HomeMy WebLinkAboutAPPLICATION - 16-00661 - 382 w 2nd s Rigby - Water HeaterCITY OF
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Building Safety Department
City of Rexburg
Submit By Email 35North 1St East
Rexburg, Idaho 83440
BUILDING APPLICATION
Mechanical
For Officc Use
Permit Number:_I_i�l61 Permit Type: ❑New ❑Remodel ❑Addition ❑Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Owner
Name: Barbara Moulton
Address: 382 W 2nd S City: Rigby State; ID Zip Code: 83442
Phone &Type: 2087457484 ❑ Office El 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? ❑ Yes (Skip to #3 and complete the Homeowner's Exemption page)
El No: l am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTR.Any r.mtrnetoi:s/sub-contractors Involved Will nrvd m it, bnUt their own signed apphtaunns.
2. Mechanical Contractor
Name: Advanced Plumbing and Mechanical Registration M C5806 Exp,; 10/2017
Address: 4091 E 600 N City: Rigby State: lD Zip Code: 83442
Phone &Type: 2087459406 0 Office ❑ Mobile Email: ahspermits@gmall.com
Contact/Rep, Name: carina Phone: 2087459406 Email: apsarinah@gmttil.com
Mechanical Contractor Authorized. Signature: Kip sales Date: 09/30/16
3. Project Description
Address: 3B2 w 2nd s OR- Lot #: — Block #: _ Subdivision:
Check one: 0 Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work: Water heater
New Commercial Work: 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 cast 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= $((130 x # of buildings)+(65 x # of units))$_
New work on any other residence and Detached Shops:_ $(65 + (10x # of HVAC fixtures))
Miscellaneous: ❑ Gas Pressure= $65 ❑ Furnace or A/C = $65 p Water Heater= $65 ❑ Requested Inspection= $65
❑ Gas Line = $65 ❑ Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Service = $65/hour
❑ Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of patjwy, I hereby certify that I have read this application and state that the information herein
is correct and 1 swear thatany Information which may hereafter be given by mein hearings before the Planning and Zoning Commission orthe City Council for the Cityof Rexburg
shall be truthful and correct 1 agree to comply with all City regulations and State laws relating to the subject matter of this application red hereby authorized relemeenmtives of the
City to enter upon the above-mentioned property for inspection purposes. NOTE: The building official may revoke a permit on approval Issued under the provisions of the 2012
International Code in msesofany false statement or misrepresentation affect in the application Oran the plans on which the permit orapproval was based. Permttvaidifnot
started within 180 days. Permitvoid ifworkstaps for 180 days.
Applicant's Name (print): Kip salas Signature: Kip sales Date: 09/30/16
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection request.%called in after 8 AM will be scheduled for the next business day.
Inspection I lotline - (208) 372.2344 www.mxburg.org permit Technician -(208)372.2341 Revised March, 2016