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Home My WebLink AboutALL DOCS - 17-00136 - 2280 W 4200 S - Gas LineInspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day. Inspection Hotline – (208) 372.2344 www.rexburg.org Permit Technician – (208) 372.2341 Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 BUILDING APPLICATION Miscellaneous Mechanical Work For Office Use Permit Number: ____________________ ⧠ Mechanical Fees Paid 1. Property OwnerName: ___________________________________________________________ Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: _________________ Phone: _____________________________________________ Email: _____________________________________________________________ Under Idaho Building Code, a homeowner is allowed to do work on their own home. Are you a homeowner doing work on your own home? ⧠ Yes (Skip to section 4 of this application and complete the Homeowner’s Exemption page as well) ⧠ No, I am working with the homeowner 2.Mechanical Contractor Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.Business: ___________________________________________________________ State License #: _________________________ Exp.: _______________________ Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: _________________ Phone: _____________________________________________ Email: _____________________________________________________________ Contact/Rep. Name: ______________________________________ Phone: _____________________ Email: __________________________________________ Mechanical Contractor Authorized Signature: ____________________________________________________________________ Date:________________ A copy of your state registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please provide a photo copy of your license. If you are unsure if your license is on file, please check with the Permit Technician by calling (208) 372-2341. 3. Project DescriptionAddress: _______________________________________ -OR- Lot #: ____ Block #: ____ Subdivision: _______________________________What type of Property: ⧠ Residential ⧠ CommercialCost of job: $___________Description of work: _____________________________________________________________________________________________________________________4. Fees: Check all that apply:⧠ Furnace or A/C = $65⧠ Gas Line = $65⧠ Water Heater = $65 ⧠ Fireplace/Solid Fuel Burning Unit: o Built-in = $130 o Free-standing = $65⧠ Miscellaneous/Requested Inspection = $65 Inspection fees can be bundled upon request. Re-inspect fees will be enforced if inspection requests exceed fee totals. 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 2012 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. Applicant’s Name (print): ___________________________________ Signature: _____________________________________________ Date: _______________ BUILDING PERMIT FORM Updated 2/2017 410 03/21/2017Scott J. Theis Scott Theis (208) 602-2877 Rexburg2280 W. 4200 S.ID 83440scotttheis@gmail.com X X Permit Inspection Summary Permit Status of (Open) as of Report Date: 04/04/2017 12:57 pm Permit Details Permit Number: 17-00136 2280 W 4200 S - Gas Line 2280 W 4200 S Madison County Mechanical Residential Permit Issued Date: 03/21/2017 Permit Inspection Statistics Total Inspections Completed: Total Inspections Passed: Inspection Pass Rate Permit Inspection History *Refer to Individual Inspection Report for more Details Mechanical Inspection Type 03/22/2017FailDon AllenGas Pressure Test 03/29/2017PassDon AllenGas Pressure Test Permit Technician – (208) 372.2341 www.rexburg.org Revised 2/2017 Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 HOMEOWNER’S EXEMPTION 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. A homeowner may do work on the owner’s own home. If this applies to you, please sign this form declaring your exemption from registration and return it with your permit application. Idaho State Statute allows a homeowner to do work on their own residence:An owner performing construction on the owner's personal residential real property, whether or not occupied by the owner, provided however, this exemption shall not apply to an owner who is otherwise regulated by this chapter who constructs a building, residence or other improvement on the owner's property with the intention and for the purpose of promptly selling the improved property, unless the owner has continuously occupied the property as the owner's primary residence for not less than twelve (12) months prior to the sale of such property; Title 54, Chapter 52, Subsection (2) I hereby certify that the above information is true and correct to the best of my knowledge. _______________________________________________________ ______________________________________ Signature Date _______________________________________________________ Print Name 03/21/2017 Scott J. Theis Transaction detail for payment to City of Rexburg. Date: 03/21/2017 - 1:43:27 PM Billing Information Scott Theis Scott Theis , 83440 scotttheis@gmail.com City of Rexburg 35 N 1st East | PO Box 280 Rexburg, ID 83440 208-359-3020 ub@rexburg.org XBP Confirmation Number: 27935083 Transaction Number: 65809031PT Visa — XXXX-XXXX-XXXX-3391 Status: Successful Account # Item Quantity Item Amount Mechanical Permit 1 $65.00 Notes: Permit # 17-00136 TOTAL:$65.00 Transaction taken by: coltonm Xpress Bill Pay - Payment Processing https://secure.xpressbillpay.com/common/payment_process.php 1 of 1 3/21/2017 1:43 PM