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HomeMy WebLinkAboutAPPLICATION - 16-00393 - 128 Webster Ave - Water LineJUN. 0 3 2016 CITY OF RMURG I CITY OF REXRU America's Family Community BUILDING APPLICATION Plumbing Building Safety Department City of Rexburg 35 North 1st East Rexburg, Idaho 83440 For Office Use Permit Number: 11D-©0343 Permit Type: ❑ New ❑ Remodel 0 Addition ❑ Basement Finish Fees Paid: 0 Yes ONO 1. Property wner 11 '' Name: MIJ LC IShrVIA r,\ Address: 121 WblysR,r ZEyt City: State:Zip Code: 3yt{D Phone & Type: 901-123°1 O Office "obile 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? XYes (Skip to #3 and complete the Homeowner's Exemption page) 0 No: I am a contractor working for the homeowner 0 No: This property is a Multi -family Residence or Commercial Property. NOTE: Any contractors/subcontractors involved will need to submit their own signed applications. 2. Plumbing Contractor Name: Registration #: Exp.: Address: City: State: Zip Code: Phone & Type: 0 Office 0 Mobile Email: Contact/Rep. Name: Phone: Email: Plumbing Contractor Authorized Signature: Date: 3. Project Descriptio 1 Water Meter Quantity: Water Meter Size: Address: 2- W -OR- Lot#:. Block#: Subdivision: Check one: Single-family Residence/- 0 Multi -family Residence 0 Commercial Check one: El New Construction* emodel ❑Addition 13 Basement Finish Description of work: New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $ 0 Up to $10,000 = (total cost of system x.02) + $60 0 $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260 0 Over $100,001= ((total cost of system -100,000) x.005) + $1,160 New Single -Family Residential Work: Sq. Ft 0 Up to 1,500 Sq. Ft = $130 0 1,501-2,500 Sq. Ft. = $195 0 2,501-3,500 Sq. Ft. = $260 0 3,501-4,500 Sq. Ft. = $325 0 Over 4,500 Sq. Ft = $325+(65 x # of additional 1,000 Sq. Ft (or portion thereof)) $ y New Multi -Family Residential: 0 Duplex= $260 0 Three or more units= $((130 x # of buildings)+(65 x # of units))$_ 0 Gray Water Systems= $130 0 Lawn Sprinklers/Backflow device= $65 0 Multipurpose Fire Sprinkler & Domestic Water Supply System = $65 or $4 per sprinkler head whichever is realer) New work on any other residence and Detached Shops: = 65 for sewer and water stub connections Miscellaneous: 0 Sewer Line = $65 0 Water Line = $65 0 Sewer and Water Line= $65 ❑Requested inspection= $65 []Sewer Turnaround (septic to city) = $65 0 Hydronic Heating= $65 + ($10 x # of manifolds/zones) 0 Technical Service= $65/hour 0 Plan Check =10% of Contracted Amount APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury,I hereby certify that l 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 be 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 of the City to enter upon the above-mentioned property for inspections purposes. NOTE : The building official m y revoke a permit on approval issued under the provisions ofthe 2012 International Code In uses ofany fake statement or misrepresentation offact in the application or on t Janson vdil he permltorapprovalwas based. Permltvaldifnot started within 180 days. Permit void ffvv9jk stops for 180 days. 03 a Applicants Name (print): Signature: Date: b D Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests IledlnafterO AM will be scheduled for the next business day. Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016