HomeMy WebLinkAboutBP & APPLICATIONS - 06-00231 - 517 Partridge Ln - New SFR MechanicalZ
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City of Rexburg/ Madiso~'ounty
BUILDING PERMIT APPLICATION l~l~~~ ~e 06 0023
zo~E3~ oao ~URG, m. s3~o ~~~ ~ ~~ ~ ~~" 517 Partridge Ln-Cnty Mech ~~
~~
PARCEL NUMBER: ~ - ' ~ ~ ~~ ~-( ~ ~,~ %( t t~.y _( _
SUEDIVISION: t~a~ ( _ C,J UNIT# BLOCK# LUI.#F_~
(Addressing is based on the information -must be accurate)
PROPERTY ADDRESS:
PHONE #: Home ( ) Work (
OWNER MAILING ADDRESS:
EMAIL
ZIP:
APPLICANT: {If other than owner) ~lc~-, ~~ ~s ~ ~L L .4~~n.-y ~lv.-• //
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner mast a company this application.)
APPLICANT INFORMATION: ADDRESS 13ZZ~v, l6 ~~ ~ CITY:~~~-~-~'~
STATE; --~1~~ r~ ZIP ~3 yY ~ EMAIL FAX 3s'i?- 5'Z7G
PHONE #: Home ( ) 3sb-~/Zl ~. Work ( ) 3~~ -Yz7G Cell ( ) 3s/-/boo/
CONTRACTOR: ____~~~o,,.,, ~! ~ //
MAILING ADDRESS: /3ZZ.~ti. l6~-`' _F, CITY~c.~c.~STATE~1~ ZIP ~YY~
PHONE: Home# 3sb -YZ/ G Work# 3.s7 -YZ ~G CeII# 357 /&~ /
EMAIL
Cell ( )
CITY: STATE:
FAX
FAX 3.s~-YZ7~
How many buildings are located on this property? (:Y~ i=
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot split? NO YES (Please bring copy of new legal description of property)
PROPOSED USE: _~'i'n
(i.e., Single Family Residence, Multi amity, Ap
Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I
have mad this application and state that the information herein is comet 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 comet. I agree to comply with all City regulations and State Taws
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 revolve 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 da s.
Signature of O r/Applicant ~ ~ ~ L~ U 1:
loo you pr ' r to be cunt ed by fax, email or phone? Clrcle
WARNING -BUILDING PERMIT MUST BE POS CONSTRUCTIO]
Plan fees are non-refundable and ate paid in full at the tim a 'cati~t~l~egi~n~ng~
City of Reaburg's Acceptance of the plan review fee does n o tote plan approval.
CONTACT PHONE # 7 f3 -Z2&'£!
2
~.~~ of REx~u~~
~3~~'~t5~ ~°(~Ill~t~~",~{:*. ~~lt° t`Il#:- ~;~~~~~~t'x3~.~~9C1~ 1~ tt~ ~{aei:~tit~~s ilai~c) u~~~~~~ #'iil str ~.~ t~,i- ts;srt
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
MECHANICAL
,~~ ~~ ~~c
Mechanical Contractor's Name: /~ 1- i ~ Business Name: ~ ~~ ~ ~
Address . ~7~~ ~i3ff.C1G„/ City~~ -~' ° State %~ Zip-~~-~C)
Contact Phone: (~~;;~) "5 [~ C~~k~ Business Phone: ( ) _3 )3 ~
Email ~~ ~~~ ~.1-- ~,:,~` /~.,. '`I~n. !^m;~ • L:,~iivr, Fax
Mechanical Estimate $ (CommerciallMnlti Family Only)
FIXTURES 8c APPLIANCES COUNT (Single Family Dwelling Only)
Furnace ~ Exhaust or Vent Ducts
G-- 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
_~`i 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
other similar vents & ducts:
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
~ ~' d Z~
a14~ii~lltil'~J U '~ ~1li+~91 ;+~~~ ,.~t)i9~3'ilC?(~T' ~1~'•'.IiSt; IILIl1lU~:1' Dates
The City of Rexburg's permit fee schedule is the same as required by the State of Idaho
Dryer Vents
Range Hood Vents
Cook Stove Vents
Bath Fan Vents
3