. N/A ❑ Structural Calculations stamped by a licensed Engineer N/A ❑ Energy Compliance Report: As per the 2006 IECC, a Compliance check must be completed and submitted (the comcheck is available online at www.energycodes.eov). ❑ Page 2 of the Application must include the Idaho Contractor's Registration Number or the exemption form must be completed and signed, see Page 10. N/A ❑ Page 5 of the Application must be completed and signed by your Plumber. N/A ❑ Page 6 of the Application must be completed by signed by your Mechanical Contractor. N/A ❑ Page 7 of the Application must be completed and signed by your Electrician. N/A ❑ Electrical panel layout and calculations must be included with the building plans. Plans will be reviewed by the electrical inspector prior to issuance of the building permit. N/A ❑ Emergency Services Construction Pemut-for fire related equipment only; to be filled out by the contractor contractor perform' the work N/A ❑ Exterior Lighting Plan including photometric layout. N/A ❑ Property Line form needs to be signed by the builder, see Page 4. Electrical Permits are now issued through the City of Rexburg. See Page 6 of the application. Remodels If you are considering a remodel, a coQ_ of the bid or estimate with the Permit Application. • 3 set of plans (may need IECC Review) • Additions — Same as new construction CITY OF RMURG Vat, Amerira3 rwmify Community Please Complete the Entire Application! If the question does not apple fill in NA for non applicable COMMERCIAL & MULTI FAMILY BUILDING PERMIT APPLICATION 19 E MAIN, REXBURG, ID 83440 208-359-3020 X326 PARCEL NUMBER (We will provide this for you) SUBDIVISION: UNIT# BLOCK# LOT# l!.y.Rlsteultunca OWNER NAME: The Church of Jesus Christ of Latter-daCONTACT PHONE # 208-656-0880 PROPERTY ADDRE4Sts 750 South 200 East Rexburg, ID 83440 PHONE #: Home ( ) Work (208) 656-0880 Cell (20� 360-5334 OWNER MAILING ADDRESS: 750 S. 200 E. CITY: Rexburg STATE: ID ZIp83440 FNMIL-rexbu-eng@ldschurch.org FAX APPLICANT (If other than owner) Architectural Nexus, Inc. (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS 5595 S. Riverwoods Parkway CITY: Logan STATE ZIP 84321 EVIL gPoetroff@archnexus.com F 435-752-4160 PHONE #: Home ( ) Work (435 753-2141 Cell (43� 770-9750 CONTRACTOR: Jacobsen Construction MAILING ADDRESS: 3131 WEst 2210 South CITY Salt Take Citv STATE UT ZIP 84119 PHONE: Cell# Work# 801-973-0500 Fax# 801-973-7396 kdickamore@jacobsenconstruction.com EMAIL IDAHO REGISTRATION # & EXP. DATE How many buildings are located on this property? one Did you recently purchase this property? E)Yes (If yes, list previous owner's name) _ Is this a lot split.2YES (Please bring copy of new legal description of property) PROPOSED USE: Religious Facility (.e., Single Family Residence, Multi Family, Apartments, emode Garage, Commercial, Addition, Etc.) - CIRCLE ONE APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certifi, 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 authorised 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 2003 International Code in cases of any false statement or misrepresentation of fact in the application or on the plags on which the permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days. 3 11 09 DATE Do you prefer td be contacted by fax, email or phone? Circle One WARNING —BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE! Plan fees arc non.refundable and arc paid in full at the time of application beginning ano m, L 2001 City of Rexburg's Acceptance of the plan review fee does not constitute plan approval "Building Permit Fees are due at time of appficadon+ > Building Permits are said if your check does not clear 06-MAY-2009 06:11 From:2086560885 Page:2/2 Building Safety Department �a�attx•�'�, C I T Y OF City of Rexburg RM VRG 19 E Moir jonesh,@rexburg.o►B Phone: 20&359.3020 ext 326 '�, M � � ,..