HomeMy WebLinkAboutAPPLICATION - 17-00201 - 621 Island St - Mechanical ResidentialCITY OF
REXBURG
(1tiY
Amcrirni Family Community
BUILDING PERMIT FORM 110
Up6au610/2016
BUILDING APPLICATION
New SFR Mechanical
Building Safety Department
City of Rexburg
35 North 1n East
Rexburg, Idaho 83440
For Office Use
Permit Number: ❑ Mechanical Fee Paid
1. Property ;v/eer
Name:
Address:City: d State: Zip Code: y�a
Phone: �� �/ - 21 f"Sa 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)
.0 -No, I am working with the homeowner
2. Mechanical Contractor
Business: Kos G/J f /%r/SPS /T Sta Lice se #: Exp.:
Address: Z % f.� _?�?K25)City: ri' State:�� , Zip Co yy�
Phone: - - Email:_��(,�✓%i//�
Contact/Rep. Name: Phon . 4,0 - - 4 Email:
Mechanical Contractor Authorized Signature: /lh A Date:
A copy ofyour state registration/license is required to be onfile. lfthis is thefirst tiirou 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: > r -PR- Lot #: _ Blof #: _ Subdivi '°n:
Description work %!0 // 7 Q�/� Q ti/D'6/� /Pie ""Xee
❑ 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.
o Up to 1,500 sq. Jt = $130. Up to 2,500 sq. Jt = $195. Up to 3,500 sq. ft = $260. Up to 4,500 sq. f t = $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 $§y�jY (ffiJ0� # of
manifolds/zones) f�' f�1111 v
APPLICANTS SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury. I hereby certify that l have read this application ante that Nei form information
herein is correct and I swear thatany information which may hereafter be given by mein hearings before the Planning and Zoning Commission or the City Coyncil f Lt'b C
Rexburg shall be truthful and correct Iagree to comply with all City regulations and State laws relating to the subject matter of this applic •ttQh,��,�'�y �` 111
representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke�V" oR3Qproval 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 w ich the permit or approval was
based. Permit void if notstarted within 180 days. Permitvoid'dwork stops for 180 days.
Applicants Name (punt): U/�tQ Signa Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspection requests called in r 8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org Permit Technician - (208) 372.2341