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HomeMy WebLinkAboutAPPLICATION - 06-00106 - Teton Thai - Remodel' . CI-IY OF REXB UR G BUILDING~PERMIT APPLICATION PERMIT # 19 E MAIN, REXBURG, ID. 83440 Please c 208-359-3020 X322 If the ques) 06 001 c PARCEL NUMBER: ~' p6 SUBDIVISION: ~ ~ ~Vf~ (~ eton ~"ha~_Rer„n (Addressing is based on the information - UNI i ~` Odel must be accurate) ~-LL~,~,~>„ -~- - OWNER: ~~ ~ ~ .-a j ~ "t~ CONTACT PHONE # PROPERTY ADDRESS: ~~' US~f% ~ ~ ~~~ PHONE #: Home ; , - ~'~ X ~ ~~ .;~' ~'t ~ ~ .~.L~) - ._ ~, ~ ~:° . _ Work ~,, ~jt~ ~°c, _ ,a OWNER MAILING ADDRESS: ' ", t = 7~ Cell ( ) -`~s ~~ ,f`~cc:•4~ ~~CITY: ,~ EMAIL ~ ~f ~'~' STATE: FAX ~_ZIP: '~~ ~ ~; `4PPLICAN7': (If other than owner) (Applicant if otl~r than owner, a statement authorizin o ~ ,~ g applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS -~ STATE; ~ -~--~ ~ ~~ ~ ; ,,; ZIP g yo EMAIL CITY: - . ,~ ~~, PHONE #: Home ( ) FAX Work (~o~ 3s~ - ~_ ~ ~~ Cell ( ) CONTRACTOR: MAILING ADDRESS: PHONE: Home# CITY STATE~ZIP Work# Cell# EMAIL -~ FAX How many buildings are located on this property? I d~ h~ r ~ S~~1uh ~ Did you recentl x -~-~~ Y purchase this propert ~ ~~ ~ ~ , ~ ~ ~s this a lot split? NO y' NO Yes (If yes give owner's name) `~ YES (Please bring copy of new legal descri tion ~'` 0 'ROPOSED USE: p of pr rt 2 QQ6 i.e., Single Family Residence, Multi Family, Ap~-nents, Remodel, Gara e Co APPLICANT'S SIGNATU g ' mmercial, Addit =- RE, CERTIFICATION AND ve read this application and state that the information herein is cottect and I swear that any information inning and Zoning Commission or the Ci AUTHORIZATION; ty Council for the City of Rexburg shall be truthful and cottect. I agree to com I p ~ ry' I hereby certify that I ating to the subject matter of this application and hereby authorized representatives of the City to ente Under penalty of er u )TE: The building official may revoke a e which may hereafter be given b P Y with all City egula6ons~ and S ate laws ps for 180 days. r upon the above-mentioned property for inspections purposes. >representation of fact in the application or on the plans on which the permit or approval was based. Permit void i P rmrt on approval issued under the provisions of the 2000 International Code in cases of any false statement or ~ ~ f not started within 180 days. Permit void if work nature of Owner/Applicant ' Y°U prefer to be conta ted b `` /~/~_ Y fax, email or phone? Circle One DATE WARNING -BUILDING PE _. Plan fees are non-refundable and are~IT MiJST BE POSTED O paid in full at the time of a N CONSTg UCTION SITE! City of Rexburg's Acceptance of the plan review fee does not constituten lan aJanuarv I ZOOS p pproval 3 '~' CfTY C~_ - - F,T r ~ ? ~ T c ~ ~ ;~ 3 ~ + AMERK../~'S FAMa.Y CQA'1MUNI7Y v - ~' ' ~ `'~` °~ + "' '~ 19 E Main (PO Box 280) ~ ~ ~. ~k-: Rexburg, Idaho 83440 Phone: 208-359-3020 x326 www.rexburQ org Fax: 208-359-3024 comdevna rexbura ora Affidavit of Legal Interest State of Idaho County of Madison I~Na re ~G7rI'/` LC C~ ~._ , T 3 ~~ S . a-pdp .W ~~~ Address ~e xb~~ c,ty o State Being first duly sworn upon oath, depose and say: A• That I am the record owner oft e property described on the attached, and I grant permission to: ~ ~, ~ ~ ~ y( my Name Address ~ ~J~C f~n 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 27~ day of ~ , 20~ Subscribed and sworn to before me the day and year first above written. (If Applicant is also Owner of Record, skip to B) ~~p,FtiE qN~ ~r?