HomeMy WebLinkAboutAPPLICATION PLUMBING - 16-00292 - 1120 John Hancock Dr - SFRCITY OF
RMURG
Amerkak family Community
BUILDING APPLICATION
Plumbing
Building Safety Department
City of Rexburg
35 North fat East
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: 0 New 0 Remodel ❑ Addition 0 Basement Finish
Fees Paid: 0 Yes 0 No
1. Property Owner ��
Name:
Address:33.2�J G " -fi Sn..pr City:dofA[,�'M State Zip Code:
Phone &Type: 0 Office 0 Mobile Email: 1/
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? 0 Yes (Skip to #3 and complete the Homeowner's Exemption page)
f)No: l am a contractor working for the homeowner 0 No: This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/subcontractors involved will need to submit their own signed applications.
2. PI in ing C ntracto
Lmb R gistratign#: P��� ^ C —121 L z Exp.:
Address: Z-i✓ City: hole. State: 2�_ Zip Code:
Phone &Type:o?OR'3 O ' 6106 3, 0 Office ffM Chile Email: �tcdl GC+a'7`/ti! 7 G) j AJl )a , 64 ,1
Contact/Rep. Name: 'T_A/d I , �� Phone: Email: 11
!,
PlumbingContractor Authorized Si nature: Dater
3. Project Description Water Meter Quantity: Water Meter Size:
Address: -OR- Lot #: _ Block #: Subdivision:
Check one: 0 Single-family Residence 0 Multi -family Residence 0 Commercial
Check one: 0 New Construction* Cl Remodel 0 Addition 0 Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ Calculated Fee (See Below): $
0 Up to $10,000 = (total cost of system x.02) + $60 0 $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260
0 Over $100,001= ((total cost of system -100,000) x.005) + $1,160
New Single -Family Residential Work: Sq. Ft
0 Up to 1,500 Sq. Ft = $130 01,501-2,500 Sq. Ft. = $195 0 2,501-3,500 Sq. Ft. = $260 0 3,501-4,500 Sq. Ft. = $325
0 Over 4,500 Sq. Ft = $325+(65 x # of additional 1,000 Sq. Ft (or portion thereof)) $
New Multi -Family Residential: 0 Duplex= $260 0 Three or more units= $((130 x# of buildings)+(65 x # of units))$_
0 Gray Water Systems= $130 0 Lawn Sprinklers/Backflow device= $65 0 Multipurpose Fire Sprinkler & Domestic Water
Supply System = $65 or $4 per sprinkler head whichever isgreater)
New work on any other residence and Detached Shops: = $65 for sewer and water stub connections
Miscellaneous: 0 Sewer Line = $65 0 Water Line = $65 0 Sewer and Water Line= $65 ORequested inspection= $65
0 Sewer Turnaround (septic to city) = $65 0 Hydronic Heating= $65 + ($10 x # of manifolds/zones)
Cl Technical Service= $65/hour []Plan Check =10% of Contracted Amount
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofpedury, I hereby certify that l have read this application and state that the information herein
Is correct and 1 swear that any information which may hereafter be given by me In hearings before the Planning and Zoning Commission or the Oty 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 ofthis application and hereby authorized 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 of the 2012
International Code in cases of any fake statement or misrepresentation of Net in the application or on the plans on which the pet t or approval was based. Permitvoldifnot
started within 180 days. Permit void if��k stops for 1:30 da s. �/
Applicants Name (print): Jov � Z&r Signatur Dater
l
Inspections most be called In before 8 AM on the day the inspection is requested. Inspection requests called in after 8 AM will be scheduled for the next business day.
Inspection Hotline -(208)372.2344 www.redaurg.org Permit Technician -(208)372.2341 Revised March, 2016