HomeMy WebLinkAboutAPPLICATION PLUMBING - 16-00432 - 505 S Millhollow Rd - SFRCITY OF
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BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use i y�
Permit Number: Ih Permit Type: IKNew ❑Remodel ❑Addition ❑Basement Finish
Fees Paid: ❑ Yes )K( -No
1. Property Owner
Name: �!1 li✓1$C1n L 35
Address ',c� 5 �%-i ; a D t✓ City: !� xState: � Zip Code:
Phone & Type: El Office ❑ Mobile Email:
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)
dNo: I am a contractor working for the homeowner ❑ No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-contmdons involved will need to submit their own signed applications.
2. Plum Contractor _ (- //
Name: c0. �/•G
- Regis ation #:I1b C 12K> Exp.:
Address: /Z E Sf ,a/ City: n i State: _ Zip Code: S(3 5 4/5�
Phone & Type: ❑ Office ❑ Mobile Email:
Contact/Rep. Name:. Pho e: 6- Yv6,3mail:
Plumbing Contractor Authorized Signature: Dater
3. Project Description Water Meter Quantity: Water Meter Size:
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: $ 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= $((130 x # of buildings)+(65 x # of units))$_
❑ Gray Water Systems= $130 ❑ Lawn Sprinklers/Backflow device= $65 ❑ Multipurpose Fire Sprinkler & Domestic Water
Supply System = $65 or $4 per sprinkler head (whichever is greater)
New work on any other residence and Detached Shops: = 65 for sewer and water stub connections ❑
Miscellaneous: ❑ Sewer Line = $65 ❑ Water Line = $65 ❑ Sewer and Water Line= $65 ❑Requested inspection= $65
❑ Sewer Turnaround (septic to city) = $65 ❑ Hydronic Heating= $65 + ($10 x # of manifolds/zones)
❑ Technical Service= $65/hour ❑ Plan Check =10% of Contracted Amount
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APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify that I have read this application and state that the information herein
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 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 of the 2012
International Code in cases ofany false statement or misrepresentation offact in the applicationoro plans on which the pertm rapproval was based. Permitvoidifnot
started within 180 days. Per mit void ifworkstops for lBRRssdayr.
Applicant's Name (print): ��✓ /Yl r r Signature: Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests rolled in after 8 AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.rexburg.org Permit Technician -(208)372.2341 Revised March, 2016