HomeMy WebLinkAboutAPPLICATION - 17-00231 - 1513 Red Cedar Rd - Hydronic HeatingFor Office Use
Permit Number:
CITY OF
REXBURG
America's Family Community
BUILDING PERMIT FORM 110
upda,ea to/x016
BUILDING APPLICATION
New SFR Mechanical
1. Property Owner
Name: [ lJ� ISI
Address: ISI Cec14A,r City: Ste
Phone: Em _
Under Idaho Building Code, a homeowner is allowed to do work on their own hom
Are you a homeowner doing work on your own home?
❑ Yes (Skip to #3 and complete the Hometwner's Exemption)
`%No, I am working with the homeowner
2. Mechanical Cot
Business: �J
Address: Ie nX
Phone:
Contact/Rep. Name:
Phone:
License #: [) J 1 Exp.:
1L1n_ State: Zip Code:
Email:
Email:
Mechanical Contractor Authorized Signature: Date:
-
A copy ofyour state registration/license is required to be on file. If this is the first timeyou 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 DescriptionI j
Address: tri 1') s , � CP tArr La -OR- Lot #: _ Block #: _ Subdivision:
Description of work: Net j (Alw
❑ SFR Construction: sq. ft.
• Fees for new construction are charged bysquare footage: Up to 1,500 sq. ft = $130 + $65 for each additional 1,000 sq, ft or
portion thereof.
o Up to 1,500 sq. ft. = $130. Up to 2,500 sq. ft. = $195. Up to 3,500 sq. ft. = $260. Up to 4,500 sq. ft = $325, etc. (i.e. a home
with 3,675 sq. ft will be charged $325)
❑ 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) AS `1' & :&07Vf LlIZ_S
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, 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 - (2 08) 372.2344
www.rexburg.org Permit Technician - (208) 372.2341