•~OTAR•'~9~ Notary Public of Idaho ~ •;Z '-~'~ Residing at: ~ ~ n F,l ~ ~ ~ l Q~ I .o G ~ ' VB L~ ,s+l•., My commission expires: ~ 2' ~ ~ ' 2 0 ~ Z -" 1 2 . EXEMPTI~S FROM STATE REUISTRATION 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.idaho.gov/cont.htm) ^ 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 th above information is true and correct to the best of my knowledge. Signature Date Print Name CJ ~Tc~cn ITm~ I G ~, c'~t~ ©-~ rzexb~r~ g acs iv~,~ss a~~ ~~ca~~o w ~Zues~io v~.v~a ~r~ (~orthe purpose of wastewaterpev~uittidcg) ~ ~~~ ~. Ttpe o f business or establisl~wt.ent? R~~'t~RAu~ T ~. vV"~ll tinis lousiness ~e doing ant tape o f food preparation, or cooing? _ ~/~ ,~ 3. wi~at ttpe o f food preparation, or coo~2ing will ~e done? -~. will here be ant deep fat frting? tes~ No ~- wLll tine fac~lztt stave food disposal ststew~s? ~. ~4re ton a business planning to occupt an exis ing building? v~-s f 0. r. M,~,~~1 pr,are ton designing a new fa cilia ? ~. Will tour business have c~tewt.ical storage? es Nom 8. will t~tis facilit operate ear round? es_1~ No t ~ Y ~. Will there be ant grease traps or suwcps at t~,e facilitt? Yes ~ No ~o. Will there be awt tapes o f c~tew~.icals used at this facilitt, otter than I~ou.sel~old cCean;zng solutions? ~=- 12. (s t~tere anti wt.an,u. facturi~n,g o f products at t}~is facilittJ, ? Yes No .~'' X12.---'" ~ppt~ca ~.ts s%g wature v-1~-~G. ~~te ~ C[TY QF ~ R~XBLIR~ -- _ _ + AMERICAS FAMILY CC~MMU1~ffY 19 E. Main St. Phone: 208-359-3020 x326 ~ Rexburg, Idaho 83440 Fax: 208-359-3024 www.rexburg.or9 cdd@rexburg.org APPLICATION: "CONSTRUCTION PERMIT" CONSTRUCTION PERMIT #:_ PERMIT APPROVED: YES/ NO ,TION: BUSINESS NAME: APPROVED BY: $50.00 FEE PAID: YES/NO OFFICE ADDRESS: '~~~ x „~w,ecz ~ ~,~~ ,g~~~~j City State Zip OFFICE PHONE NUMBER: ( ) CONTACT PERSON: 5tA rvl CELL PHONE # ( o ~ )1113 - z S ~ y -LOCATION OF WORK TO BE DONE: STREET ADDRESS WHERE WORK WILL BE DONE: (C~ ~ . ~~~ S'~Tk~rt ~- BUSINESS NAME WHERE WORK WILL BE DONE: ~,,-,-,~~ ~-T-N,~ j DATES FOR WORK TO.BE DONE: TO CONTACT PERSON: - ~(~ ~ t PHONE NUMBER: ( ) ELL # L 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 APPLI ANTS SIGNATURE DATE ........................................................................................... 6 J~ P.Q. Box-280 O~uRGlO // Q ~ ~ ~ ~ ~~ ~ 12 Piarth Gente~ Street ,, - o `l./ ~ ~ Rexburg, fdaho 83440 . ~ Phone (208j 359-3020-. ~ - ~ STATE OF IDAHO Fax(208~ 359=3022 ~- -` ~ e-mail rexburg@srv.net ~T'98t~sN~D ~~ Grease Traps and Inspections TO ALL : Local Business Owners and Management The City of Rexburg requires that all facilities dealing with any fats, oils, or greases must have grease traps in place in order to stop them from discharging into the city collection system. Fats, oils and greases cause blockage in private services as well as the public sewer lines and. also create a large cost to treat and remove them at the city Wastewater Treatment Plant. The City of Rexburg is currently upgrading ~t s record keeping system in regards to the cleaning of grease traps and stepping up its monitoring to assure compliance. Due to the lack of