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Home My WebLink AboutAPPLICATION - 06-00293 - 3912 W 2250 N - New SFR Mechanical CITY,OF REXBURG 0~, 00293 MECHANICAL PERMIT APPLICATION Pleas ~ 19 E MAIN, REXBURG, ID. 83440 If the ql 3 9 l 2 W 22 5 0 N-Casty Mecl1 e 208-359-3020 X326 PARCEL NUMBER: ~ a~~ ~'~ ~ ~~ ~ ~ C~ `~(~ (We will provide this for you) SUBDIVISION: UNIT# B~O~K# LOT# (Addressing is based on the information -must be accu>ate) ~ ~: `" ~1 ~d ~~- ~.. Ck~ ~ 'fie f rh ~~ :~ M, - ~ ~, ~ o ~~- l OWNER: ~i'e-rw./ ~ ~ CONTACT PHONE # ~ PROPERTY ADDRESS: .~ ~ ~ 2. ~ ~-5~7" Z Z PHONE #: Home ( ) Work ( ) Cell ( ) OWNER MAILING ADDRESS: CITY: STATE: ZIP: EMAIL FAX --- APPLICANT: (If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.) APPLICANT INFORMATION: ADDRESS STATE; ZIP EMAIL PHONE #: Home ( ) CITY: FAX Work ( ) Cell CONTRACTOR: MAILING ADDRESS: CITY STATE ZIP PHONE: Home# Work# Cell# EMAIL FAX How many buildings are located on this property? 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.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.) 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 heazings 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 2003 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 of Owner/Applicant DATE Do you prefer to be contacted by fax, email or phone? Circle One WARNING -BUILDING PERMIT MUST 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 PIeaSQ Complete the entire ApphcatlOri~ If the question does not apply fill in NA for non applicable r NAME PROPERTY ADDRESS SUBDIVISION Required!!! MECHANICAL Permit# Mechanical Contractor's Name: A N ~P-~ a~ v-Sc~~~ Business Name:.] b~ ~ ~+~''~~ ~~ Address ~'/(~ Lv i ~~o~oft~Ul~- G~C,I e. City ~+-1wrC~ State ~~ Zip 8 3`1~~/~ Contact Phone: (`~,vS) 39a --y~ZS' Business Phone: ( ) Email ~D~ ~'i h e~a~rti ~ ~. +M 5 ~ , cO~ Fax ~ S~ ' d s~2 S 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 ~JJ Fuel Gas Pipe Outlets including stubbed in or future outlets other similar vents & ducts: ~ >~ Inlet Pressure (Meter Supply) PSI Pro ~w~Z Heat (Circle all that apply) .Gas Oil Coal Fireplace Electric Hydronic Mechanical Sizing Calculations must be submitted with Plans & Application `~ ~~ Point of Delivery must be shown on plans. ~a-~~'„u, 1 ~ ~ ~ ~ 1 ` d l~ l~ U V l~ Signature ~ Licensed Contractor License number to NOV 1 5 2006 The City of Rexburg's permit fee schedule is the same as required by th State of Idaho CITY OF REXBURG Dryer Vents Range Hood Vents Cook Stove Vents ~- Bath Fan Vents w ~ City of Rexburg/ Madiso~'ounty PERMIT # BUILDING PERMIT APPLICATION 1-'lc~~t,~t t°~~tt$r~i~ta~ i:i~~; ~;~a4:at°~ ~~~~t~ic"~~li':'~~_ 19 E MAIN, REXBURG, lD. 83440 `ti° i#~~= ~; 20$-359-3020 X322 06 00293 PARCEL NUMBER:~.~~C.~,~~~ ~ ( W SUBDIVISION: UNr 3 912 W 22 S O N-Casty Mech (Addressing is based on the information - must be accurate) CONTACT PHONE #~q-f~~ br~~~/ ~-- PROPERTY PHONE #: Home -/q ~ ~, Work Cell ( )~/-S/!v ~ ~3 OWNER MAILING ADDRESS: ~~ ~. ~~ /V , CITY:~r~~STATE;ZIP:~_~ EMAIL~(jt ~d r~ ~~, ~i~Pr~i 2YI_S FAX ~,~~ - / g ~ ~, ~ ~.l ( -~ r5 ~ APPLICANT: {If other than owner) (Applicant if other than owner, a statement authorizing applicant to act as agent for owner most accompany this application.) APPLICANT INFORMATION: ADDRESS STATE; ZIP PHONE #: Home CITY: EMAIL FAX Work ( } Cell CONTRACTOR: 17 MAILING ADDRESS: ~ ~D f' ~ ' / ~ CITY STATE~ZIP~S~ PHONE: Home# j ~ ~ ~'-l ~j~~~ Work# Cell#~~--t~(d~3 EMAIL How many buildings are located on this property? f Did you recently purchase this property? No Yes (If yes give owner's name) ~L°~-i~ Is this a lot split?~ YES (Please bring copy of nevi legal description of property) PROPOSED USE: ~ ~ (i.e., Single Family Residence, M i Family, Apartments, Re odel, Garage, Commercial, Addition, Etc.) APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that 1 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 properly 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. ) , , ~ Signatur~ of dwner/Applicant U ~ ~D~'Ell 1J (~ Do you prefer to be contacted by fa;c, email or phone? Circle One WARNING -BUILDING PERMIT MUST BE POSTED ON CO CTIQ~~ tSI E;, Plan fees are aon-refundable aad are paid in full at the time of applicati nin u ~ 2~1J City of Reaburg's Acceptance of the plan review fee does not constitute lan a proval. CITY OF REXCUf~G FAX 2 .. .« ~~ 3~~`ii5t' ~'tllil~)~t'~,~` ~~11' t;tl ' z'~~>~~;.il,r~Ctt9i~~ 1~'t#~ ~;~? ,~tia.c~ fi~acil: ti~i~~9',` tilt i~~ i"4.~ l~as• s~E?i~ <~gi~,ic<~~~t=; NAME PROPERTY ADDRESS SUBDIVISION Permit# .. ~~ ~~ ~~~ ~~! ,> ! MEC15~A1VICAL !~ Mechanical Contractor's Name: ~,;; ~~2 ~~usiness Name: ~ ~5~~7~_J~~ 5 ~r~~ ~ Address ~~ Z ~6 ~~ ~T_City 92~ ,,~ State..~~ Zip~~~ Contact Phone: (~ ZcS~) ?o ,~~1 ~ Business Phone: (2~~ 7a ,~ (asl Email Fax Mechanical Estimate $ (CommerciaUMulti Family Only) FIX~RES & APPLL9NCES COUNT (Single Family Dwelling Only) Furnace _~ Exhaust or Vent Ducts Furnace/Air Conditioner Combo Heat Pump Air Conditioner Evaporative Cooler Unit Heater c9 ~ ~ '~ t,~ ~~> 1 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 ,~.- r_.,.,~..- Heat (Circle all that apply) ~Gas~ Oil Coal (Fireplac Electric other similar vents & ducts: Mechanical Sizing Calculations must be submitted with Plans & Application Point of Delivery must be shown on plans. ~'~ ~ ~ i ~ l~~ o~ 3i.;na[tr ~~!' I,iae~1;,<~ {~;untractr~r License ~1t3rnber Date ~aL;~~a~,-+:~i! _~ Dryer Vents Range Hood Vents Cook Stove Vents Bath Fan Vents The City of Rexburg s permit fee schedule is the same as required by the State of Idaho