HomeMy WebLinkAboutAPPLICATION - 17-00233 - 449 Rolling Hills Dr - Fireplace/May. 3. 2017 9:10AMop LEISURE TIME
' aXAmericariFaBURG
BUILDING APPLICATION
Mechanical
Bulldi..Noo' 8162tyiP:..Iirtment
City of Rexburg
35 North 1St East
I Rexburg, Idaho 83440
For Off -cc Use
Permit Number: Permit Type: ❑ New ❑ Remodel ❑ Addition [],Basement Finish
Fees Paid: ❑ Yes ❑ No
1. Property Owner
Name: ` RS E NDEt2SON _
Address: Hqq IpOLLI N(r I city: PEXRULG „State: TO Zip Code: _534`92
Phone & Type: 3l1 — 2914 ❑OAfice ❑ 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?0 Yes (Skip to #3 and complete the Homeowner's Exemption page)
KNo: I am a contractor working for the homeowner❑ No: This property is a Multifamily Residence or Commercial Property.
NOTE: Any contraCtom/sub.conttactots involved will need to submit thaer own signed applications.
2. Mechanical Contractor
Name: TU I I C (CODE P Lz l UIi.Q tf 1MR * p!G • Registration #: E
Address: (>n N • Ini0pp2 U FF �"
Phone &Type: 2 City: State: T k� Zip Code:
�OfBce❑Mobile Email: STT LLIbUjWI-1MLrNC LOM
Contact/Rep. Name: RtpqANIEIn e G Ij Phone: _S23 Email:
MechanicalContractor Authorized Signature: ate:
3. Project Description,
Address: OR- Lot #: _ Block #: — Subdivision:
Check one: 13 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 1$10,0014100,000 = ((total cost of system -10,000) x .o 1) + $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 z $130 ❑ 1,501-2,500 Sq. FL = $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 Scl. Ft or portion thereo $
New Niulti-Family Residential:❑ Duplex = $260 ❑ Three or more units =_$ (130 x # ofbuildings)+(65 x# of units)) 8_
New wont on any other residence and Detached Shops:=$ 65 + (10 x —# Of HVAC fixtures))
Miscellaneous:❑ Gas Pressure= $65 ❑ Furnace or A/c = $650 Water Heater as $650 Requested inspection se $65
19 Gas Line as $65 P Fireplace/Solid Fuel Burning Unit= $65 ❑ Technical Service= $65/hour
❑ Plan Check =10% of Contracted Amount
••••••—•••-•••••. 'wnurnd nen"'"TnvRIZATION: Under penaltyofperjury, Ihereby cent"atl have readshis 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 City Council for the City of Rexburg
shall be truthful and correct Iagrsemcomplywlth all city regulations and State laws relating in the subject matter afthis 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 ofthe 2012
Imernabohal Code In cases of any false srarementor misrepresentation of fact In the application or on the plans on which the permit erapproval was based. Parmltvoidifnot
atsrred within 190 days. Permit void ifwork stops for 130 days. 1
Applicants Name (print): MOWN M RNSFLQI P Signature:Date: S 3 17
Inspections must be called In before 9 AM on the day the Inspection Is requested. Inspection requests called In after a AM will be scheduled for the next buslness day.
Inspection Hodine - clog) 372,a344 www,rexburg.org Permit Technician -(209)372.2341 Revised March. 2026