• :tmerita3 fiasuy t:ensntknify Rexhurg, ID 83440 www.rexbvg.org Fax: 208.369.3024 State of Tdaho County of Madison Is Mike In== Nance Rekbutr. City Affidavit of Legal Interest Addsesa I� .. Ste" 750 South 200 East Being fast duly sworn upon oath, depose =d gay: Of Applicant is also Ownet of Record, skip to R) A. That I am tlic record awtxr of the property described on the Attached, and 1 grant my pettnission to: Bob Petnff J95 South Aiverraods PA,JMv. Suite 258 Nunc Addrms Logeu, UT 84321. to submit the accompanying application pertaining to that property. 14. i' agree to Wenlay, defend and hold Rexburg Citti and its employees harmlc4s ftiam any claim or liability resulting from any dispute as to the statements contained herin or as to the ownersthip of the property which is die subject of the appticntirni. Dated this �, d-,ty of ?, r r , 2U O q Signature Subscribed and sworn to Worc me tlse day and year First above written. maim Milk of Idaho r0� Residing at: I CIO f�•� `•� ..... ��` My commissirIn rrpii•cc: Building Safety Department City of Rexburg 19 E. Main ionellh@rexburg.org Phone: 208.359.3020 ext 326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 Property Lines �i010.UQC's U'G CITY OF RMURG r~ America's Family Community 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. N/A Interior Remodel Only Signature Printed Name Date Building Safety Department ;oF AE 9Uq�eG C I TY OF City of Rexburg '; 7�E BT RG ., 1\P1L�.D V 1�t7 nv 19E Main ionellh@rexburg.org Phone: 208.359.3020 x326 America's Family Community ID 83440 www.rexburo.ora Fax: 2011359.3024 Remodeling You Buildin /Home (need Estimate)z4,453 SURFACE SQUARE FOOTAGE. (Shall include the exterior wall measurements of the building) Infill existing opening with First Floor Area new door. Unfinished Basement area Second floor/loft area Finished basement area Third floor/loft area Garage area Shed or Bam Carport/Deck (30" above grade)Area Water Meter Quantity: Required!!! PLUMBING """"' Water Meter Size: Plumbing Contractor's Name: N/A Business Name: Contact Phone: ( ) Business Phone: ( FIXTURE COUNT (including roughed Fixtures) Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal Hot Tub/Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate (Commercial Only) Sprinklers Tub/Showers Toilet/Urinal Water Heater Water Softener Required! Signature of Licensed Contractor License number Date 5 `F3aUq Building Safety Department °` = 7��CITY V�I Tn�Y7Tn7m7P�/� City of Rexburg ° 1tGADV1\ti cti 19EMain janellh@rexburg.org Phone: 208.359.3020 x326 Amcn°is Family Community Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 OWNER'S NAME The Church of Jesus Christ of Latter-day Saints PROPERTY ADDRESS 750 South 200 Fast Permit#N/A SUBDIVISION PHASE LOT BLOCK Requiredffl MECHANICAL Mechanical Contractor's Name: ?4/e Business Name: Address City S Contact Phone: ( ) Business Phone: ( ) Mechanical Estimate $ (Commercial/Multi Family Only) FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas -fired appliance Incinerator System Boiler Pool Heater Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure (Meter Supply) PSI Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic Required! Signature of Licensed Contractor License number Dare 0 Building Safety Department City of Rexburg 19 E Main janellh@rexburg.org Phone: 208.359.3020 x326 Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 OWNER'S NAME The ;hurch of Jesus Christ of latter-day Saints PROPERTY ADDRESS Permit# SUBDIVISION PHASE LOT BLOCK RequlredN Electrical Contractor's Name ELECTRICAL Name 0 N/A CITY OF RFMURG Amerim's Romily Community Address City —State—Zip— Cell Phone ( Fax ( Phone ( Electrical Estimate (cost of wiring & labor) $ (COMMERCIAL ONLY) (Includes the tort of materials installed regattlkss of the pally srrpplbirtg it). TYPES OFINSTALLATION (New Residential includes everything contained addiin the residential structure and attached garage at the same time) RESIDENTIAL ONLY ❑ *Up to 1,500 sq ft - $72 ❑ *1,501 to 2,500 sq & - $120 ❑ *2,501 to 3,500 sq ft - $168 ❑ *3,501 to 4,500 sq ft - $216 ❑ **Over 4,500 sq ft - $216 plus $.04/sq ft: sq ft total ❑ Existing Residential (# of Branch Circuits) - $40 plus $10 per circuit: # of circuits ❑ Multi -Family Only: # of units per budding - $120/bldg + $60/unit ❑ Services: Alterations/Repairs that require utility disconnection. (Estimate applicable for commercial). ❑ Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year) - $40 ❑ Spa, Hot Tub, Swimming Pool - $40 plus $40 grounding grid where applicable ❑ Electric Central Systems Heating and/or Cooling (when not part of a new residential mnstrmetion permit and no additional wiring) - $40 ❑ Modular, Manufactured or Mobile Home - $50 plus $10 per circuit ❑ Other Installations: Wiring not specifically covered by any of the above: Cost of Wiring & Labor. $ (Includes the mst of materials installed regardless of theparo supplying it). ❑ Pumps (Domestic Water, Irrigation, Sewage): horse power ❑ Requested Inspections (of existing wiring) - $40/hr (1 hr minimum) plus $40/hr thereafter ❑ Temporary Amusement/Industry - $40 plus $10 per ride, concession or generator *Includes a maximum of 3 inspections. Additional inspections charged at requested inspection rate of $40 per hour. ** Includes a maximum of 4 inspections. Additional inspections charged at requested inspection rate of $40 per hour. of Licensed Contractor License number Date Building Safety Department aF yEi9 qC City of Rexburg 19 E. Main janellh@rexburg.org Phone: 208.359.3020 ' e Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024 APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT CITY OF REXBURG N Amerimi Family Commwity PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO APPROVED BY: -APPLICANT INFORMATION: Business Name: Jacobsen Construction Office Address: 3131 West 2210 South Salt lake Ctiy UT 84119 City State Zip Office Phone Number: (S01 ) 973-0500 Contractor Performing the Work: Jacobsen Construction Contact Person: Kirk Dickamore Cell Phone # (801 ) -LOCATION OF WORK TO BE DONE: Street Address Where Work Will Be Done: 750 South 200 East Business Name Where Work Will Be Done: Rexburg Idaho LDS Temple Dates For Work To Be Done: August 3, 2009 To August 17, 2009 Contact Person: Kirk Dickamore Phone Number: (801 ) 973-0500 Cell # ( ) PLEASE CHECK THE TYPE OF PERMITS) YOU ARE APPLYING FOR: ❑ AUTOMATIC FIRE -EXTINGUISHING SYSTEMS ❑ COMPRESSED GASES ❑ FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT ❑ FIRE PUMPS AND RELATED EQUIPMENT ❑ FLAMMABLE AND COMMBUSTIBLE LIQUIDS ❑ HAZARDOUS MATERIALS ❑ INDUSTRIAL OVENS ❑ LP -GAS ❑ PRIVATE FIRE HYDRANTS ❑ SPRAYING OR DIPPING ❑ STANDPIPE SYSTEMS ❑ TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES Applicant's Signature Date ........................................................................................... 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: EXEMPTIONS FROM STATE REGISTRATION As of January 1, 2006, the City of Rexburg can no longer sell permits without having a copy of your State registration number or your exemption from the State registration. Please send a copy of your state registration or fill out this form showing your exemption and send it with your license renewal or your next permit application. (This list is a summarization of Idaho Code Title 54 Chapter 5205, for full definitions of these exemptions please see the State's website at www.ibol.idahn.gov/conthtm) ❑ Currently State licensed pursuant to Title 54 Idaho Code, Chapters: 3 Architects, 10 Electrical Contractors/Journeyman, 12 Engineers/Surveyors, 19 Public Works Contractors (exempt from fee only registration required), 26 Plumbing/Plumbers, 45 Public Works Construction Management Licensing Act (exempt from fee only registration required), or 50 Installation of heating, ventilation and air conditioning systems ❑ Employee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit charitable activity with no wages or salary ❑ Employee of a US Government agency (State, City, County, or other municipality) ❑ Public Utility doing construction, maintenance, or development to its own business ❑ Involved with gas, oil or mineral operations ❑ Supplier doing no installation or fabricating ❑ Contracting a project or projects with a total cost less than $2000 ❑ Operation of a farm or ranch or construction