HomeMy WebLinkAboutAPPLICATION MECHANICAL - 17-00194 - 280 Baldwin - SFRCITY OF
REXBURG
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BUILDING PERMIT FORM 110
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BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Mechanical Fee Paid
1. Pronet} Owner 11
Name: gV4-o4A� .I-FDyI-"
Address: 9T4 %- VciXeuK-11^e iiya s 2+') City: C4 State; 119 Zip Code: $3
Phone: 5JL4- 2. it V Email: �1-ertiL� IGtwir hn. hn0ya,. a�
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)
`L9allo, l am working with the homeowner
2. Mechanical Contractor f (,(,(,
Business: t,011419LC State License #: 0175-5-2— Exp.: S j!
Address: "Signatu
City: Stat : � Zip Code: 'n Lrfa/2
Phone: `6 Em II: d u= 4,r a *—
Contact/Rep. Name:Phone: - t Email:0"14,-
Mechanical Contract�
A copy ofyour slate registration/license is required to be on/)le Ifthls Is t first thneyou have done work In the City of Rexburg, please provide
a photocopy ofyour license. If you are unsure Ifyour license Is on file, please check with the Pennit Technician by calling (200) 372.2341.
3. Project Description
Address: aFi%d4 wiA OR- Lot#: Block#:Subdivision: �D�/l�ar5 �V4rx
Description of work: N2tet liovvr -
❑ SFR Construction: ZG XV sq. ft.
• Feesfor new construction are charged by squarefootage:Up to 1,600 sq -ft =$130# f65for each additional 1,000 sq.f. or
portion thereof.
o Up to 1,500 sq. ft =$130. Up to 2,500 sq. ft -$195. Up to 3,500 sq, ft. =$260. Up to 4,500 sq.R = $325, etc. (le. a
hotne with 3,675 sq. ft. ivlll be charged $325)
❑ Number ofFireplaces:
• Note thatflreplaces are not Included fn squarefootage costs and will be charged $65 per inspection.
❑ Hydronic Heating: _rar�-
• Note that hydronk heating Is not included In squorefoologe costs and will be charged and additional $65 * (Vox #of
manifolds/zones)
APPLICAMI"S SIGNAIURE,CERI-IFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby caddy that l have read this application and state that the Information
he rin is correct and I swear that any Information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Council for the City of
Rexburg shall be truthral and correct I agree to comply with all City regulations and State laws relating to Ute subject matter ofth"ppilution and hereby authorized
representatives of the City to enter upon lire above-mentioned property for Inspections purposes. NOTE: The building official may revoken permit on approval Issued under the
provisions of tire 20121nternational Code In cases orany false statement or misrepresentation of fact In the eppllcatlon or on the plans on which the permit or approval was
based Permit void if hot surfed within 180 days, Permit void tfworkstops for 180 days.
Applicant's Name (print): -'Iia S Signature•�/f/ Date: y
Inspections ntuslbe called In before 8 AM on the day the inspection Is requested. Inspection requests called In after If AM will be scheduled for Ute next business day.
Inspection Ilolilne- (208) 372.2344 wsvw.rexburg.org Permit Techn [clan - (208) 372.2341