HomeMy WebLinkAboutAPPLICATION - 08-00215 - 260 S 3 E - ElectricalCITY OF REXBUR •
G PERMIT #
MECHANICAL PERMIT APPLICATION Please complete the entire Application!
19 E MAIN, REXBURG, ID. 83440 If the question does not apply fill in NA for non applicable
208 - 359 -3020 X326
PARCEL NUMBER: �-- (D (DL'S (�, (0 LS. We will provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information - must be accurate)
OWNER: CONTACT PHONE #
PROPERTY ADDRESS: 26a
PHONE #: Home (
Work
Cell (
OWNER MAILING ADDRESS: CITY: x STATE: 7D ZIP: k4
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:
PHONE #: Home (
Work (
Cell (
CONTRA CTOR 474oJ � 1L
MAILING ADDRESS: Z q CITY C STATE
PHONE: Home# Work# Cell # C� �
EMAIL FAX
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name) "p
Is this a lot split? J!D YES (Please bring copy of new legal description of property)
PROPOSED USE: S,&
(i.e., Single Family Residence,
CITY:
ZIP EMAIL
Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalt of perjur I hereb certif 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 2003 International Code in cases of any false statement or misrepresentation of fact in
the application or on the plans on whic "e permit or approval was based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
/ / 0r
FAX
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
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
04 �exeo
.A.
Vs� 70
C I T Y OF
REXBURG
Americas Family Community
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required!!!
Mechanical Contractor's Name:
Address
Cell Phone: ( )
Fax: ( )
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLL4NCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace /Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
Space Heater
Decorative gas -fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets
Heat (Circle all that apply) Gas Oil Coal Fireplace Electric Hydronic
Zip
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on Dlans.
Signature of Licensed Contractor
MECHANICAL
License number
The City of Rexburg's permit fee schedule is the same as
Date
by the State of Idaho
City
Business Name:
State
Business Phone: ( )
Email
E
Building Safety Department ° 4�tiXg�A�
.� . c 'rY of
City of Rexburg —-
° REXBURG
19 E Main jonellh @rexburg.org Phone: 208.359.3020 x326 -
326 Americds Family Community
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
OWNER'S NAME
PROPERTY ADDRESS -, rc� "n _ �' Permit#
SUBDIVISION P-e)--
PHASE LOT BLOCK
RequiredMf
ELECTRICAL
Electrical Contractor's Name &20Af Ze,� -1.Gy,,A -A( Business Name ,0l L2*—
Address r- / 4 2 5 ,e . �j ' - 1 ` T - � - City P^ State — Zip F-W < <" J
Cell Phone (Zci) -35; O .�- Business Phone (zci) 3s v- "77G
Fax ( ) Email
Electrical Estimate (cost of wiring & labor) $ (COMMERCIAL /MULTI - FAMILY ONLY)
TYPES OF INSTALLATION
(New Residentialincl es everything contained within the residential structure and attachedgarage at the same time)
G Up to 200 amp Service*
201 to 400 amp Service*
Over 400 amp Service*
Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year)
Existing Residential (# of Branch Circuits)
Spa, Hot Tub, Swimming Pool
Electric Central Systems Heating and /or Cooling (when not part of a new residential construction permit
and no additional wiring)
Modular, Manufactured or Mobile Home
Other Installations: Wiring not specifically covered by any of the above
Cost of Wiring & Labor: $
Pumps (Domestic Water, Irrigation, Sewage)
Requested Inspections (of existing wiring)
Temporary Amusement /Industry
*Includes a maximum of 3 inspections. Additional inspections charged at requested inspection rate of $40 per hour.
Signature of Licensed Contractor License number Date
The
fee schedule is the same as required by the State of Idaho