of agriculture buildings exempt from Idaho Building Code ❑ Any type of water district operations ❑ Work in rural districts for fire prevention purposes ❑ Owner who performs work on own property or contracts with a registered contractor to do work as long as the property is not for resale within 12 months ❑ Owner or lessee of commercial property performing maintenance, repair, alteration or construction on that property ❑ Real estate licensee/property manager acting within Idaho Code ❑ Engaging in the logging industry ❑ Renter working on the property where they live with the property owners approval ❑ Construction of a building used for industrial chemical processing per Idaho Code ❑ 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 Print Name Date 10 CITY OF REXB URG �,,w PERMIT # BUILDING PERMIT APPLICATION Please complete the entire Application! 19 E MAIN, REXBURG, ID. 83440 If the questi-- 208-359-3020 X322 PARCEL NUMBER: V_y9y?C A b�ow;�(W, 0600024 SUBDIVISION: UNIT Temple (Phase 3) (Addressing is based on the information - must be accurate) OWNER: The Church of Jesus Christ of Latter-day Saints CONTACT PHONE # 801-240-2042 PROPERTY ADDRESS: 792 South 200 East, Rexburg, ID 83440 PHONE #: Home ( ) Work ( 801 ) 240-2042 Cell ( 801 ) 518-7796 OWNER MAILING ADDRESS: 50 East North Temple CITY: Salt Lake City STATE: Utah ZIP: 84150 EMAIL martindalevl@ldschurch.org FAX 801-240-1335 APPLICANT. (If other than owner) Architectural Nexus (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS 135 N. Main Street Suite 200 CITY: Logan STATE: Utah ZIP: 84321 EMAIL bpetroff@archnexus.com FAX 435-752-4160 PHONE #: Home ( ) Work (435 ) 753-2141 Cell (435 ) 770-9750 CONTRACTOR: Jacobsen Construction, Inc. c/o Chad Richards MAILING ADDRESS: 3131 W. 2210 S. CITY Salt Lake City STATE Utah ZIP 84119 PHONE: Home# Work # 801-983-5193 or 208-496-2981 Cell # 208-403-1384 EMAIL chad@jacobsenconstruction.com FAX 801-973-7496 Or 208-496-2982 How many buildings are located on this property? One Did you recently purchase this property? (D Yes (If yes give owner's name T TD Is this a lot split? NO YES (Please bring copy of new legal description of propert3 J AN 1 1 2006 PROPOSED USE: Religious Facility (i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Et 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 2000 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. 01/ /a /L16 DATE Do you prefer"to be contacted by fax, email or phone. Circle One WARNING — BUILD UST BE POSTED ON CONSTRUCTION SITE! Plan fees are non-refundable and are paid in full at the time of application beginning January 1, 2005. City of Rexburg's Acceptance of the plan review fee does not constitute plan approval u CITY OF R.EXBURG AMERICA5 NWILY CONAWI I IY 19 E. Main (PO Box 280) Phone: 20B-359-3020 x326 Rexburg, Idaho 83440 Fax: 208-359-3024 www.rexbum.om comdev(alrexbura.oru Affidavit of Legal Interest State of Idaho County of Madison I,r). N ill �� In �tnfi�., llb+fit nor Name Address SEC � Gt-ly 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 liability resulting from any dispute as to the statements contained herin or as to the ownership of the property which is the subject of the application. Dated this n \10 day of A1L�4 20 O� Signature LS Subscribed and sworn to before me the day and year first above written. luu BAN 1 1 2006 Notary Public of Edah Residing at: My commission expires: L l 0 rwmm==: il. 6, Noe.mm r1 CONft Nl'J d. ROBERTS 1 EOFs.e iHoa�IsWnPWcua stlun'°°`�11•thip0'/ awa t aw Bon / 1. �• • rit>ii"� O •Ii *"Building Permit Fees are du time of application" *"Building Permits are v T you check does not clear" Please complete the en`Ire Application! `° If the question does not apply fill in NA for non applicable NAME Rexburg Idaho Temple PROPERTY ADDRESS 792 S. 200 E. Permit# SUBDIVISION Dwelling Units: N/A Parcel Acres: SETBACKS FRONT SIDE SIDE BACK Remodeling Your Building/Home (need Estimate) $ SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building) First Floor Area Second floor/loft area Third floor/loft area Shed or