HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 16-00568 - Medicine Shoppe - RemodelCITY OF
REXBURG
Amends Family Community
Submit By E7
mall
APPLICATION
Electrical
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
For Office Use
Permit Number: L�' 0 ? ` Permit Type: ❑ New ❑ Remodel []Addition ❑ Basement Finish
Fees Paid: []Yes ❑ No
1. Property Owgqer `
Name: eT c;nt
Address:/1�167 Aqf a ' In City:? X b u r_ State: SJ I Zip Code:
Phone & Type: _ ❑ Office ❑ Mobile Email:
Under Idaho Building Code, a homeowner is allowed to do work on their own home.
Aou a homeowner doing work on your own home? []Yes (Skip to #3 and complete the Homeowner's Exemption page)
Are
I am a contractor working for the homeowner [9'90: This property is a Multi -family Residence or Commercial Pro er
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2. Electr Contractor/
Name: Qv v� o iN 5 pI p � 4K < <#: #: _Exp.:
Address: s X -7 6 City: h� _State:, Zip Code: -3!Z2! d
Phone & Type: 3,5�a O6❑ Office Erg-obile Email:-- _
Contact/Rep. Name: r/ P _Phone: !_2-6iLS" Email:
�lectrrical Contractor Authorized Signatur' 7 r � Date:
3. Project Description
Address: _ -OR- Lot #: _ Block #: _ Subdivision:
Check one: ❑ Single-family Residence J] Multi -family Residence Q -Commercial
Check one: []New Construction* BRemodel ❑ Addition ❑ Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ L✓�la 6D 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
E3 Ove. $108,001 - fftotal cost of systent 100,0001 x.005) i $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 Amount
L]Temporary Construction Services ONLY= $65 200 amp or less. One location for less than 1 ear.
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenaltyofpeoury, Iherebyeertify that i have read this application and state thatthe information herein
is correct and I swear that any information which may hereafter be given bymein hearings before the Planning and Zoning Commission or the City Council for the Cityof Rexburg
shall be truthful and correct I agree to comply with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the
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 of any false statement or misrepresentation of fact in the application onthe plans on whichtha permit orapproval was based. Permitvoidifnot
started within 180 days. Permit void ifworkstops for 18 ys.
Applicant's Name (print):JA M Signatur . ✓u" ��G Date: 7 /� —,2 7`�) nl 4
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called inafter 8 AM will be scheduled for the nextbusiness day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016