HomeMy WebLinkAboutAPPLICATION ELECTRICAL & RECEIPT - 16-00823 - 141 S 1st W - Northpoint Apartments - SignBuilding Safety Department
AOQaexavRo ' — CITY OF
City of Rexburg
nT+vn�G BUILD[NGPERMITFORM 420 35 North1st East
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America's Family Community Rexburg, Idaho 83440
BUILDING APPLICATION
Miscellaneous Electrical Work
For Office UseJ3 Electrical Fees Paid
Permit Number:' 66 CMB'�-3
1. Property Own 1,
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Name: L/ / a✓ l—&Iek & Zip Code: / Y
Address: CITY.
Phone: Email: /`xli,rr�A11ie�i?/JF %74'2'r IiYP.K%irlop
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 #4 and complete the Homeowner's Exemption)
2, Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
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Business: Exp.:
i c� i � � ` �,�� State License #: , T
State: 1 D—Zip C[
Address: City: , rCO
r,u__... 7nfe, -Ael1—A770 Email: lo:ShlyttYs7CJ
Contact/Rep. Name: l'iYonf tom/ Ise'
/� c Dater
Electrical Contractor Authorized Si
A copy of your state registration/license is required to be o e. If this is the first time you have acne work m the City of Rexburg, please prov
a photo copy ofyour license. lfyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: OR -
What type of Property: ❑ Residential ❑ Commercial
Cost of job: $
Description of work:
4. Fees: Check all that apply:
❑ Central Heating/Cooling Systems = $65
❑ Temporary Electrical Services ONLY = $65 (200 amp
or less. One location, for less than 1 year.)
❑ New Circuits = $(65 + ($10 x # of branch circuits))
❑ Miscellaneous/Requested Inspection as $65
❑ Generators = $65
❑ Irrigation Machine = $65 for center pivot + $10 per
tower or drive motor = $
Lot #: _ Block #: _ Subdivision:
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❑ Pumps - Water, Irrigation, Sewage (per motdr)014
o $65-upto25HP UFC
o $95 - 26- 200HP [�
o $130 - over 200HP /?tlr ��(/
❑ Spas, Hot Tubs, and Swimming Poo s -
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❑ Temporary Amusement = $65 + $10 per ridlevo,
concession, or generator $
Inspection fees can be bundled upon request R&mapeet fees will be
enforced if inspection requests exceedfea totals.
APPLICANT'SSIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpedury, I hereby certify that l haveread this application and state that the information herein
is shall beftandulswear
add
any information which may hereafter be regulations andSmte awsreting to thes b)rt matter of this appliven by me In hearings before the Planning and Zoning cation and hereby authorized representaumn or the City Council for the City of tives
urg
of he
shall be truthful and correct 1 Brum a comply with all City
City in enter upon the above-mentionedpraperty for iupeNons purposes NOTE: The building officialmy revoke a permit on approval Issued under the provisions of the 201
International Code in cues of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was based. Permitvoid if not
started within 180 days. Permit void ifwork stops for 180 days.
(P J re g 1-N1.5X V i1 Signawlm-� - e --s em Date:
Applicant's Name tint)
Inspections most be called in before a AM on the day the Inspection is requested Inspection requests called in after 6 A will be scheduled for thee'eext mines) 3722341
Inspection Hotline - (208) 372.2344 www.cexbmg org
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0.131 {)1 City of Rexburg
,= .a 35 N 1st East I PO Box 280
R.EXBURG Rexburg, ID 63440
-- c 208.359.3020
r1 we ird, A,wd} Cwwli jwntr ub@rexburg.org
XBP Confirmation Number: 26109839
► Transaction detail for payment to City of Rexburg. Date: 12/3012016 -12:19:14 PM
Transaction Number: 61921844PT
Visa — XXXX-XXXX-XXXX-8451
Status: Successful
'Account# 'Item '1Quantity ;Item Amount
1600823 Electrical Permit 1 $65.00
Notes: NORTHPOINT APTS.
TOTAL: $65.00
Billing Information Transaction taken by: mary
CHRIS LEISHMAN
,83440
https://secure.xpressbillpay.com/common/payment_process.php 12/30/2016