HomeMy WebLinkAboutFS APPLICATION - 16-00482 - Campus Courtyard 2 Bld 8 Inspections 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 Revised March, 2016
Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440
BUILDING APPLICATION Fire Sprinkler
For Office Use Permit Number: ____________________ Permit approved: ⧠ Yes ⧠ No Fees Paid: ⧠ Yes ⧠ No 1. Applicant Business Name: ___________________________________________________________ Office Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: ____________ Office Phone: _______________________ Contact Person: _______________________________________ Cell Phone: ______________________________ Contractor’s Authorized Signature: ____________________________________________________________________ Date: ________________ License/Registration #_________________________ Expiration: ____________________________ 2. Location of Work to be Done Street Address: ___________________________________________________ City: __________________________ State: ____________ Zip Code: ____________ Business Name: ______________________________________________________________________________________________________________________________ Contact/Rep. Name: ________________________________________ Phone: _______________________________________________⧠ Office ⧠ Cell Phone Email: _________________________________________________________________________________________________________________________________________ Dates for work to be done: From ______________________ to ______________________ 3. New Construction Contracted Amount: $_____________________________ Calculated Fee (See Below): $___________________________ ⧠ Up to $10,000 = (total cost of system x .02) + $60 ⧠ $10,001-$100,000 = ((total cost of system -10,000) x .01) + $260 ⧠ Over $100,001 = ((total cost of system -100,000) x .005) + $1,160 4. Miscellaneous ⧠ New Construction = $1 per sprinkler head ($2,000 max) # of heads: ____________________ ⧠ Existing Inspection Base = $65 ⧠ Plan Review = 10% of Contracted Amount ⧠ Re-Inspection = $65 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 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: _______________