reporting from some existing businesses and documents not being given to new coming businesses, we are sending this letter out to help businesses and ourselves become on the same page. Please fill out the attached forms. An business which receives this letter and does not have ease tra sand does not 'schar a fats oils or eases into the ci sewer can 'ust fill out Attachment A (The Business Information Form} and ma~~ disrefard the following. Each business is responsible far the cleaning and reporting of their grease traps to the City Form. Please make copies of this. The Grease of Rexburg. Inclosed is a Grease Trap Cleaning ease tra cleaning Trap Cleaning 1~'orm is a written record that must be filled out after every gr p wether traps are cleaned twice a week, once a week, once a month, etc. At the end of each month, the compiled Grease Trap Cleaning Forms need to be mailed to the City of Rexburg. The address for mailing is on the forms. Make sure to make copies for personal records. Also included is 'a Grease Trap Cleaning Log. Please make copies of this. The Grease Trap Cleaning Log needs to be kept and turned in every six months to the City of Rexburg and a copy kept by the business. This log will keep just the dates cleaned and the name of the company that cleans the traps. The City of Rexburg will do random inspections of facilities to assure that proper cleaning of grease traps have been done and that there is not currently any problems with fats, oils, or greases being discharged into the system. If the City has any concerns that proper cleaning and removal of grease in the traps has nbt been met, or if a business fails to comply by not sending in the cleaning forms and logs, we will have to take action to assure that requirements are met. We hope that we can assist you if you have any questions, so feel free to callus at (208) 359-3035. Ask for either Donna, Jade, or Ron. P.S. Several businesses that have been outstanding in sending us the proper in, formation in the past will get this letter also. We want to thank you, for your e, f,}orts to help us create a quality Pretreatment Program. Thanks Y u, ,~ MAR 0 3 2006 {s J', astewater Treatment Plant ~:., __ .~ FORM A BUSINESS INFORMATION FORM Name of Business:~~ ~ 't"u t~ ~I~ A L Address of Business: 1 d C /11 ~ r nl Si Mailing Address: ,. ~. Contact Person: ~Arv- C' o.,~.~: ~r2r~.l~~-~-Phone Number: ~~J ~ - Co 3 [p Co 2°d Contact Person: J ~ mkt ~ ~~ ~ C~ Phone Number: 3 ~ p r 5~ S' y Does your business work with any Fats, Oils, or Greases? Yes Do you have grease traps currently at your facility? Yes_/~/ How regularly do you have your grease traps cleaned? Please Return to the City of Rexburg City Hall C/O Waste Water Department NO NO P.O. Box 280 Rexburg, ID $3440 Form A (Continued) BUSINESS INFORMATION FORM (Fill Out If Applicable) 1. On the lines below, please describe the location of your grease traps and wether or not they are inside or outside your facility. '~ Location of Grease Traps: 'j:~ ~ y, - _ r'.l.hl f~~12P~CA•TH ~t: SII~~ 2. On the lines below, please describe the type and size of grease traps you use at you 're facility to the best of you 're knowledge. TYPe and Size: 1 t=o®~ ,~ 2 F ~~ ~ Lc,u ~~ I ~~ •,- c~..5 ~ ~ F I 1 ) ,~ C" fL~T 1 r rc-- ~ ~ ~ r ~ uc.~ i'~f~. 7~ ~ ~ i'" 1 -~~.. ,