HomeMy WebLinkAboutAPPLICATION - 16-00531 - 4986 S 2000 W #18 - New gas line countyA�OQ pP.XIIURO,>
V'O
CITY OF
REXBURG
America's Amoly Commodity
BUILDING APPLICATION
Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition ❑Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Owl
r
Name:M4" /ll ldCr�rXae
Address:Y9&6 ! .,Qeoew- -"/fr —City: ;< y�G State: Zip Code: �e_
Phone &Type:_ `p(p-� ❑Office �vlobile 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? Cl Yes (Skip to #3 and complete the Homeowner's Exemption page)
g,No: I am a contractor working for the homeowner O No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sulscontractms involved will need to submit their own signed applications.
2. Mech, ical Contra 01 /',,
Name: �.ne,?r egis ation#: e-�6oa Exp.:
Address:,`i W—Ty �City: ✓ _ State:•. Zip Code:vr)
Phone & Type —1 HoU ❑ Office gh<obile Email: —=
Contact/Rep. Name: moi. �.-r_ Phone:
Mechanical Contractor Authorized Signature: Date:'9--V—//,
3.ProjectDescriptimt.Tr9fe// Ne,.1 GaS Lrp/r
Address: -OR- Lot #: _ Block #: _ Subdivision:
Check one: ifL3 5 ngle-family Residenc_e,��❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* gafcemodel ❑Addition ❑ Basement Finish
Description of work: _
New Commercial Work; Contracted amount: $ 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. Pt. = $260 ❑ 3,501-4,500 Sq. Ft. = $325
❑ Over 4,500 Sq. Ft.c: $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 + (10 x # of HVAC fixtures)) _ _
Miscellaneous: ❑ Furnace or A/C = $65 ❑ Water Heater = $65 ❑ Requested Inspection= $65
E (as 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 perjury, I hereby certify that 1 have read this application and state that the Information herein
is correct and 1 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 he truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter ofthis 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 ofthe 2012
International Cade 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. PerneRvoid if not
started within 180 days. Permit void Ifwork stops for 180 days,
Applicant's Name (print): Do _&S. Signature d �� Dater
Inspections must be called in before 8 AM on the daythe inspection is requested. Inspection requests called In after 8 AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www,rexleurg.org Permit Technician -(208)372.2341 Revised March, 2016