HomeMy WebLinkAboutAPPLICATION - 17-00253 - 2127 W 440 S - New SFR MechanicalCITY OF
REXI3URG
BUILDING PERMIT FORM Dk_
Updated 2t 2017
Building Safety Department
City of Rexburg
35 North 1St East
'9'"_z .noy Rexburg, Idaho 83440
BUILDING APPLICATION
New SFR Mechanical
For Office Use
Permit Number: ❑ Mechanical Fee Paid
1. Property Owner
Name: 910-M7�nS�'7
Address: 27 12 W, 1/1/0 57o,)777 City: L LVUr�2 State: � Zip Code: ? L/D
Phone: SOq -- �;5�3 - Email: V; cke-r 36, e Ayre I • L4r V1
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 section 3 of'this application and complete the Homeowners Exemption page as well)
RNo, I am working with the homeowner
2. Mechanical Contractor
Business: t4e,4-,-�,c--, ,+lc_ State License #: AV( --C-- 13 2.7 Exp.: 0-3i-18
Address: (o4,& City: State: -c"> Zip Code:
Phone: Z fir' ` 3l0 c5 -Z-5- Email:
Contact/ Rep. Name: ,uho sv.i Phone: 2vS '�, 9v c szs Email: is � �^sa-� dtea,» ^�s is rJ, «•!,
Mechanical Contractor Authorized Signature: 1' �`` _ Date: r . 11, -00 7
A copy ofyourstate registrotion/license is required to be on ff e. If this is the first ti,,y,, 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 P*'W r(7
Address: Z l Z-7 jvz5r 41110 OR. Lot #: Block #: _ Subdivision:
Description of work: tJ40 PO -5- oro; e- a- f,
,0 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. jt. or
portion thereof.
o Up to 1,500 sq. }i. = $130. Up to Z 500 sq.h = $195, Up to 3,500 sq, It = $260, Up to 4,500 sq. A = $325, etc. (i.e. a
home with 3,675sq. jt, will be charged $325)
-0 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
manifolds/zones)
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 me in hearings before the Planning and Zoning Commission or the City Council for the City of
Rexburg shall be truthful and correct l 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 lfwork steps for 180 days.
Applicant's Name (print): �7wk �h rl•�-+ Signature; fate: L f
Inspections must be called in before 8 AM on the day the inspection Is requested. Inspection req esu tailed in after 8 AM will be scheduled for the next business day.
Inspection Hotline - (208)372.2349 www.rexburg.org Permit Technician - (208) 372.2341