HomeMy WebLinkAboutAPPLICATION FIRE SPRINKLER - 16-00481 - 269 S 5th W - Campus Courtyard 2 Bldg 7 - 21 UnitsCITY OF
REXBURG
America's Family Community
Building Safety Department
Submit By Email City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
BUILDING APPLICATION
Fire Sprinkler
For Office Use
Permit Number:
Permitapproved: ❑ Yes ❑ No
Fees Paid: ❑ Yes ❑ No
1. Applicant
Business Name: Phoenix Fire Protection
Office Address: 4130 Airport Rd. City: Nampa
State: IO Zip Code: 83687
Office Phone: 208-468-9115 Contact Person: Teri Cruickshank
Cell Phone:
Contractor's Authorized Signature:
Date: 05.04.17
License/Registration # FPSC- 108 Expiration: 12/2017
2. Location of Work to be Done
Street Address: 275s5th w City: Rexburg
State: IO Zip Code: 83440
Business Name: Campus Courtyard Bldg #7
Contact/Rep. Name: Teri Cruickshank Phone: 208-468-9115
❑Office ❑Cell Phone
Email: teri@phoenixfp.com
Dates for work to be done: From to
3. New Construction Contracted Amount: $ 30,081 Calculated Fee (See Below): $ 461
❑ 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
4. Miscellaneous
[L -]New Construction = $1 per sprinkler head ($2,000 max) # of heads:
❑ Existing Inspection Base = $65
IDPlan Review = 10% of Contracted Amount
1011e -Inspection = $65
$507.10
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpedury,Ihereby certify that l have read this application and state that the information herein
correct and I swear that any information which may hereafterhe given by me In 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 regulators 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 fake statement or misrepresentation of fact In the application or on the plans on which the permit or approval was based. Permitvoid if nat
started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print): Teri Cruickshank
Signature:
Teri
Cruickshank
Date: 05.04.17
Inspections must be called in before 8 AM on the day the inspection Is requested. Inspection requests called in after RAM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016