HomeMy WebLinkAboutAPPLICATION - 16-00696 - 98 Douglas Dr - SolarCITY OF
REXBURG
01
America's ramify Community
BUILDING APPLICATION
Miscellaneous Electrical Work
Building Safety Department
City of Rexburg
35 North 15C East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: Electrical Only
1. Property Owner
Name: D&A1i5e PotAS�Oj
Address: q$' Oct or- City: a State: L,jZ Zip Code:
Phone: 20$' yO 3 6607 Email:
2. Electrical Contractor
Business: e441 r,/ State License #: 01-791 4' Exp.: �2F//7
Address: &ZO Phlfa500t R dAe ICity: 61 CA State: //Q Zip Code: CT q0A
Phone: 2 2 ?-- �52 Email::2 o%c sea /ci/r �r-ectrrr
Contact/Rep. Name: % Gri'_Qa /Ylara rg Phone: Email:
ElectricajContractor Authorized Signature: Date: /0-//-
3. Project Description
Address: 98' OWg)/ a S p/ -OR- Lot #: _ Block #: _ Subdivision:
What type of Property:jKlResidential 0 Commercial ° 0 Multi -Family Residential
Description of work: i t /'!'A, g L a0 ;7_, /S er,
4. Fees ,/43
0 Central Heating/Cooling Systems = $65 V plo � i a 0 G
0 Irrigation Machine = $65 for center pivot+ $10 per tower or drive motor = $
0 Pumps - Water, Irrigation, Sewage (per motor) = o $65 - up to 25HP 0 $95 - 26- 200HP 0 $130 - over 200HP
0 Requested Trip/Inspection = $65
0 Spas, Hot Tubs, and Swimming Pools = $65
0 Technical Service = $65/hour
0 Temporary Amusement = $65 + $10 per ride, concession, or generator $
0 Temporary Electrical Services ONLY = $65 (200 amp or less. One location, for less than 1 year.)
0 New Circuits = $(65 + ($10 x # of branch circuits)) $
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, Ihereby 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 be truthful and correa I agree to comply with all City regulations and State laws relating to 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 permit on approval Issued under the provisions of the 2012
International Code In cases ofanyfalse statement or misrepresentation affect in the application or on the plans on which the permltor approval was based Permitvoidifnot
started within 180 days. Permit void ifwark stops for 180 days.
Applicant's Name (print):
Signature:
Date:
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 Hodine - (208) 372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016