HomeMy WebLinkAboutAPPLICATION - 17-00195 - 290 North 1st East - High Pressure Gas LineCITY OF
America's Family Community
Building Safety Department
City of Rexburg
Submit By Email 35 North 1St East
BUILDING APPLICATION
Plumbing
Rexburg, Idaho 83440
For Office Use
Permit Number: Permit Type: 0 New 0 Remodel ❑ Addition 0 Basement Finish
Fees Paid: C7 Yes 0 No
1. Prope O ner ls!/1C
Name: ,4 4D
Address: City: State: Zip Code:
Phone & Type: 1=3 Office 0 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)
No: I am a contractor working for the homeowner 0 No. This property is a Multi -family Residence or Commercial Property.
NOTE: Any contractors/sub-contractors involved will need to submit their own signed applications.
2. Plumb' g C ntra
11
Name: 0( � istration M "! q Exp.: I
Address: T
State: Zip Code:
Phone & Type: _Office 0 Mobile Emai . r
LP
Contact/Rep. Name: e: "Z V7Email:
Plumbing Contractor Authorized Si nature: Date:
3. Project Description Water Meter Qufn' Water Meter Size:
Address: -OR- Lot M _ Blo k #: — Subdivision:
Check one: 0 Single-family Residence 0 Multi -family Residence Commercial
Check one: 0 New Construction` 0 Remodel 0 Addition 0 Basement Finish
Description of work:
New Commercial Work: Contracted amount: $ CaIculated Fee (See Below): $
0 Up to $10,000 = (total cost of system x.02) + $60 0 $10,001-$100,000 = ((total cost of system -10,000) x.01) + $260
0 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 = $130 01,501-2,500 Sq. Ft" _ $195 0 2,501-3,500 Sq. Ft. _ $260 0 3,501-4,500 Sq. Ft. _ $325
0 Over 4,500 Sq. Ft. _ $325+(65 x # of additional 1,000 Sq. Ft. (or portion thereof)) $
New Multi -Family Residential: 0 Duplex::-- $260 0 Three or more units= $((130 x# of buildings)+(65 x # of units))$
0 Gray Water Systems= $130 0 Lawn Sprinklers/Backflow device= $65 0 Multipurpose Fire Sprinkler & Domestic Water
Supply System = $65 or $4 per sprinkler head (whichever is greater)
New work on any other residence and Detached Shops: = 65 for sewer and water stub connections 0
Miscellaneous: 0 Sewer Line = $65 0 Water Line = $65 ❑ Sewer and Water Line = $65 ORequested inspection = $65
* Sewer Turnaround (septic to city)_ $65 0 Hydronic Heating= $65 + ($10 x # o manifolds/zones)
0 Technical Service= $65/hour 0 Plan Check =10% of Contracted Amount fl16flPRe(nLV0
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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 1 swear that any information which may hereafterbe given by mein 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 ofthe
Cityto enter upon the above-mentioned property for inspections purposes. NOTE: The building officia revoke a permit approval issued under the provisions of the 2012
International Code in cases of any false statement or misrepresentation of fact in the application or the ns on_w ' rY the pe"r approval was based. Permit void'f not
started within 180 days. Permit void if 1 sto for 180 r„�.r----- ))7 Applicant's Name (print): Signa Date:
Inspections must be called in before 8 AM on the day the inspection is requested. Inspecti revoke
Calle 'n after 8 AM will be scheduled for the next business day.
Inspection Hotline - (208) 372.2344 www.rexburg.org rmit Technician - (208) 372.2341 Revised March, 2016