HomeMy WebLinkAboutAPPLICATION PLUMBING - 16-00559 - 840 N 2nd E #2 - New dance hallCITY OF
REXBURG Submit By Email
Antcffm's huffily Comuuadl r
BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
PermitNumber: 16-00ES-% Permit Type: ❑New Remodel ❑Addition. ❑ Basement Finish
Fees Paid: 'Yes []No
1. Property Owner
Name: M(Vt RCLH Rvan lef'Sj rvinyi
Address: ` City: RPahu✓g State: Zip Code:S�3G1�y0
Phone&Type:na-„__�` G--� ❑ Office'R-Mobile Email:
Under Idaho Building Cade, a homeowner is allowed to do work on their own home.
Are you a homeowner doing work on your own home? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page)
*o: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2. Plumbing Contractor
Name: lCtl\d-enf\t"cd P1 -VV\ n3 Re istration#: ��.�0� Exp.:
Address: oo � yk� City: tr!' State: �— Zip Code:
Phone & Type:/ r ❑ Officel l Mobile Em I :
Contact/Rep. Name: -Sta•cmv C;za Phone: 3{%fr90,?- Email:
Kumbin --- Contractor- Authorized- Si— nature ----
Date:
3. Project Description Water Meter Quantity: Water Meter Size:
Address: •OR- Lot #: Block #: Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ �Zr Calculated Fee (See Below): $
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,000 = ((total cost of system -10,000) x.01) + $260
❑ Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. Ft
❑ 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 thereof)) $
New Multi -Family Residential: ❑ Duplex= $260 ❑ Three or more units= $((130 x # of buildings)+(65 x # of units))$_
❑ Gray Water Systems= $130 ❑ Lawn Sprinklers/Back(low device= $65 ❑ Multipurpose Fire Sprinkler & Domestic Water
Supply System = $65 or $4 per sprinkler head (whichever is greater)
New work on any other residence and Detached Shops: = 65 for sewer and water stub connections ❑
Miscellaneous: ❑ Sewer Line = $65 ❑ Water Line = $65 ❑ Sewer and Water Line= $65 ❑Requested inspection = $65
❑ Sewer Turnaround (septic to city) = $65 ❑ Hydronic Heating= $65 + ($10 x# of manifolds/zones)
❑ Technical Service= $65/hour ❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, l hereby certify that l 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 he truthful and correct I agree to comply with all City regulations and State laws relatingto the subject matter of this application and hereby authorized representatives ofthe
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permiton approval issued under the provisions ofthe 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. Pe rmitvoidifworksjpps for 180 days.y� •
Applicant's Name (print):Signature' %-M� Y/,L Date:
Inspections mustbe called in before 8 AM on the day the inspection is requested. Inspection requests called inafter B AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexhurg.org Permit Technician -(208)372.2341 Revised March, 2016