HomeMy WebLinkAboutAPPLICATION - 16-00390 - Jefferson County Fairgrounds - ElectricalMEN
CITY OF Building Safety Department
REXBURG City of Rexburg
t t 35 North 1St East
Au:eaim's Fimtily Cornn+uuiq Rexburg, Idaho 83440
BUILDING APPLICATION
Electrical
For Office Use
Permit Number: Permit Type::❑ New []Remodel ❑ Addition ❑ Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Owner r7
Name: G
Address: P/ -a > GY . a : 12 a k w �itv: q to �y Stater Zip Code: 5? 3 VAI
Phone & Type: ❑Office ❑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)
AND: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2. Electrical Contractor� //p.,
Name: a)/ )r d&4 04 VV7 A Registration #: � � e ' L t9'T71 c4 Exp.: 0— 716
Address•,'/it;-C4 'y T- City: Led" 4v-AL0 State: Z Zip Code: '9 3 Al 4 14
Phone & Type: r v ^ t b8:3. ❑ Office [ 'Mobile Email: e�ov /P ! % a �,z a'y.? ufl. 9
Contact/Rep. Name: hone: Z Email:
(Electrical Contractor Authorized Signature t " Date: 6 /
Address t f iption �Jg d- O
] .p
— �e�u�,.. G �v ru-% p n R- Lot #z_ Block #; _Subdivision:. _
Check one: ❑ Single-family Residence ❑ Multi -family Residence []Commercial
Check one: ` []New Construction* ❑ Remodel []Addition ❑ Basement Finish
Description of work: P1v& I OV X. aLL,',,r
New Commercial Work: Contracted amount: $ 600 Calculated Fee (See Below): $
CIU to $10,000 = (total cost of system x.02) + $6 ❑ $10,001-$100,000 = ((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. 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)) $ e `)
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 branch circuits)) $
Miscellaneous: ❑ Small Works (work costing less than $200 with no change in service connections)=$10(needs no inspection.
❑ Central Heating/Cooling Systems= $65 ❑ Spas, HotTubs, and Swimming Pools= $65 ❑ Requested Inspection= $65
❑ Pumps -Water, Irrigation, Sewage (per motor) = ❑ $65 up to 25HP ❑ $95 26- 200HP ❑ $130 -over 200HP
❑ Irrigation Machine= $65 for center pivot+ $10 per tower of drive motor $ ❑ Technical Service= $65/hour
❑ Temporary Amusement= $65 + $10 per ride, concession, or generator $ ❑ Plan Check =10% of Contracted Amoun
❑ Temporary Construction Services ONLY= 65 f200 amp or less. One location for less than 1 year.1
t
60
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that l have read this appucanon and state tnattne inrortnation 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
shag be truthful and correct. I agree to comply with all City regulations and State laws relating to the subject matter oftbis application and hereby authorized representatives of the
City to enter upon the above-mentioned property forinspections purposes. NOTE: The building official may revoke a permiton apppl* issued underthe provisions ofthe 2012
International Code in rases ofany false statement ormisrepresentation offset in the applicatio on ons on whichth perm orapprovalwasbased. Permttvoidifnot
started within 180 days. Permit void ifwork stops y�r180da
Applicants Name (print): o v/L" , � /Lf !/�1 U rl% Signature: Date: & ,Ag a^z /6
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 nextbusiness day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016