HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 16-00572 - Grace Baptist - AdditionCITY OF Building Safety Department
` RMURGCity of Rexburg
* Submit By Email
OW 35 North list East
•'•<„� , AmerlragFamify Community Rexburg, Idaho 83440
BUILDING APPLICATION
Electrical
For Office Use
Permit Number: -I-6 `-� Permit Type: ❑ New ❑ Remodel ❑ Addition []Basement Finish
Fees Paid: ❑ Yes ❑ Nci
1. Property Owner
Name: C—LAIC= • nyls�- e�wcl\
Address: n-Lt,2 pi 2a o w City: �
State: A __ Zip Code:
Phone & Type: ❑ Office [jMobile Email: IZZIF
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)
❑ No: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Anycontracton/sub-contractors involved will need to submit theirown signed applications.
2. Electrical Contractor
Name: CA5,rt E Registration #: C1"14011, Exp.: 2. — l Z — 1-7
Address: 1325 Tt FFRNY City: =1 • F- State: _T�b Zip Code: 2"5c rer -i
Phone &Type: oho -631- (-14 2;_1 ❑ Office p -Mobile Email:
Contact/Rep. Name: 1 Phone: Email: _
,Electrical Contractor Authorized Signatures Date:_?!-^dk —/ 6
3. Project Description
Address: OR- Lot #: _ Block #: _ Subdivision:
Check one: ❑ Single-family Residence ❑ Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑ Remodel ❑ Addition ❑ Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ So— Calculated Fee (See Below): $
❑ Up to $10,000 = (total cost of system x.02) + $60 ❑ $10,0014100,000 = ((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)) $
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, Hot Tubs, 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= 65 200 amn or less. One location for less than 1 year.1
APPLICANT'SSIGNATIIRF rRRTIRICATInuea,n
'------•••-•••-^ =1P-1wv, Pequry,I nereoycerntymat t nave read this application and sure thatthe information herein
is correct and I swear that anyinermation which may hereafter be given bymein hearings before the Planning and Zoning Commission or the city Council for the City of Rexburg
shall be truthful and correct I agree to comply with all City regulations and state laws relating ad the subject matter of this application and herebyauthorised representatives ofthe
City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions ofthe 2012
International Code in cases ofany false statement or misrepresentation affect in the application oron th on which the ermi rapproval was based. Permiteohnfnot
stadadwithin 180 days. PermitvoidifworXItops for 180 days.
Applicant's Name (print):Ce-ti 2Lj4s; J Signature:
Inspecduns must be called in before 8 AM an the day the inspection is requested. Inspection requests called inafter 8 AM will be scheduled far the nextbosiness day.
Inspection Hotline -(208)372.2344 www.rexburgorg Permit Technician -(208)372.2341 Revised March, 2016