HomeMy WebLinkAboutAPPLICATION - 17-00313 - 906 Twin Butte Rd - Heat PumpCITY OF
REXBURG
America's Family Community
BUILDING PERMIT FORM 110
Updated 10/2016
BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Numbers ❑ Mechanical Fee Paid
1. Property Owner
Name: V%exl i- au r l -
Address: ftlj '-FW In B(A-fft R00A City: rvl LV)Uj/-) State: cZCAZip Code:
Phone: 151 - 5003 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)
❑ No, I am working with the homeowner
2. Mechanical CoNactor
Business: nO.Yi T G • State License #: VI VG- C-- 151 Z Exp.:
Address: 4y W . r3 -b e* City: J G (A40 T5QUA State: 5d Zip Code:
Phone: 5'7z,337:J-. Email: IDri I h S51co MSh , cam
Contact/Rep. Name: BTrnPhone: Email:
Mechanical Contractor Authorized Signature: Date:
A copy of your state registration/license is required to be on file. If this is the first time you have done work in the City of Rexburg, please provide
a photo copy ofyour license. Ifyou are unsure ifyour license is on file, please check with the Permit Technician by calling (208) 372-2341.
3. Project Description
Address: -OR- Lot #:_ Block #: _ Subdivision:
Description of work: 1�-I bre 0i [Y11V11 zw 1 � ME zoyle h-f-od- OUilYUO
❑ SFR Construction: sq. ft.
• Fees for new construction are charged by square footage: Up to 1,500 sq. ft. = $130 + $65 for each additional 1,000 sq. ft. or
portion thereof.
0 Up to 1,500 sq. ft. = $130. Up to 2,500 sq. ft. = $195. Up to 3,500 sq. ft. = $230. Up to 4,500 sq. ft. = $295, etc. (i.e. a home
with 3,675 sq. ft. will be charged $295)
❑ Number of Fireplaces:
• Note that fireplaces are not included in square footage costs and will be charged $65 per inspection.
❑ Hydronic Heating:
• Note that hydronic heating is not included in square footage costs and will be charged and additional $65 + ($10 x # of
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, l 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 of any false statement or misrepresentation of fact in the application or on the plans on which the permit or approval was
based. Permit void if not started within 180 days. Permit void if work stops for 180 days.
Applicant's Name (print):
Signature:
Date:
Inspections must 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.rexburg.org Permit Technician - (208) 372.2341