HomeMy WebLinkAboutAPPLICATION - 16-00309 - Rigby Chevrolet - ElectricalC I TY OF
REXBURG
America's Run ily Community
Building Safety Department
City of Rexburg
35 North 15L East
Rexburg, Idaho 83440
BUILDING APPLICATION -
Electrical s- I -I ka
For Office Use
Permit Number: Permit Type: 0 New 0 Remodel 0 Addition 0 Basement Finish
Fees Paid: 0 Yes ONO
1. Property Owner
Name: k e-1' _
Address: City: RuState: :XD Zip Code:3�(�
Phone&Type:z/7R- ROfffc 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? 0 Yes (Skip to #3 and complete the Homeowner's Exemption page)
0 No: l 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 their own signed applications.
2. Electrical CoIyt1�actoJ // /
Name: �/: s �1 /` ,, . ��� l'i� - C c Rggis ation #: Exp.:
Address: l7 Yf 3,/ q. —! City: � State: 'X7_� Zip Cade: ri
Phone &Type: a�f1$'� 3l r% �'5 r, ce obile Email:
✓n rrt/sT Y�r�t�r� �
Contact/Rep. Name: Phot: Email:
Electrical Contractor Authorized Signature: Date:
3. Project Des ription
Address: ?R7 FG r r1,5c..9CY4� 1 2. G.4s� -OR- Lot #: _ Block #: _ Subdivision:
Check one: 0 Single-family Residence00 Multi -family Residence %Commercial
Check one: 0 New Construction* 0 Remodel 0 Addition 17 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 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)) $
New Multi -Family Residential: 0 Duplex= $260 0 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: CI Small Works (work costing less than $200 with no change in service connections)=$10(needs no inspection.
[]Central Heating/Cooling Systems= $65 0 Spas, Hot Tubs, and Swimming Pools= $65 0 Requested Inspection= $65
0 Pumps -Water, Irrigation, Sewage (per motor) = 0 $65 up to 25HP 0 $95 26- 200HP 0 $130 over 200HP
0 Irrigation Machine = $65 for center pivot+ $10 per tower of drive motor $ 0 Technical Service = $65/hour
0 Temporary Amusement= $65 + $10 per ride, concession, or generator $ 0 Plan Check =10% of Contracted Amount
0 TemporarV Construction Services ONLY = 65 200 amp or less. One location for less than 1 year.1
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpedury, I 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 Cityof Rexburg
shall he truthful and correct. I agree to comply with all City regulations and State laws relating to the su t matter of this application and hereby authorized representatives of the
City to enter upon the ahove-mentioned property for Inspections purposes. NOTE: Tbebuildingofficia m yrevokeapermit approval issued undertheprovisiorsofthe2012
International Code in cases of any false statement or misrepresentation of fact in [he appliption or ont Wer which permitorappmval wasbased. Permitvoidifnot
started within 180 days. Permit void' urkstops forj�O days.
Applicants Name (print):_ c (' ers[.2 Signatur Date: 1 l
Inspections most be piled in before 8 AM on the day the inspection is requested. Inspection reque(tf called inafter 8 AM will be scheduled for the next business day.
Inspection Hotline -(206)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016