HomeMy WebLinkAboutAPPLICATION - 17-00300 - 33 N 4000 W - New SFR Mechanicale aexeuRc
CITY OF
7 mG BUILDING PERMIT FORM
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Amerua's Family Community
BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North 1St East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Mechanical Fee Paid
1. Propq� Owner,11
Name: m xxs
Address 5t 40iaD City: L State:��Zip Code: M46{a
Phone: 209'-.V3-Mg1 Email: 69M
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?
ikes (Skip to #3 and complete the Homeowner's Exemption)
❑ No, I am working with the homeowner
2. Mechanical Contractor
Business: State License #: Exp.:
Address: City: State: Zip Code:
Phone: Email:
Contact/Rep. Name: Phone: Email:
Mechanical Contractor Authorized Signature: Date:
A copy ofyour 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: 33 tJ q00 IAJ• -OR- Lot #: _ Block #: _ Subdivision:
Description of work:
❑ SFR Construction: S�2oC1 sq. ft. p
• Feesfor new construction are charged by squarefootage: Up to 1,500 sq.R.=$130+$65for each additional 1,000 sq. ft. or
portion thereof.
0 Up to 1,500 sq. Jt. = $130. Up to 2,500 sq. Jt. = $195. Up to 3,500 sq.)t. = $260. Up to 4,500 sq. ft. = $325, etc. (i.e. a
home with 3,675 sq. /t. will be charged $325)
❑ Number of Fireplaces: _9L__ 50meene eA(e Is +VAV"
• Note that fireplaces are not included in square footage costs and will be charger] $65 per inspection.
❑ Hydronic Heating: C5
• Note that hydropic heating is not included in square footage costs and will be charged and additional $65 + ($10 x # of
manifolds/zones)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty ofperjury, I hereby certify that l have read this application and state that the information
herein is correct and I swear that any information which may hereafter be 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 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
CITY OF
REXBURG
Amerlcat Family Community
HOMEOWNER'S EXEMPTION
Building Safety Department
City of Rexburg
35 North 1st East
Rexburg, Idaho 83440
As of January 1, 2006, the City of Rexburg can no longer sell permits without having a copy of your State
registration number or your exemption from the State registration. Please fill out this form showing your
exemption and send it with your permit application.
Idaho State Statute allows a homeowner to do work on their own residence:
An owner performing construction on the owner's personal residential real property, whether or not occupied by
the owner, provided however, this exemption shall not apply to an owner who is otherwise regulated by this chapter
who constructs a building, residence or other improvement on the owner's property with the intention and for the
purpose of promptly selling the improved property, unless the owner has continuously occupied the property as the
owner's primary residence for not less than twelve (12) months prior to the sale of such property;
Title 54, Chapter 52, Subsection (2)
1 hereby certify that the above information is true and correct to the best of my knowledge.
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Signature Date
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Print Name �
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Permit Technician -(200) 372.2341 w .rexburg.org Revised 10/2016