HomeMy WebLinkAboutAPPLICATION ELECTRICAL - 16-00505 - 609 S Hidden Valley Rd - SFROgg%g0q
CITY O P
° RMURG
Submit By Email
AmerkA Fanm'IyCommunt
Building Safety Department
City of Rexburg
35 North 1st East
ry Rexburg, Idaho 83440
BUILDING APPLICATION
Electrical
For Office Use
Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition ❑ Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Owner/ /
Name: R`e7/�'l S�/��J �
Address: W7 t167.1AA1 City:f4State: —Jo—Zip Code:OJ
Phone & Type: ❑ Office ❑ Mobile Email: T
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)
Oo:1 am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractor:/sub�coramctore involved will need to submit their own signed applications.
2. Electrical ntractor /
Nae: /f ;:K `43i7 Regis ation #: 'C'a7 -'3 Exp.: 3/ %&
Address: t /77 City: State: Zip Code:
Phone & Type: _gEO-7)- 30C)3 ❑ Officel'Mobile Email:
Contact/Rep. Name: eiaKe Phone: -?X/3< mail:
Electrical Contractor Authorized Signature: Date:
3. Project De rl' ion 11 ''��
Address: /on', I HSM -OR- Lot #: _ Block #: _ Subdivision:
Check one: ingle-family R Multi -family Residence ❑ Commercial
Check one: ❑ New Construction* ❑Remodel ❑ Addition ❑ Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ 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 �21Zti501-3,500 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: Cl 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
OTemporary Construction Services ONLY = 65 f200 amp or less. One location for less than 1 year.1
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penaltyofperjury, i herebycertify that l have read this application and state thatthe information herein
Is correctand 1 swear that any information which mayhereafterbe given byme in hearings before the Planning and Zoning Commission orthe City Council forthe Cityof Rexburg
shall be truthful and correct Iagree to complywith all City regulations and State laws relating to the subject matter of this application and herebyauthorized representatives cribs
City in enter upon the above-mentioned property forinspections purposes. NOTE: The building official may revoke a permiton approval issued under the provisions ofthe 2012
International Cade in cases of any false statement or misrepresentation of fact in the application aron�plansich to permit gppmvalwasbased. Permitvoidifn t
started within 180 days. Permitvoidifw to�sJnrlBydays. 9
Applicants Name (print): Lf_e �tA �7 Signature: Date: G% r
Inspections montbe called in before 8 AM on the day the inspection is requested. Inspection requests called in after8 AM will be scheduled forthe nextbusiness day.
Inspection Hotline -(208)372.2344 www.mxburg.org Permit Technician -(208)372.2341 Revised March, 2016