HomeMy WebLinkAboutAPPLICATION - 17-00375 - BYUI - New Cheese Lab CircuitsC I TY OF
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Ame7imd Family Community
BUILDING PERMIT FORM
updated 10/2416
BUILDING APPLICATION
Miscellaneous Electrical Work
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
1'L1r Ullirf' I)se
Permit Number:
❑ Electrical Fees Paid
1. Pr 1) rt , (1�vner
Name. - )
Address- IV,- 4Z
121k1a State: Zip Code:
Phone: � b=_3'5 /9
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 #4 and complete the Homeowner's Exemption)
❑ No, I am workin with the homeowner
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Under Idaho Building Code, a registered contractor must do the work for a Commercial Building,
Business: -Z
State License #: E A F
Address: % v' daL 3%44,, ity:
Statexl.l�_ Zip Code:' t�
Phone:
Email:
Contact/Rep. Name: Phone
13-t Email:�1�
Electrical Contractor Authorized Signature:
µ Date:
A copy ofyour state registration/ffcense is required to be oil file if this
is the first time_vou have done work in rile City of Rexburg, please provide
a photo copy ofyour license. lfyou are unsure ffyour license is on file., please check with the Permit Technician by calling (208) 372-2341.
A, Projekt Description
Address:..—( X:C - -Agy-; . 14A _OR_ Lot #: — Block #: Subdivision:
What type of Property: ❑ Residential ❑ Commercial
Cost of job: $
Description of work:. 1 1 2 G)A1/ l i- 7-n.,...
G P P n-
n.1.
.1 -Ives: Check all that apply:
® Central Heating/Cooling Systems = $65
❑ Pumps - Water, Irrigation, Sewage (per motor)
❑ Temporary Electrical Services ONLY = $65 {200 amp
o $65 - up to 25HP
or less. One location, for less than 1 year.)
o $95 - 26- 200HP
New Circuits = (65 + ($10 x # of branch circuits))
O $130 - aver 200HP
$—
❑ Spas, Hot Tubs, and Swimming Pools = $65
❑ Miscellaneous/Requested Inspection = $65
0 Temporary Amusement = $65 + $10 per ride,
❑ Generators = $65
concession, or generator $
❑ Irrigation Machine = $65 for center pivot + $10 per
tower or drive motor = $
Inspection feescan he bundled upon request Re-fnspectfees will he
enforced ifinspection requests exceed fee totals.
neruii xsvr v a atuPull o mr, Ln1%1 tr1LR r vvry flnu AV-rrluHIZA i -aura: under penalty of perjury, I hereby certify that I 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 or Rexburg
shall be truthful and correct. I agree to comply with all City regulations and State laws relating to the snbiect matter of this application and hereby authorized representatives orthe
City to enter upon the above-mentioned property for inspections purposes. NOTEr The building official may revoke a permit on approval issued under the provisions of the 2012
International Code 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. Permit void if not
started within 180 days. Permit void i€work stops for 180 days.
Applicant's Name (print): I Signature:0 ` Date:
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Inspections must 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 Hot) Ine - (208) 3 72.2 344 www.rexburg.org Permit Technician - (208) 372.2341