HomeMy WebLinkAboutAPPLICATION - 17-00039 - 966 N 3000 W - Built-in Fireplace/Jan. 31, 2017 7:33AMO p LEISURE TIME
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BUILDING APPLICATION
Mechanical
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City of Rexburg
35 North 1St East
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For Office Use
Permit Numb 7-oo�PermitType: ❑New ❑.Remodel ❑Addition ❑Basement Finish
Fees Paid: is Yes U No
1. Property Ov✓ner LLL"�+
Name: Ka f llKy(P FG'Ive k I
Address: '74KO N3(:City:re0u!—State: :22 Zip Code: 3`YL 0
Phone & Type: 209 -931 -WC) 130ffice ❑ Mobile 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?a Yes (Skip to #3 and complete the Homeowner's Exemption page)
13 No: I am a contractor working for the homeowner❑ No: This property is a Multi -family Residence or Commercial Property,
NOTE: Anycontmcmrs/sub•conttactots Involved will need to submit their own signed applications.
2. Mechanical Contractor
Name: Lt Gf�ifJ F-21 JK71'C C•
y: -Re istration#: Exp.:Address: 2
State: Zip Code: —
Phone & Type: OCA - S 23-y G'33 ❑ Office U Mobile Email:
Contact/Rep. Name: S Lti LPR hone Email: 5 07 tmi�GV iMe1 C<
MechaniralC0 tractor Authorized Signature; Date: l77
3. Project Description,
Address: R. Lot #: _ Block #: _Subdivision:
Check one:❑ Single-family Residence[] Multi -family Residence ❑ Commercial
Check one:I3New Construction"❑Remodel ❑Addition OBasement Finish
Description of work:
New Commerciai Work:Contracted amount: $ Calculated Fee (See Below): $
❑Up to $10,000 = (total cost of system x.02) + $60 0$101001-$100,000 ea ((total cost of system -10,000) x .01) + $260
❑Over $100,001 ea ((total cast Ofsystem -100,000) x.005) + $1,160
New Single -Family Residential Worki Sq. Ft
O Up to 1,500 Sq. Ft = $130 ❑ 1,501-2,500 Sq. Ft = $195 ❑ 2,501-3,500 Sq. Ft = $260 ❑ 3,501-4,500 Sq. Ft = $325
[]Over 4,500 Sq. Ft = $325+(65 x # of additional 1,000 Sq. Ft (or portion thereo $
New Multi -Family Residenrial:❑ Duplex= $260 ❑ Three or more unitsis $((130 x # of buildings)+(65 x # of units))$_
New work on any other residence and Detached Shops:=$(65 + (10 x # of HVAC fixtures))
Miscellaneous:0 Gas Pressure= $65 ❑ Furnace or A/C= $650 Water Heater = $6513 Requested Inspection in $65
❑ Gas Line = $65 G(Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Service = $65/hour
❑ Plan Check =10%ofContracted Amount 54-11 in Fl (a,Ce' I',*Ik?k'L
APPLICnrvra atuNATUIth, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury. I hereleyeerti"atl have read this application and state that the Information herein
Is correct and 1 swear that any information which mayhereafterbe given by me In hearings before the Planningand Zoning commission or the City Council for the City of Rexburg
shall be truthful and correct Iagree to complywith all City regulations and State laws reletingto the subiectmatter ofthis application and herebyauthariaed representatives ofthe
City to enter upon the above-mentioned property for itlsP<ctlons purposes. NOTE: The building official may revoke a permit on approval issued underthe provisions of the 2o12
International eodetn cases creep, wse statement or misrepresentation of fact in me application Oran the plans on which the permieerapprevsh was based. Pcrmievoidifnat
smrctdwlibm180days. Fermitvold ifworkstops for 180 days.
Applicant's Name (print): [cW k � � Signature:. Date: V41
Inspections must be called in before 8 AM on the day the Inspection is requested. foapettion requests Called in after AM will be scheduled for the next business day.
Inspection Natilne—(208)372.2394 www,rexburg.org permit Technician -(208)372.2341 Revised March, 2016