HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 17-00194 - 280 Baldwin - SFRav vvxouac
� rd CITY OF
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REXBURG
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BUILDING PERMIT FORM ZZ�
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BUILDING APPLICATION
New SFR Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number 17q 0 Electrical Fee Paid
1. Property OwY�hr�.,,.��
Name: 11C"na
Address: $0 S• 21li1 City: vY _ State: 110 Zip code: 83Lltta
Phone: 519-2114 Email:--T_rs�dV���rian„r ha es... lcs�
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 03 and complete the Homeowners Exemption)
4;ACO, I and working with the homeowner
2, Electrical Contractor t
Business:� r"y ��ec i4Z r -A4- StateLicenseli: DiS��' Exp.:
y
Address: t Y / //d City: r /%I'?, State:!_ Zip Code: 8 i0/C
Phone: - Email: ✓�sw�-u�r �3 Y�O.wta.%.G�te�
Contact/Rep. Nance: Phone: a Email:
Electrical Colfracfor4ufliorlied Signafui•eI Date:
A copy ofyour slateregistratlon/ilcense is require beonflle.f dsLathef/rsttlnreyou have done work in tire CltyofRexburg, pleaseprovlde
a photo copy ofyoor license. Ifyou are unsure( ourlicense lsou/Ile, please check(Nth the Permit Technician bycolihlg(200)372.2341.
3. Project Description
Address: 210 P-14a4win -OR- Lot O:HBlockf3: $Subdivision:
Description of work:"-• 4,O`Nr
❑ New SFR Construction: O-Wl4 sq. ft.
• Feesfornew construction are charged by squarefootage: Up to 1,500sq.f.=$130+$65for each additional 1,000 sq.ft. or
portion thereof.
o Up to 1,500sq.ft=$130. Up to 2,500sq.ft.=$195. Up to 3,500sg.ft.=$260. Up to 4,500sq.ft.=$325, etc. (Le.a
home with 3,675 sq. ft. will be charged $325)
❑ Spas/Pools/Generators: O Yes EeNo
• Note that spas/pools/generatens•are not Included III squnrefootagecosts and ivillbecharged $65per Inspection.
APPI.ICAN•f S SIGNATURE' CEIfI'IFICA•I•ION AND AUTHORMATION: UndarpenaDyuf parties, I hereUycerilfy that I have read this application and Into that Ilia Information )retain
Is correct and I wear that any interaction whldunay hereafter be given by Ilia In hearings before lite Pioudagaud 2uningConunlaslon or the City Council for the City of Rexburg
shall be tmihful and correct. 1 agree to comply will. ell City regulations and State laws telling to the Subject earlier or this application and hereby authorized representatives of file
City to e.LLer upon the above-.neatio.sed properly for Inspections purposes. NOTE: The bonding of ictal may revall" pe silt all approval Issued radar the provislin sof Ilse 2012
intemelosnl Code fn cases orally false statement or Odsrepresentation M fart In the application or an the plans on Witch the parents or approval was based. Perndt void Ifnot
slnrtedwitbhll00days. Penult void lrwork stops for IGO days.
Applicant's Name(p14nt):TarAls-m- Signature:—r , Date: I7
inspections must becalled In before DAM all Uc tiny tha Inspection Is renneated.Inspectien requests called ht aver OAM will be scbedoled for the next business day.
Inspection Ratline- (200) 372.2344 tvsvw.rexhurgorg PerurltTechnician - (200) 372.2341