HomeMy WebLinkAboutAPPLICATION - 16-00392 - 120 Webster Ave - Water LineCITY OF
REXBURG
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America's Family Community
JUN 0 3 2016
CITY OF REXBURG
BUILDING APPLICATION
Plumbing
g Safety Department
City of Rexburg
35 North 15t East
Rexburg, Idaho 83440
For Office Use
Permit Number: IL -00387- Permit Type: O New O Remodel O Addition O Basement Finish
Fees Paid: O Yes []No
1. Property Owner
Name: °'lilwrm-1-� //��
Address: l?o 41,r,6S<lr City: /1e'rl""State: Zip Code: J
Phone &Type: �V )f / - 3 13 OfffceFMobile 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? P'Yes (Skip to #3 and complete the Homeowner's Exemption page)
O No: I am a contractor working for the homeowner O No: This property is a Multi -family Residence or Commercial Property,
NOTE: Any contractors/sub-contractors involved will need to submit theirown signed applications.
2. Plumbing Contractor
Name: Registration #: Exp.:
Address: City: State: Zip Code:
Phone & Type: O Office O Mobile Email:
Contact/Rep. Name: Phone: Email:
Plumbing Contractor Authorized Signature: Date:
3. Project Description Water Meter Quantity: Water Meter Size: 3�
Address: l' t✓e,6"149 -OR- Lot #: Block #: Subdivision:
Check one: -Single-family Residence O Multi -family Residence O Commercial
Check one: O New Construction* XRemodel O Addition O Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
O Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,000 = ((total cost of system -10,000) x.01) + $260
O Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. Ft
O Up to 1,500 Sq. Ft = $130 O 1,501-2,500 Sq. Ft. = $195 O 2,5013,500 Sq. Ft. = $260 O 3,501-4,500 Sq. Ft. = $325
O Over 4,500 Sq. Ft = $325+(65 x# of additional 1,000 Sq. Ft (or portion thereof)) $
New Multi -Family Residential: O Duplex= $260 ❑ Three or more units= $((130 x# of buildings)+(65 x # of units))$_
❑ Gray Water Systems= $130 O Lawn Sprinklers/Backflow device= $65 O Multipurpose Fire Sprinkler & Domestic Water
Supply System = $65 or $4 per sprinkler head whichever is Feat)
New work on any other residence and Detached Shops: = $65 for sewer and water stub connections
Miscellaneous: O Sewer Line = $65 P -Water Line = $65 O Sewer and Water Line= $65 ❑Requested inspection= $65
O Sewer Turnaround (septic to city) = $65 O Hydronic Heating= $65 + ($10 x # of manifolds/zones)
O Technical Service= $65/hour []Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpedury, l hereby 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 coned. 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 may revoke a permit on approval Issued under the provisions ofthe 2012
International Code in cases ofany fake statement or misrepresentation effect In the application or on ikr plans on which the permit or approval was based. Permltvoid if not
startedwithin 180 days. Permitvoidifyvprk stops for 180 da
Applicant's Name_-_ (prnt): !T" 5;80
Signature: Date: y
Inspections most 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)3722341 Revised March, 2016