Barn Water Meter Count: Required!!! PLUMBING Plumbing Contractor's Name: DE Unfinished Basement a Finished basement area Garage area above Water Meter Size: Business Name: Address City State Zip Contact Phone: ( FIXTURE COUNT (including roughed fixtures) Clothes Washing Machine Dishwasher Floor Drain Garbage Disposal N/A_ Hot Tub/Spa Sinks (Lavatories, kitchens, bar, mop) Plumbing Estimate $, Business Phone: ( ) Fax Sprinklers N/A _ Tub/Showers Toilet/Urinal Water Heater Water Softener (Commercial Only) Required! Signature of Licensed Contractor License number The City of Rexburg's permitfee schedule is the same as Date the State ofl n Please complete the entils.Application! applicable NAME Rexburg Idaho Temple PROPERTY ADDRESS 792 S. 200 E. SUBDIVISION Required!!! If the question doesti..c apply fill in NA for non Permit# MECHANICAL Mechanical Contractor's Name: TBD Business Name: State Contact Phone: ( ) Business Phone: ( Email Fax Mechanical Estimate $ (Commercial/Multi Family Only) FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only) Furnace Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater Space Heater Decorative gas -fired appliance Incinerator System Boiler Pool Heater Similar fixtures or Appliances Fuel Gas Pipe Outlets including stubbed in or future outlets Inlet Pressure (Meter Supply) PSI Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents other similar vents & ducts: Zip Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. Signature of Licensed Contractor Required! The License number schedule is the same as Date the State E COMMUNITYDEVELOPMENT WWI RCITY OF • • • ° REXBUR-G �',, AiMERK AS ITYIILY CON6\IIINI I Y 19 E. Main St. Phone: 208-359-3020 x326 B�,5HEO Rexburg, Idaho 83440 Fax: 208-359-3024 w .rexburo.oro cdd@rexburg.org APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #: PERMIT APPROVED: YES/ NO $50.00 FEE PAID: YES/NO APPROVED BY: -APPLICANT INFORMATION: BUSINESS NAME: Jacobsen Construction, Inc. OFFICE ADDRESS: 3131 W. 2210 South, Salt Lake City UT 84119 City State Zip OFFICE PHONE NUMBER: (208) 496-2984 or (801) 973.5193 CONTACT PERSON: Chad Richards CELL PHONE # (208) 403-1384 -LOCATION OF WORK TO BE DONE: STREET ADDRESS WHERE WORK WILL BE DONE: 792 S. 200 E. BUSINESS NAME WHERE WORK WILL BE DONE: Rexburg LDS Temple DATES FOR WORK TO BE DONE: July 2005 TO Dec 2007 CONTACT PERSON: Sam Moss PHONE NUMBER: (208) 496-2981 or CELL # (801) 560.3952 PLEASE CHECK THE TYPE OF PERMIT(S) YOU ARE APPLYING FOR: AUTOMATIC FIRE -EXTINGUISHING SYSTEMS COMPRESSED GASES FIRE ALARM AND DETECTION SYSTEMS AND RELATED EQUIPMENT FIRE PUMPS AND RELATED EQUIPMENT FLAMMABLE AND COMMBUSTIBLE LIQUIDS HAZARDOUS MATERIALS INDUSTRIAL OVENS LP -GAS PRIVATE FIRE HYDRANTS SPRAYING OR DIPPING STANDPIPE SYSTEMS TEMPORARY MEMBRANE STRUCTURES, TENTS, AND CANOPIES APPLICANTS SIGNATURE DATE .........................................................................................., 6 E9 SUBCONTRACTOR LIST- (TBD) 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: 7 Mer` rry TX Result Report ( Feb, 9. 207�10:06AM 2) Date/Time: Feb. 9. 2007 10:03AM File Page No. Mode Destination Pg(s) Result Not Sent ---------------------------------------------------------------------------------------------------- 3670 Memory TX 18019735193 P. 5 OK ---------------------------------------------------------------------------------------------------- Reason for error E. 1) Hang up or line fail E. 2) Busy E. 3) No answer E. 4) No facsimile connection E. 5) Exceeded max. E—mail size v I.gF_M FA&OM PhKrlltt]i9jW.'.Q6 RMORM Fax "Wo"Am 0 TOC Jaoobsirn Cors:<nrclfan R= JCIhW Hanlon Fax 801.973.5193 Payer 5 MOM bah c FebnM 9, 2007 Rac ac 13 S O Par Rmftw o Rome Comsat O Pleaso" O Ptoaso a -Yale The fokm&o kftmalion has not bean mcaved k s ft Rmtmu Temple W PrumbErg & mechanbd appEceftm signed by the contactor, con*ucffon pamiU sloned by fro d=thptdder comport, and a baorst=cw M fried out. Florio ham the appoprlafe conkadors sign the app6caffons and fox back to us. If you have oN quasffaru, please oaf roe. Thank YO% JaNW Han