HomeMy WebLinkAboutAPPLICATION - 17-00260 - 36 Professional Plaza St - Office OutletsCITY OF
REXBLaG BUILDING PERMIT FORM 4 20
tY' t,tb. iofzme
Amcrfces fumfly Community
BUILDING APPLICATION
Miscellaneous Electrical Work
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Electrical Fees Paid
1. Property Owner
Name: Navpx (11nhal
Address: 36Professional Plaza City:RPXhurB State: TT) Zip Code: 83440
Phone: ( 208) 709-7970 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 #4 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
2. Electrical Contractor
Under Idaho Building Code, a registered contractor must do the work for a Commercial Building.
Business: Freedom Electrir, Tnr- State License #:C-010569 Exp.:
Address: 09 South 200 East City: iTerome State: T Zip Code: B 318
Phone: ( 208) 735-0038 Email: tma 1 mmripWlfrppdnmel pct ri c nrg
Contact/Rep. Name: Tony Malone Phone{ 208)735-003:SIail:tma l nnp(alf rppcinnil l-ri- ri
Electrical Contractor Authorized Signature: Date: n ci / 1 7/17
A copy ofyourstate registration/license is required to be on file. If this is the first timeyou have done work in the City of Rexburg, please provide
n photo copy ofyour license. Ifyou are unsure if your license is on file, please check with the Permit Technician by calling (208) .372-2341.
3. Project Description #120
Address36 Proffaggional Pima OR- Lot #:_ Block #:_Subdivision:
What type of Property: O Residential :p Commercial
Cost of job: $ 7, 5 0 0 .0 0
Description of work: Additional nffirp nntlptg
4. Fees: Check all that apply:
❑ Central Heating/Cooling Systems = $65 ❑ Pumps - Water, Irrigation, Sewage (per motor)
❑ Temporary Electrical Services ONLY = $65 (200 amp o $65 - up to 25HP
or less. One location, for less than 1 year.) o $95 - 26- 200HP
AR New Circuits = $(65 + ($10 x # of branch circuits)) o $130 - over 200HP
$ 99-0() ❑ Spas, Hot Tubs, and Swimming Pools = $65
❑ Miscellaneous/Requested Inspection = $65 ❑ Temporary Amusement= $65 + $10 per ride,
❑ Generators = $65 concession, or generator $
❑ Irrigation Machine = $65 for center pivot+ $10 per
Inspection fees can 6e bundled upon request Re-inspec[fees will be
tower or drive motor = $ enforced if inspection requests exceed fee totals.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that[ have read this application and state that the information herein
is correct and I swear that any information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg
shall beouthfu] andcorrect Iagree 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 pians 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)Tony Malone Signature ;":;�% —Date: (719/17/17
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
org